How to Apply for Extra Help With Prescription Costs

What Extra Help Is and Who Can Get It

Extra Help is a federal program that pays part or all of your prescription drug costs if your income and savings are below certain limits. It works alongside Medicare Part D (the prescription drug coverage you choose through Medicare). The program covers both the monthly premium you pay for Part D and the costs when you pick up medications at the pharmacy.

You do not have to be retired or a certain age to may have access to — you only need to be enrolled in Medicare Part A or Part B. The income and savings limits change each year. For 2024, you can have a monthly income up to about $1,550 as an individual or $2,100 for a married couple, though these figures vary slightly by state. Your savings (including bank accounts, stocks, and bonds, but not your home or car) must be under $8,100 for an individual or $12,150 for a married couple.

Key Takeaways

• Extra Help pays your Part D premium and reduces what you pay at the pharmacy, and you can start receiving it within weeks of applying.
• You can apply through Social Security, Medicare, or your state Medicaid office — all three routes lead to the same program, and Social Security is usually fastest.
• You will need proof of income (recent pay stubs, tax return, or Social Security statement) and a list of your current medications to complete your application.
• If you are already on Medicaid, your state may automatically enroll you in Extra Help without requiring a separate application.
• You can reapply any time your income or savings change, and the program runs on a calendar year — coverage ends December 31 and restarts January 1.

Applying Through Social Security (Usually the Fastest Route)

The Social Security Administration handles most Extra Help applications and typically processes them within two to three weeks. You can apply online, by phone, or in person at your local Social Security office.

To apply online: Go to ssa.gov/benefits/medicare/forms.html and look for the form titled "Application for Extra Help With Medicare Prescription Drug Plan Costs" (Form SSA-1020). You will fill it out on the Social Security website and submit it electronically. This route is usually fastest because you get a confirmation number immediately and can track your application status online.

To apply by phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). A representative will ask you questions about your income, savings, and household size and will file the application for you. Have your Social Security number, Medicare number, and recent income information ready before you call.

To apply in person: Visit your local Social Security office with proof of income and savings. You can find the nearest office at ssa.gov/locator. Bring your Medicare card and a photo ID.

What Documents You Need Before You Start

Gather these items before you apply, whether online, by phone, or in person. Having them ready means your application will not be delayed while Social Security waits for you to send something in later.

Proof of income: Social Security will ask about your household's total monthly income. Bring recent pay stubs (last two months), your most recent tax return, a Social Security statement, or a letter from your employer showing your salary. If you receive benefits (Social Security, pension, unemployment), bring a recent statement from that source. If your income varies month to month, bring three months of statements so Social Security can average it.

Proof of savings: You will need to report the total value of bank accounts, savings accounts, money market accounts, stocks, and bonds. Bring recent bank statements (within the last two months) showing the account balance. You do not need to report the value of your home, car, or personal belongings.

List of current medications: Write down every prescription drug you take, including the name of the drug, the dose (for example, 10 mg), and how often you take it. You do not need to bring bottles or receipts — just the list. Social Security uses this to estimate your drug costs and show you how much Extra Help will save you.

Your Medicare number: This is on your Medicare card. Have it ready whether you apply online, by phone, or in person.

Applying Through Medicare or Your State Medicaid Office

If you prefer not to use Social Security, you can apply directly through Medicare or through your state's Medicaid program. Both routes work, but they are usually slower than Social Security.

Through Medicare: Call 1-800-MEDICARE (1-800-633-4227) and ask to apply for Extra Help. A representative will take your information over the phone. Processing typically takes three to four weeks.

Through your state Medicaid office: If you are already receiving Medicaid, your state may automatically enroll you in Extra Help. If not, you can contact your state Medicaid office directly to apply. Find your state office at medicaid.gov/about-us/contact-us/state-contacts.html. Some states process applications faster than others — call ahead to ask about their timeline.

What Happens After You Apply

Social Security will send you a notice in the mail within two to three weeks telling you whether you were approved, denied, or need to send in more information. If you applied by phone or in person, ask the representative when you should expect to hear back.

If you are approved, you will receive a letter with your Extra Help status and a list of Part D plans you can choose from. You do not automatically get Extra Help — you still have to pick a Part D plan. Once you enroll in a plan, Extra Help will start paying your premium and reducing your pharmacy costs right away. If you already have a Part D plan, Extra Help will start working with that plan immediately.

If Social Security asks for more information, they will tell you exactly what they need and give you a deadline (usually 30 days) to send it in. Send documents by mail or upload them through your Social Security account online. Do not ignore the request — if you miss the deadline, your application may be denied.

If you are denied, the letter will explain why. Common reasons include income or savings above the limit, or not being enrolled in Medicare Part A or Part B. You can appeal the decision or reapply if your circumstances change.

If You Are Already on Medicaid

Many states automatically enroll people who are on both Medicare and Medicaid into Extra Help without requiring a separate application. This is called deemed may be able to access. If your state does this, you will receive a notice in the mail confirming your Extra Help status — you do not have to do anything.

If your state does not automatically enroll you, you can still apply using any of the methods above. Call your state Medicaid office to ask whether your state does automatic enrollment, or simply apply through Social Security and they will check your Medicaid status for you.

What Extra Help Pays For

Extra Help covers your Part D premium (the monthly cost of your prescription drug plan) and reduces what you pay when you pick up medications. How much you pay depends on your income level — the lower your income, the more Extra Help covers.

If your income is very low, Extra Help may cover your entire premium and reduce your pharmacy costs to just a few dollars per prescription. If your income is higher (but still below the limit), you might pay a small premium and a small copay at the pharmacy. The program also covers the costs during the coverage gap (the "donut hole"), which is when you normally would pay more out of pocket.

Extra Help does not cover over-the-counter medications, vitamins, or supplies like syringes or test strips — only prescription drugs covered by Medicare Part D.

Frequently Asked Questions

Can I apply if my income is slightly above the limit?

The income limits are firm, but they vary by state and change each year. If you are close to the limit, call Social Security at 1-800-772-1213 and ask them to check your specific state's current limit. Some states have slightly higher limits than others, and your household size affects the calculation.

What if my income or savings change after I am approved?

You can reapply any time your circumstances change. If your income goes down, reapply to potentially pay less out of pocket. If your income goes up above the limit, you will lose Extra Help, but you can reapply the following year if it drops back down. Extra Help coverage runs January 1 through December 31 each year.

Do I have to switch Part D plans to get Extra Help?

No. If you already have a Part D plan, Extra Help will work with that plan. You only need to choose a plan if you do not have one yet. When you do choose a plan, pick one that covers your medications — Extra Help works with any plan you select.

How long does it take to start receiving Extra Help?

If you apply through Social Security, you usually hear back within two to three weeks. Once you are approved and enrolled in a Part D plan, Extra Help starts immediately. If you applied through Medicare or Medicaid, allow three to four weeks.

What if I was denied but think there was a mistake?

You have the right to appeal. The denial letter will explain how to request an appeal and the deadline for doing so (usually 60 days). You can appeal by mail or by calling Social Security. If you appeal, send any new information that supports your case — for example, updated income documents if your situation has changed.