Extra Help with Medicare drug costs in Ohio

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. Since 2024, everyone who qualifies gets the full subsidy. 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. If you have full Ohio 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.
• Medicare.gov says you may be able to change your drug coverage once a month, for example to a different standalone Part D plan, instead of only at Open Enrollment.
• 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 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 Ohio

Under 42 CFR 423.773(c), Medicare treats you as eligible, with no application, if you have:

• Full Ohio Medicaid, including people in MyCare Ohio;
• Supplemental Security Income (SSI); or
• A Medicare Savings Program: QMB, SLMB or QI-1, which Ohio calls the Medicare Premium Assistance Programs. See Medicare Savings Programs in Ohio.

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

The income limit is 150 percent of the federal poverty level. The resource limits shown are the ones Medicare.gov and Social Security publish, 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. Resources include bank accounts, stocks, bonds and other investments. Social Security doesn't count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments of Social Security or SSI.

How to apply

1. 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.
2. Have your numbers ready. Bank, investment and retirement account balances, and income such as pensions from OPERS, STRS Ohio or SERS. Social Security may ask for proof later, so keep your statements.
3. Decide about the Ohio referral. Medicare.gov says Social Security will send your information to Ohio to start a Medicare Savings Program application unless you tell it not to. Leaving that on is usually worth it.
4. 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. If your income or savings drop later, you can reapply.

Step by step: How do I apply for Extra Help in Ohio?

Choosing a drug plan in Ohio

Ohio is its own Part D region (Region 14). For 2027, 9 standalone Part D plans from 5 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 Ohio.

Sources

• Medicare.gov — Help with drug costs (Extra Help, 2026 limits, 2027 costs, LI NET)
• Social Security — Extra Help with Medicare prescription drug plan costs
• Social Security — Understanding the Extra Help With Your Medicare Prescription Drug Plan (PDF, August 2026)
• CMS — CY 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (PDF)
• eCFR — 42 CFR 423.773, Requirements for eligibility (deemed eligibility)
• Ohio Administrative Code — Rule 5160:1-3-02.1, Medicare premium assistance programs (MPAP)

Frequently asked questions

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