If you receive SSDI and are enrolled in Medicare, you know that Medicare isn't free. Between premiums, deductibles, and copays for prescription drugs, healthcare costs can take a big bite out of your disability benefits. The good news is that a program called Extra Help (also known as the Low-Income Subsidy) can dramatically reduce your Medicare Part D prescription drug costs—and many people who qualify don't even know it exists.
In this article, we'll cover:
- What Extra Help is and how much it can save you
- Who qualifies for Extra Help
- The difference between full and partial Extra Help
- How to apply for Extra Help benefits
- Special rules for SSI recipients
- Other programs that can help with Medicare costs
What Is Extra Help?
Extra Help is a federal program that helps people with limited income and resources pay for Medicare Part D prescription drug coverage. Part D is the portion of Medicare that covers medications, and without help, the costs can be significant.
With Extra Help, you can receive assistance paying your monthly Part D premium (often reduced to zero), your annual deductible (eliminated or reduced), and your copays for each prescription (reduced to a few dollars per medication). The program can save qualifying individuals an average of $5,300 or more per year in prescription drug costs.
Extra Help is administered by Social Security, but it specifically assists with Medicare Part D costs. If you have Medicare and take regular medications, this program could make a meaningful difference in your monthly budget.
Who Qualifies for Extra Help?
To qualify for Extra Help in 2025, you generally must meet these requirements:
Income limits: Your annual income must be below $22,590 for an individual or $30,660 for a married couple living together. These limits are adjusted each year.
Resource limits: Your resources must be below $17,220 for an individual or $34,360 for a married couple. Resources include savings accounts, stocks, and bonds, but do not include your home, one car, personal belongings, burial plots, up to $1,500 set aside for burial expenses, or funds in most retirement accounts.
Medicare enrollment: You must be enrolled in Medicare Part A or Part B (or both).
These limits are higher than SSI's resource limits, so even if you don't qualify for SSI, you might still qualify for Extra Help.
Full vs. Partial Extra Help
The program has two levels of assistance depending on your income and resources.
Full Extra Help is available if your income is at or below 135% of the federal poverty level and your resources are below the limits mentioned above. With full Extra Help, you pay no premium for a basic Part D plan, no annual deductible, and only $4.50 for generic drugs and $11.20 for brand-name drugs in 2025 (or even less if you live in a nursing home).
Partial Extra Help is available if your income is between 135% and 150% of the federal poverty level. You'll still receive significant assistance, but you'll pay a sliding-scale premium, a reduced deductible of about $119 in 2025, and 15% coinsurance for your medications.
Even partial Extra Help can save you thousands of dollars a year compared to paying full price for Part D coverage.
How to Apply for Extra Help
You can apply for Extra Help in several ways. The easiest option for many people is to apply online at SSA.gov. The application takes about 10-15 minutes to complete, and you'll get a decision relatively quickly.
You can also call Social Security at 1-800-772-1213 to apply over the phone, visit your local Social Security office to apply in person, or mail in form SSA-1020, which you can download from Social Security's website.
When you apply, you'll need information about your income (Social Security benefits, pensions, wages, etc.), your resources (bank accounts, investments, cash on hand), your Medicare information, and your monthly expenses for things like food, utilities, and medical costs.
Social Security will review your application and send you a letter explaining whether you qualify and at what level.
Special Rules for SSI Recipients
If you receive SSI, you're in luck—you automatically qualify for full Extra Help. You don't need to apply separately. When you become eligible for Medicare (either through age or after 24 months on SSDI), Social Security will automatically enroll you in Extra Help.
This automatic enrollment applies even if your state pays your Medicare premiums through a Medicare Savings Program. You'll receive the full level of Extra Help benefits without any additional paperwork.
One thing to note: if you receive both SSI and SSDI, you'll get Medicare through your SSDI eligibility after the 24-month waiting period. Your SSI status ensures you automatically get Extra Help when that Medicare coverage begins.
Other Programs That Help with Medicare Costs
Extra Help specifically assists with Part D drug costs, but other programs can help with additional Medicare expenses.
Medicare Savings Programs (MSPs) are state-run programs that can pay your Medicare Part B premium (which is over $185 per month in 2025), and some MSPs also cover deductibles and coinsurance. There are four levels of MSPs with different income limits. Your state Medicaid office handles these programs.
Medicaid provides comprehensive health coverage for people with low incomes. If you're on SSI, you likely already have Medicaid. For people with slightly higher incomes, Medicaid can work alongside Medicare to cover costs Medicare doesn't pay.
State Pharmaceutical Assistance Programs (SPAPs) exist in many states and provide additional help with drug costs beyond what Extra Help covers.
Pharmaceutical company patient assistance programs may provide free or discounted medications if you can't afford them even with Extra Help. Many drug manufacturers offer these programs for their specific medications.
Don't Leave Money on the Table
Many people who qualify for Extra Help don't apply because they don't know about it or assume they won't qualify. Given that the program can save you over $5,000 a year, it's worth taking the 15 minutes to apply—even if you're not sure you'll qualify.
If your income or resources are close to the limits, apply anyway. Social Security will make the final determination, and you might be pleasantly surprised.
Managing your benefits and healthcare costs on disability income takes careful planning. Purple offers a checking account designed for people on SSI and SSDI, helping you track your finances and stay on top of your benefit requirements.