You apply for Extra Help, Medicare’s Low-Income Subsidy for Part D prescription drug costs, through the Social Security Administration using Form SSA-1020. For 2026, you qualify if your annual income stays below $23,940 as an individual or $32,460 as a married couple living together, and your countable resources fall below $18,090 (individual) or $36,100 (couple).1Medicare. Help With Drug Costs You can file online, by mail, by phone, or at a local Social Security office. Some people never need to apply at all.
Check Whether You Even Need to Apply
Three groups are automatically enrolled and should not file an application:
- People with both Medicare and full Medicaid coverage.
- People who receive Supplemental Security Income.
- People enrolled in a Medicare Savings Program as a Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, or Qualified Individual.
If you fall into any of these groups, CMS identifies you from state Medicaid and SSA records and enrolls you in a Part D plan if you don’t already have one. You’ll receive a purple notice from Medicare confirming your status; keep it, but you don’t need to act on it.2Medicare. Deemed Status Notice
One boundary to note: the Qualified Disabled Working Individuals program does not confer automatic eligibility. If that’s your only coverage besides Medicare, you still need to apply.3Social Security Administration. HI 03001.005 – Medicare Part D Extra Help (Low-Income Subsidy)
2026 Income and Resource Limits
Income is the first gate. To qualify in 2026, your annual income must fall below 150 percent of the Federal Poverty Level: $23,940 for an individual, $32,460 for a married couple living together. Income includes wages, pensions, Social Security benefits, and most other money coming in. In-kind support such as free housing or meals does not count.4Social Security Administration. POMS HI 03001.020 – Eligibility for Extra Help (Prescription Drug Low-Income Subsidy)
The resource limit for 2026 is $18,090 for an individual and $36,100 for a couple. Those figures already include a $1,500-per-person exclusion for burial expenses.5Centers for Medicare and Medicaid Services. Calendar Year (CY) 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) Countable resources include checking and savings accounts, certificates of deposit, stocks, bonds, and mutual funds. Excluded from the count: your home, one vehicle, personal belongings such as furniture and jewelry, and the cash surrender value of life insurance policies.4Social Security Administration. POMS HI 03001.020 – Eligibility for Extra Help (Prescription Drug Low-Income Subsidy)
Everyone who now qualifies receives the full subsidy. That means a $0 monthly Part D premium, a $0 annual deductible, and copays capped at $5.10 for generics and $12.65 for brand-name drugs your plan covers. Once your total drug costs reach $2,100 for the year, copays disappear entirely.1Medicare. Help With Drug Costs
What to Gather Before You Start
The application asks for specific numbers, and SSA cross-checks what you report against IRS and other federal data.6Social Security Administration. Privacy Program – Computer Matching Programs A mismatch can delay a decision or cause a denial, so pull your paperwork first:
- Social Security numbers for you and your spouse, even if your spouse isn’t applying.
- Recent statements for checking, savings, and investment accounts showing current balances.
- Your most recent tax return, W-2s, and 1099-R forms for pensions or retirement distributions. Include VA and railroad retirement benefit statements if they apply.
- Any life insurance policies you hold. The cash value doesn’t count as a resource, but the application may ask about them.
Four Ways to File Form SSA-1020
The application is Form SSA-1020B-OCR-SM, “Application for Extra Help with Medicare Prescription Drug Plan Costs.”7Social Security Administration. SSA-1020 Forms Choose whichever channel is easiest:
- Online at ssa.gov. You get an immediate confirmation number.
- By mail to Social Security Administration, Wilkes-Barre Data Operations Center, P.O. Box 1020, Wilkes-Barre, PA 18767-9910.8Social Security Administration. Social Security Handbook 2601 – Eligibility for Extra Help with Prescription Drug Costs
- By phone at 1-800-772-1213 (TTY 1-800-325-0778).
- In person at your local Social Security office.
Two Questions That Trip People Up
One question asks how many relatives live with you and depend on you for at least half of their financial support. Household size changes the poverty-level percentage applied to your case and directly affects whether you qualify.9Social Security Administration. POMS HI 03010.038 – Completing the Extra Help Subsidy Application Count only relatives by blood, adoption, or marriage who live with you and whom you support. Don’t count your spouse; the spouse is already factored in separately.
The form also has a checkbox asking whether SSA can share your information with your state Medicaid agency. Check it. That lets the state screen you for Medicare Savings Programs, which help pay your Medicare Part B premium and can save you additional money each month.
What Happens After You Submit
SSA reviews the application and sends a written decision by mail. The form itself says only that SSA “will review your application and send you a letter to let you know if you qualify,” without committing to a timeline.10Social Security Administration. Application for Extra Help with Medicare Prescription Drug Plan Costs If SSA needs more information, they’ll contact you before deciding. Watch your mail closely.
An approval letter confirms your Extra Help enrollment and explains that your premiums, deductible, and copays are reduced. If you aren’t already in a Part D plan, CMS will enroll you in one.3Social Security Administration. HI 03001.005 – Medicare Part D Extra Help (Low-Income Subsidy)
If You’re Denied
A denial letter states the specific reason, usually that income or resources exceeded the limits. To appeal, file Form SSA-1021.11Social Security Administration. Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs You generally have 60 days from the date you receive the notice.12Social Security Administration. Your Right to Question the Decision Made on Your Claim The form asks why you disagree, invites supporting documents such as updated bank statements or corrected income records, and lets you request a telephone hearing. Step-by-step guidance is on Form SSA-1021-INST.13Social Security Administration. Instructions for Completing the Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs
Keeping the Benefit After Approval
SSA periodically reviews your eligibility. You’ll receive Form SSA-1026 listing the income and resource information on file; confirm or correct it and return it within 30 days. A 30-day extension is available if you need more time. After the review, SSA may keep the subsidy the same, raise it, lower it, or end it.14Social Security Administration. POMS HI 03050.035 – Extra Help Redetermination Forms
Between reviews, report changes that could affect the subsidy: income going up, a significant change in savings, someone moving into or out of your household, or a change in marital status. When SSA logs a subsidy-changing event, they send a separate form with a 90-day response window.14Social Security Administration. POMS HI 03050.035 – Extra Help Redetermination Forms
One benefit worth using: Extra Help recipients get a Special Enrollment Period to change their Medicare Part D or Medicare Advantage plan outside the annual window. As of 2025, that SEP allows one plan change per year for people who applied through SSA. Those deemed eligible through Medicaid, SSI, or a Medicare Savings Program can still switch once per calendar month.3Social Security Administration. HI 03001.005 – Medicare Part D Extra Help (Low-Income Subsidy)