New Rules for Extra Help: Full Benefits for More Low-Income Seniors

Good news for people living on a limited income: the Low-Income Subsidy (LIS) program, also known as “Extra Help,” is getting some meaningful improvements. These updates could make a real difference for seniors and individuals with disabilities who are struggling to keep up with the cost of their prescription medications. If you or someone you care about is enrolled in Medicare and has a tight budget, it’s worth understanding what’s changed and how it could help.

The LIS program has always been a vital safety net for people on Medicare. It helps cover the costs of prescription drug plans (Part D), lowering or even eliminating monthly premiums, annual deductibles, and copays for medications. Until recently, the level of help a person received depended on how much money they had, with different levels of support based on income and assets. That tiered approach often meant that even small increases in income could disqualify someone from full benefits.

Thanks to recent changes, this system is becoming more generous and a lot easier to navigate. One of the most important updates is the expansion of full LIS benefits to a broader group of people. Previously, only those with incomes up to 135% of the federal poverty level (FPL) qualified for the full subsidy. Now, eligibility has been extended to include individuals earning up to 150% of the FPL. This change means that many who were previously only getting partial help—or none at all—will now qualify for more robust support.

For example, if you’re a single person making just over $20,000 a year or a couple earning around $27,000, you may now qualify for full Extra Help under the new rules. That can mean zero-dollar premiums on certain plans, no annual deductible, and significantly lower copays—sometimes as little as $4 for generics.

Another key improvement is that the new LIS structure eliminates the confusing partial subsidy category. In the past, this “in-between” category gave some help but still left people paying more out-of-pocket than they could afford. The updated approach gets rid of that middle ground and offers a clearer, more supportive system for everyone who qualifies.

In addition, the application process is becoming more streamlined. Many people who are eligible don’t even realize they qualify, in part because the paperwork can be daunting. But now, if you already receive Medicaid, Supplemental Security Income (SSI), or participate in a Medicare Savings Program, you’ll likely be automatically enrolled in Extra Help. That’s one less form to fill out, and one more way the system is trying to work in your favor.

If you’re unsure whether you qualify, it’s worth checking. You can contact your local State Health Insurance Assistance Program (SHIP) for free guidance. You can also apply online at the Social Security Administration website or call them directly. It doesn’t cost anything to apply, and even if you’ve been denied in the past, the new rules might change your outcome.

These changes to the LIS program reflect a broader commitment to make Medicare work better for people who need it most. Prescription drug costs continue to be a major burden, especially for seniors living on fixed incomes. With this new expansion, thousands more people can breathe a little easier, knowing they can afford the medications that keep them healthy.