Madison
Prescription medications are one of the biggest expenses for seniors and people with disabilities in the United States. That’s why Medicare Part D offers the Extra Help program, also called the Low-Income Subsidy (LIS), which helps pay for drug coverage.
In 2025, Extra Help is even more valuable because out-of-pocket costs are being capped, and thousands of beneficiaries will save more than ever before.
But not everyone needs to apply — some people qualify automatically. Knowing whether you’re one of them can save you both time and money.
What Is the Extra Help Program?
The Extra Help program lowers the costs you pay under Medicare Part D. If you qualify, Extra Help may cover or reduce:
- Monthly premiums for prescription drug plans.
- Annual deductibles.
- Copayments at the pharmacy.
- Late enrollment penalties for Part D.
In 2025, beneficiaries with Extra Help will not pay more than:
- $4.90 for generic drugs.
- $12.15 for brand-name drugs.
Once you reach the new $2,000 out-of-pocket cap on covered drugs in 2025, you will pay nothing for the rest of the year.
Who Gets Extra Help Automatically?
Some Medicare recipients do not need to apply for Extra Help — they are enrolled automatically. You qualify automatically if you:
- Have full Medicaid coverage.
- Receive help from your state to pay Medicare Part B premiums (through a Medicare Savings Program).
- Get Supplemental Security Income (SSI) benefits.
If you fall into one of these groups, you’ll receive a letter in the mail explaining your Extra Help status. If you’re not already in a Part D plan, Medicare will place you in one.
What If You Do Not Qualify Automatically?
If you are not covered by Medicaid, do not receive SSI, and do not have state help for Part B, you can still qualify based on income and resources.
For 2025, the financial eligibility limits are:
| Household Type | Annual Income Limit | Resource Limit |
|---|---|---|
| Single individual | $23,475 | $17,600 |
| Married couple (living together) | $31,725 | $35,130 |
If your income and assets fall within these limits, you can apply directly.
How Much Will Beneficiaries Pay in 2025?
Even with Extra Help, there are small copays, but the savings are huge. Here’s what beneficiaries can expect:
| Category | With Extra Help |
|---|---|
| Monthly premium | $0 |
| Deductible | $0 |
| Copay (generic drugs) | Max $4.90 |
| Copay (brand-name drugs) | Max $12.15 |
| After $2,000 out-of-pocket | $0 for rest of year |
This new $2,000 annual cap applies to all Part D participants starting in 2025, but Extra Help ensures low copays until you hit the threshold.
Why Extra Help Matters
For many seniors, high drug prices mean skipping pills or splitting doses. Extra Help ensures beneficiaries don’t have to choose between their health and their budget.
By eliminating premiums, deductibles, and high copays, the program saves people hundreds or even thousands of dollars each year.
How to Apply If You’re Not Automatically Eligible
If you do not qualify automatically, you can still apply in several ways:
- Online through the Social Security Administration’s website.
- By calling 1-800-772-1213.
- By visiting your local Social Security office.
- Through free counseling at your State Health Insurance Assistance Program (SHIP).
If your financial situation changes, you can reapply.
The Medicare Part D Extra Help program in 2025 provides crucial support for low-income beneficiaries. Many seniors will be automatically enrolled if they already have Medicaid, SSI, or state premium assistance. Others can qualify by meeting income and resource limits.
With Extra Help, you’ll pay no monthly premiums, no deductibles, very low copays, and nothing once you reach $2,000 in out-of-pocket costs.
If you think you may be eligible, don’t wait—getting Extra Help could make the difference between affording your medication and going without it.
FAQs
How do I know if I automatically qualify for Extra Help in 2025?
You automatically qualify if you get Medicaid, SSI, or state help with Medicare Part B premiums.
What if I don’t qualify automatically?
You may still qualify based on income (under $23,475 for singles or $31,725 for couples) and resources. You can apply through Social Security.
How much will I pay for prescriptions with Extra Help in 2025?
With Extra Help, you’ll pay no premium or deductible, no more than $4.90 for generics and $12.15 for brand-name drugs, and nothing after reaching the $2,000 out-of-pocket cap.