Medicare Part D

Medicare Extra Help eligibility rules for Dublin residents

DUBLIN, Ohio — Millions of people with Medicare pay more for their prescriptions than they need to, simply because they don't know a federal program called Extra Help exists. If your income and savings are modest, this benefit can quietly take a big weight off your monthly budget — but you have to apply.

Here's a plain-language guide to who qualifies, what it pays for, and the mistakes to avoid when you sign up.

What Extra Help actually is

Extra Help — also called the Low-Income Subsidy (LIS) — is a federal program that helps people with Medicare pay for their Part D prescription drug coverage. It can lower or eliminate your Part D premium and deductible, and it caps what you pay at the pharmacy counter for covered drugs.

It works alongside a Part D plan or a Medicare Advantage plan that includes drug coverage. It does not replace those plans; it helps you afford them.

As of 2024, Congress expanded Extra Help so that everyone who qualifies gets the full benefit. The old "partial" Extra Help tier is gone. That change is still bringing new people into the program in 2027.

Who qualifies in 2027

Two things determine eligibility: your income and your resources (savings and certain assets).

According to Medicare, to qualify for Extra Help you generally need:

• Income at or below 150% of the federal poverty level. For most people that's roughly $23,475 a year for one person and $31,725 for a married couple living together (higher in Alaska and Hawaii).
• Resources below about $17,600 for one person or $35,130 for a married couple. Resources include things like money in checking, savings, stocks, and bonds. They do not include your home, one car, burial plots, household items, or life insurance.

You may automatically qualify — with no application needed — if you have Medicare and any of the following:

• Full Medicaid coverage
• A Medicare Savings Program (helps pay Part B premiums)
• Supplemental Security Income (SSI)

If that's you, Medicare will mail you a letter. Keep it.

What Extra Help pays for

If you qualify, you generally pay:

• $0 for your Part D plan's premium (up to a benchmark amount)
• $0 Part D deductible
• A small, capped copay for each prescription — set by Medicare, not the plan

And because of the broader Part D changes for 2026, everyone with Part D — Extra Help or not — has a new $2,100 annual out-of-pocket cap on covered drugs, and a maximum deductible of $615. The old "donut hole" coverage gap was eliminated in 2025, so Part D now has just three simple phases.

Extra Help sits on top of those protections, making costs lower still.

Common mistakes to avoid

This is where people leave money on the table. Watch out for:

1. Assuming you make "too much." Many people who qualify never apply because they think they earn too much. The income limit is higher than it used to be, and things like a spouse or dependents can raise it further. 2. Counting your house or car as resources. They don't count. Neither does the money you've set aside for burial (up to certain limits). 3. Skipping the application because you have Medicaid. If you have full Medicaid, you're already in — but confirm it with your plan so your pharmacy charges you the right amount. 4. Waiting for a special enrollment window. You can apply for Extra Help any time of year. You don't have to wait for the Annual Enrollment Period (Oct. 15 – Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31). 5. Not re-checking after a life change. A drop in income, the loss of a spouse, or new medical bills can make you newly eligible. Reapply.

How to apply

There are three free ways to apply, and none of them require going through an insurance agent:

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

You'll need basic information about your income, your savings, and any investments. The application takes most people under 30 minutes.

For one-on-one help — free and unbiased — contact your State Health Insurance Assistance Program (SHIP). In Ohio, that's OSHIIP, reachable at 1-800-686-1578. Dublin residents are in Franklin County, and OSHIIP counselors can meet with you locally.

How this fits with your plan choices

Dublin is in Franklin County, where Medicare beneficiaries have a wide range of stand-alone Part D drug plans and Medicare Advantage plans with drug coverage to choose from. Extra Help works with most of them, but the amount you pay can still vary by plan and by which drugs you take. If you qualify for Extra Help, it's worth using Medicare's Plan Finder at medicare.gov/plan-compare — or asking a SHIP counselor — to see how your specific medications are covered.

If you're worried about a big pharmacy bill early in the year, ask about the new Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs across monthly payments instead of paying all at once at the counter.