How to Use Medicare Extra Help for Generic Prescriptions to Save Money

For many seniors on Medicare, the biggest cost isn’t the plan itself-it’s the generic prescriptions they need every month. Blood pressure pills, cholesterol meds, diabetes drugs, and arthritis treatments add up fast. Without help, a single generic prescription can cost $30, $50, or even more. But if you qualify for Medicare Extra Help, those costs drop to just $4.90 per fill-or even $1.60 if you’re also on Medicaid. This isn’t a discount. It’s a lifeline.

What Medicare Extra Help Actually Covers

Medicare Extra Help, officially called the Part D Low-Income Subsidy (LIS), is a federal program that pays for nearly all of your prescription drug costs. It doesn’t just lower copays. It removes your entire Part D premium and deductible. In 2025, if you get Extra Help:

• You pay $0 for your monthly Part D plan premium
• You pay $0 for your annual deductible
• You pay no more than $4.90 for each generic drug
• You pay no more than $12.15 for each brand-name drug
• You don’t hit the coverage gap (the "donut hole") at all

That means if you take 12 different generic medications each month, you’ll spend about $705 a year on copays instead of $748+ just on copays (not counting premiums or deductibles) if you had no help. And that’s before you factor in the $595 deductible you’d normally have to pay first.

Who Qualifies for Extra Help in 2025

Eligibility is based on income and resources-not just your Social Security check. The rules are strict, but they’re clear:

• Income limit: $23,475 per year for one person, $31,725 for a married couple
• Resource limit: $17,600 for one person, $35,130 for a couple

Income includes Social Security, pensions, wages, veterans’ benefits, and alimony. It does NOT include housing assistance, food stamps, or Medicaid payments.

Resources are what you own: savings, stocks, bonds, mutual funds, IRAs, and cash. But your home, one car, and personal belongings don’t count. You also get a $1,500 allowance for burial expenses that won’t be counted.

If your income is below 100% of the Federal Poverty Level (about $16,590 in 2025) and you’re on Medicaid, you pay just $1.60 per generic prescription. That’s the best-case scenario.

Why So Many People Miss Out

Over 15 million Medicare beneficiaries get Extra Help. But experts say nearly 1 in 3 eligible people don’t apply. Why?

• They think they make "too much"-even if it’s just $500 over the limit
• They don’t know about it
• They’re scared of the paperwork

One Reddit user, "StressedSeniorCA," shared how a $500 increase in Social Security benefits knocked her off Extra Help. Her monthly generic prescriptions went from $4.90 each to over $100 each. Her annual out-of-pocket jumped from $700 to more than $1,200-plus the $595 deductible she now had to meet. "It’s devastating," she wrote.

Meanwhile, a retired pharmacist on the same forum said: "I’ve seen patients skip their meds because they couldn’t afford $30 copays. Once they got Extra Help, they filled every prescription. Their blood pressure dropped. Their hospital visits stopped."

How to Apply-Step by Step

You don’t need a lawyer or a financial advisor. Here’s how to apply:

1. Go to ssa.gov and look for "Extra Help" under Medicare Part D
2. Apply online-it takes about 20 minutes
3. Or call Social Security at 1-800-772-1213
4. Or visit your local Social Security office

If you already get Supplemental Security Income (SSI), Medicaid, or a Medicare Savings Program, you’re automatically enrolled. No application needed.

State Health Insurance Assistance Programs (SHIPs) offer free one-on-one help in every state. You can find yours at shiptacenter.org. They’ll walk you through the form, help you list your income and assets, and even check if you qualify for more help.

What Happens After You Apply

Once you apply, it takes 3 to 6 weeks to get a decision. If approved:

• Your Part D plan will be notified
• Your copays will drop to $4.90 (or $1.60) at the pharmacy
• You’ll get a new Medicare card with a special indicator

But here’s the catch: you have to renew every year.

Each August, you’ll get a form in the mail asking you to update your income and resources. You have 30 days to return it. If you miss the deadline, your Extra Help ends on January 1st. No warning. No grace period.

That’s why so many people lose it. They think, "I’m fine," and ignore the letter. Then in January, they show up at the pharmacy and are shocked to see their $4.90 copay jump back to $50.

How to Use Extra Help Wisely

Extra Help doesn’t mean you can pick any drug. You still need to use a Part D plan that covers your medications. But here’s the advantage: Extra Help beneficiaries get a Special Enrollment Period. That means you can switch your Part D plan once a month to find the one with the lowest cost for your exact drugs.

Use the Medicare Plan Finder tool at medicare.gov. Enter your drugs, pharmacy, and zip code. Filter for plans with the lowest out-of-pocket cost for your generics. Then switch. You can do it anytime if you have Extra Help.

Also, always tell your pharmacist you have Extra Help. Sometimes the system doesn’t auto-update. A quick reminder can save you from paying full price.

What’s Coming Next

In 2025, insulin costs are capped at $35 per month for all Medicare Part D beneficiaries-even those without Extra Help. That’s a big win. But for other generics, Extra Help remains the best deal.

The Biden administration has proposed expanding Extra Help to people earning up to 175% of the poverty line-about $28,500 for one person. If that happens, over a million more seniors could qualify. For now, though, the rules stay the same.

Experts warn that without changes, the program’s costs will keep rising. But right now, it’s the most powerful tool in Medicare for lowering prescription costs. If you’re struggling with drug bills, don’t assume you don’t qualify. Call Social Security. Talk to your local SHIP counselor. Fill out the form. It could save you thousands.