Extra Help in 2027: Lower Drug Copays and Who Qualifies

Extra Help is a federal program that lowers the cost of a Part D drug plan. It helps people with limited income and limited savings. In 2027 the help gets a bit stronger at the pharmacy counter. This guide sets out what a member pays in 2027, who can qualify, and how to apply.

The 2027 pay amounts start on January 1, 2027. The income and savings limits in this guide are the 2026 limits, because the 2027 limits have not been published yet. Each part is labeled with its year so you can tell them apart. Our Paying for Care section holds our other cost guides.

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What you pay in 2027

Extra Help cuts each part of drug cost. The plan premium goes to $0 for a plan at or below the local benchmark amount. The plan deductible goes to $0. At the pharmacy, you pay up to $5.80 for a generic drug and up to $14.40 for a brand-name drug (Ledger K5).

Those copays are caps, not fixed prices. A drug can cost less than the cap. A generic drug that costs $4 at your plan's rate still costs $4. The cap only bites when the normal share would be higher.

Later in the year, the cost can drop to zero. Once total drug costs reach $2,400 in 2027, you pay $0 for covered drugs for the rest of the year (Ledger K5). The $2,400 line is the same Part D out-of-pocket cap that applies to all members in 2027 (Ledger A18). Our guide on Part D in 2027 explains that cap in full.

One lower rate sits inside the table. People who have full Medicaid and are also in a Medicare Savings Program pay no more than $4.90 for a covered drug in 2027 (Ledger K5). Our guide on checking Medicare Savings Programs and Extra Help walks through those programs.

Who qualifies on their own

Some people get Extra Help without a separate application. You qualify on your own if you have full Medicaid coverage. You also qualify on your own if you are in a Medicare Savings Program. And you qualify on your own if you get Supplemental Security Income payments.

If you are in one of those groups, do not wait for a form. Check your drug plan papers for the Extra Help notice. If the help is not shown, call your plan and ask why. A missing notice can be a record error, and a call can fix it.

People who qualify keep the help through December 31 of the year, even if their income or savings rise later that year. Members can also switch Part D plans once a month, which helps if a plan drops a drug mid-year.

Who else can qualify

Everyone else is tested on income and on resources. For 2026, the income limit is below $23,940 a year for one person and below $32,460 a year for a married couple who live together (Ledger K1). The limits are higher in Alaska and Hawaii.

Counted income includes wages, Social Security checks, pensions, rent income, veterans benefits, and annuity payments. Some income does not count, so a person a bit over the line on paper may still qualify after the full test.

For 2026, the resource limit is below $18,090 for one person and below $36,100 for a couple (Ledger K2). Resources include money in bank accounts, stocks, and bonds. Your home does not count. One car does not count. A burial plot and household goods do not count either.

Apply even if you think you are a bit over. The test has parts that a quick guess can miss. Social Security runs the test when you apply, and the answer is free.

How to apply

State help desks and local aging offices can help with the form at no charge. You never need to pay a firm to apply for this program.

• Apply through Social Security, online, by phone, or at a local office.
• Have your income records and bank and investment statements at hand.
• After approval, pick a Part D plan if you do not have one. Extra Help lowers the cost of a plan. It is not a plan on its own.
• If you are turned down, read the notice. It tells you how to ask for a second look and what facts you can correct.

Who pays for what

• Medicare runs Part D and sets the Extra Help rules. Medicare and the federal government fund the premium and copay help the program pays.
• Your Part D plan pays its share of your drug costs and applies the lower copays at the pharmacy.
• Medicaid: people with full Medicaid get Extra Help on their own, and they get their drugs through Part D, not through Medicaid.
• Private pay: without Extra Help, you pay the full plan premium, the deductible, and the normal copays of your plan. With Extra Help, those costs drop to the amounts in this guide.

Sample situation

Rosa is 71 and lives on a Social Security check and a small pension. Her total income for 2026 is below $23,940, and her bank savings are below $18,090, so she passes both 2026 tests (Ledger K1 and Ledger K2). She applies through Social Security in the fall and is approved. In 2027 she picks a drug plan at the benchmark level and pays no premium and no deductible (Ledger K5). In January she fills one generic drug and one brand drug. She pays up to $5.80 for the generic and up to $14.40 for the brand drug (Ledger K5). Her drug costs build across the year. Once her total drug costs reach $2,400, she pays $0 for covered drugs for the rest of 2027 (Ledger K5). Rosa's case shows why the application is worth the time: each part of her cost fell, and the last part fell to zero.

Steps to take this fall

• Check if you are in a group that gets Extra Help on its own: full Medicaid, a Medicare Savings Program, or Supplemental Security Income.
• Add up your income and your bank and investment savings and compare them with the 2026 limits above.
• Apply through Social Security if you may be close to the limits.
• After approval, check that your plan shows the lower copays before your first fill of 2027.

Sources

• https://www.medicare.gov/basics/costs/help/drug-costs
• https://www.medicare.gov/health-drug-plans/part-d/basics/costs