Medicare says people who get Supplemental Security Income, known as SSI, do not have to apply for Extra Help with their prescription costs. On its drug cost help page, Medicare puts it this way: “You’ll get Extra Help automatically if you get” full-benefit Medicaid coverage, help from a state Medicare Savings Program with Part B premiums, or SSI payments from Social Security.
Three doors into Extra Help
Extra Help is a federal program that lowers what people with limited income and resources pay for Medicare drug coverage. The three groups Medicare names are:
- People with full-benefit Medicaid, the version that pays for medical care and not only some Medicare costs.
- People who get a state’s help paying Part B premiums through a Medicare Savings Program.
- People who get SSI payments, the monthly check Social Security pays to older or disabled people with very little income.
Anyone in one of those groups has Extra Help without filling out the application. For SSI recipients on Medicare, that means there is nothing to file at the Social Security office to get it.
The wording matters for the rest of the household’s paperwork. Extra Help is about drug costs. It does not pay Medicare’s Part B premium, the monthly charge for doctor visits and outpatient care. That job belongs to the Medicare Savings Programs, which are run by states, and which differ in who qualifies and how to apply.
Extra Help covers drugs, but state-run help with Medicare premiums and other costs varies from one state to the next. The Medicare Cost & Coverage Protection Kit includes 51 state Medicare cost-help packs.
Get the state cost-help packs for people on SSI and Medicare →
What it changes at the pharmacy counter
Medicare lists what Extra Help means for 2027: a $0 plan premium and a $0 deductible, with copayments of up to $5.80 for generic drugs and $14.40 for brand-name drugs. Once total drug costs reach $2,400, Medicare says the copay drops to $0 for each covered drug.
People who get Extra Help through a Medicare Savings Program see a related cap for the current year. The Medicare Savings Programs page says those enrollees “pay no more than $12.65 in 2026 for each drug your Medicare drug plan covers.”
When the automatic help does not apply
People outside the three groups can still qualify, but they have to apply. Medicare gives 2026 limits for Extra Help of $23,940 in yearly income and $18,090 in resources for an individual, and $32,460 in income and $36,100 in resources for a married couple. Applications go through Social Security at ssa.gov/medicare/part-d-extra-help, by phone at 1-800-772-1213, or with free help from a State Health Insurance Assistance Program, known as a SHIP.
Social Security says people can apply “any time before or after” they enroll in Part D, and suggests gathering bank statements, tax returns, retirement account balances and statements for pensions, veterans’ benefits, annuities and railroad retirement benefits before starting.
Letters in the mail and what they mean
Medicare says people with automatic Extra Help get a notice by mail with their plan assignment, their cost-sharing amounts and their yearly eligibility status. The page also says: “If you don’t get a notice from Medicare or Social Security, you’ll keep getting Extra Help and keep the same plan for next year.”
That sentence is the one to keep in mind this fall. A person on SSI who gets no letter does not need to do anything to hold on to Extra Help. A person who does get a letter should read it for a new plan assignment, since a change in plan can change which pharmacies and drugs are covered.
Confirming Extra Help and finding state help
Anyone unsure whether the drug-cost help is in place can ask the plan or the pharmacist whether Extra Help is on the account, and compare the copay on the last fill with the Medicare figures above. Social Security’s phone line, 1-800-772-1213, can answer questions about SSI payments themselves.
The next job is state help with the Part B premium. Medicare says Medicare Savings Programs “are run by your state,” and that people should contact their state to apply. Each state sets its own application process, so the first call is to the state Medicaid office or the local SHIP. Write down the SSI award letter date, the Medicare number and the monthly premium amounts being withheld from Social Security before calling.
Medicare’s own page on drug cost help names the three automatic groups, and it is the page to show a pharmacist or plan representative who says an application is still needed.
The Medicare Cost & Coverage Protection Kit puts its 51 state Medicare cost-help packs next to a medication and cost tracker, so premium help and drug costs can be followed in one place.
Open the state packs and medication tracker for Medicare and SSI households →
This article was produced with AI assistance and edited for accuracy against the Medicare and Social Security pages linked above.
