Extra Help is a Medicare program that helps people with limited income and resources pay Part D drug costs, including premiums, deductibles and copays, and it waives the Part D late enrollment penalty. For 2026 the limits are $23,940 in income and $18,090 in resources for an individual, or $32,460 and $36,100 for a married couple. In 2027 you pay up to $5.80 for each generic and $14.40 for each brand-name drug. Many people qualify automatically. Here is who qualifies, what it pays and how it works in North Carolina, South Carolina and Tennessee.
What is Medicare Extra Help?
Extra Help, sometimes called the Low-Income Subsidy, is a federal program for people with Medicare drug coverage. Medicare.gov describes it as a program to help people with limited income and resources pay Medicare drug coverage premiums, and it also helps with deductibles and coinsurance. If you qualify, you don't pay the Part D late enrollment penalty, even if you went without drug coverage in the past.
Extra Help works with a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage. It doesn't replace your plan. It lowers what you pay inside it.
Who qualifies for Extra Help?
You qualify based on income and resources. These are the limits Medicare.gov lists for 2026:
| Household | Income limit | Resource limit |
|---|---|---|
| Individual | $23,940 | $18,090 |
| Married couple living together | $32,460 | $36,100 |
Resources include money in checking and savings accounts, stocks and bonds. Your home, one car and personal belongings don't count. If your income or resources are a little over the limit, apply anyway; Social Security looks at the details, and some income doesn't count the way people expect.
Do I get Extra Help automatically?
Many people do. Medicare.gov says you'll get Extra Help automatically if you get any of these:
- Full-benefit Medicaid.
- Help from your state paying your Part B premium through a Medicare Savings Program.
- Supplemental Security Income (SSI).
If you qualify automatically, Medicare mails you a notice, usually on purple paper, and you don't need to apply. If you don't get one of these, you can apply through Social Security online, by phone or at a local office. Family members and caregivers can help complete the application, answering as if the applicant were filling it out.
What will I pay with Extra Help in 2027?
Medicare.gov lists what people with Extra Help pay in 2027:
- Up to $5.80 for each generic drug.
- Up to $14.40 for each brand-name drug.
- No more than $4.90 for each covered drug if you have full Medicaid and are a Qualified Medicare Beneficiary.
Medicare.gov also lists $0 premiums and deductibles under Extra Help. In practice, if you choose a drug plan whose premium is higher than the amount Extra Help covers, you may pay the difference, so plan choice still matters. Compare that with the standard Part D benefit, where the maximum deductible in 2027 is $700 and the yearly out-of-pocket cap is $2,400.
How do I apply for Extra Help?
If you don't qualify automatically, the application is free and takes most people less than an hour. Here is the order that works best:
- Gather recent bank and investment statements, and any Life Insurance policy cash values, so you can report resources accurately.
- Gather proof of income: Social Security, pensions, wages and any other regular income for you and a spouse living with you.
- Apply online through Social Security, by phone or at a local Social Security office. A family member can help fill it out.
- Watch the mail for a decision letter, and keep it with your Medicare records.
- Once approved, compare drug plans against your prescriptions. Approval lowers your costs, but the plan you are in still decides which drugs are covered and at which pharmacies.
- Check each year whether you still qualify. Social Security may review your situation, and Medicare mails notices if your status changes.
You can also apply for a Medicare Savings Program through your state Medicaid office. Being approved for one of those programs brings Extra Help with it, and the state program may also pay your Part B premium.
Can I change plans more often with Extra Help?
Yes. Medicare.gov says that if you have Medicaid or get Extra Help, you can make changes to your coverage once a calendar month, and the change takes effect the first day of the next month. Most people with Medicare can only switch during set times of the year.
Be precise about what this monthly window allows. It lets you switch drug plans, move to Original Medicare with a stand-alone drug plan, or join an integrated Dual Eligible Special Needs Plan if you also have Medicaid. It does not open every Medicare Advantage plan to you each month. Our page comparing Original Medicare and Medicare Advantage with Extra Help walks through which path tends to fit.
How does Extra Help work in North Carolina, South Carolina and Tennessee?
Extra Help itself is federal, so the income limits and copays are the same in all three states. The state connection is through Medicaid and Medicare Savings Programs, because qualifying for either one gives you Extra Help automatically. In North Carolina, Medicare Savings Programs run through NC Medicaid. In South Carolina they run through Healthy Connections Medicaid. In Tennessee they run through TennCare. Each state has its own application and income rules for those programs, which our state pages on help paying for Medicare in North Carolina, South Carolina and Tennessee explain.
A practical tip for families in the Charlotte area: if a parent lives in Fort Mill, Rock Hill or Indian Land, their Medicaid and Medicare Savings Program applications go through South Carolina, even if their doctors are in Charlotte.
How The Jordan Insurance Agency can help
People who qualify for Extra Help often don't know it, and people who have it often stay in a plan that no longer fits their drugs. We'll check whether you or your parent likely qualify, help you understand the application, and compare drug plans so the plan you choose works well with Extra Help and covers every prescription. Schedule Your Consultation to review your options.
Reviewed by Billy Jordan Jr., licensed insurance agent · Licensing & Credentials · Last reviewed November 12, 2026 · Sources are linked in the answer above.
Licensing: Billy Jordan Jr. is licensed in 23 states, including North Carolina, South Carolina and Tennessee. See Licensing & Credentials.
Office: North Carolina and South Carolina clients are served by the Charlotte office, 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, (704) 926-7565. Tennessee clients are served by the Nashville office, 159 4th Ave N, Suite 100, Nashville, TN 37219, (615) 558-6082.
Medicare disclaimer: We do not offer every plan available in your area. Currently we represent 8 organizations which offer 91 products in North Carolina, 7 organizations which offer 70 products in South Carolina, and 7 organizations which offer 65 products in Tennessee. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Read the full Medicare disclaimer.
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