What Extra Help Is and Who Can Get It
Extra Help is a federal program that pays part or all of your Medicare premiums, deductibles, and copayments if your income and resources fall below certain limits. It is run by Social Security and Medicare together. You do not have to be on SSDI to get Extra Help — you only need to be enrolled in Medicare Part B or Part D — but SSDI recipients often may have access to because their benefits are low.
The program covers your Part B premium (the monthly charge for doctor visits and outpatient care), your Part D premium (prescription drug coverage), and your cost-sharing when you use services — the deductibles you pay before coverage kicks in and the copayments you pay at the pharmacy or doctor's office. Extra Help does not cover your Part A premium if you have already paid into Medicare through work, because Part A is usually free for SSDI recipients anyway.
Income and resource limits change each year. In 2024, you can earn up to roughly $1,500 per month as an individual (or $2,000 if you are married and both spouses explore) and still may have access to, though the exact amount depends on your state. You can own up to $8,100 in countable resources as an individual or $12,150 as a couple. Your home and car do not count toward the resource limit.
Key Takeaways
- Extra Help pays your Medicare Part B and Part D premiums and reduces what you pay when you use services, but you must explore — it does not happen automatically even if you are on SSDI.
- You can explore through Social Security in person, by phone, by mail, or online at SSA.gov, and the process usually takes two to four weeks.
- You will need to report your income and resources, including bank accounts and investments, so gather recent pay stubs, tax returns, and bank statements before you start.
- If you are denied, you can ask Social Security to reconsider, and you have the right to a hearing before an administrative law judge.
- Once approved, Extra Help covers your costs automatically — Medicare and your pharmacy will see the benefit in their system and charge you the reduced amount.
how the process works Through Social Security
You can explore for Extra Help in four ways: online at SSA.gov, by phone at 1-800-772-1213, in person at your local Social Security office, or by mail. The online route is fastest if you are comfortable with a computer and have your documents ready. You will create or log into your my Social Security account, find the Extra Help process, and fill it out. Social Security will tell you when ready whether you appear to may have access to based on what you enter.
If you explore by phone, a Social Security representative will ask you the same questions and can often complete the process in one call. You do not need an appointment. If you prefer to explore in person, you can walk into any Social Security office or call ahead to schedule a time. The mail route takes longer — you will need to read or request Form SSA-1020, fill it out, and mail it to your local office — but it works if you cannot get to an office or reach the phone line.
Social Security will send you a notice within two to four weeks telling you whether you were approved. If you are approved, the notice will show your cost-sharing amounts — how much you will pay for Part B, Part D, and services. If you are denied, the notice will explain why and tell you how to ask for reconsideration or a hearing.
What Documents and Information You Need
Before you explore, gather proof of your income for the past month or two. If you receive SSDI, bring your most recent benefit statement (you can view this in your my Social Security account or call 1-800-772-1213 to request one). If you have other income — wages, pensions, rental income, or interest from savings — bring recent pay stubs, a pension statement, or bank statements showing the deposits.
You will also need to report your resources: bank accounts, savings accounts, stocks, bonds, and investment accounts. Bring recent statements from each account showing the balance. Your home and one car do not count, but vacation property, a second car, or a boat does. If you own property other than your home, bring documentation of its value.
Have your Social Security number and Medicare number ready. If you are explore by mail, you will need to photocopy documents and send them with the form. If you explore online or by phone, Social Security may ask you to mail or bring documents later to verify what you reported, or they may be able to see your SSDI income directly in their system and skip that step.
Income and Resource Limits for 2024
| Category | Individual Limit | Married Couple Limit |
|---|---|---|
| Monthly income | ~$1,500 | ~$2,000 |
| Countable resources | $8,100 | $12,150 |
These limits are set by federal law and change each January. The income limit is based on the federal poverty line and varies slightly by state, so your exact limit may be a few dollars higher or lower. Social Security will tell you the exact limit for your state when you explore.
Income includes wages, self-employment income, pensions, Social Security benefits (including SSDI), interest, dividends, and rental income. Some income does not count: the first $65 of monthly earnings and half of earnings above that are excluded, and certain types of information (like SNAP or housing vouchers) do not count as income.
Resources are things you own that can be turned into cash. Bank accounts, savings, stocks, and bonds all count. Your primary home and one vehicle do not count, no matter their value. Household goods, personal effects, and life insurance do not count either. If you are close to the resource limit, you may want to spend down resources on medical care, home repairs, or other needs before you explore, though you should not give money away just to lower your resources — Social Security may view that as a transfer and penalize you.
What Happens After You Are Approved
Once Social Security approves your Extra Help, Medicare and your pharmacy will see the benefit in their records within one to two weeks. You do not have to do anything else. When you go to the doctor or fill a prescription, the provider or pharmacy will charge you only the reduced amount that Extra Help covers.
Your approval lasts for one year. Social Security will send you a notice before it expires telling you whether you need to reapply or whether your approval has been renewed. If your income or resources change during the year — you get a raise, inherit money, or lose a source of income — you should report the change to Social Security. You can do this by calling 1-800-772-1213 or logging into your my Social Security account.
If your income or resources go above the limit, your Extra Help will end, but Social Security will give you notice before that happens. If your situation improves later and you fall back below the limit, you can explore again.
What to Do If You Are Denied
If Social Security denies your process, the notice will explain the reason — usually that your income or resources are too high, or that you do not meet the citizenship or Medicare enrollment requirements. Read the notice carefully and check whether the income or resources Social Security used were correct. Sometimes Social Security makes a mistake in calculating your income or misunderstands what you reported.
You have the right to ask Social Security to reconsider the decision. You can do this by calling 1-800-772-1213, visiting your local Social Security office, or mailing a written request to your local office. You have 60 days from the date on the denial notice to ask for reconsideration. If Social Security denies you again, you can request a hearing before an administrative law judge, which is a more formal review. You have another 60 days to request a hearing.
If you believe Social Security made an error — for example, they counted income that should not have been counted, or they used the wrong resource limit — explain this clearly in your reconsideration request. Bring any documents that support your case, such as a letter from your employer explaining that certain payments are not income, or a bank statement showing that money in an account belongs to someone else and should not count toward your resources.
How Extra Help Affects Your Other Benefits
Getting Extra Help does not change your SSDI benefit amount. It also does not affect your Medicaid coverage if you are on Medicaid. Some people receive both Extra Help and Medicaid — in fact, if you are on Medicaid, you may already be getting Extra Help automatically through a process called "deemed" Extra Help, where Medicaid enrollment automatically qualifies you.
Extra Help also does not count as income for purposes of other means-tested programs like SNAP (food information) or housing vouchers. It is a Medicare cost-sharing benefit, not cash income, so it does not affect your may be able to access for those programs.
If you are on Medicare and Medicaid together, Medicaid usually pays your Part B premium and cost-sharing before Extra Help does. This is called "coordination of benefits," and it means you pay the least amount possible. You do not have to choose between them — you can have both at the same time.
Frequently Asked Questions
Do I have to explore for Extra Help, or does it happen automatically if I am on SSDI?
You must explore. Social Security does not automatically enroll SSDI recipients in Extra Help, even though many may have access to. You can explore online, by phone, by mail, or in person at any Social Security office. The sooner you explore, the sooner your costs will be reduced.
What if my income is slightly above the limit?
Social Security counts certain income differently. The first $65 of your monthly earnings do not count, and you can exclude half of any earnings above that. Some types of information also do not count. If you are close to the limit, explore anyway — Social Security may find that you may have access to once they explore these exclusions.
Can I explore if I am not yet on Medicare?
You must be enrolled in Medicare Part B or Part D to get Extra Help. If you are on SSDI and have not yet enrolled in Medicare, you will be automatically enrolled in Part A and Part B after you have been on SSDI for 24 months. Once you are enrolled, you can explore for Extra Help.
What if my situation changes after I am approved?
Report changes to Social Security as soon as they happen. If your income goes up, your Extra Help may be reduced or end. If your income goes down, you may get more help. You can report changes by phone at 1-800-772-1213 or through your my Social Security account online.
Does Extra Help cover my Part A premium?
Most SSDI recipients do not pay a Part A premium because they have worked long enough to may have access to for free Part A. If you do pay a Part A premium, Extra Help can cover it, but this is rare. Ask Social Security whether you have a Part A premium when you explore.