Medicare Part D

The Federal Program That Cuts Medicare Drug Bills in St Albans

ST. ALBANS, Vt. — If you take Medicare prescription drugs and money feels tight, there is a federal program that may quietly do a lot of the heavy lifting for you. It is called the Low-Income Subsidy, better known as Extra Help. It is run by Medicare and the Social Security Administration, and it is designed to lower what you pay for Part D drug coverage — sometimes by a large amount.

A quieter way to lower drug costs in St. Albans

Many people who qualify never apply. Some assume they earn too much. Others have not heard of it at all. In 2027, with the yearly cap on out-of-pocket drug costs under Part D rising to $2,400, Extra Help can make an already stronger benefit even more affordable for those who qualify.

What Extra Help actually does

Extra Help lowers the cost of your Medicare Part D prescription drug coverage. According to Medicare, people who qualify get help with:

• Their Part D monthly premium
• Their Part D deductible
• Their copays at the pharmacy for covered drugs

Since 2024, Extra Help has been a single, full benefit — there is no longer a partial version. If you qualify, you get the full subsidy. You also get a Special Enrollment Period that lets you join or switch a Part D plan outside the usual fall window, which is unusual in Medicare.

Who qualifies in 2027

Eligibility is based on income and resources, and the limits are updated each year. As a general guide from Medicare and Social Security, you may qualify if:

• Your income is at or below roughly 150% of the federal poverty level, and
• Your resources (things like money in checking, savings, stocks, and bonds) fall under set limits.

Your home, one car, household items, burial plots, and a modest amount set aside for burial expenses do not count as resources. Life insurance policies generally do not count either.

A few important notes:

• If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you automatically get Extra Help — you do not need to apply.
• If you live with a spouse, both incomes and resources are counted together.
• Even if you were denied in the past, it is worth checking again. The rules have loosened in recent years.

For exact 2027 income and resource numbers, check medicare.gov or ssa.gov, since those figures update annually.

How Extra Help fits with the 2027 Part D changes

Part D continues to look different in 2027 than it did just a couple of years ago. The changes apply to everyone with Part D, not only people with Extra Help:

• The out-of-pocket cap for covered drugs is $2,400 for the year in 2027 (it was $2,100 in 2026).
• The maximum Part D deductible is $700 in 2027 (it was $615 in 2026).
• The old coverage gap ("donut hole") is gone — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets anyone with Part D spread their drug costs into monthly payments instead of paying big amounts at the pharmacy counter.

Extra Help sits on top of these changes. If you qualify, your share of costs in each phase is much lower than the standard amounts above.

How to apply from St. Albans

You can apply for Extra Help at any time — there is no enrollment window for the subsidy itself. There are a few ways to do it:

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. 4. With free help from Vermont's SHIP program (the State Health Insurance Assistance Program), which offers unbiased, one-on-one Medicare counseling to Vermonters, including residents of Franklin County.

When you apply, you will be asked about income, savings, and household size. It usually takes less than 30 minutes.

What plans this affects locally

St. Albans is in Franklin County, where Medicare beneficiaries can choose from stand-alone Part D drug plans as well as Medicare Advantage plans that include drug coverage. Extra Help works with Part D coverage in either setting. It does not lock you into a specific plan, and it does not replace the need to compare plans based on the drugs you actually take.

If you get Extra Help, remember your Special Enrollment Period: you can generally switch stand-alone Part D drug plans, or leave a Medicare Advantage plan for Original Medicare with a stand-alone Part D plan, once a month outside the usual Annual Enrollment Period of October 15 – December 7, with the change taking effect the first day of the following month. You can confirm which rules apply to you by calling 1-800-MEDICARE.