Extra Help Income Limits 2026, 2027 Copays and Medicare Savings Programs

“Income and resource limits in 2026:”

“Section 11404 of the Inflation Reduction Act of 2022 (IRA) expanded eligibility of the full LIS group to individuals with incomes up to 150 percent of the federal poverty level (FPL) and who meet the statutory resource requirements.”

“To be eligible for the subsidy, an individual or couple must have countable income below certain limits prescribed by the law. We base these income eligibility limits on the Federal Poverty Levels (FPL) issued annually by the Department of Health and Human Services (HHS).”

“In or after 2024, to be eligible for a full (100%) premium subsidy, the individual must have countable income less than 150% of the FPL for the applicable State and family size.”

“An applicant is ineligible for any subsidy if their countable income is 150% or more of the FPL for the applicable State and family size.”

“One set of poverty levels apply to the 48 contiguous States and the District of Columbia. Alaska and Hawaii have separate and slightly higher poverty levels. When an individual applies for subsidy, we apply the FPL that corresponds to the individual’s State of residence, in the month they file the application.”

“HHS bases the FPL dollar amounts on the size of the individual’s family. The dollar amount increases as the family size increases.”

“If the subsidy applicant lives with a relative and provides that relative with at least one-half support, count the relative as a member of the family for purposes of determining the applicable poverty level. (We do not consider the relative’s income and resources in determining the subsidy.)”

“The CY 2026 resource limits are $16,590 ($33,100 if married) for the full LIS benefit. For beneficiaries who notified the Social Security Administration (SSA) that they expect to use some of their resources for burial expenses, pursuant to 20 CFR 416.1231, the CY 2026 resource limits are $18,090 ($36,100 if married) for the full LIS benefit.”

“The Medicare Application Processing System (MAPS) automatically adds $1500 to individual applicants resource limit amount (or $3,000 from married couple applicants), unless applicants report NONE of their resources will be used to pay for funeral or burial expenses. If an individual or couple expects to use some of their resources for funeral or burial expenses, ADD $1,500 per individual ($3,000 for a married couple) to the below individual or married couple resource limit amounts.”

“For purposes of determining Medicare Part D Extra Help eligibility, if the applicant alleges that he or she expects to use some of his or her resources for funeral or burial expenses, $1,500 is excluded from that applicant’s countable resources. For a married couple who live together, we exclude up to $3,000 ($1,500 for each member who alleges that he or she expects to use some of his or her resources for funeral or burial expenses).”

“Countable resources are $16,590 or less”

“If countable resources are $16,590.01 or more, the individual is not eligible for any subsidy but can enroll in Part D.”

“Countable resources are $33,100 or less”

“If countable resources are $33,100.01 or more, the couple is not eligible for any subsidy regardless of countable income, but can enroll in Part D.”

“Less than 150% of FPL and countable resources are less than or equal $16,590 for an individual, $33,100 for a married couple.”

“has income below 150 percent of the poverty line applicable to a family of the size involved; and (iii) meets the resources requirement described in subparagraph (D) or (E).”

“If the individual’s countable income is less than the FPL income limit prescribed by HHS regulations for the applicable State and family size, the individual is eligible for a full premium subsidy regardless of whether the individual’s countable resources are under Extra Help resource limits prescribed by law ($16,590 in 2026).”

“In most cases, to qualify for Extra Help, you must have income and resources below a certain limit. These limits may go up each year.”

“Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more.”

“If the individual is married and living with their spouse at the time they apply for a subsidy or in the month we redetermine subsidy eligibility, we count the income of the individual and the spouse.”

“If the individual is married but separated from their spouse at the time the individual applies for a subsidy or in the month we redetermine subsidy eligibility, we count only the individual’s income.”

“The $20 per month general income exclusion applies to all unearned income including income based on need (IBON). NOTE:Except for any unused portion of the $20 per month general income exclusion, unused unearned income exclusions are not applied to earned income.”

“All interest and dividends, regardless of the source, are excluded from income to determine eligibility for the subsidy.”

“We apply the following income exclusions to earned income in the order listed to determine countable earned income. We never reduce the individual’s earned income below zero or apply any unused earned income exclusion to unearned income.”

“Any portion of the $20 per month general income exclusion which has not been excluded from the unearned income of the individual (or of the combined unearned income of the individual and living-with spouse) received in that same month (SI 00810.420);”

“$65 per month of the individual’s earned income (or the combined earned income of the individual and living-with spouse) received in that same month (SI 00820.520);”

“One-half of the remaining earned income that the individual (or the individual and living-with spouse) receives in that same month (SI 00820.520); and”

“whose income (as determined under section 1382a of this title for purposes of the supplemental security income program, except as provided in paragraph (2)(D)) does not exceed an income level established by the State consistent with paragraph (2), and”

“individuals who would be qualified medicare beneficiaries described in section 1396d(p)(1) of this title (including such individuals enrolled under section 1395o(b) of this title) but for the fact that their income exceeds the income level established by the State under section 1396d(p)(2) of this title but is less than 110 percent in 1993 and 1994, and 120 percent in 1995 and years thereafter of the official poverty line (referred to in such section) for a family of the size involved; and”

“individuals who would be qualified medicare beneficiaries described in section 1396d(p)(1) of this title (including such individuals enrolled under section 1395o(b) of this title) but for the fact that their income exceeds the income level established by the State under section 1396d(p)(2) of this title and is at least 120 percent, but less than 135 percent, of the official poverty line (referred to in such section) for a family of the size involved and who are not otherwise eligible for medical assistance under the State plan;”

“whose income (as determined under section 1382a of this title for purposes of the supplemental security income program) does not exceed 200 percent of the official poverty line (as defined by the Office of Management and Budget and revised annually in accordance with section 9902(2) of this title) applicable to a family of the size involved;”

“$20 = monthly SSI general income exclusion.”

“Eligible beneficiaries receive subsidized premiums, deductibles, and co-payments.”

“Individuals who are eligible for Extra Help with a full premium subsidy who choose to participate in a more expensive plan, are responsible for the difference between the benchmark premium and the premium of the plan they choose.”

“CMS rounds up to the nearest dollar when computing the monthly income limits.”

“In most cases, your income and resources must be below a certain limit to qualify for a Medicare Savings Program, as described below. These limits go up each year.”

“You may still qualify for these programs in your state even if your income or resources are higher than the federal limits listed. Some states don’t count certain types or specific amounts of income or resources when deciding who qualifies.”

“States can, however, effectively raise these limits for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individuals (QI) eligibility groups above the federal statutory limits by disregarding amounts or certain types of income and resources. Some states have used this authority to effectively eliminate resources tests when determining eligibility for these MSP eligibility groups.”

“The Medicare Savings Programs (MSPs) are mandatory Medicaid eligibility groups that assist low-income Medicare beneficiaries with some or all of their Parts A and B premiums and cost-sharing. State Medicaid agencies determine whether or not an individual is eligible for Medicaid coverage, including the MSPs.”

“You can apply for Extra Help any time before or after you enroll in Part D.”

“Your eligibility depends on your income and resources.”

“Available in most U.S. time zones Monday through Friday, 8 a.m. to 7 p.m., in English, Spanish, and other languages.”

“Tell the representative you want to set up an appointment to apply for Part D Extra Help.”

“You’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply.”

“You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time. These state programs provide help with other Medicare costs. Social Security will send information to your state to initiate an MSP application unless you tell them not to on the Extra Help application.”

“Qualified Disabled Working Individuals (QDWI) are not deemed eligible for Extra Help.”