There is a federal program that eliminates most prescription drug costs for Medicare beneficiaries with low incomes. It covers Part D premiums, deductibles, and copays, reducing what many seniors and disabled adults pay for medications from hundreds of dollars per month to a few dollars per prescription. It has existed since 2006. It is free to apply for. And according to data from the Kaiser Family Foundation and the Centers for Medicare and Medicaid Services, roughly one in three eligible people are not enrolled in it. The program is called Extra Help, also known as the Low Income Subsidy (LIS), and the gap between who qualifies and who actually receives it is one of the most documented failures of benefit program outreach in the Medicare system.

What Extra Help Actually Covers

The Extra Help program is administered by the Social Security Administration and provides assistance with Medicare Part D prescription drug costs for people who meet income and resource limits. In 2026, eligibility extends to individuals with annual income up to approximately $22,590 and resources up to $17,220, and to couples with income up to approximately $30,660 and resources up to $34,360. Resources include bank accounts and investments but exclude the home you live in, one car, and burial funds up to a certain amount, which means the resource limit is less restrictive than it appears on the surface.

The financial benefit of enrollment is substantial. Full Extra Help recipients pay no Part D premium for a benchmark plan, no deductible, and copays capped at $4.90 for generic drugs and $12.15 for brand-name drugs in 2026. For a person taking multiple medications for chronic conditions, the difference between paying these capped amounts and paying standard Part D cost sharing can easily exceed $3,000 per year. Partial Extra Help recipients receive scaled assistance that still produces meaningful savings compared to standard Part D cost sharing.

The Enrollment Numbers Tell a Concerning Story

The Kaiser Family Foundation’s analysis of Extra Help enrollment consistently finds that a significant share of Medicare beneficiaries who meet the income and resource criteria for Extra Help are not enrolled. Estimates place the unenrolled eligible population at somewhere between 1.5 and 2 million people nationally in recent years. These are adults who are paying full or near-full Part D cost sharing when they qualify for a program that would eliminate most of those costs. The Medicare Payment Advisory Commission (MedPAC) and the Government Accountability Office (GAO) have both published reports documenting this gap and examining its causes.

The dollar value of unclaimed Extra Help benefits across all unenrolled eligible beneficiaries runs into the billions annually. For individual households, the missed savings represent a material share of monthly income for people living near or at the federal poverty level, where prescription costs often force real tradeoffs against food, utilities, and other necessities.

Why Eligible Adults Are Not Enrolling

Research on the Extra Help enrollment gap points to several consistent explanations. The first is awareness. The program operates under two names, Extra Help and the Low Income Subsidy, neither of which appears in Medicare’s primary marketing materials with the prominence that corresponds to its value. Many Medicare beneficiaries have never heard of either name. The Social Security Administration’s Extra Help page is accurate and informative but is not prominently featured in the annual Medicare and You handbook that beneficiaries receive, which covers dozens of programs across hundreds of pages.

The second explanation is the means test stigma that affects enrollment in virtually every income-tested government program. Beneficiaries who spent their working lives not receiving government assistance are reluctant to apply for a program they perceive as welfare, even when the benefit is directly tied to a program they paid into through their working years. Research on benefit stigma in older adult populations consistently finds this pattern across Medicare savings programs, Extra Help, and SNAP.

The third explanation is confusion about eligibility. The resource limits for Extra Help are complex enough that many eligible adults incorrectly conclude they do not qualify before applying. A homeowner with a modest savings account may assume their assets disqualify them without knowing that the home, one vehicle, and several other categories of assets are excluded from the resource calculation. The SSA’s Extra Help eligibility screening tool provides an online check that takes under ten minutes and produces a clear eligibility determination based on actual program rules rather than a self-assessment.

Automatic Enrollment Closes Part of the Gap

The Medicare Improvements for Patients and Providers Act (MIPPA) established automatic enrollment in Extra Help for certain populations. People who receive both Medicare and Medicaid, known as dual eligibles, are automatically enrolled in Extra Help with full subsidy status. People who receive Supplemental Security Income (SSI) are also automatically enrolled. For these populations, the enrollment gap does not exist because no application is required. The gap is concentrated among people who meet the income and resource criteria for Extra Help but do not receive Medicaid or SSI, and who therefore must apply actively to access the benefit.

States Are Expanding Outreach but Progress Is Uneven

Several states have implemented proactive outreach programs specifically designed to identify and enroll eligible adults who are not receiving Extra Help. These programs use Medicaid and SNAP enrollment data to identify individuals who likely qualify and reach out to them directly by mail, phone, or through community health workers. California, New York, and Illinois have the most developed state-level LIS outreach infrastructure. In states with less developed outreach, the identification of eligible unenrolled adults depends almost entirely on community organizations, pharmacists, and healthcare providers who happen to know about the program and mention it during routine contact with patients and clients.

The Medicare Rights Center is one of the most reliable national resources for Extra Help information and provides a free counseling helpline at 800-333-4114 where trained counselors help beneficiaries determine eligibility and complete the application. The State Health Insurance Assistance Program (SHIP) operates in every state and provides free one-on-one counseling to Medicare beneficiaries including assistance with Extra Help applications. Accessing Extra Help program gaps information through SSA directly or through a SHIP counselor is the most efficient way to move from uncertainty about eligibility to an actual enrollment decision based on the real program rules rather than assumptions about what a resource test might exclude.