Eligibility for Extra Help


Some people with limited resources and income may be able to get Extra Help (Low Income Subsidy) to pay all or some of the costs of a Medicare prescription drug plan, including premiums, annual deductibles, and copays. See how Extra Help can lower your premiums with Silver Script. To find out if you qualify, the Social Security Administration will need to know whether you are single or married, the value of your savings, investments, real estate (other than your home) and your income. There are two ways to get Extra Help:

  • Some people need to apply directly through the Social Security Administration
  • Others automatically receive Extra Help without applying

You are automatically eligible for Extra Help if:

  • You are eligible to receive both Medicare and Medicaid (referred to as full dual eligibility)
  • You have a Medicare Savings program (you have partial dual eligibility)
  • You receive Supplemental Security Income (SSI) benefits but not Medicaid

Note: If any of these apply to you, you may also get help to pay your monthly Medicare Part B premium.

Applying for Extra Help with Medicare

In most cases you apply for Extra Help either through the Social Security Administration or through your state Medicaid Office. For more information or to apply:


Completing the Extra Help Application Form:

To ensure accuracy, the Social Security Administration encourages you to complete the Extra Help form with the help of a family member or a caregiver. The application requires you to identify the assets you own alone, with your spouse or with someone else, not including your home, any vehicles, burial plots or personal possessions. Note: It will save time and make the application process easier if you review all of your income and gather your records before starting the application for Extra Help with Medicare Prescription Drug Plan Costs.

Records you will need to complete the Extra Help Application Form include:

  • Current account balance statements from banks, credit unions or other financial institutions
  • Investment statements and stock certificates
  • Life insurance policy statements and tax returns
  • Pension award letters and payroll slips

Extra Help Application Forms are available by calling the Social Security Administration and by visiting the Social Security Administration’s website.

Extra Help Program 2016 Income and Asset Limits

To be eligible for Extra Help, you must meet the following national levels. You may apply for Extra Help directly with the Social Security Administration.

  • Your State
  • Your Medicare Eligibility
  • Your Income and Assets
    • Medicare Part A or Part B
    • You are Married
    • You are Single
    • Your State
    • Any of the contiguous 48 states (U.S. Mainland)

    • Your Medicare Eligibility
    • Medicare Part A or Part B
    • You are entitled to Medicare Part A (Hospital Insurance)
      —OR—
      You are enrolled in Medicare Part B (Medical Insurance)
    • Your Income and Assests
    • You are Married
    • You have an annual income of up to $24,030 and assets of less than $27,250.*
    • You are Single
    • You have an annual income of up to $17,820 and assets of less than $13,640.*
    • Your State
    • Alaska
    • Your Medicare Eligibility
    • Medicare Part A or Part B
    • You are entitled to Medicare Part A (Hospital Insurance)
      —OR—
      You are enrolled in Medicare Part B (Medical Insurance)
    • Your Income and Assests
    • You are Married
    • You have an annual income of up to $30,030 and assets of less than $27,250.*
    • You are Single
    • You have an annual income of up to $22,260 and assets of less than $13,640.*
    • Your State
    • Hawaii
    • Your Medicare Eligibility
    • Medicare Part A or Part B
    • You are entitled to Medicare Part A (Hospital Insurance)
      —OR—
      You are enrolled in Medicare Part B (Medical Insurance)
    • Your Income and Assests
    • You are Married
    • You have an annual income of up to $27,645 and assets of less than $27,250.*
    • You are Single
    • You have an annual income of up to $20,505 and assets of less than $13,640.*

*These asset limits include $1,500 per person for burial expenses. Assets include money in cash, checking accounts, savings accounts, money market accounts, stocks, bonds and other assets you may have.

Note: These income and resource amounts are for 2016. Income and asset amounts may change each year.

Using the Best Available Evidence Policy (BAE)

You can use the Best Available Evidence (BAE) when the Low Income Subsidy (LIS) information your Medicare prescription Drug Plan (PDP) has is not up to date. Because of the way in which date data is exchanged and stored, your LIS information may not be up to date or accurate.

If your information is incorrect, you can use the BAE policy to show that you qualify, using such evidence as your award letter from Social Security Administration, your Medicaid card or other proof of your eligibility for Extra Help. When you provide this information to your Medicare Prescription Drug Plan, your plan will update you Low Income Subsidy information as soon as possible.

Helpful Links on Medicare Part D Extra Help Eligibility