Medicare Part D
Extra Help Could Ease Drug Costs in Box Elder
BOX ELDER, S.D. — For many people on Medicare, the pharmacy counter is where a fixed income gets stretched the thinnest. A federal program called Extra Help, also known as the Low-Income Subsidy (LIS), can quietly take a big bite out of what you pay for prescription drugs — but only if you know it exists and apply.
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Click to call 855-729-3240Key takeaways
- Extra Help is a federal program from Social Security and Medicare that can lower or eliminate your Part D premium and deductible and cap what you pay for covered drugs.
- For 2025, you may qualify with income around $23,475 a year for a single person or $31,725 for a married couple, and resources around $17,600 or $35,130, though some income and assets don't count.
- You're automatically enrolled if you have Medicare and also have Medicaid, get SSI, or get help from a Medicare Savings Program, and since 2024 everyone who qualifies gets the full subsidy with no partial level.
- You can apply for free online at ssa.gov/extrahelp, by phone at 1-800-772-1213, or in person at a Social Security office, and it's worth applying even if you're unsure since denials can be appealed.
Here's a plain-language look at who qualifies, what it pays for, and where Box Elder residents can get help walking through the paperwork.
What Extra Help actually does
Extra Help is a federal program run through the Social Security Administration and Medicare. It lowers the cost of Part D prescription drug coverage for people with limited income and savings.
If you qualify, Extra Help can reduce or eliminate your Part D premium and deductible, and it caps what you pay for covered generic and brand-name drugs at your pharmacy. It works alongside your Medicare drug plan — you still enroll in a Part D plan, but Extra Help pays a share of the costs.
As of 2024, Extra Help was expanded so that everyone who qualifies now gets the full subsidy. There is no longer a "partial" level.
Who qualifies in 2025
To qualify for Extra Help, you generally need to:
- Be enrolled in Medicare Part A, Part B, or both,
- Live in one of the 50 states or D.C., and
- Have income and resources below the federal limits.
For 2025, the income limit is roughly 150% of the federal poverty level — about $23,475 a year for a single person and $31,725 for a married couple living together. Resource limits are about $17,600 for an individual and $35,130 for a couple. Some income and assets don't count, so don't rule yourself out based on a quick glance at your bank statement.
You are automatically enrolled in Extra Help if you have Medicare and also qualify for Medicaid, receive Supplemental Security Income (SSI), or get help from a Medicare Savings Program.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Pennington County
(MA penetration in Pennington County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
How Extra Help fits with Part D changes in 2026 and 2027
Even without Extra Help, Part D looks different now and will change again next year:
- The out-of-pocket cap for covered drugs is $2,100.
- The maximum Part D deductible is $615.
- The old coverage gap (the "donut hole") is gone — Part D now has three simpler phases.
- Anyone can spread drug costs across the year using the Medicare Prescription Payment Plan.
Extra Help sits on top of these protections. If you qualify, your costs at the pharmacy are typically far lower than the standard cap, and the deductible generally doesn't apply.
What this looks like locally
Box Elder is in Pennington County, where Medicare beneficiaries choose from a range of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Extra Help works with either type — it's tied to you, not to a specific plan or carrier.
That matters during the Annual Enrollment Period (Oct. 15 – Dec. 7, 2026), when you can compare Part D options for 2027. If you have Extra Help, you have flexibility to switch drug plans outside the usual windows as well.
How to apply
There are three straightforward ways to apply:
1. Online at ssa.gov/extrahelp. 2. By phone at Social Security, 1-800-772-1213. 3. In person at your local Social Security office.
The application is short — a few pages about your income, savings, and household. You do not need to be a U.S.-born citizen to apply, and there is no fee, ever.
If you're not sure whether you'll qualify, apply anyway. Social Security makes the final call, and denials can be appealed.
Free local help in Box Elder
South Dakota has a State Health Insurance Assistance Program (SHIP) — locally called Senior Health Information and Insurance Education (SHIINE) — that offers free, unbiased Medicare counseling. Counselors can help you:
- Screen for Extra Help and Medicare Savings Programs,
- Fill out the LIS application,
- Compare Part D plans on Medicare.gov using your actual drug list.
You can reach SHIINE's Western South Dakota office at 1-877-286-9072.
Try it
Find your 2026 Medicare premium
Most people pay the standard Part B premium. If your 2024 income was higher, an income-related surcharge (IRMAA) applies. Enter your details to see your bracket.
Surcharges are added to your premiums and based on your 2024 tax return. Married-filing-separately uses a different schedule. Confirm at Medicare.gov.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Good to know
Frequently asked questions
Do I have to reapply for Extra Help every year?
I have a little money saved. Am I automatically disqualified?
Can I get Extra Help if I have a Medicare Advantage plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.