Extra Help Part D in Pennsylvania — How to Get the Low-Income Subsidy

What Extra Help Covers

Extra Help — formally the Part D Low-Income Subsidy (LIS) — is a federal program that reduces what you pay for Medicare prescription drugs. Depending on your income level, it can eliminate your Part D plan premium, wipe out the annual deductible, and cut copays to a few dollars per prescription.

In 2026, the standalone income limits for Extra Help are approximately $1,956 per month for a single person ($23,475 annually) and $2,644 per month for a couple ($31,725 annually). Resource limits are $18,090 single and $36,100 couple — significantly more generous than the MSP limits.

The Automatic Route Through Pennsylvania's Medicare Savings Programs

If you're enrolled in any tier of Pennsylvania's Healthy Horizons program — QMB, SLMB, or QI — you automatically qualify for Extra Help. No separate application needed. The federal government "deems" you eligible based on your MSP enrollment.

This is one of the strongest reasons to apply for an MSP even if you only qualify for SLMB or QI. Those programs pay your Part B premium, and the auto-deeming hands you Extra Help on top of it.

SSI recipients in Pennsylvania also automatically receive Extra Help.

Applying Directly for Extra Help

If you don't qualify for an MSP but your income falls under the Extra Help limits, apply directly through Social Security:

• Online at ssa.gov/medicare/part-d-extra-help
• By phone at 1-800-772-1213
• In person at your local Social Security office using Form SSA-1020

Here's a useful backdoor: filing Form SSA-1020 for Extra Help triggers a data transfer to Pennsylvania DHS under the MIPPA law. Pennsylvania then evaluates you for the Medicare Savings Programs using the same data — so one Extra Help application can result in both federal drug savings and state premium assistance.

How Extra Help Works with PACE and PACENET

Pennsylvania runs its own prescription assistance programs — PACE and PACENET — through the Department of Aging. When a beneficiary has both Extra Help and PACE or PACENET, the programs coordinate:

Part D is the primary payer, while PACE or PACENET provides secondary coverage. Extra Help reduces eligible Part D premiums, deductibles, and copayments; PACE or PACENET can then provide wraparound coverage for covered prescriptions.

This layering is one of Pennsylvania's strongest safety nets for prescription costs. A senior who qualifies for QMB, Extra Help, and PACE pays essentially nothing for covered medications.

What Extra Help Reduces

With full Extra Help benefits in 2026:

• Part D plan premium: reduced to $0 for benchmark plans (or a low amount for above-benchmark plans)
• Annual deductible: eliminated
• Copays: $2.00–$4.90 for generics and $5.00–$11.90 for brand-name drugs
• Coverage gap (donut hole): eliminated under the 2025 Part D redesign — the $2,100 annual out-of-pocket cap now applies to everyone

Getting Started

Check whether you might qualify for a Medicare Savings Program first — the auto-deeming path gives you both premium help and drug savings. The Pennsylvania Medicare Savings Programs, Extra Help & PACE/PACENET Guide maps the full interaction between MSP, Extra Help, and PACE/PACENET so you can maximize every layer of assistance your parent is entitled to.

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