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Medicare Extra Help Program Income Limits

Summary: Medicare Extra Help is a low-income subsidy for individuals enrolled in Medicare Part D. This federal program helps reduce the out-of-pocket costs for prescription drugs. There are income and resource limits in order to qualify for Extra Help. Learn more about these limitations below. Estimated Read Time: 7 min

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Table of Contents:

  1. Medicare Extra Help Benefits
  2. How to Qualify for Medicare Extra Help
  3. Medicare Extra Help Drug Costs
  4. What are the Medicare Extra Help Income and Resource Limits for 2023?
  5. What are the Medicare Extra Help Income and Resource Limits for 2022?
  6. Levels of Extra Help
  7. Applying for Extra Help with Medicare
  8. How to Find a Medicare Part D Prescription Drug Plan

If you are a Medicare Part D beneficiary struggling with the cost of prescription drugs, Extra Help may be the assistance you need. Extra Help is a low-income subsidy that offsets the cost of prescription drugs on your Medicare Part D plan. You may qualify for assistance if your resources are below a certain threshold. Below, we help you understand how this program works with Medicare Part D, who is eligible, and how to apply.

Medicare Extra Help Benefits

The Extra Help program assists people with limited income and resources with paying for Medicare Part D prescription drug coverage. This low-income subsidy helps with monthly premiums, annual deductibles, and co-payments.

When you qualify for Extra Help, you will receive a letter detailing the level of help you’ll receive.

Medicare Extra Help benefits can eliminate or reduce your Part D costs

Receiving Extra Help with your Medicare Part D can:

  • Eliminate the Medicare Part D late enrollment penalty
  • Reduce your out-of-pocket costs for prescription drugs
  • Reduce or eliminate your monthly Medicare Part D premium
  • Reduce or eliminate your annual Medicare Part D deductible
  • Eliminate the coverage gap, also known as the donut hole

By qualifying for Extra Help, you will not have to pay your plan’s premium or deductible. Extra Help also eliminates the Medicare Part D donut hole coverage phase. Normally, after your total drug costs reach the donut hole threshold, you leave the initial coverage phase and enter the donut hole. When in the donut hole, you are responsible for paying 25% of the cost of your prescription drugs. You stay within this coverage phase until your total costs reach the next drug phase.

As Extra Help removes the donut hole, your prescriptions will not cost more when you exceed the annual spending limit. The program saves beneficiaries nearly $5,000 in annual Medicare Part D costs.

How to Qualify for Medicare Extra Help

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

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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:

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 $4.50 for generic drugs and up to $11.20 for brand-name drugs in 2024. If your total drug costs reach $8,000 (this includes what you pay plus what your plan pays) you will pay $0 for all covered drugs.

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 2024?

An individual’s Medicare Part D Extra Help income limit in 2023 is $22,590. For a married couple, the 2024 income limit is $30,660. Income limits for Extra Help are based on your adjusted gross income as reported on your tax return.

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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 $17,220 as an individual or $34,360 as a married couple living together (with burial expenses).

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 2024 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.

Marital Rights 2024 Extra Help Resource Limit 2024 Extra Help Resource Limit with Burial Expenses 2024 Extra Help Income Limit
Single $17,220 an additional $1,500 $22,590
Married $34,360 an additional $3,000 $34,360

Below, we provide historical Extra Help income and resource data. As you can see, previously, full and partial Extra Help levels were available. However, in 2024, all individuals who qualify for Extra Help will receive the same coverage.

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Medicare Extra Help Limits 2023 Chart

Extra Help Level Marital Rights 2023 Extra Help Resource Limit 2023 Extra Help Resource Limit with Burial Expenses 2023 Extra Help Income Limit
Full Single $9,090 $10,590 $21,870
Full Married $13,630 $16,360 $29,580
Partial Single $15,160 $16,660 $21,870
Partial Married $30,240 $33,240 $29,580

Medicare Extra Help Limits 2022 Chart

Extra Help Level Marital Rights 2022 Extra Help Resource Limit 2022 Extra Help Resource Limit with Burial Expenses 2022 Extra Help Income Limit
Full Single $8,400 $9,900 $20,625
Full Married $12,600 $15,600 $27,705
Partial Single $14,010 $15,510 $20,625
Partial Married $27,950 $30,950 $27,705

Levels of Extra Help

In the past, if your income and resources were more significant than the limits outlined above, you could still apply and potentially qualify for partial Extra Help. However, as Medicare Part D has been rapidly changing, starting in 2024, all individuals who qualify will receive the same level of Extra Help, based on the same income and resource limits.

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.

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 will automatically qualify Extra Help.

How to Find a Medicare Part D Prescription Drug Plan

Finding the right Medicare Part D plan can be confusing. Our licensed agents are Medicare experts dedicated to putting your needs first. We specialize in finding the best Medicare Part D plans for our clients. Our agents compare how each Medicare Part D plan covers prescriptions and dosages.

We work with beneficiaries nationwide to find the best plan for their needs and budget. Call us today at the number above to compare plans from top-rated carriers. Or, complete our online rate form to compare policies today.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Extra Help, Medicare. Accessed July 2023.
    https://www.medicare.gov/publications/11215-extra-help-not-automatically-qualify.pdf
  2. Find Your Level of Extra Help, Medicare. Accessed July 2023.
    https://www.medicare.gov/media/publication/12200-extra-help-postcard.pdf
  3. Prescription Help, SSA. Accessed July 2023.
    https://www.ssa.gov/benefits/medicare/prescriptionhelp.html
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

16 thoughts on "Medicare Extra Help Program Income Limits"

  1. Due to unfortunate family affairs,I didn’t fill out and return my application for SLMB.Ive filled the application out.Do I take it to SS office or Tncare office.Or mail it to Nashville?

    1. Hello Gina,

      You’ll want to speak with Social Security either by calling the toll-free number at 1 (800) 772-1213 or visiting your local office. You may also find assistance at your local Medicaid office as well. Best of luck.

  2. I can not afford Medicare part B as my income is below poverty level. I’m 66 with Medicare part A only which is useless alone. Is there financial aid to pay the $170/month premium that is Not for Medicare Advantage, I do not want that!?

  3. I’m 73 and currently receiving “Extra Help”. I receive $1323 in Social Security every month. My question is how much money can I earn working (if I get a part time job) and still be able to qualify for “Extra Help”

    1. Philip, the annual income limit for full Extra Help benefits is $20,385 or $27,465 for a married couple. If you excees this income limit, you will not receive full Extra Help benefits.

    1. Scott, Extra Help can end at any time. If you exceed the asset limit, once Social Security receives that information, your Extra Help benefits will end.

    1. Jane, a Roth IRA does count as a resource. If your IRA amount exceeds the limits, you would be ineligible for Extra Help.

  4. Good afternoon,
    I turned 64 years on 27 September 1957. I am a retired Veteran with a 70 % disability awarded in 2020. I use Tricare Prime and reside in Corpus Christi, Tx.
    1. When should I enroll in Medicare?
    2. What plans would I need to have? A or B, D?
    Please advise

    1. Hi Kay – firstly, thank you for your service.

      1) We recommend you enroll in Medicare Parts A and B during your Initial Enrollment Period, around your 65th birthday. Medicare does not consider TRICARE to be creditable coverage for Parts A and B, so you would face late penalties when you eventually enroll in Medicare. When you enroll in Medicare Parts A and B, you’ll automatically enroll in TRICARE For Life (TFL). TFL acts as a wraparound for Medicare and covers certain costs.

      2) Per the above, we recommend you enroll in Parts A and B. If you’ve paid Medicare taxes for at least 40 quarters (10 years), you’ll get Part A premium-free. With TFL, you won’t need to buy extra prescription drug coverage for as long as you have TFL, as it is creditable for Part D.

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