People who get Medicare’s Extra Help with drug costs are not tied to the fall open-enrollment calendar for a stand-alone drug plan. They can switch once a month, any month of the year. The rule covers stand-alone Part D plans only, not Medicare Advantage plans that include drug coverage.
How does the monthly switch work?
The New York State Office for the Aging’s 2026 Extra Help notebook says beneficiaries with Extra Help have a special enrollment period once per month to enroll in a stand-alone Part D plan. Medicare.gov says people with Medicaid or Extra Help can change coverage once per calendar month, and that the change takes effect on the first day of the next month.
A switch requested in October would start November 1. Most people with Medicare can change drug coverage only at certain times of the year, Medicare.gov notes, which is what makes the monthly option unusual.
Why does older guidance say something different?
A January 2023 CMS guide describes an older rule that allowed one change in each of three periods: January through March, April through June and July through September. The Idaho Department of Insurance’s training slides, current as of January 1, 2025, say the Extra Help period now allows enrollment into any stand-alone drug plan once per month.
The same CMS guide lists the standard windows that apply to everyone else: annual open enrollment from October 15 to December 7, and the Medicare Advantage open enrollment period from January 1 to March 31. The Extra Help period sits outside both calendars, which is why a person on Extra Help can act after December 7 and before the spring.
For someone on Extra Help comparing drug plans, the question is no longer when a window opens. It is which stand-alone plan costs least for the drugs in the cabinet, and the Medicare Plan Finder at medicare.gov/plan-compare can be run in any month, not only in the fall.
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What are the 2026 income and asset limits for Extra Help?
New York’s notebook lists the 2026 limits as gross monthly income of $2,015 for an individual or $2,725 for a couple, figures that include a $20 disregard. Assets must be $18,090 or less for an individual and $36,100 for a couple, including $1,500 for burial funds.
When applying directly through Social Security, the income limits are higher if a dependent relative lives with the applicant and relies on the applicant or spouse for at least half of their support. Extra Help also removes any Part D late-enrollment penalty, the notebook says.
What can the monthly switch not do?
The notebook states that “a beneficiary cannot use this SEP to enroll in a Medicare Advantage Plan with drug coverage.” Someone in a Medicare Advantage plan can use it to leave for Original Medicare with a stand-alone Part D plan. Medicare.gov adds that the period is not available to people flagged as “at-risk” or “potentially at-risk” under a Part D drug management program.
People who have Medicaid get a second monthly period, which lets them join an integrated Dual-eligible Special Needs Plan, the notebook says. Idaho’s slides add that integrated-care enrollment works the same once-a-month way.
What do Extra Help copays look like?
For 2026, copays are $5.10 for generics and $12.65 for brand-name drugs for people with Medicare only or a Medicare Savings Program, and for dual-eligible people with income above 100% of the poverty level. Dual-eligible people below 100% pay $1.60 and $4.90.
Institutionalized dual-eligible people, home- and community-based waiver participants and managed long-term care plan members pay $0, the notebook says. Because premiums and drug lists differ from plan to plan, a monthly option is only as good as the side-by-side comparison behind it.
Is your drug plan still the cheapest?
A person on Extra Help can switch drug plans any month, but a switch made on premium alone can raise the cost of the specific drugs in the cabinet. Extra Help copays in 2026 run $5.10 for generics and $12.65 for brand-name drugs for many people, and a plan that leaves a drug off its list changes that math.
The 2027 Medicare Open Enrollment Decision Kit includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors and a prescription-by-plan comparison that lines each drug up against each plan.
Get the drug-plan cost calculator and prescription comparison →
More Financial Reading
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- 21 Ways Retirees Can Raise $1,000 Fast Without a Job
This article was produced with AI assistance and edited for accuracy against the sources linked above.
