Extra Help with Medicare Drug Costs in New York

What Extra Help Does

Extra Help — officially the Low-Income Subsidy (LIS) — is a federal program that cuts the cost of Medicare Part D prescription drug coverage. For qualifying seniors, it eliminates or sharply reduces:

• Part D plan premiums: $0 for plans at or below the benchmark ($58.82/month in New York for 2026)
• Annual deductible: $0
• Drug copays: capped at $5.10 for generics and $12.65 for brand-name drugs
• Late enrollment penalty: waived entirely
• Coverage gap: eliminated (the Inflation Reduction Act already closed the gap, but Extra Help provides additional protection)

Extra Help also grants a Special Enrollment Period to switch Part D plans once in each of the first three calendar quarters (January through September) — outside the standard Annual Election Period — so the senior can change plans if a better option becomes available.

The Fastest Route: Apply for QMB or QI First

In New York, the easiest path to Extra Help is through the Medicare Savings Program. When the state approves QMB or QI, CMS automatically "deems" the enrollee eligible for full Extra Help — no separate application or independent resource review.

This is automatic program deeming, not a separate income test. The state transmits the MSP approval to CMS, and CMS notifies the Part D plan directly.

This bypasses the federal Extra Help resource test entirely. In 2026, the base resource limits are $16,590 for an individual and $33,100 for a married couple living together; with the burial-expense exclusion, they rise to $18,090 and $36,100. Deemed eligibility through QMB or QI does not require a separate resource test.

Applying Directly for Extra Help

If the senior does not qualify for QMB or QI but might qualify for Extra Help on its own, there are two routes:

Through Social Security: File form SSA-1020 online at ssa.gov, by phone at 1-800-772-1213, or at a local Social Security office. In 2026, direct Extra Help eligibility generally requires countable income below 150% of the federal poverty level (about $1,995/month for an individual or $2,705 for a couple) and resources within the applicable $16,590/$33,100 base limits, increased to $18,090/$36,100 when the burial-expense exclusion applies.

Through EPIC: When a New York senior enrolls in the EPIC program, EPIC screens for Extra Help eligibility and submits the application to Social Security on the member's behalf. This automatic screening catches eligible seniors who might not know about Extra Help.

There is also a pipeline that works in reverse: under the Medicare Improvements for Patients and Providers Act (MIPPA), when someone applies for Extra Help through Social Security, SSA automatically transmits the application data to New York State to initiate an MSP evaluation. The MSP application date is backdated to the Extra Help filing date.

When Extra Help Kicks In at the Pharmacy

After CMS deems the senior eligible, the status has to reach the Part D plan's system. This data transmission can take a few weeks. During the gap, the pharmacy may charge full copays or deductibles.

If that happens, the senior or caregiver can use the Best Available Evidence (BAE) policy: present the MSP approval letter, an eMedNY eligibility printout, or the SSA LIS award letter directly to the pharmacist. Federal rules require the pharmacy to manually adjust copays based on any of these documents.

If no documentation is available yet, the pharmacist can enroll the senior in the LI NET (Limited Income Newly Eligible Transition) program — temporary Part D coverage that provides LIS-level copays at the point of sale while the permanent enrollment processes.

The New York Medicare Savings Programs Guide covers the Extra Help enrollment timeline, what to bring to the pharmacy during the transition, and how all three programs — MSP, Extra Help, and EPIC — stack for maximum savings.

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