Do I qualify for Medicare Extra Help? Income limits 2025
If you qualify for Medicare Extra Help, it will help you pay premiums, co-payments and deductibles of your Medicare prescription drug plan. Whether you qualify for Medicare Extra Help depends on your financial resources.
Medicare Extra Help income limits 2025
The following amounts are for 2024 and may change in 2025:
To qualify for Extra Help, your income must be limited to $22,590 for an individual or $30,660 if you and your spouse live together. Also, your resources must be below $17,220 ($34,360 if you are married).
Note that “resources” doesn’t mean “income”. “Resources” are your combined savings, investments and real estate. Your primary home, your vehicles, any personal possessions, your life insurance and some other financial sources however do NOT count.
You may still qualify for Extra Help even if your resources are higher than the limit, e.g. if you live in Hawaii or Alaska or support family members living with you.
Only people living in one of the 50 states or D.C. can get Extra Help. The best way to find out if you qualify is to visit the SSA.gov website.
Medicare Extra Help application
If you think you may qualify, you can apply for Extra Help by submitting an application by filing form SSA-1020 with the Social Security Department. You can do so online or at your local SSA office.
A purple note from Medicare
If you received a “purple notice” from Medicare in the mail (which is officially called “Deemed Status Notice”, printed on purple paper), you don’t need to apply for Extra Help as the letter confirms that you do qualify for Extra Help, because you either:
- have both Medicare and Medicaid
- are in a Medicare Savings Program (MSP)
- or receive Supplemental Security Income (SSI) benefits
What should I do after receiving the note by Medicare about Extra Help?
After receiving the note, you must now do the following:
First, keep the letter and make sure to show it each time to your pharmacist when you get a prescription filled, so she knows that you get Extra Help.
Next, enroll in a Medicare drug plan if you don’t have one yet. You can select a plan by either with the help of a reputable insurance broker specializing in Medicare, by contacting the insurance company directly, or by comparing plans at the Medicare.gov website.
If you are already enrolled in a Medicare Part D prescription drug plan, make sure to notify your plan provider ASAP. Let them know that you are entitled to Extra help. From now on, your plan must make sure that you don’t pay anything over the LIS (Low income subsidy) drug coverage cost limit. The LIS limit means that you don’t pay more than a specific amount for each generic or brand-name drug. Of course, your prescriptions must be covered by the plan!
If you don’t select a prescription drug plan on your own, you will be automatically enrolled in a plan by Medicare. If this happens, you will receive another notice from Medicare, this time printed on yellow or green paper, which tells you the plan they have you enrolled in.
How to appeal the Medicare Extra Help determination by SSA?
If Social Security has denied your application for Extra Help, you can appeal the determination, asking for an “Appeal of Determination for Extra Help” by filing form SSA-1021. Typically, SSA will schedule a hearing to review your case with you by phone. Visit your local Social Security office or the ssa.gov website for more information.
Is there also Extra Help for Medicare Part B?
While “Extra Help” only helps you with your prescription drugs, there are other “Medicare Savings Programs” which are run by the State and may help qualified persons with their Medicare Part B costs for medical insurance. If you qualify for Extra Help, you may also submit your application for the Medicare Savings program in your state. Each state has different regulations about the eligibility. You can get more information at your state’s Medicaid office or your State Health Insurance Assistance Program (SHIP).
