Medicare Extra Help Program Income Limits

How to Qualify for Medicare Extra Help

To qualify for Extra Help, you will need to meet the following requirements:

Enroll in Medicare Part A and/or Part B

To apply for Extra help, you are required to be enrolled in at least one part of Original Medicare. You do not have to be enrolled in a Medicare Part D plan before applying for Extra Help. If you are not already enrolled in a Medicare drug plan, you will be automatically enrolled in one once your Extra Help application is approved.

Be a United States citizen

To be enrolled in Original Medicare, you must be a United States citizen. Thus, to enroll in extra help for Medicare Part D costs, you must also have been a U.S. citizen or legal resident for at least five consecutive years.

Meet the income and resource limits

There are certain income limits you must not exceed in order to enroll in Medicare Extra Help. The chart below helps outline these limits.

In certain cases, there are exceptions to the above requirements. You automatically qualify for Extra Help if you are eligible for full Medicaid coverage or any of the following Medicare Savings Programs:

• Qualified Medicare Beneficiary(QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)

If you automatically qualify for Extra Help, you do not need to apply. You will automatically be enrolled in both the Extra Help program and a Medicare drug plan. You will receive a letter in the mail detailing your coverage.

Medicare Extra Help Drug Costs

With Extra Help, your out-of-pocket costs for prescription drugs will be reduced. If you have full Extra Help, you will only pay up to $4.15 for generic drugs and up to $10.35 for brand-name drugs. If your total drug costs reach $7,400 (this includes what you pay plus what your plan pays) you will pay $0 for all covered drugs.

If you have partial Extra Help, you will pay no more than 15% of the cost for each drug covered under your plan. Once you reach $7,400 in total drug costs, you’ll pay no more than $4.15 for each generic drug and $10.35 for each brand-name drug.

If you did not enroll in Medicare Part D when you first became eligible, you do not have to pay the late enrollment penalty if approved for the program. Approval waives this cost if you would otherwise owe the penalty.

What are the Medicare Extra Help Income and Resource Limits for 2023?

An individual’s Medicare Part D Extra Help income limit in 2023 is $21,780. For a married couple, the 2023 income limit is $29,580. Income limits for Extra Help are based on your adjusted gross income as reported on your tax return.

When calculating your income, governmental assistance such as food stamps, housing, and home energy assistance do not negatively impact you.

You should apply if you think you qualify, but your income exceeds the limits. In some scenarios, you may still be eligible for Extra Help when your income is over the limit. These cases include when you or your spouse:

• Provide financial support for other family members currently living with you
• Earn money by working
• Reside in Alaska or Hawaii

Resource limits also apply when determining your eligibility. To be eligible for partial Extra Help, your resources (assets) must be equal to or below $16,660 as an individual or $33,240 as a married couple living together (with burial expenses). Without burial expenses, the resource limit for an individual is $15,160 and $30,240 for a married couple.

To receive full Extra Help benefits, the resource limit with burial expenses for an individual is $10,590 and $16,630 for a married couple. Without burial expenses, the resource limit for an individual to receive full Extra Help benefits is $9,090, and $13,630 for a couple.

The following examples count as resources:

• Real estate (primary residence excluded)
• Money in bank accounts (checking, saving)
• Stocks
• Bonds
• Mutual funds
• Individual Retirement Accounts (IRAs)
• Any cash

The following do not count as resources:

• Your primary residence
• Vehicle(s)
• Your personal belongings
• Burial expenses
• Interest on money slated for use as burial expenses

Contact Social Security for a comprehensive list of excluded resources.

Medicare Extra Help Limits 2023 Chart

The chart below displays the general limits for Extra Help with Medicare Part D in 2023. Still, individuals with higher incomes and resources may qualify for partial assistance in some circumstances.

What are the Medicare Extra Help Income and Resource Limits for 2022?

In 2022, the annual income limit for Extra Help for an individual is $20,625. For a married couple living together, the limit is $27,705.

The 2022 resource limits for partial Extra Help benefits are $15,510 for an individual with burial expenses or $14,010 for an individual without burial expenses. The asset limits for a married couple are $30,950 with burial expenses or $27,950 without burial expenses.

The 2022 resource limits for full Extra Help benefits are $9,900 for an individual with burial expenses or $8,400 for an individual without burial expenses. For a married couple, 2022 asset limits are $15,600 with burial expenses or $12,600 without burial expenses.

Medicare Extra Help Limits 2022 Chart

Levels of Extra Help

If your income and resources are more significant than the limits above, you can still qualify for partial Extra Help. With Extra Help, there are levels of assistance that depend on your income and resources.

You can mail your Extra Help qualification letter to your Medicare Part D plan to help verify the level of Extra Help for which you qualify. Those dual-eligible to receive Medicare and Medicaid qualify for full Extra Help.

Applying for Extra Help with Medicare

To apply for Extra Help, you can complete Form SSA-1020 on the Social Security website. You can also call Social Security to apply over the phone or visit your local Social Security office to apply in person.

Social Security will mail a letter to you informing you whether you qualify. You can choose a Medicare Part D prescription drug plan after becoming eligible for Extra Help. If you do not yet qualify, you can still look for a Medicare Part D plan that fits your budget and includes your prescriptions on the formulary.