2026 Medicare Part D Extra Help Income and Asset Limits and How to Apply

Medicare Part D Extra Help is a federal low-income subsidy program that lowers prescription drug costs for Medicare beneficiaries with limited income and assets. The Social Security Administration (SSA) handles applications and eligibility reviews, and approved assistance is applied to Medicare Part D premiums, deductibles, and prescription drug out-of-pocket costs.

2026 Income and Asset Limits

The general limits for 2026 are as follows. The limit for married couples applies when two married individuals live together.

The asset limits reflect amounts that may be excluded for funeral and burial expenses. The CMS figures of $18,090 and $36,100 each include a $1,500 funeral expense exclusion per person.

These limits are not used solely as absolute cutoffs that automatically disqualify every applicant. If any of the following applies, you may still apply to SSA for an individual determination even if your income is somewhat higher than the published amount.

• You support family members who live with you
• You or your spouse has earned income
• You live in Alaska or Hawaii, where cost-of-living standards differ
• Your current income has recently decreased because of retirement, job loss, divorce, the death of a spouse, or another reason

You must accurately report your current circumstances and expected annual income on the application. SSA determines final eligibility after reviewing the applicant’s household composition, types of income, allowable deductions, and assets.

What Assets and Income Are Reviewed

SSA primarily reviews financial assets that can be converted to cash and used for living or medical expenses.

Assets Generally Reviewed

• Checking and savings accounts and certificates of deposit
• Cash, stocks, bonds, savings bonds, and mutual funds
• Retirement accounts such as IRAs and 401(k)s
• Real estate other than your primary residence
• Other investment assets that can be converted to cash

Items Generally Excluded From Assets

• The home in which you live
• Vehicles
• Household goods and personal belongings
• Burial plots and certain funeral and burial expenses
• Standard life insurance policies

The income review may include not only Social Security benefits but also wages, self-employment income, pensions, annuity payments, railroad retirement benefits, veterans’ benefits, and other recurring income. Because certain payments may be excluded or only partially counted under the law, it is safer not to omit them on your own and instead report everything as requested by the SSA application.

2026 Costs Reduced by Extra Help

The general maximum costs that apply to Extra Help recipients in 2026 are as follows.

The prescription drug amounts in the table are the maximum out-of-pocket costs for drugs covered by Medicare. Depending on income level, Medicaid eligibility, or residence in a long-term care facility, the actual cost may be lower or $0.

The $0 premium benefit applies when you select a Part D plan within the regional benchmark premium limit. If you choose a plan that costs more than the benchmark or includes additional benefits, you may have to pay the difference. You should also verify whether your medications are included in the plan’s formulary and whether your pharmacy is in the network.

Automatic Eligibility and Who Must Apply Separately

If you receive Medicare and meet any of the following conditions, you generally qualify for Extra Help automatically.

• You receive full coverage from your state Medicaid program
• Your state helps pay your Medicare premiums through a Medicare Savings Program
• You receive both Supplemental Security Income (SSI) and Medicare

People who qualify automatically do not need to submit a separate SSA Extra Help application. Medicare or Medicaid will verify eligibility information and send a notice, and will assist with enrollment in a Part D plan if necessary.

The following individuals must apply directly to SSA.

• People who have Medicare but do not receive Medicaid, a Medicare Savings Program, or SSI
• People who previously qualified automatically but whose eligibility has ended
• People whose current income and assets have decreased to within the limits
• People who have not received an automatic eligibility notice and believe they meet the requirements

Approval for Extra Help and enrollment in a Part D plan are separate processes. To apply Extra Help to actual prescription drug costs, you must be enrolled in a Part D plan. If you do not yet have a plan, Medicare may assign one, but it is best to verify personally whether the plan is suitable based on the medications you take and the pharmacies you use.

Information to Prepare Before Applying

You do not have to upload all supporting documents immediately with the online application, but preparing the following information in advance will help you complete it accurately. SSA may request additional documentation during the review process.

• Social Security numbers and Medicare information for you and your spouse
• Recent checking and savings account balances
• Current values of stocks, bonds, mutual funds, and other investment assets
• Balances in retirement accounts such as IRAs and 401(k)s
• The value of real estate other than your primary residence and any related debt
• Income from Social Security, wages, self-employment, pensions, and annuities
• Veterans’ benefits and other recurring payments
• Income and asset information for a spouse who lives with you
• Information about family members who live with you and whom you financially support

If you do not remember the exact amounts, review recent account statements, pension statements, pay stubs, and benefit determination notices. Intentionally omitting assets or income may delay the review or change the eligibility decision.

How to Apply for Extra Help Through SSA

1. Check Whether You Qualify Automatically

If you receive Medicaid, a Medicare Savings Program, or SSI, first check whether you have received an automatic eligibility notice. People who qualify automatically do not need to submit another SSA application to receive the same benefits.

2. Complete the SSA Online Application

On SSA’s official Extra Help application page, enter income, financial asset, pension, and household information for yourself and your spouse. Review the application before submitting it and retain the submission confirmation information.

3. Use Telephone Assistance

If applying online is difficult, call SSA’s main number at 1-800-772-1213 to request application assistance or a telephone appointment. The TTY number for hearing assistance is 1-800-325-0778. For counseling about Medicare plans, call 1-800-MEDICARE or contact the State Health Insurance Assistance Program where you live.

4. Review SSA’s Decision Notice

After reviewing the submitted information, SSA will provide notice of its approval or denial decision by mail or another method. If you receive a request for additional information, follow the deadline and submission instructions in the notice. Keep the approval notice because it may contain information needed to apply the benefit.

5. Check Your Part D Plan Status

After approval, check your Medicare account or plan notice to confirm that Extra Help has been applied. To estimate your actual costs, you must also review the prescription drug list, network pharmacies, and any premium difference.

Application Period and Reapplying

Extra Help does not have a specific annual application deadline. If you believe you are eligible, you may apply to SSA at any time, either before or after enrolling in Part D.

If your income or assets decrease after a denial, you may reapply without waiting until the following year. For example, if your financial circumstances change because of retirement, job loss, the death of a spouse, divorce, or depletion of assets, reapply using your new current information.

If you believe SSA’s decision is factually incorrect, review the decision notice for the reconsideration or appeal procedures and deadlines. People who receive notice that their automatic eligibility is ending may also apply separately to SSA if they meet the current income and asset limits.

What to Check After Applying

• Approval for Extra Help does not automatically cover every medication you take.
• You must check the formulary and prior authorization requirements of your selected Part D plan.
• A plan with a premium above the benchmark may result in a monthly premium difference.
• If your address, marital status, income, or assets change significantly, update your information in accordance with guidance from SSA and the relevant agencies.
• For people who qualify automatically, changes in Medicaid, Medicare Savings Program, or SSI eligibility may also affect Extra Help.

Extra Help applications are not limited to the annual Medicare enrollment period. Medicare beneficiaries whose circumstances are close to the current limits should apply to SSA for an official determination rather than assuming on their own that they are ineligible.