Extra Help (officially the Part D Low-Income Subsidy, or LIS) is a federal program run by Social Security and Medicare. It helps pay Part D plan premiums, deductibles and copays. Since 2024, everyone who qualifies gets the full subsidy; there is no longer a partial level. The rules and limits are the same across the lower 48 states, but how it connects with Oregon's own programs is worth knowing.
What Extra Help pays in 2026
- Premium: you pay no monthly premium if you choose a "benchmark" Part D plan (a plan with a premium at or below the subsidy amount for Oregon and Washington's Part D region). With another plan, you pay the difference.
- Deductible: $0.
- Copays: no more than $5.10 for a generic and $12.65 for a brand-name drug covered by your plan. People with full Medicaid and income at or below 100% of the poverty level pay no more than $1.60 and $4.90, and people with full Medicaid who live in a nursing home or get home- and community-based services pay $0.
- After the cap: once your out-of-pocket costs reach the 2026 Part D cap of $2,100, you pay $0 for covered drugs for the rest of the year.
Coverage still depends on each plan's drug list (formulary), so check that your drugs are covered before you choose a plan.
Who qualifies
| 2026 limit | Single | Married, living together |
|---|---|---|
| Yearly income (150% of the federal poverty level) | $23,940 | $32,460 |
| Resources | $16,590 | $33,100 |
| Resources, if you plan to use some for burial | $18,090 | $36,100 |
Resources include bank accounts, stocks and bonds. Your home, one car, household goods and personal belongings don't count. Social Security counts income in its own way (some income isn't counted), so apply even if you are a little over the income limit. The 2027 income limits follow the federal poverty guidelines published in early 2027.
Who gets Extra Help automatically
You don't have to apply if you have Medicare and any of these:
- Full coverage from the Oregon Health Plan (Medicaid). OHA says most OHP members with Medicare have "OHP with Limited Drug," which means Medicare Part D covers their drugs.
- An Oregon Medicare Savings Program: QMB, SMB (called SLMB elsewhere) or the SMF benefit (called QI elsewhere).
- Supplemental Security Income (SSI).
Medicare mails you a notice that you qualify. If you have one of these and don't pick a Part D plan, Medicare enrolls you in one, which you can change.
An Oregon route to Extra Help: Oregon has had no asset limit for QMB, SMB or the SMF benefit since January 1, 2016. Extra Help has a resource limit, but anyone enrolled in a Medicare Savings Program gets Extra Help automatically. So if your income is low but your savings are above the Extra Help limit, apply for a Medicare Savings Program through ODHS. See Medicare Savings Programs in Oregon.
How to apply
- Apply with Social Security. Online at ssa.gov/extrahelp, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or at a Social Security office.
- Or apply for a Medicare Savings Program in Oregon. Online at one.oregon.gov, by calling the ONE Customer Service Center at 1-800-699-9075 (TTY 711), or at a local ODHS office. If you qualify, you get Extra Help automatically.
- Watch for the decision. Social Security sends a letter. If you are approved, it also tells Medicare.
- Choose a Part D plan. Pick a plan that covers your drugs. A benchmark plan means no premium.
Changing plans with Extra Help
- Monthly special enrollment period. Since January 1, 2025, people with Extra Help or Medicaid can switch standalone Part D plans, or leave a Medicare Advantage plan for Original Medicare with a standalone Part D plan, once a month. The change starts the first of the next month.
- Integrated plans. People with full Medicaid can also join certain dual eligible special needs plans (D-SNPs) that are integrated with OHP once a month.
- Open Enrollment. Everyone can change plans from October 15 to December 7.
- At the pharmacy. If you are charged more than the Extra Help copay soon after you qualify, show your Extra Help or Medicaid letter. Medicare has a process to get the correct amount applied.
Choosing a Part D plan with Extra Help
For 2027, CMS data show 8 standalone Part D plans in Oregon from 4 companies, and many Medicare Advantage plans include drug coverage. With Extra Help, the two things to check are whether the plan is a benchmark plan (no premium for you) and whether it covers each of your drugs. You can compare plans by ZIP code on PlanMatch or Medicare.gov, or you can request a call from a licensed insurance agent to review plans from the companies they work with.
Related guides
- Medicare Savings Programs in Oregon
- The Oregon Health Plan and Medicare
- Medicare Part D in Oregon
- How do I get Extra Help with drug costs in Oregon?
Sources
- Social Security — Extra Help with Medicare prescription drug plan costs
- Medicare.gov — Help with drug costs (Extra Help)
- CMS — CY 2026 Resource and Cost-Sharing Limits for the Low-Income Subsidy (memo)
- Social Security POMS HI 03001.020 — 2026 Extra Help income limits
- CMS — Dual/LIS and integrated care special enrollment periods job aid (January 1, 2025)
- Oregon Department of Human Services — Medicare Savings Programs (no asset limits; how to apply)
- ODHS transmittal APD-PT-21-041 — resource limits for QMB, SMB and SMF eliminated January 1, 2016
- Oregon Health Authority — OHP and Medicare (OHP with Limited Drug)
Frequently asked questions
How much income can I have and still qualify for Extra Help in Oregon?
For 2026, up to 150% of the federal poverty level: $23,940 a year for one person or $32,460 for a married couple living together. Your resources must also be under $18,090 (single) or $36,100 (married), counting up to $1,500 each set aside for burial. The limits are the same in every state except Alaska and Hawaii.
Do I have to apply for Extra Help if I have the Oregon Health Plan?
No. If you have Medicare and full OHP coverage, an Oregon Medicare Savings Program (QMB, SMB or the SMF benefit) or SSI, Medicare gives you Extra Help automatically and mails you a notice. You don't need a separate application.
How do I apply for Extra Help if I don't get it automatically?
Apply online at ssa.gov/extrahelp, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or visit a Social Security office. You can also apply for an Oregon Medicare Savings Program through ODHS; if you qualify, Extra Help follows automatically.
How much will my drugs cost with Extra Help in 2026?
No more than $5.10 for each generic and $12.65 for each brand-name drug covered by your plan, and less for some people with full Medicaid. Once your out-of-pocket costs reach the yearly Part D cap, you pay nothing for covered drugs.
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