Health & Benefits

You may qualify for help with drug costs to pay for all or part of your Medicare Part D premiums Money that must be paid every month, such as for health insurance and other costs.

Some people are automatically eligible and do not need to apply, although they still need to enroll in a Prescription Drug Plan. Others may qualify if their income and resources are below a certain level. 

To qualify for Extra Help:

• You must reside in one of the 50 States or the District of Columbia;
• Your resources must be limited to $17,600 for an individual or $35,130 for a married couple living together. Your home, car, or any life insurance policy do not count; and
• Your annual income must be limited to $23,475  for an individual or $31,725  for a married couple living together. If your income is higher, you still may be able to get some help.

You are automatically eligible for Extra Help if you receive Medicare, and:

• You also receive Medicaid (if so, you are considered a dual-eligible person);
• You also receive Supplemental Security Income A federal program that gives money to low-income elderly, blind and disabled people on a monthly basis (SSI); or
• You get help from your state Medicaid program paying your Medicare premiums (Medicare Savings Program).

Benefits of Extra Help:

A person can get up to $5900 in savings in 2025. The Part D deductible and plan premium is waived.  In 2025, you will pay no more than $12.15 for each brand-name drug the plan covers and $4.90 for generic drugs. 

Once total out-of-pocket drug costs reach the catastrophic coverage threshold, you will have no copays. This threshold is $2,000 in 2025. If you also have full Medicaid coverage and are enrolled in the Qualified Medicare Beneficiary A person that gets property or money from someone when they die (QMB) Medicare Savings Program, you'll pay no more than $4.80 for each covered prescription drug.

Applying for Extra Help

If you are not automatically eligible, you must apply. You may apply:

• Through a Social Security Administration office,
• Through an Illinois Department of Human Services (DHS) office, or
• Online.

There is an advantage to applying through DHS. You can ask DHS to review your eligibility for Medicaid or other programs that help you pay other Medicare costs under Parts A and B. 

Applying through the Social Security Administration may be easier, though. For example, SSA may not require you to bring papers proving your income.

Renewing Extra Help

By law, SSA is required to review a beneficiary's eligibility for Extra Help periodically. When it is time for your review, the SSA will send you a form called "Social Security Review of Your Eligibility for Extra Help" or the SSA-2016 form. You have 30 days to complete and return this form. 

Learn more about Extra Help.