Extra Help for Part D — and what it means for GLP-1 medications.
Extra Help, also called the Low-Income Subsidy (LIS), is a federal program that lowers Medicare Part D premiums, deductibles, and prescription copays for eligible beneficiaries. For patients using GLP-1 medications, that difference can be hundreds of dollars a month.
In 2026, Medicare Part D caps total out-of-pocket prescription costs at $2,100 for the year. Patients who qualify for Extra Help pay even less — as little as $4.90 per branded prescription — and may owe nothing once they reach the catastrophic phase. If a GLP-1 medication is covered under your Part D plan (for diabetes, cardiovascular risk, MASH, moderate to severe sleep apnea), Extra Help is the single largest lever for making it affordable.
What you pay with — and without — Extra Help.
Source: Centers for Medicare & Medicaid Services, 2026 Part D benefit parameters.
| Coverage phase | Standard Part D | Extra Help (full) | Dual eligible (Medicare & Medicaid) |
|---|---|---|---|
| Annual deductible | Up to $615 | $0 | $0 |
| Initial coverage (until $2,100 OOP) | 25% of drug cost | $5.10 generic / $12.65 branded | $1.60 generic / $4.90 branded |
| Catastrophic coverage | $0 | $0 | $0 |
Plan designs vary. The Medicare Prescription Payment Plan (“smoothing”) is a separate option that spreads out-of-pocket costs into monthly installments throughout the year.
Two paths to Extra Help.
Automatically enrolled
- You receive both Medicare and Medicaid (dual eligible).
- You are enrolled in a Medicare Savings Program.
- You receive Supplemental Security Income (SSI).
If any of these apply to you, Medicare enrolls you in Extra Help automatically. No application required.
May qualify by applying
- Single annual income at or below approximately $23,475 (2026 federal poverty guideline).
- Married annual income at or below approximately $31,725.
- Resource limits also apply — savings, investments, and certain assets are reviewed.
- Income limits update each year; apply even if you're close, since some income is excluded.
Many people who qualify never apply because they assume they wouldn’t be approved. If your monthly prescription costs feel hard to manage, it’s worth checking.
Three ways to check or enroll.
- 01 · Apply online
Visit ssa.gov/extrahelp to complete the Social Security Administration application. It takes about 10 minutes and there is no fee.
- 02 · Call Medicare
Call 1-800-MEDICARE (1-800-633-4227) to ask whether you already receive Extra Help or to be walked through your options.
- 03 · Check at the pharmacy
If your branded prescription copay is $12.65 or less, you may already be receiving Extra Help. Ask your pharmacist or your Part D plan to confirm.
When a GLP-1 is covered under your Part D plan, Extra Help is what makes a sustainable, multi-year course of treatment financially realistic for many Medicare patients. It’s worth confirming your status before your next prescription.