What Extra Help does
Part D has four cost layers: a monthly premium, an annual deductible, copays or coinsurance on each fill, and, historically, a coverage gap. Extra Help flattens most of that.
Someone with the full subsidy pays no Part D premium for a plan at or under the regional benchmark, and pays small fixed copay amounts per prescription instead of a percentage. For a household filling several prescriptions a month, that is the difference between a manageable line in the budget and a decision about which drug to skip.
The change most people missed
Section 11404 of the Inflation Reduction Act took effect on January 1, 2024. It extended the full subsidy to everyone up to 150% of the federal poverty level who meets the resource requirements.
Before that date there were two tiers. Under 135% of the poverty level you got the full subsidy. Between 135% and 150% you got a partial one, with a sliding premium and a deductible.
The partial tier is gone. Everyone under 150% who meets the asset test now gets the full benefit.
Who qualifies
Income at or below 150% of the federal poverty level, counted for your household.
Resources at or below the annual limits. For 2026 the full-subsidy figures are $16,590 for an individual and $33,100 if married. Resources means countable savings and investments. Your home and your car are not counted.
Automatic qualification. People with full Medicaid, people in a Medicare Savings Program, and people receiving SSI get Extra Help automatically without a separate application. If you are in one of those groups and are still paying Part D premiums, something is wrong and it is worth a call.
The 2027 copays
With Extra Help, a covered drug costs no more than a fixed copay. For 2027 the federal maximums are:
| Generic | Other drugs | |
|---|---|---|
| Most people with Extra Help | $5.80 | $14.40 |
| Full Medicaid, income at or below 100% of the poverty level | $1.65 | $5.00 |
Your plan can charge less, never more, for a covered drug.
How to apply
- Apply through Social Security, not through your drug plan. Online, by phone, or at an office.
- Have your resource figures roughly ready: bank accounts, investments, cash value of life insurance. Not your home, not your car.
- Answer the household questions carefully. Whether someone is married and living together changes both the income and the resource limit.
- Ask for a written decision, and keep it. It is what you need if the drug plan does not apply the subsidy at the counter.
- If you are approved, check your next pharmacy visit. Subsidies occasionally do not reach the plan’s system, and the fix is a phone call rather than a re-application.
The other two things to check in the same sitting
A Medicare Savings Program. Pays the Part B premium, no asset test in New York, and gets you Extra Help automatically. Apply at the local district social services office.
EPIC, if you are 65 or older and live in New York. It is a state program whose income limits reach far higher than Extra Help’s, up to $75,000 for a single person, and it caps your copay at $20 per drug. Applications are taken year round with no documents attached. How EPIC works.
These three do not cancel each other. The mistake is treating them as one decision.
The Part D cap, separately from all of this
Since the redesign of Part D, there is an out-of-pocket ceiling for everyone, subsidy or not. In 2026 it is $2,100; in 2027 it rises to $2,400. Payments Extra Help makes on your behalf count toward it. Once your own spending on covered Part D drugs reaches it, you pay nothing for covered drugs for the rest of the calendar year.
The cap resets each January. For anyone taking an expensive medication, that makes the timing of a December fill against a January one a real question worth raising with the prescriber.
Questions people ask
What is Extra Help?
The Medicare Part D low income subsidy. It gives a $0 premium and low fixed copays on drug coverage to people who meet the income and resource tests.
What changed in 2024?
The full subsidy was extended to 150% of the federal poverty level. The partial subsidy tier between 135% and 150% no longer exists.
I was rejected years ago. Should I try again?
Yes, if your income is at or under 150% of the poverty level. The rules changed and the resource limits are adjusted annually.
What are the 2026 resource limits?
$16,590 for an individual and $33,100 for a married couple, for the full subsidy. Your home and car are not counted.
Where do I apply?
Through Social Security, not through your Part D plan.
Do I have to apply if I have Medicaid or an MSP?
No. Full Medicaid, a Medicare Savings Program or SSI qualifies you automatically. If you are in one of those and still paying a premium, call.
Is there a limit on my total drug spending?
Yes. Once you have paid $2,100 out of pocket for covered Part D drugs in 2026, or $2,400 in 2027, covered drugs cost nothing for the rest of that year.
Sources
- CMS — Part D low income subsidy (checked 2026-09-08)
- Medicare.gov — help with drug costs (checked 2026-09-08)
- CMS — 2027 Rate Announcement (Part D cap and Extra Help copays) (checked 2026-09-29)
- Social Security Administration — apply for Extra Help (checked 2026-09-08)
More in Prescription Costs in New York: Who Pays and What Caps Exist
- Insulin Costs Nothing in New York Now. If You Are Being Charged, Here Is Why — Since January 1, 2025 New York bans all cost sharing on prescription insulin: no deductible, no copay, no coinsurance. Which plans it covers, which it does not, and what to say at the counter.
- NYRx: Why Your Medicaid Pharmacy Claim Stopped Going Through Your Plan — Since April 1, 2023 the Medicaid pharmacy benefit in New York runs through NYRx, the state program, instead of through managed care plans. What changed, who is exempt, and what to do at the counter.
- Your Plan Will Not Cover the Drug: The Order of Operations — A formulary denial is a process, not a verdict. Which of the five rejection reasons you actually got, who has to fix each one, and the appeal route for commercial, Medicaid and Medicare.
This page explains how the system works. It is not medical advice. More.