Medicare Part D

Federal Extra Help program and Medicare drugs in Cedar City

CEDAR CITY, Utah — If prescription costs are making you skip pills or stretch doses, there's a federal program that could ease the strain — and many people who qualify never sign up. It's called Extra Help, also known as the Low-Income Subsidy (LIS), and it lowers what you pay for Medicare Part D prescription drugs.

Here's a plain-English look at who qualifies, what it covers, and how to apply — including where to get free help right here in Iron County.

What Extra Help actually does

Extra Help is a federal benefit run by the Social Security Administration and Medicare. It helps pay for the costs tied to a Medicare Part D drug plan, including monthly premiums, the annual deductible, and the copays you pay at the pharmacy.

Under 2027 rules, people with full Extra Help pay no Part D premium (for a benchmark plan), no deductible, and only small, capped copays for covered generic and brand-name drugs. Even people who qualify for partial Extra Help get meaningful reductions.

This matters more than ever in 2027, because Medicare Part D now has:

• A $2,100 out-of-pocket cap on covered drugs.
• A maximum deductible of $615.
• No more "donut hole" — the coverage gap was eliminated in 2025.

Extra Help sits on top of those protections and pushes costs down further for people with limited income.

Who qualifies in 2027

To get Extra Help, you must have Medicare Part A and/or Part B and live in one of the 50 states or D.C. Then Social Security looks at two things: your income and your resources (savings and certain assets).

As a general guide, you may qualify if:

• Your yearly income is at or below roughly 150% of the federal poverty level (about $23,000 for a single person and $31,000 for a married couple living together, based on current guidelines — these numbers update each year).
• Your resources are below the annual limit set by Medicare. Resources include money in checking, savings, stocks, and bonds — but not your home, one car, burial plots, or household items.

As of 2024, Congress expanded Extra Help so that everyone who qualifies now gets the full subsidy — the older "partial" tier is gone. That's a real change worth knowing.

You automatically get Extra Help (no application needed) if you have Medicare and any of the following:

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

If that's you, Medicare will mail you a letter. Keep it — you'll want it when you pick a drug plan.

How to apply

Applying is free, and you can do it any time of year — you don't have to wait for the Annual Enrollment Period (Oct. 15 – Dec. 7).

Three ways to apply:

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

You'll need basic information about your income, savings, and any investments. If you're married and living with your spouse, their information counts too. Social Security usually responds within a few weeks by mail.

Approval for Extra Help also opens a Special Enrollment Period, meaning you can switch to a Part D plan that works better for you without waiting for fall.

Free, unbiased help in Cedar City

Cedar City is in Iron County, where seniors have access to Utah's State Health Insurance Assistance Program (SHIP), locally known as Utah SHIP. Counselors are trained volunteers — they don't sell plans and don't earn commissions. They can:

• Help you fill out the Extra Help application
• Screen you for Medicaid and Medicare Savings Programs
• Compare Part D drug plans using your actual medication list

To reach a Utah SHIP counselor, call 1-800-541-7735. You can also call 1-800-MEDICARE (1-800-633-4227), available 24/7.

Don't overlook the Prescription Payment Plan

Even if you don't qualify for Extra Help, Medicare offers another tool worth knowing in 2027: the Medicare Prescription Payment Plan. It lets you spread your drug costs across the calendar year in monthly bills, instead of paying a large amount at the pharmacy counter. It doesn't lower the total price, but it can make budgeting easier — especially for people who hit big costs early in the year. Ask your Part D plan how to opt in.