Extra Help (Low-Income Subsidy) in Hawaii
Extra Help — also called the Low-Income Subsidy (LIS) — is a federal program that dramatically reduces what Medicare beneficiaries pay for prescription drugs. If you qualify, your medication costs drop to a few dollars or less per fill.
What Extra Help covers
If you qualify for full Extra Help in 2026:
- $0 Part D plan premium for benchmark plans (the cheapest plans in your area)
- $0 Part D deductible
- $1.55 max copay for generic drugs
- $11.20 max copay for brand-name drugs
- $0 cost after you reach the catastrophic coverage threshold
- $0 copay for institutionalized beneficiaries (nursing homes)
2026 income and asset limits for Extra Help
Hawaii uses the federal limits, but Hawaii's higher cost of living means more people qualify:
| Category | Income limit | Asset limit |
|---|---|---|
| Single — full Extra Help | ~$23,475/year | ~$17,600 |
| Married couple — full Extra Help | ~$31,725/year | ~$35,130 |
Excluded assets: your home, one car, household items, burial plot, $1,500 burial fund per person.
Automatic qualification
You automatically qualify for Extra Help if you:
- Have full Med-QUEST (Medicaid)
- Have any Medicare Savings Program (QMB, SLMB, or QI)
- Receive Supplemental Security Income (SSI)
If you fall into any of these categories, the Social Security Administration enrolls you in Extra Help automatically — no application needed.
How Extra Help affects Part D plan choice
With Extra Help, your Part D options change:
- You can enroll in any Part D or Medicare Advantage Prescription Drug (MAPD) plan
- Benchmark plans (those at or below the regional benchmark) have $0 premium with Extra Help
- You can change plans monthly via the Extra Help Special Enrollment Period
- If you don't choose a plan, Medicare auto-enrolls you in a benchmark plan
Applying for Extra Help
If you don't qualify automatically, you can apply through Social Security:
- Online: secure.ssa.gov/i1020/start
- Phone: Call Social Security at 1-800-772-1213
- In person: Visit a Social Security office
- Free help: Sage PLUS Hawaii at 1-888-875-9229 can walk you through the application
Applying for Extra Help does not require applying for any other benefit. The application is straightforward — typically 10-15 minutes.
Apply for MSP at the same time
If you qualify for Extra Help, you may also qualify for a Medicare Savings Program through Med-QUEST. SSA will share your Extra Help application data with Hawaii Med-QUEST if you check the box authorizing it — Med-QUEST then determines MSP eligibility separately.
Partial Extra Help
If your income is slightly above the full Extra Help limit, you may qualify for partial Extra Help with smaller benefits. As of 2024, the partial vs. full distinction was largely eliminated by the Inflation Reduction Act — most beneficiaries who would have qualified for partial now get full Extra Help.
Frequently asked questions
No. Once you qualify, you stay qualified unless your circumstances change significantly. Social Security may send periodic verification requests; respond promptly to keep your benefits.
Yes. Extra Help has higher income limits than Medicaid. Many Medicare beneficiaries qualify for Extra Help without qualifying for full Medicaid.
Extra Help dramatically reduces costs but doesn't change what's on your plan's formulary. You still need a Part D plan that covers your specific medications. Use Medicare.gov Plan Finder with your medication list to find the best fit.
Extra Help covers the Part D portion of a Medicare Advantage Prescription Drug (MAPD) plan. If the MAPD plan has a non-drug premium, that part is not covered by Extra Help.