Medicare Part D

Extra Help explained for Boulder Medicare Part D enrollees

BOULDER, Colo. — If you take Medicare Part D prescriptions and money feels tight, there's a federal program you should know about by name: Extra Help, also called the Low-Income Subsidy (LIS). It's run by Social Security and Medicare, and it can lower what you pay for your monthly Part D premium, your deductible, and the cost of your prescriptions at the pharmacy.

Extra Help could ease the sting of prescription costs — here's how it works

Extra Help isn't a private plan or a sales offer. It's a benefit you apply for, and if you qualify, it stays with you no matter which stand-alone Part D plan or Medicare Advantage drug plan you use.

Here's a plain-language guide to who qualifies, what it's worth, and how to apply from Boulder for 2027 coverage.

What Extra Help actually pays for

Extra Help lowers your out-of-pocket costs for Medicare Part D, the part of Medicare that covers prescription drugs. People who qualify pay much less — and in many cases nothing — for their Part D premium and deductible, and pay only small, capped amounts for covered prescriptions.

A few figures give this some context:

• The standard Part D deductible can be as high as $615 in 2026.
• Part D now has a $2,100 out-of-pocket cap on covered drugs for everyone with Part D — a major change that took full effect after the coverage gap ("donut hole") was eliminated in 2025.
• People with Extra Help typically pay well below those amounts, sometimes just a few dollars per prescription.

In short: Part D already has stronger protections than it used to. Extra Help stacks on top of those.

Who qualifies for Extra Help

Congress expanded Extra Help so that, starting in 2024, there is now just one full level of the benefit — the partial level was eliminated. That made the program simpler and more generous.

To qualify, you generally need to meet limits in two areas: income and resources (savings and certain assets). Medicare updates the exact dollar figures each year. As a general guide from Medicare.gov:

• Income is looked at against the federal poverty level, with some money set aside (for example, earnings from work).
• Resources include things like money in checking, savings, stocks, and bonds. Your home, one car, and personal belongings do not count.

You may qualify automatically — with no application needed — if you already have:

• Medicaid, or
• A Medicare Savings Program (which helps pay Part B costs), or
• Supplemental Security Income (SSI).

If you're in one of those groups, Medicare mails you a notice, usually on colored paper, telling you you're set.

If you're not automatic, it's worth applying anyway. Many people who would qualify never apply because they assume they earn too much. Social Security encourages you to apply and let them do the math.

How to apply from Boulder

Boulder is in Boulder County, and the application process is the same statewide. You can apply for Extra Help in any of these ways:

1. Online at ssa.gov/extrahelp — this is the fastest route. 2. By phone at 1-800-772-1213 (Social Security). 3. In person at your local Social Security office. 4. With free help from Colorado's State Health Insurance Assistance Program (SHIP), which in Colorado is administered through the state's Division of Insurance and local Area Agencies on Aging. A SHIP counselor can sit with you, walk through the questions, and also check whether you qualify for Medicaid or a Medicare Savings Program at the same time.

There's no fee to apply, and no salesperson is involved. Be wary of anyone who calls out of the blue claiming they can "sign you up for Extra Help" for a fee — that's not how it works.

How Extra Help fits with your Part D plan

Boulder is in Boulder County, where a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage are offered. Extra Help works with any of those; it changes what you pay, not which plans you can join.

A few things worth knowing:

• If you get Extra Help, you have a Special Enrollment Period that lets you switch Part D plans outside the usual Annual Enrollment Period (Oct. 15 – Dec. 7).
• If you don't get Extra Help, you can still take advantage of the new Medicare Prescription Payment Plan, which lets anyone with Part D spread their drug costs across the year in monthly payments instead of paying big amounts at the pharmacy counter.
• IRMAA — the income-based surcharge on Part B and Part D — only kicks in above $109,000 in income for a single filer in 2026, so most people who might qualify for Extra Help are nowhere near that line.

Common mistakes to avoid

• Assuming you earn too much. The income and resource limits are higher than many people expect, and work income is treated more generously.
• Forgetting to reapply after a life change. If your income drops — say, after retirement or the loss of a spouse — you can apply (or reapply) any time.
• Missing the mailed notices. Medicare and Social Security send letters about Extra Help on colored paper. Don't toss them with the junk mail.
• Paying anyone to apply. The application is free.