Medicare Part D

How the Low-Income Subsidy lowers Medicare drug bills in St Louis

ST. LOUIS — If prescription costs are stretching your budget, there's a federal program that could quietly do a lot of the heavy lifting. It's called Extra Help — also known as the Low-Income Subsidy (LIS) — and it helps people with Medicare pay for their Part D prescription drug coverage.

Many people who qualify never apply. Some assume they make too much. Others don't realize the rules changed in 2024 to let more people in. Here's a clear look at who qualifies, how to apply, and the mistakes worth avoiding.

What Extra Help actually does

Extra Help is a federal benefit run by the Social Security Administration and Medicare. If you qualify, it can lower or eliminate your Part D premium and deductible, and cap what you pay at the pharmacy counter at a small set amount per prescription.

It works alongside a Part D drug plan — you still need to be enrolled in one — but it takes a large chunk of the cost off your shoulders. This is separate from the Part D out-of-pocket cap on drug spending that applies to everyone (it is $2,100 in 2026 and $2,400 in 2027), and separate from the Medicare Prescription Payment Plan, which lets any Part D enrollee spread drug costs across the year.

Who qualifies in 2027

Since 2024, Extra Help has been a single, full benefit — the old "partial" tier is gone. To qualify, you generally need to meet two tests:

• Income: Your annual income is at or below 150% of the federal poverty level. That figure changes each year, so check the current number on medicare.gov or with Social Security.
• Resources: Your countable resources (things like money in checking, savings, stocks, and bonds) are under the annual limit. Your home, car, and personal belongings don't count.

You may automatically qualify — with no application needed — if you have Medicare and also:

• Have full Medicaid (MO HealthNet, here in Missouri),
• Get help from a Medicare Savings Program, or
• Receive Supplemental Security Income (SSI).

If that's you, Medicare will mail a letter letting you know.

How to apply

If you're not automatically enrolled, applying is free and fairly straightforward:

• Online: ssa.gov/extrahelp
• By phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• In person: Visit your local Social Security office

You do not need a lawyer, an agent, or a paid service to apply. If someone asks you to pay to file this application, walk away.

In St. Louis, you can also get free, unbiased help from CLAIM, Missouri's State Health Insurance Assistance Program (SHIP). Counselors can walk through the application, screen you for related programs, and check your Part D options during enrollment windows.

Common mistakes to avoid

A few missteps trip up people who would otherwise qualify or benefit:

• Assuming you make too much. The income limits are higher than many people think, and some income and resources are excluded. Apply and let Social Security decide.
• Not reapplying after a life change. If your income drops — a spouse passes away, you stop working, medical bills climb — you can apply (or reapply) any time of year.
• Forgetting you still need a Part D plan. Extra Help pays toward a drug plan; it doesn't replace one. If you don't pick a plan, Medicare may enroll you in one automatically, but you can switch.
• Missing your special enrollment window. People with Extra Help can switch stand-alone Part D drug plans once a month — not just during the Annual Enrollment Period (Oct. 15–Dec. 7), with the change generally taking effect the first day of the following month.
• Confusing Extra Help with Medicaid. They're related but separate. You can qualify for Extra Help without qualifying for full Medicaid.

How this fits with the rest of Part D in 2027

Even without Extra Help, Part D looks different in 2026 than it did a couple of years ago. The coverage gap — the old "donut hole" — is gone as of 2025, replaced by a simpler three-phase design. Part D plans can charge a deductible of up to $615, and once your out-of-pocket spending on covered drugs hits $2,100 in 2026 ($2,400 in 2027), you pay $0 for covered drugs the rest of the year.

For higher earners, IRMAA surcharges on Part B and Part D premiums kick in above $109,000 in income for a single filer in 2026 (based on your 2024 tax return).

Extra Help sits on top of all of this and reduces costs further for those who qualify.

A quick note on local plan availability

St. Louis is in St. Louis city, where Medicare drug and Advantage plan availability is set at the county level. The number and mix of Part D and Medicare Advantage plans available to you depends on your county, not the city itself. When you compare plans on the Medicare Plan Finder, use your ZIP code so the tool pulls the right county's options.