What Extra Help does
Extra Help is a Medicare program that Social Security and Medicare run the same way in every state. Medicare.gov describes it as help paying Part D premiums, deductibles, coinsurance and other drug costs. With Extra Help in 2026:
- You pay no more than $5.10 for each generic drug and $12.65 for each brand-name drug your plan covers. With full Medicaid and income at or below the poverty level, the caps are $1.60 and $4.90.
- You don't pay a Part D late enrollment penalty while you have it.
- Once your drug costs reach the Part D out-of-pocket cap ($2,100 in 2026), you pay nothing more for covered drugs that year.
- Medicare.gov says you may be able to change your drug coverage once per month.
Medicare.gov has already posted slightly higher copay caps and a higher out-of-pocket cap for 2027; see Medicare costs in 2027.
Who gets it automatically in Florida
Under 42 CFR 423.773(c), Medicare treats you as eligible, with no application, if you have:
- Full Florida Medicaid, for example through SSI, Medically Needy or long-term care Medicaid;
- Supplemental Security Income (SSI); or
- A Medicare Savings Program: QMB, SLMB or QI1, which DCF decides. See Medicare Savings Programs in Florida.
You get a notice in the mail. If you don't already have a drug plan, Medicare enrolls you in one so the savings start; you can pick a different plan. Medicare.gov says you keep Extra Help through December 31 even if your income changes during the year. If you qualify but aren't in a plan yet, Medicare's Limited Income Newly Eligible Transition (LI NET) program can cover drugs for a short time (1-800-783-1307, TTY 711).
2026 limits if you apply
| Your situation | Yearly income below | Resources up to |
|---|---|---|
| Single | $23,940 | $18,090 |
| Married, living together | $32,460 | $36,100 |
The income limit is 150 percent of the federal poverty level. The resource limits are the ones Medicare.gov publishes, which include up to $1,500 per person that you expect to use for funeral or burial costs; without that, CMS lists $16,590 and $33,100. DCF's own chart for Florida, Appendix A-9.1, shows the same Extra Help asset limits and a 150 percent income column by household size.
Extra Help reaches further than Florida's Medicare Savings Programs. QI1 stops at 135 percent of the poverty level, and the Medicare Savings Program asset limit is $9,950 for one person. Extra Help goes up to 150 percent with a higher resource limit, so many Floridians who are over the DCF limits still qualify. Apply even if DCF turned you down.
How to apply in Florida
- Apply with Social Security. Online at ssa.gov/medicare/part-d-extra-help, by phone at 1-800-772-1213 (TTY 1-800-325-0778), with paper form SSA-1020, or at a Social Security office. You can apply any time of year.
- Leave the Medicare Savings Program referral on. Medicare.gov says Social Security sends your information to the state to start a Medicare Savings Program application unless you tell it not to. In Florida that case goes to DCF, which can also pay your Part B premium.
- Read the decision letter. If you're approved, choose or keep a Part D plan or a Medicare Advantage plan with drug coverage. If you're turned down, the letter explains how to appeal, and you can reapply if your income or savings drop.
Step by step: How do I apply for Extra Help in Florida?
Other Florida help with drug costs
Florida doesn't have a state drug-assistance program for seniors (more on that), so for most people Extra Help is the help that exists. People living with HIV can ask the Department of Health's AIDS Drug Assistance Program (ADAP) what it covers for people with Medicare. Anyone with Part D can also spread drug costs over the year through the Medicare Prescription Payment Plan.
State retirees who keep State Group Insurance as secondary coverage after Medicare don't need a separate Part D plan: the State's retiree FAQ says its drug coverage is creditable. Ask People First before joining any outside Medicare plan. See Florida state retirees and Medicare.
Choosing a drug plan in Florida
Florida is its own Part D region (Region 11). For 2027, 11 standalone Part D plans from 6 companies are offered statewide, plus Medicare Advantage plans with drug coverage that vary by county. With Extra Help, what you pay depends on the plan you choose, so check that your drugs are on the plan's list. You can compare plans with your drugs at PlanMatch, or you can request a call from a licensed insurance agent to compare plans from the companies they work with. Medicare.gov and 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) can give you information on all of your options. More in Medicare Part D in Florida.
Sources
- Medicare.gov — Help with drug costs (Extra Help, 2026 limits, 2027 costs, LI NET, MSP referral)
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — CY 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (PDF)
- eCFR — 42 CFR 423.773, Requirements for eligibility (deemed eligibility)
- Florida DCF — Appendix A-9.1, Medicare Savings Programs and LIS Financial Standards, effective April 2026 (PDF)
- Florida Department of Health — AIDS Drug Assistance Program (ADAP)
- Division of State Group Insurance — Frequently Asked Questions, Retirees
- Medicare.gov — Medicare Savings Programs
Frequently asked questions
Does a Medicare Savings Program qualify me for Extra Help automatically?
Yes. Medicare.gov says people who get help from their state paying Part B premiums through a Medicare Savings Program get Extra Help automatically, and so do people with full Medicaid or SSI. In Florida that means anyone DCF approves for QMB, SLMB or QI1 doesn't need to apply separately.
What are the Extra Help income limits for 2027?
They aren't published yet. The income limit is 150 percent of the federal poverty guidelines, which HHS updates early each year. Until then, the 2026 limit is yearly income under $23,940 for one person or $32,460 for a married couple.
Does Florida have its own drug-assistance program for seniors?
No. Florida doesn't run a state drug-assistance program for older adults, so Extra Help is the main help with Part D costs. People living with HIV can ask the Florida Department of Health's AIDS Drug Assistance Program what it covers for people with Medicare.
Can I change drug plans during the year with Extra Help?
Medicare.gov says people with Medicaid or Extra Help may be able to change their drug coverage once per month. Most people with Medicare can switch only during set enrollment periods.
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