Medicare Part D

2027 Extra Help rules for Medicare in Valley Stream

Valley Stream, N.Y. — If prescription costs feel heavier every trip to the pharmacy, there is a federal program that could quietly do a lot of the lifting. It's called Extra Help, and in 2027 it remains more generous — and easier to qualify for — than many people realize.

Here in Valley Stream, part of Nassau County, thousands of Medicare beneficiaries may be eligible and not know it. This guide walks through who qualifies, what Extra Help actually does, and how to apply.

What Extra Help Is

Extra Help — also known as the Low-Income Subsidy (LIS) — is a federal program run by Social Security and the Centers for Medicare & Medicaid Services (CMS). It helps people with Medicare pay for Part D, the prescription drug portion of Medicare.

For people who qualify, Extra Help can lower or eliminate:

• The monthly premium for a Part D drug plan
• The annual deductible (the Part D maximum deductible is up to $615 in 2026 and $700 in 2027)
• The copays at the pharmacy for covered drugs

Extra Help also protects you from late enrollment penalties for Part D and gives you a Special Enrollment Period so you can join or switch plans outside the usual windows.

Who Qualifies in 2027

Thanks to changes from the Inflation Reduction Act, Extra Help is now available at one full level for everyone who qualifies — there is no longer a partial benefit tier. That's a meaningful expansion.

To qualify in 2027, you generally need to:

• Have Medicare Part A and/or Part B
• Live in one of the 50 states or D.C.
• Have income at or below 150% of the federal poverty level (roughly $22,590 for a single person and $30,660 for a married couple, based on the most recent guidelines — figures update each year)
• Have limited resources (savings, investments, and real estate other than your home) under the annual limit set by Social Security

Some things don't count against you — your home, one car, life insurance policies, burial plots, and household items. Many people rule themselves out too early because they assume their small savings disqualify them. It's worth checking.

You're automatically enrolled in Extra Help if you have Medicare and:

• Get full Medicaid benefits, or
• Get help from Medicaid paying your Medicare premiums (a Medicare Savings Program), or
• Receive Supplemental Security Income (SSI)

How Extra Help Fits With Part D Changes

Even without Extra Help, Part D continues to look different heading into 2027:

• Out-of-pocket drug spending is capped at $2,100 per year in 2026 and $2,400 in 2027.
• The coverage gap ("donut hole") is gone — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets anyone with Part D spread drug costs over monthly installments instead of paying big amounts at the pharmacy counter.

Extra Help layers on top of these protections. If you qualify, your costs start lower and stay lower all year.

What This Looks Like Locally

Valley Stream is in Nassau County, where Medicare beneficiaries have a wide selection of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Extra Help works with either type of plan — you keep your Part D coverage, and the subsidy reduces what you owe.

New York also runs EPIC, a state pharmacy assistance program for older adults, which can work alongside Extra Help for eligible residents. A local counselor can walk you through whether stacking these programs makes sense.

How to Apply

There is no cost to apply, and you can do it three ways:

1. Online at ssa.gov/extrahelp 2. By phone at Social Security, 1-800-772-1213 (TTY 1-800-325-0778) 3. In person at your local Social Security office

The application is short — most people finish it in under 30 minutes. Have your Medicare card, income information (Social Security statements, pension, wages), and a rough total of your savings and investments ready.

After you apply, Social Security sends a decision letter. If you qualify, you can then choose a Part D plan or let Medicare enroll you in one.

Free, Unbiased Help in Your Area

You don't have to figure this out alone. New York's State Health Insurance Assistance Program (SHIP) — called HIICAP here — offers free, one-on-one counseling. Nassau County residents can reach the county's HIICAP counselors through the Department of Senior Affairs. They do not sell insurance; they help you understand your options.