I was on Medicaid but my income increased—do I still get Extra Help?

Not automatically. If your income now exceeds Extra Help limits, you'll need to reapply. However, if you still qualify based on current income and resources, you can apply through Social Security.

I thought Extra Help only covered Part D—does it help with other Medicare costs?

Extra Help specifically covers Part D (prescription drugs). However, if you qualify for Medicare Savings Programs (which often overlap), those programs help pay Part A and Part B costs too, including the $202.90/month Part B premium and $283 annual Part B deductible in 2026.

Will I lose Extra Help if I switch Part D plans?

No. Extra Help follows you regardless of which Part D plan you choose. However, if you switch to a plan with a premium above the benchmark, you'll pay the difference.

I Was on Medicaid, Do I Automatically Get Extra Help?

If you've been receiving Medicaid benefits and are transitioning to Medicare, you'll automatically qualify for Extra Help (the Low-Income Subsidy) in most cases. Extra Help can save you significantly on Part D prescription drug costs — including reduced or $0 premiums, minimal copays, and no coverage gap. The details depend on your specific Medicaid status.

What Is Extra Help?

Extra Help is a federal program that helps pay for Medicare Part D prescription drug costs. For 2026, Extra Help can save you:

Part D premiums: Reduced or eliminated
Deductibles: Reduced or $0
Copayments: $5.10 for generics and $10.65 for brand-name drugs (maximum amounts)
Coverage gap: No "donut hole" if you qualify for full Extra Help
Annual out-of-pocket cap: Part D's $2,100 out-of-pocket maximum in 2026

Who Automatically Qualifies for Extra Help?

You automatically qualify for Extra Help if you:

Have full Medicaid (full-benefit dual eligible): You receive comprehensive Medicaid benefits
Receive Supplemental Security Income (SSI): Even if you don't have Medicaid
Qualify for Medicare Savings Programs (MSP): Including QMB, SLMB, or QI programs
Receive state pharmaceutical assistance: Some state programs trigger automatic enrollment

Full vs. Limited Medicaid Benefits

The type of Medicaid you have affects your Extra Help level:

Medicaid Type	Extra Help Level	What It Means
Full Medicaid	Full Extra Help	$0 premiums, minimal copays
QMB	Full Extra Help	Medicare premiums paid, full drug benefits
SLMB	Full Extra Help	Part B premium assistance + full drug benefits
QI	Full Extra Help	Part B premium help + full drug benefits

How Automatic Enrollment Works

If you're "deemed eligible" (automatically qualify), here's what happens:

CMS identifies you through data matching with Social Security, state Medicaid agencies, and the Railroad Retirement Board
You receive a purple notice (officially called the "LIS Rider") confirming your Extra Help status
You're enrolled automatically into a Part D plan if you don't choose one — typically a benchmark plan with $0 premium

Important: Even if you're auto-enrolled, you can switch to a different Part D plan during Open Enrollment (October 15–December 7) or use your Special Enrollment Period.

2026 Income Limits for Extra Help

If you're not automatically deemed eligible, you can still apply. For 2026:

Household Size	Income Limit
Individual	$24,180/year
Married couple	$32,700/year

Resource limits also apply. For 2026, resources must be below $17,220 (individual) or $34,360 (couple), excluding your home, one car, burial plots, and up to $1,500 in burial funds.

What If I Lose Medicaid?

If your Medicaid ends, you may lose automatic Extra Help eligibility — but you have options:

Apply directly for Extra Help through Social Security (even without Medicaid, you may qualify based on income/resources)
Check for Medicare Savings Programs in your state
Report income changes to Social Security if your situation improves

Special rule: If you lose Medicaid due to a "Medicaid unwinding" or redetermination, you may qualify for a Special Enrollment Period to change your Part D plan.

How to Confirm Your Extra Help Status

Check your Medicare & You handbook (mailed annually)
Log into Medicare.gov and view your coverage
Call 1-800-MEDICARE (1-800-633-4227)
Contact your State Health Insurance Assistance Program (SHIP) for free counseling