Medicare Extra Help Income Limits for 2026

Medicare Extra Help is a subsidy program that helps eligible Medicare recipients pay for their prescription drug costs. Some people with Medicare Part D automatically qualify for Extra Help benefits. Those who don’t qualify automatically can still apply, with eligibility based on income and assets. Before filling out the application, it’s important to understand the Medicare Extra Help income limits for 2026.

If you have questions about how Medicare Extra Help can impact your retirement, speak with a financial advisor.

What Is Medicare Extra Help?

Medicare Extra Help is a subsidy program designed for certain Medicare recipients with Part D drug coverage. It can help in several ways.

Reduces your out-of-pocket costs for prescription drugs
Eliminates Medicare Part D premiums
Reduces or eliminates your annual Medicare Part D deductibles
Eliminates the Medicare donut hole, or coverage gap
Avoids the late enrollment penalty

The program can drastically reduce your prescription costs. Once Extra Help participants have total drug costs of $2,100 in 2026 ($5.10 for generic prescription drugs and $12.65 for brand-name drugs), covered medicines are free.

2026 Income Limits for Medicare Extra Help

Medicare Extra Help eligibility is based on someone’s income and the financial resources they have available to help pay for Medicare prescription drug costs. The limit that applies to you can depend on whether you’re married or not.

The 2026 Medicare Extra Help income limits depend on whether you are single or married.

Single person: Annual income below $23,475 ($1,956.25 monthly).
Married person: Annual income below $31,725 ($2,643.75 monthly).

It’s possible to qualify if your income is above the Medicare Extra Help income limits for 2026. There may be higher income allowances if you are still working, have dependents who live with you or you live in Alaska or Hawaii. To discuss options, check with your local social services or Social Security office.

Certain types of income are also excluded from calculations for Extra Help eligibility for nine months.

Supplemental Nutrition Assistance Program (SNAP) benefits
Housing assistance benefits
Home energy assistance
Assistance with medical treatment and drugs
Disaster assistance
Earned income tax credit payments
Assistance from others to pay household expenses
Victim’s compensation payments
Scholarships and education grants

You can also follow up with Social Security to ask about any other income exclusions that may apply. The more types of income you can exclude, the easier it may be to qualify for Medicare Extra Help under the 2026 income limits.

Aside from income, Medicare considers several types of financial assets to determine Extra Help eligibility.

Certain resources are excluded. For example, Medicare doesn’t look at the value of your home, household items, one vehicle and up to $1,500 for burial costs when calculating your resources.

These types of resources are not counted for nine months.

Retroactive Social Security or Supplemental Security Income (SSI) payments
Housing assistance payments
Tax advances and refunds for earned income and child tax credits
Compensation paid to you as a crime victim
Relocation assistance received from a state or local government

Similar to income, you can check with Social Security to see what other exclusions may apply.

Who Automatically Qualifies for Medicare Extra Help?

Those who meet the eligibility requirements may qualify for Medicare Extra Help, regardless of income.

Have full Medicaid coverage
Receive help from your state Medicaid program for Medicare Part B premiums
Receive Supplemental Security Income benefits

People who qualify for Extra Help automatically receive the same prescription drug benefits as those who qualify based on income.

How to Apply for Medicare Extra Help

To take advantage of Medicare Extra Help benefits, you must be enrolled in a Medicare Part D prescription drug program. You can technically apply for Extra Help if you’re not yet enrolled in Part D coverage, but if approved, your benefits wouldn’t kick in until you have prescription drug coverage in place.

You can apply for Extra Help online if you are enrolled in Medicare Part D or Medicare Part B and live in one of the 50 states or the District of Columbia. There are also financial resource limitations.

You don’t need to fill out the online application if you have Medicare and Medicaid or have Medicare and receive SSI benefits. In that case, you should receive a letter explaining that you’re automatically approved for Medicare Extra Help.

You can apply for Extra Help in several ways.

Apply online.
Call Social Security at 1-800-772-1213.
Visit your local Social Security (may require an appointment).

Social Security suggests collecting specific documents before you apply.

Social Security card
Bank account statements
Statements for IRAs and other investment accounts
Tax returns
Payroll slips
Your most recent Social Security benefits award letter or statements for Railroad Retirement benefits, veterans benefits, pensions and annuities

If you don’t have those documents, you must give Social Security your best estimate of income.

If approved for Medicare Extra Help, you’ll be subject to a periodic eligibility review. This is to ensure you’re still eligible for aid based on your income and financial resources.

If you’re denied for Extra Help based on your income or resources, you can file an appeal. There’s a specific Social Security appeal form you’ll need to complete and send in. You can request a hearing by phone to have Social Security reconsider your eligibility.

Medicare Extra Help and Part D Plan Choices in 2026

Medicare Extra Help changes how Part D prescription drug plans work for beneficiaries who qualify.

While the program lowers or eliminates premiums, deductibles and copayments, it does not remove the need to choose and manage a Part D plan. Enrollees are still subject to plan rules, formularies and pharmacy networks, which means plan selection can still affect access to medications and overall out-of-pocket costs.

Each year, Medicare sets regional benchmark Part D plans that qualify for full premium coverage under Extra Help. If your current Part D plan’s premium rises above your area’s benchmark, Medicare may automatically reassign you to a lower-cost benchmark plan to avoid premium charges.

This reassignment happens unless you actively choose to stay in your existing plan and pay the difference. Automatic reassignment can reduce costs, but it may also change which drugs are covered or which pharmacies are in-network.

Extra Help does not standardize drug coverage across plans. Formularies still vary, meaning two plans may cover the same medication differently or require different prior authorizations or step therapy. Even with fixed copay amounts, a medication that is not on a plan’s formulary may cost significantly more or require switching drugs. For this reason, reviewing a plan’s drug list each year remains important, even for people who qualify for full Extra Help benefits.

Pharmacy networks also continue to matter. Some Part D plans use preferred pharmacy networks offering lower copays, even under Extra Help. Using an out-of-network pharmacy can increase costs or limit access, particularly for brand-name drugs. Mail-order options, when available, may also differ by plan and affect both convenience and refill timing.

Because Extra Help beneficiaries can change Part D plans outside the standard open enrollment period, there is more flexibility to respond to coverage changes during the year. This special enrollment right allows beneficiaries to switch plans if a medication becomes uncovered or costs change unexpectedly, helping maintain access to needed prescriptions without waiting for the next enrollment window.

Bottom Line

Medicare Extra Help reduces prescription drug costs by lowering Part D premiums, deductibles and copayments for people with limited income and assets. For 2026, income limits are expected to increase slightly to reflect inflation. Meanwhile, eligibility continues to depend on both income and countable resources, such as savings and investments, with key assets like a primary home and vehicle excluded.

Retirement Planning Tips

Consider talking to a financial advisor about Medicare enrollment, Extra Help and how to pay for health care costs not covered by Medicare, such as long-term nursing care. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
Medicare eligibility begins in the year you turn 65. Once you’re enrolled in Medicare, you have the option to change your coverage each year during the annual open enrollment period. For example, you may decide to switch to a Medicare Advantage plan if you’re already enrolled in Original Medicare or add Part D coverage. Comparing plan costs and coverage can help you decide which Medicare option may work best for you, based on what you need and what you can afford to pay.