Medicare Part D

Medicare Part D Extra Help income limits Franklin Township

FRANKLIN TOWNSHIP, N.J. — If you take a fistful of prescriptions each month, you already know how quickly the pharmacy line can turn into a budget problem. There's a federal program built specifically to help with that, and many people who qualify for it never sign up — often because they don't realize the income limits are higher than they think.

It's called Extra Help, also known as the Low-Income Subsidy (LIS). Here's a plain-English look at how it works, who qualifies, and how to apply from Franklin Township.

What Extra Help actually does

Extra Help is a federal program run through Medicare and the Social Security Administration. It lowers what people with limited income and resources pay for their Medicare Part D prescription drug coverage.

For people who qualify, Extra Help can reduce or eliminate the Part D premium, wipe out the deductible, and cap what you pay at the pharmacy counter to small, set copays for covered generic and brand-name drugs. It also removes the late-enrollment penalty for Part D — a penalty that otherwise sticks to your premium for life if you sign up late without other creditable drug coverage.

Extra Help works alongside a Part D plan; it does not replace one. You still need to be enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes drug coverage.

Who qualifies in 2027

As of 2024, Congress expanded Extra Help so that everyone who qualifies now gets the full benefit — there is no longer a partial subsidy tier. To qualify, you generally need to:

• Be enrolled in Medicare Part A and/or Part B.
• Have income at or below 150% of the federal poverty level.
• Have resources (things like money in checking, savings, stocks, and bonds) below the annual limit set by Social Security.

Your house, one car, personal belongings, and burial funds up to a set amount don't count toward the resource limit. Income limits are a little higher in Alaska and Hawaii, and Social Security updates the exact dollar figures each year — so it's worth checking the current numbers at ssa.gov/medicare/prescriptionhelp before assuming you make too much.

One important note: if you already have full Medicaid, receive Supplemental Security Income (SSI), or get help from a Medicare Savings Program, you're automatically enrolled in Extra Help. You don't have to apply separately.

How Extra Help fits with the 2027 Part D changes

Part D looks different heading into 2027 than it did just a couple of years ago. A few program-wide facts to keep in mind:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that ceiling, you pay nothing more for covered drugs the rest of the year.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap was eliminated in 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets anyone with Part D spread their drug costs into monthly payments across the year instead of paying big bills at the counter.

Extra Help layers on top of these rules. If you qualify for LIS, you generally won't come close to that cap because your copays are already limited to small fixed amounts.

Applying from Franklin Township

Franklin Township is in Somerset County, where residents have access to both stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Extra Help works with either.

There are three straightforward ways to apply:

1. Online at ssa.gov/medicare/prescriptionhelp. 2. By phone at 1-800-772-1213 (Social Security). 3. In person at your local Social Security office.

New Jersey also runs a free counseling program called SHIP (State Health Insurance Assistance Program), which in New Jersey is delivered through NJ SHIP. A counselor can sit down with you at no cost, look at your income and drug list, and help you file the Extra Help application. You can reach NJ SHIP at 1-800-792-8820.

Somerset County residents can also contact the county Office on Aging and Disability Services for local help identifying benefit programs.

Don't stop at Extra Help — check these too

If you qualify for Extra Help, you may also qualify for a Medicare Savings Program (MSP), which helps pay Part B premiums and, depending on the level, other cost-sharing. Many people who qualify for one qualify for the other. Applications for MSP go through the state — in New Jersey, through your county Board of Social Services.

Also worth knowing: qualifying for Extra Help gives you a Special Enrollment Period. You can switch Part D or Medicare Advantage drug plans outside the normal Annual Enrollment Period (October 15 – December 7) if your situation changes.