How to Use Medicare Extra Help to Pay Less for Generic Prescriptions

If you’re on Medicare and take generic medications every month, you might be paying far more than you need to. For many seniors, the cost of blood pressure pills, diabetes meds, or cholesterol drugs adds up fast-sometimes over $1,000 a year. But there’s a federal program designed specifically to cut those costs to just a few dollars per prescription. It’s called Medicare Extra Help, and if you qualify, you could pay as little as $1.60 for each generic drug you fill.

What Medicare Extra Help Actually Does

Medicare Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a government program that covers nearly all the costs of your Medicare Part D prescription drug plan. It doesn’t just lower your copays-it wipes out your monthly premium and annual deductible entirely. For generic drugs, the most you’ll pay in 2025 is $4.90 per prescription. If your income is below 100% of the Federal Poverty Level and you’re also on Medicaid, you pay only $1.60.

Compare that to standard Part D coverage: without Extra Help, you’d first need to pay a $595 deductible before your plan kicks in. Then you’d pay 25% of the drug’s cost. A $50 generic pill would cost you $12.50 after the deductible. Multiply that by 12 prescriptions a month, and you’re looking at $748.80 just in copays-plus the $595 deductible and up to $400 in premiums. Extra Help cuts that total cost by more than 80%.

Who Qualifies for Extra Help in 2025

To qualify, your income and resources must be below strict federal limits. For 2025, these are:

• Income limit: $23,475 per year for an individual; $31,725 for a married couple living together.
• Resource limit: $17,600 for an individual; $35,130 for a couple.

Income includes Social Security, pensions, wages, and veterans benefits. It does not include housing assistance, food stamps, or medical care payments. Resources include bank accounts, stocks, bonds, mutual funds, and IRAs-but not your primary home, one car, or personal belongings. You’re also allowed a $1,500 burial expense allowance that doesn’t count against your resource limit.

Many people think they don’t qualify because they’re “just above the limit.” But that’s a myth. Even if your income is $500 over, you should still apply. There are exceptions, and some states offer additional help that can bridge the gap.

How Much You Save on Generic Drugs

Here’s a real-world example: Someone taking five generic prescriptions monthly, each costing $40 on average.

• Without Extra Help: $595 deductible + $400 premium + $4.90 copay × 60 prescriptions = $1,435 total.
• With Extra Help: $0 premium + $0 deductible + $4.90 × 60 = $294 total.

That’s $1,141 saved in one year-just for generics. If you’re on Medicaid too, your copay drops to $1.60, saving you another $198 annually. That’s enough to cover a year’s worth of over-the-counter pain relievers, vitamins, or even a new pair of glasses.

How to Apply for Extra Help

You don’t need to be a paperwork expert to get this help. There are three easy ways to apply:

1. Online: Go to ssa.gov and search for "Extra Help". The application takes about 15 minutes.
2. By phone: Call 1-800-772-1213. Representatives can walk you through the form over the phone.
3. In person: Visit your local Social Security office. No appointment needed.

If you already get Supplemental Security Income (SSI), Medicaid, or a Medicare Savings Program, you’re automatically enrolled. You’ll get a letter confirming it. If you’re not sure, call 1-800-MEDICARE (1-800-633-4227) and ask.

Most applications are processed in 3 to 6 weeks. Once approved, your savings start immediately-even if you’re still waiting for your official letter.

What Happens Every Year

Extra Help isn’t a one-time deal. Every August, you’ll get a form in the mail asking you to update your income and resources for the next year. This is called the annual redetermination.

You have 30 days to return it. If you don’t, your benefits stop on January 1. No warning. No grace period. That’s why so many people lose coverage accidentally. Set a calendar reminder for early August. If you’re not sure how to fill it out, call your State Health Insurance Assistance Program (SHIP). They offer free, local help. Find yours at shiptacenter.org.

Common Mistakes and How to Avoid Them

Many people lose Extra Help because of small errors:

• Not reporting a small raise: If your Social Security check increased by $20 a month, you might go over the income limit. Report it honestly-you might still qualify for partial help.
• Forgetting to update your bank account balances: If you sold a stock or cashed in an IRA, that money counts as a resource. Even if you spent it, you must report what you had on the last day of the month before your redetermination.
• Assuming you’re too rich: The income limit sounds low, but it’s designed for people living on fixed incomes. Many who think they’re above the limit actually qualify.

One man in Ohio lost his Extra Help after his pension increased by $30 a month. He was paying $1,200 a year for his diabetes meds until he reapplied and found he still qualified. He’s now paying $4.90 per prescription.

What If You Don’t Qualify?

If your income is slightly over the limit, don’t give up. Some states have their own pharmaceutical assistance programs that can help cover the difference. For example, New York’s EPIC program and California’s PAP offer discounts even if you’re above the federal threshold.

You can also ask your pharmacist about manufacturer coupons or patient assistance programs. Many drugmakers offer free or low-cost generics to people without insurance coverage. Ask for the "Patient Assistance Program" (PAP) form for your specific medication.

And remember: starting in 2025, all Medicare Part D beneficiaries pay no more than $35 a month for insulin-no Extra Help needed. That’s a separate rule that helps everyone.

Real Stories From People Who Used Extra Help

A retired teacher in Florida was paying $60 a month for her blood pressure med. After applying for Extra Help, her copay dropped to $4.90. "I used to skip doses when my check ran low," she said. "Now I take it every day. My blood pressure is stable for the first time in years." A veteran in Texas was paying $1,800 a year for his heart and diabetes meds. He didn’t think he qualified because he owned a 2018 pickup. But cars don’t count as resources. He got approved and now saves over $1,500 a year.

On the flip side, a woman in California lost her Extra Help because she didn’t return her renewal form. She didn’t realize her benefits were tied to paperwork. When she tried to refill her asthma inhaler, the pharmacy told her it would cost $120. She cried in the parking lot. She got help reapplying, but it took three months. That’s three months without her meds.

Final Advice: Don’t Wait

Extra Help is one of the most underused benefits in Medicare. An estimated 37% of people who qualify don’t enroll-mostly because they think it’s too complicated or they don’t know it exists.

If you take any generic drugs, even one, you should check your eligibility. The savings are real. The process is simple. And the consequences of not applying can be dangerous.

Call 1-800-MEDICARE today. Or visit SSA.gov. Spend 15 minutes filling out the form. Your health-and your wallet-will thank you.