Medicare Extra Help (LIS) in 2026: The $23,475 Income Limit, $18,090 Resource Cap, and What It Saves SSDI Beneficiaries on Part D Drugs

By Anthony Albert, Benefits Research Director - Updated May 16, 2026

If you're on Medicare and your prescription drug costs are eating your budget, there's a federal program that can wipe most of that bill off the books. It's called Extra Help, also known as the Low Income Subsidy or LIS, and SSA estimates it's worth about $5,700 a year per person who qualifies. For 2026, single filers with annual income up to $23,475 and resources up to $18,090 qualify. Married couples get up to $31,725 in income and $36,100 in resources. The benefit pays your Part D premium, drops the deductible to zero, and caps each prescription co-pay at $5.10 generic or $12.65 brand. Once you spend $2,100 out of pocket in a year, every covered drug is free for the rest of the year.

The catch isn't the rules. The catch is that millions of people who qualify never apply. CMS data shows about 12.5 million Part D enrollees in Extra Help, but the agency estimates another 2 to 3 million people qualify and either don't know it or never filed. That gap matters because Extra Help isn't retroactive. If you should have been enrolled in 2024 and didn't apply until 2026, you don't get reimbursed for the two years of overpayments. The drug costs you paid are gone.

Here's the full picture for 2026, what changed under the Inflation Reduction Act, how to know if you auto-qualify, and the application path if you don't.

What Extra Help Pays For in 2026

Extra Help covers four parts of Medicare Part D prescription drug coverage:

• Part D premium. Subsidy pays the monthly premium up to the regional benchmark amount. Most plans listed in a state's "benchmark" tier have $0 premium with Extra Help.
• Part D deductible. Zero. You pay nothing toward the deductible before drug coverage starts.
• Copays per prescription. Capped at $5.10 for each generic drug and $12.65 for each brand-name drug covered by your plan in 2026.
• Catastrophic coverage threshold. Once your annual out-of-pocket spending hits $2,100, you pay nothing for the rest of the year on covered drugs. This $2,100 cap came from the Inflation Reduction Act and went into effect in 2025 at $2,000, rising to $2,100 for 2026.

Full LIS beneficiaries living in institutional settings or receiving home and community-based services have $0 copays for every covered drug.

The 2026 Income and Resource Limits

Eligibility runs on two tests: income and resources. Both have to be under the limit. Here are the 2026 numbers from the SSA Extra Help publication and the CMS October 2025 LIS memo.

Alaska and Hawaii residents get slightly higher income limits because federal poverty levels are higher in those states. Check with SSA for the exact figures if you live there.

The 2026 income limit sits at 150 percent of the federal poverty level. That ceiling came from the Inflation Reduction Act. Before 2024, people between 135 percent and 150 percent of FPL got a partial subsidy with higher copays. The IRA wiped out the partial tier and bumped everyone up to the full benefit. About 300,000 additional people moved into the full Extra Help bucket as a result.

What counts as income

• SSDI monthly benefit
• SSI payments
• Wages from a job
• Self-employment net earnings
• Pensions and annuities
• Railroad Retirement
• Veterans benefits (non-disability portion)
• Interest and dividends
• Rental income
• Alimony

What doesn't count as income

• SNAP (food stamps)
• Housing assistance benefits like Section 8
• Home energy assistance (LIHEAP)
• Medical treatment and prescription drug assistance
• Disaster relief payments
• Earned Income Tax Credit refunds
• Victim compensation
• Scholarships and education grants
• VA service-connected disability compensation in some cases
• Help from family members to pay specific household bills

What counts as a resource

• Checking accounts
• Savings accounts
• Certificates of deposit
• Stocks, bonds, mutual funds
• Individual Retirement Accounts (IRAs)
• Other retirement accounts
• Cash on hand
• Real estate other than your primary home

What doesn't count as a resource

• Your home, regardless of value
• One vehicle (one car, truck, or van)
• Personal property and household goods
• Burial plot
• Up to $1,500 per person designated for burial expenses
• Life insurance policies with face value at or below $1,500
• Retroactive SSDI or SSI back payments (excluded for 9 months from receipt)
• Housing assistance payments
• Tax refunds and advances tied to EITC or child tax credit

Who Auto-Qualifies in 2026

You don't have to apply for Extra Help if you fall into any of these categories. CMS auto-enrolls you based on data sharing with SSA and state Medicaid agencies.

• You have full Medicaid coverage. Includes Medicaid-only beneficiaries and full duals (Medicare and Medicaid both).
• You're enrolled in a Medicare Savings Program. Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI) all trigger auto-enrollment.
• You receive SSI. All SSI recipients with Medicare are auto-enrolled in Extra Help, regardless of state.

If you fall in any of these buckets, you'll get a notice from CMS or SSA confirming Extra Help. The notice says which Part D plan you've been auto-assigned to (CMS picks one at random from the benchmark plans in your state). You can change plans without penalty during the first three quarters of the year.

How Extra Help Stacks with Medicare Savings Programs

Medicare Savings Programs (MSPs) help with Part A and Part B costs. Extra Help helps with Part D. Each program has its own income and resource limits, but they overlap heavily, so most people who qualify for one qualify for all.

The smart move is to apply for QMB, SLMB, or QI first through your state Medicaid agency. Approval triggers auto-enrollment in Extra Help and you skip the separate Extra Help application. The MSP application is shorter and most states process it within 45 days.

QMB is the most generous MSP. It pays Part A and Part B premiums plus all the cost-sharing. Combined with full Extra Help, a QMB enrollee pays nothing for Medicare hospital coverage, doctor visits, or most prescriptions.

The 2026 Part D Cost-Sharing Table

Here's what you actually pay at the pharmacy with Extra Help in 2026, based on the CMS October 2025 LIS memo:

Once any LIS-eligible person hits $2,100 in annual out-of-pocket spending, every covered drug is free for the rest of the year. That cap is the same for all LIS categories.

What Changed Under the Inflation Reduction Act

Three big shifts hit the Extra Help program because of the IRA.

Partial subsidy eliminated. Before 2024, people between 135 and 150 percent of FPL got a smaller subsidy with higher copays (around $4.50 generic, $11.20 brand) and a small deductible. Section 11404 of the IRA wiped that tier out. Everyone who qualifies now gets the full benefit. Roughly 300,000 partial LIS enrollees rolled into full LIS in 2024.

Annual out-of-pocket cap. Section 11201 of the IRA added a hard ceiling on Part D out-of-pocket drug spending. The cap was $2,000 in 2025 and rises to $2,100 in 2026. The cap applies to all Part D beneficiaries, not just LIS. So even people slightly above the Extra Help income line benefit from the $2,100 ceiling.

Resource limits indexed. The 2026 LIS resource limits include a 3.01 percent statutory adjustment. The limit went from $16,100 single in 2025 to $16,590 in 2026 (without burial set-aside), and from $32,130 to $33,100 for couples. The annual update keeps the resource test from getting tighter in real terms.

How to Apply for Extra Help

If you don't auto-qualify, you file an application with SSA. Three ways:

1. Online. Use the SSA Extra Help application at ssa.gov/medicare/part-d-extra-help. Takes about 10 minutes.
2. By phone. Call SSA at 1-800-772-1213. They can mail the application or take it over the phone.
3. In person. Visit your local SSA office. Appointments are recommended.

The form is the SSA-1020. It asks for:

• Social Security number and name
• Date of birth
• Marital status and spouse's Social Security number if married
• Income from all sources for you and your spouse
• Resources for you and your spouse
• Information about any expected changes (retirement, sale of property, etc.)

You don't need to submit bank statements with the initial application, but SSA often follows up to verify. Keep the most recent statements from each account ready.

SSA usually issues a decision within 2 to 4 weeks. The decision letter includes the start date for Extra Help. Coverage begins the first day of the month after approval, with limited retroactive coverage in some cases.

The Medicare Connection for SSDI Beneficiaries

If you're on SSDI, you become eligible for Medicare 24 months after the SSDI entitlement date. The 24-month clock starts from the date your benefits actually began, not from when you applied. That means most SSDI beneficiaries hit Medicare eligibility roughly 24 months plus the application processing time after the original disability onset.

Two exceptions:

• ALS (Lou Gehrig's disease). Immediate Medicare eligibility from the first month of SSDI entitlement. No 24-month wait.
• End-stage renal disease (ESRD). Medicare starts the third month of regular dialysis or after a kidney transplant.

If you're new to Medicare through SSDI, your Initial Enrollment Period for Part D is the 7-month window around your Medicare start date. Missing IEP means waiting until annual open enrollment (October 15 to December 7) and a late enrollment penalty unless you had creditable drug coverage in the gap.

Extra Help eliminates the Part D late enrollment penalty once you qualify. So if you missed IEP but later qualify for LIS, the penalty disappears when LIS starts. This is one of the cleanest benefits of the program for people with messy Medicare timelines.

For the full Medicare timeline and how SSDI feeds into it, see SSDI and Medicare 2026.

State-Level Patterns

Extra Help is a federal program, so the income, resource, and benefit numbers are the same in every state except Alaska and Hawaii. What varies by state is enrollment density and which Part D plans hit the benchmark.

States with the highest dual-eligible populations (where Medicaid and Medicare overlap heavily) have the strongest auto-enrollment pipelines. Big examples are California, New York, Texas, Florida, and Pennsylvania. These states have over a million LIS enrollees each.

Each state has a different roster of benchmark Part D plans. CMS publishes the regional benchmark rate each year. Plans that bid below the benchmark are tagged as $0 premium for LIS enrollees. In states like Florida and Arizona, 8 to 12 plans usually qualify. In smaller market states like Wyoming or North Dakota, the list is shorter, sometimes only 3 to 5 plans.

Some states run State Pharmaceutical Assistance Programs (SPAPs) that pay residual drug costs on top of Extra Help. New York's EPIC program and Pennsylvania's PACE and PACENET are the largest. Check with your State Health Insurance Assistance Program (SHIP) for what's available locally.

Common Mistakes That Block Extra Help

Overstating resources. The most common reason applications get denied. Applicants count their primary home, their car, or burial expenses against the limit when those items are excluded. Read the resource list carefully before reporting.

Not reporting income exclusions. SNAP, housing assistance, energy assistance, and others are excluded from income. Some applicants include them by mistake and get denied for being over the income limit.

Skipping the spouse's information. If you're married and living with your spouse, you have to report both. Skipping the spouse's income on the assumption it's a household calculation usually gets the application kicked back.

Confusing Extra Help with Medicare Savings Programs. They're different programs with different applications. Some applicants file Extra Help and then are surprised they still owe Part B premiums. The fix is to also apply for QMB or SLMB through your state Medicaid agency.

Missing the annual redetermination. SSA pulls IRS and bank data each year to recertify Extra Help. If your income jumped (back to work, inheritance, retirement account distribution), you might lose eligibility. Report changes promptly so the recertification doesn't surprise you.

Steps to Take Now

1. Check whether you auto-qualify. Are you on full Medicaid, in a Medicare Savings Program, or getting SSI? If yes, you should already be in Extra Help. Look for a CMS letter or call 1-800-MEDICARE to confirm.
2. Pull your tax records and bank statements. Compare your annual income against $23,475 single or $31,725 married. Compare countable resources against $18,090 single or $36,100 married.
3. If you might qualify but aren't enrolled, apply this week. The 10-minute online SSA-1020 is the fastest path. Coverage starts the first day of the month after approval.
4. Apply for a Medicare Savings Program at the same time. QMB or SLMB through your state Medicaid agency auto-enrolls you in Extra Help and also pays Part B premiums. Better total benefit.
5. Review your Part D plan during open enrollment (October 15 to December 7). If you're auto-enrolled, the plan CMS picked may not cover your specific medications well. Switch to a plan that covers the drugs you actually take.
6. Use the $2,100 catastrophic cap. Once you hit $2,100 in out-of-pocket spending in a calendar year, every covered drug is free for the rest of the year. Front-load expensive medications early in the year if cash flow allows.

Frequently Asked Questions

What is Medicare Extra Help and who runs it?

Extra Help is the federal Low Income Subsidy that pays Medicare Part D premiums, deductibles, and most of the prescription drug copays for people with limited income and resources. It's administered jointly by the Social Security Administration and the Centers for Medicare and Medicaid Services. SSA handles applications and eligibility. CMS sets the benefit levels and runs the Part D framework Extra Help plugs into. SSA estimates the average annual value at $5,700 per person.

What are the 2026 income and resource limits for Extra Help?

Annual income must be at or below $23,475 for an individual and $31,725 for a married couple living together. Resources must be at or below $18,090 single and $36,100 married, with $1,500 per person set aside for burial expenses. Without the burial set-aside, the limits are $16,590 single and $33,100 married. Alaska and Hawaii have slightly higher income figures. The 2026 numbers reflect the 3.01 percent resource adjustment factor and the Inflation Reduction Act's expansion to 150 percent of the federal poverty level.

What did the Inflation Reduction Act change?

Effective January 1, 2024, the IRA eliminated the partial LIS category. Everyone who qualifies now gets the full benefit: zero premium, zero deductible, capped copays. Before 2024, people just above the strict income cut-off got a partial subsidy with higher copays. The IRA expansion brought roughly 300,000 additional Part D enrollees into the full benefit. The Act also capped annual out-of-pocket drug spending at $2,000 for all Medicare beneficiaries in 2025, rising to $2,100 in 2026.

Do I have to apply if I'm already on SSI or Medicaid?

No. SSA and your state Medicaid agency share data with CMS each month. If you have full Medicaid, a Medicare Savings Program, or SSI, you're auto-enrolled in Extra Help. CMS sends a confirmation letter. You should still review your Part D plan during open enrollment because auto-enrolled people get assigned a plan at random by CMS and the assigned plan may not be the best fit for the specific drugs you take.

How does Extra Help interact with Medicare Savings Programs?

Medicare Savings Programs (QMB, SLMB, QI, QDWI) help with Part A and Part B premiums and cost sharing. Extra Help helps with Part D. Enrollment in any MSP automatically triggers Extra Help enrollment because the resource and income tests for MSPs are similar or stricter than for Extra Help. So an applicant should usually file for MSP first, get auto-enrolled in Extra Help as a result, and avoid the separate Extra Help application.

What if my income or resources change after I'm enrolled?

Report changes to SSA. Extra Help eligibility is reviewed annually based on data SSA pulls from IRS and state databases. If your income drops, you may stay eligible even if it rose temporarily. If you cross the resource limit, you'll lose Extra Help going forward but won't owe back any of the subsidies already paid as long as the change was reported honestly. There's a one-time grace year after some changes.

Can I get Extra Help if I'm under 65 and on SSDI?

Yes, as long as you're enrolled in Medicare. SSDI beneficiaries become eligible for Medicare after the 24-month waiting period from the SSDI entitlement date, with an exception for ALS (immediate eligibility) and end-stage renal disease (third month of dialysis or after transplant). Once Medicare starts, you can apply for Extra Help based on the same income and resource limits as any other Medicare beneficiary.