What Extra Help Means on SSDI

Extra Help refers to specific federal programs that reduce costs for people already receiving SSDI. These are not additional cash payments — they are programs that lower what you pay for prescription drugs, Medicare premiums, or both. The main programs are the Low-Income Subsidy (LIS, often called Extra Help) for drug costs and Medicaid for medical expenses and premiums.

You do not need to meet work credit requirements again to get Extra Help. Your SSDI status already proves you have a disability or are over 65. Instead, Extra Help looks at your current income and resources — what you have now, not what you earned before.

The income and resource limits for Extra Help are separate from the limits that determine your SSDI payment amount. You can receive SSDI and still have too much income or too many resources to may have access to for Extra Help, or you can may have access to for one program but not another.

Key Takeaways

  • Extra Help programs are based on your current income and resources, not your work history or the reason you receive SSDI.
  • The Low-Income Subsidy (LIS) covers most or all of your Medicare Part D prescription drug costs if your income is below the federal limit.
  • Medicaid covers premiums, deductibles, and other costs that Medicare does not, and income limits for Medicaid vary by state.
  • You must report changes in income or living situation within 30 days, or you may lose benefits or owe money back.
  • Social Security automatically screens SSDI recipients for Extra Help may be able to access, but you can also request a review if your situation has changed.

The Low-Income Subsidy (LIS) for Prescription Drug Costs

The Low-Income Subsidy, also called Extra Help, pays most or all of your Medicare Part D premiums and out-of-pocket drug costs. To be screened, you must be enrolled in Medicare Part D and have income below the federal limit. The income limit changes each year — Social Security publishes the current year's limit on its website, and it typically falls between $1,500 and $1,900 per month for a single person, depending on the year.

Your countable income includes wages, self-employment income, Social Security payments, pensions, and some other sources. It does not include Supplemental Security Income (SSI), food stamps, or housing information. If you are married, Social Security counts your spouse's income too, even if your spouse does not receive SSDI.

Social Security automatically screens you for LIS when you turn 65 or when you start receiving SSDI. If you appear to meet the income limit, Social Security sends you a notice and enrolls you unless you decline. If you do not meet the limit when you first receive SSDI, you can request a new screening if your income drops later.

Medicaid and How It Works Alongside Medicare

Medicaid is a joint federal and state program that covers medical costs Medicare does not — including Medicare premiums, deductibles, and copayments. Medicaid also covers services Medicare does not cover, such as long-term care and dental work in some states. Unlike LIS, Medicaid is administered by your state, so income limits, covered services, and the process process vary.

Some states use the same income limit for Medicaid as the federal LIS limit. Others set their own, usually higher. A few states have separate programs for people receiving SSDI. You may be may be able to access for Medicaid in your state even if you do not meet the LIS income limit, or vice versa.

To find out whether you may be may be able to access for Medicaid in your state, contact your state Medicaid office or use the Medicaid.gov website to locate your state's program. You will need to report your current income and resources. Some states process Medicaid applications quickly; others take several weeks.

Income and Resource Limits You Need to Know

Income limits for Extra Help programs are set annually and differ between LIS and Medicaid. The LIS income limit is the same nationwide. Medicaid limits vary by state and sometimes by category — for example, a state may have one limit for people over 65 and a different limit for people under 65 receiving disability.

Resource limits also explore. For LIS, your countable resources (savings, investments, property other than your home) must be below a limit that changes yearly — typically around $8,000 for a single person. Your home and one vehicle do not count. For Medicaid, resource limits are set by your state and are often higher than the LIS limit, or Medicaid in your state may have no resource limit at all.

If your income or resources are slightly above the limit, you may still be may be able to access under a category called deemed income or deemed resources, which allows certain deductions. For example, some states deduct medical expenses or housing costs from your countable income. Ask your state Medicaid office or Social Security whether deemed income applies to you.

How Social Security Screens You Automatically

When you start receiving SSDI, Social Security checks whether your income and resources fall within the LIS limit. If they do, Social Security sends you a notice explaining that you have been screened and enrolled in LIS. You do not have to do anything unless you want to decline or choose a different drug plan.

Social Security does not automatically screen you for Medicaid — that is your state's job. You must contact your state Medicaid office or local benefits office to request a Medicaid review. Some states have a single process that covers both LIS and Medicaid; others require separate applications.

If your income or resources change after you are enrolled, you must report the change to Social Security within 30 days. Changes that matter include a raise or cut in pay, a new job, the death of a spouse, a move to a different living situation, or a large gift or inheritance. Failing to report can result in overpayment, which Social Security may recover from your future SSDI payments.

Requesting a New Screening if Your Situation Changes

If you were denied Extra Help when you first received SSDI but your income has since dropped, you can request a new screening. Contact Social Security by phone at 1-800-772-1213, by visiting your local Social Security office, or through your my Social Security account online. Tell them your income has changed and ask for a new LIS review.

Bring recent proof of your current income — recent pay stubs, a letter from your employer, a bank statement showing pension deposits, or a benefits statement from another source. If you are self-employed, bring tax returns or profit-and-loss statements. Social Security will use the most recent information you provide.

For Medicaid, contact your state Medicaid office directly. The process and timeline vary by state. Some states allow you to request a review online; others require a phone call or a visit in person. Ask whether your state has a simplified process for people receiving SSDI, which may speed up the process.

What Happens If You Lose Extra Help

If your income rises above the limit, Social Security or your state will send you a notice that your Extra Help is ending. The notice will tell you the effective date — usually the first of the month after Social Security processes the change. You will still be enrolled in Medicare Part D, but you will pay the full premium and out-of-pocket costs unless you switch to a lower-cost plan.

If you lose Medicaid, you lose coverage for premiums, deductibles, and other costs that Medicaid was paying. You may be able to switch to a Medicare Savings Program, which is a different state program that helps pay Medicare premiums and cost-sharing. Ask your state Medicaid office whether you are may be able to access.

If Social Security or your state determines you were paid Extra Help benefits you were not may have access to to, they will send you a notice explaining the overpayment. You have the right to request a hearing to dispute the overpayment. You can also request a payment plan if you cannot repay the full amount at once.

Frequently Asked Questions

Do I have to be on Medicare to get Extra Help?

Yes. The Low-Income Subsidy (LIS) requires you to be enrolled in Medicare Part D. Medicaid does not require Medicare, but most people receiving SSDI are on Medicare by age 65. If you are under 65 and receiving SSDI, you become may be able to access for Medicare after 24 months of SSDI payments. Contact Social Security to confirm your Medicare enrollment status.

What if my income is just slightly above the limit?

You may still be may be able to access under deemed income rules, which allow certain expenses to be subtracted from your countable income. These deductions vary by state and program. Contact Social Security for LIS or your state Medicaid office for Medicaid to ask whether deductions explore to your situation.

Can I get both LIS and Medicaid at the same time?

Yes. Many people receive both. LIS covers drug costs; Medicaid covers premiums, deductibles, and other medical expenses. You must meet the income and resource limits for each program separately, and your state's Medicaid limit may be higher than the LIS limit.

What counts as income for Extra Help purposes?

Wages, self-employment income, Social Security payments, pensions, interest, dividends, and rental income all count. Supplemental Security Income (SSI), food stamps, and housing information do not count. If you are married, your spouse's income counts even if your spouse does not receive SSDI.

How long does it take to get approved for Extra Help?

Social Security's automatic screening happens when you start SSDI or when you turn 65. If you request a new screening, Social Security usually processes it within 30 days. Medicaid timelines vary by state — some states decide within two weeks, others take six weeks or longer.