Extra Help in Florida: 2026 Income Limits, 2027 Copays and How to Apply

$23,940 a year in income and $18,090 in savings. Those are the 2026 lines for one person to get Extra Help, Medicare's program that helps pay Part D premiums, deductibles and copays. For a married couple living together, it's $32,460 and $36,100. Come in under both, and in 2027 you'll pay no Part D deductible and no more than $14.40 for a covered brand-name drug.

A lot of Floridians already have it. In June 2026, CMS counted 1,020,967 Florida Part D enrollees with Extra Help, about 23% of everyone in the state with Medicare drug coverage. About 92% of them didn't have to apply for Extra Help; they got it automatically through Medicaid, a Medicare Savings Program or SSI. The people I'd most want to check are the ones just above the Medicaid lines, with a Social Security check and some savings, who assume a federal program won't count them. It might.

Source: Medicare.gov, Help with drug costs (2026 limits); CMS CY 2027 Rate Announcement, Table V-2 (copays); CMS Medicare Monthly Enrollment, Florida, June 2026 (deemed plus non-deemed Extra Help enrollees, summed).

The 2026 income and resource limits

Extra Help is the same program in every state. Florida doesn't set its own limits; Social Security and CMS do. The income test is "less than 150% of the federal poverty level," based on household size, and the resource test is a flat dollar figure that CMS raises each year with inflation. Divided by 12, the income lines are about $1,995 a month for one person and $2,705 for a couple (my arithmetic).

Source: Medicare.gov, Help with drug costs; Medicare & You 2027, p. 96. Income and resources must be below these figures. Resource limits include the $1,500-per-person burial allowance (CMS CY 2026 LIS memo).

Three details that change who qualifies:

• The resource figure assumes burial money. CMS's base 2026 limit is $16,590 for one person and $33,100 for a couple. Social Security adds $1,500 per person ($3,000 for a couple) if you say you expect to use some of your savings for funeral or burial costs, and its system adds it automatically unless you say none of it is for that. That's how you get to $18,090 and $36,100.
• Dependents raise the line. Social Security's manual (POMS HI 03020.055) counts you, your spouse if you live together, and any relatives living with you who depend on you for at least half their support. Their income and resources aren't counted. For 2026 the 150% line is $40,980 for a household of three and $49,500 for four. A grandparent in Kissimmee supporting a grandchild on a Social Security check is the kind of case where that matters.
• It's "less than," and it's income after exclusions. Social Security applies its own income exclusions before comparing you to the line, and Medicare's handbook says the limits are higher if you still work. If you're within a few hundred dollars, apply and let Social Security run the numbers.

A married couple living together is tested as a couple even if only one spouse applies. That's in Social Security's manual (POMS HI 03030.025 and HI 03020.055), and it applies even when the other spouse isn't on Medicare yet.

The 2027 limits aren't out yet. CMS's CY 2027 Rate Announcement says the 2027 resource limits come in a separate memo after the September 2026 inflation figure is published; the 2026 memo was dated October 31, 2025. That same 2026 memo said CMS would release the income standards early in the year, after the new poverty guidelines, and I'd expect the same pattern for 2027. I'll update this page when they're published.

What counts and what doesn't

This is where people can rule themselves out by mistake. They add up the value of the house and the car and figure they're "not low-income." Extra Help doesn't count either one.

Source: Medicare.gov, Help with drug costs; Medicare & You 2027, p. 96; CMS CY 2026 LIS memo (real estate other than primary residence); SSA POMS HI 03030.020.

A few notes from CMS and Social Security's manual. Resources mean things you can turn into cash within about 20 days, plus real estate that isn't your home; that's the definition CMS uses under 42 CFR 423.772. For applications filed since January 1, 2010, the cash surrender value of a life insurance policy doesn't count, and neither does "in-kind support," such as a family member covering your rent or groceries. And for the burial allowance, Social Security doesn't ask how much you've actually set aside. You say you expect to use some of your resources for burial, and $1,500 comes off.

The one that does count is the IRA. A $20,000 rollover IRA sitting untouched in a brokerage account puts a single person over the line on its own. That's worth knowing before you apply, not after.

Extra Help vs. Florida's Medicare Savings Programs

Florida's Medicare Savings Programs (QMB, SLMB and QI-1) pay Medicare's Part B premium and, for QMB, a lot more. Get any of them and Extra Help comes along automatically. But Extra Help's limits are much higher, so there's a band of Floridians who earn too much for an MSP and still qualify for Extra Help.

QMB$1,330SLMB$1,596QI-1$1,796Extra Help$1,995

Source: Florida DCF Appendix A-9.1, effective April 2026 (MSP lines); Medicare.gov, Help with drug costs (Extra Help monthly computed from $23,940/yr)

Show the numbers

Item	Monthly income limit
QMB	$1,330
SLMB	$1,596
QI-1	$1,796
Extra Help	$1,995

The resource gap is wider still: $9,950 for an MSP versus $18,090 for Extra Help, for one person. One thing to know about the MSP bars: Florida's Department of Children and Families (DCF) compares them to your income after a $20 disregard, which is why Medicare.gov shows the same lines $20 higher ($1,350 for QMB). Social Security applies its own exclusions before testing you against the Extra Help line. Our Florida Medicare Savings Program guide explains that and the rest of DCF's rules.

Example (hypothetical). Say you're single, living in Ocala, with a Social Security benefit of $1,850 a month ($22,200 a year) and $15,000 in savings. After DCF's $20 disregard you're at $1,830, over the QI-1 line of $1,796, so no MSP. But $22,200 is under $23,940, and $15,000 is under even the base resource limit of $16,590. On those numbers you'd likely qualify for Extra Help, and only an application tells you for sure.

The two applications are linked. When you apply for Extra Help, Social Security sends your information to the state to start an MSP application unless you tell it not to on the form. In Florida that goes to DCF. If you're close to the MSP lines, leave that box alone.

What Extra Help pays in 2026 and 2027

Since January 2024, everyone who qualifies gets the full benefit. The Inflation Reduction Act raised the income line from 135% to 150% of the poverty level and ended the old "partial" subsidy, so there's no sliding scale anymore. What changes is the copay tier, and that depends on whether you also have full Medicaid and where your income falls.

Source: CMS CY 2027 Rate Announcement, Attachment V, Table V-2 (published April 6, 2026). "Generic" covers generic and preferred multi-source drugs; "brand" is all other drugs. Maximums apply up to the out-of-pocket cap; deductible is zero in every group.

"Most people" here means everyone else who qualifies, including people with only a Medicare Savings Program and people approved on a Social Security application.

Those are ceilings set by CMS, not plan prices, and they apply at your plan's participating pharmacies. One wrinkle: Medicare.gov's 2027 Extra Help page still says people with full Medicaid and QMB pay no more than $4.90, while CMS's table sets that brand-name ceiling at $5.00 for 2027. I've gone with CMS's table. Here's what else Extra Help does:

• No deductible. The standard Part D deductible is $615 in 2026 and $700 in 2027. With Extra Help, you skip it.
• Nothing after the cap. Once your total drug costs, counting what Extra Help pays for you, reach $2,400 in 2027 ($2,100 in 2026), Medicare.gov says you pay nothing more for covered drugs that year.
• Premium help up to a benchmark. Social Security's manual says the premium subsidy covers up to the greater of the lowest plan premium or a CMS-set regional "benchmark" amount. If you pick a plan priced above that benchmark, you pay the difference. That's why plan choice still matters with Extra Help, and why the Medicare.gov plan finder or SHINE is worth using before you switch.
• No Part D late penalty. While you have Extra Help, you don't owe it, and a penalty you had before goes away. If you lose Extra Help, join a drug plan within 2 months to avoid it coming back. Our late enrollment penalty guide shows the math.

Example (hypothetical). You fill one generic and two brand-name prescriptions a month in 2027, in the highest copay tier. The most you'd pay is $5.80 + 2 x $14.40 = $34.60 a month, or $415.20 for the year. Those are ceilings for covered drugs at participating pharmacies.

Insulin is its own rule: no more than $35 for a month's supply of each covered insulin product, with no deductible, for everyone with Part D. Our Medicare Part D 2027 changes post covers the rest of next year's drug numbers.

Automatic, or you have to apply

You don't apply if you have Medicare and any of these:

• Full Florida Medicaid
• A Medicare Savings Program that pays your Part B premium (QMB, SLMB or QI-1)
• Supplemental Security Income (SSI)

CMS calls these people "deemed" eligible. Medicare mails a purple letter saying you qualify, and if you don't have a drug plan, Medicare may enroll you in one (you'll get a yellow or green letter) so you can use the help. You can switch to a different plan. One exception: Social Security's manual says people in the QDWI group (Florida calls it Working Disabled) aren't deemed, so they apply like anyone else (DCF's manual, chapter 2000, lists Working Disabled with Florida's Medicare Savings Programs). If you have full Medicaid and Medicare together, our Florida Medicaid and Medicare guide covers how the two fit.

Everyone else applies through Social Security. That's most of the people in the gap above: retirees with a modest pension or Social Security check, no Medicaid, some savings.

• Full Extra Help (not deemed)
• Partial Extra Help

025,00050,00075,000100,000

79,0390

2019202120232025

Source: CMS Medicare Monthly Enrollment, Florida, annual rows

Show the numbers

	Full Extra Help (not deemed)	Partial Extra Help
2019	67,675	29,797
2020	68,987	27,278
2021	68,058	23,797
2022	64,527	20,340
2023	63,704	22,889
2024	76,485	0
2025	79,039	0

The non-deemed group is small next to the 941,671 deemed Floridians in June 2026, but look at 2024. Partial Extra Help went to zero when the law changed, and full Extra Help for non-deemed enrollees jumped from 63,704 in 2023 to 76,485. In June 2026 the count was 79,296. CMS doesn't publish how many Floridians qualify but never apply, so nobody can tell you the size of that group from these numbers. What they do show is that the application route is open and people use it.

How to apply, step by step

1. Gather numbers. Your Social Security award letter (gross amount, before the Part B premium comes out), pension and annuity statements, recent bank statements, and balances for IRAs, brokerage accounts and any property other than your home. Have your spouse's too if you live together.
2. Apply with Social Security. Medicare's handbook points to SSA.gov/extrahelp, and you can apply any time of year. Social Security's paper form is the SSA-1020; its online version is the i1020. SHINE can sit with you and help you fill it out.
3. Decide on the MSP box. Unless you opt out, Social Security forwards your data to Florida to start an MSP application. If DCF contacts you, answer; QMB, SLMB or QI-1 could also pay your $202.90 Part B premium.
4. Have a drug plan. Extra Help only works through Part D, either a standalone plan or a Medicare Advantage plan with drug coverage. Social Security's manual says your Extra Help usually starts the month you apply if you're already in a plan, or the month after the month you enroll in a plan (never before your plan coverage begins).
5. Read the decision letter. It tells you whether you qualify and what you'll pay. If you think it's wrong, the letter explains how to appeal.
6. Check the pharmacy charge. If you're charged more than the Extra Help amounts, call your plan with proof (the colored Medicare letter, an SSI award letter or a Medicaid card), or call 1-800-MEDICARE.

If you qualify but aren't in a drug plan yet, Medicare's LI NET program (1-800-783-1307) gives temporary drug coverage and can pay you back for covered drugs bought after you qualified. Keep the receipts.

Not approved? Medicare.gov says you can reapply any time your income or resources change.

Source: Medicare & You 2027, pp. 97-98; SSA POMS HI 03001.020 (SSA-1020 and i1020); SSA POMS HI 03001.005 (start date, MSP data sharing); Medicare.gov (LI NET, proof, reapplying).

Open Enrollment, the monthly change and the colored letters

Open Enrollment runs October 15 to December 7, 2026, and changes you make take effect January 1. With Extra Help you aren't limited to that window. Under federal rule 42 CFR 423.38(c)(4), and as Medicare.gov describes it, people with Extra Help or Medicaid can change drug coverage once each calendar month: switch to a different drug plan, or leave a Medicare Advantage plan with drug coverage and go back to Original Medicare by joining a standalone drug plan. The change takes effect the first day of the next month.

Two limits on that. It's a change into a standalone drug plan, not into a Medicare Advantage plan (people with full Medicaid have a separate monthly option for integrated dual-eligible plans, where one is available). And it's not available to someone the plan has flagged as "at-risk" under a drug management program; the plan sends a letter if so. There's also a separate 3-month window after you gain, lose or change Extra Help or Medicaid, or get notice of it.

Extra Help runs by calendar year. Once you have it, Medicare.gov says you keep it through December 31 even if your income changes. The fall mail tells you what happens next:

Source: CMS, Guide to consumer mailings in 2026/2027 (as of September 2026); SSA POMS HI 03050.020.

The gray letter is the one not to set aside. It goes to people who were deemed this year (say, through Medicaid) and lost that status. Per Social Security's manual, you keep deemed Extra Help through the end of the calendar year, then it stops unless you apply. Losing Medicaid doesn't mean you're over the Extra Help limits, which are higher. Apply before January if you can.

If an orange letter shows up this month, or a tan or blue one in November, Open Enrollment (through December 7) is a good time to look at drug plans side by side. Our page on Medicare Part D in Florida explains how drug coverage works, and the Medicare.gov plan finder shows plans in your ZIP code.

Where to get help in Florida

• Social Security takes Extra Help applications: SSA.gov/extrahelp.
• 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) can tell you your Extra Help level and help fix a wrong charge with your plan.
• Florida DCF handles QMB, SLMB and QI-1 (limits in its Appendix A-9.1): apply at MyACCESS or call 1-850-300-4323.

Our Florida Medicare overview has the rest of the Medicare calendar.

FAQ

What is the income limit for Extra Help in Florida in 2026?

Less than $23,940 a year for one person and less than $32,460 for a married couple living together. Florida uses the national limits. They're higher if you have dependents living with you or still work.

What is the resource limit for Extra Help in 2026?

$18,090 for one person and $36,100 for a couple. Those figures include $1,500 per person for burial expenses. Your home, one car, a burial plot, household items and life insurance policies don't count.

Do I have to apply for Extra Help if I have Medicaid?

No. If you have Medicare and full Medicaid, a Medicare Savings Program that pays your Part B premium, or SSI, you get Extra Help automatically and Medicare mails you a purple letter. Everyone else applies through Social Security.

How much are Extra Help copays in 2027?

No more than $5.80 for a covered generic and $14.40 for a covered brand-name drug for most people with Extra Help, with no deductible. People with full Medicaid and income at or below the poverty level pay no more than $1.65 and $5.00.

Can I change my drug plan outside Open Enrollment if I get Extra Help?

Yes. With Extra Help or Medicaid you can switch drug plans, or leave a Medicare Advantage plan for Original Medicare plus a standalone drug plan, once each calendar month. The change starts the first day of the next month.

Federal rules and your own income, resources and coverage decide what you qualify for. Confirm your situation with Social Security, SHINE, 1-800-MEDICARE or a licensed agent, and talk to an attorney about legal questions.

Sources

1. Medicare.gov: Help with drug costs (Extra Help)
2. Medicare.gov: Medicare Savings Programs
3. Medicare.gov: Special Enrollment Periods
4. Medicare.gov: Joining a plan (enrollment periods)
5. Medicare.gov: Insulin
6. Medicare & You 2027 handbook
7. CMS: CY 2027 Rate Announcement (Attachment V, Table V-2)
8. CMS: CY 2026 Resource and Cost-Sharing Limits for LIS (memo, Oct. 31, 2025)
9. CMS: Guide to consumer mailings from CMS, Social Security and plans in 2026/2027
10. CMS: Medicare Monthly Enrollment (Florida)
11. SSA POMS HI 03001.020: Eligibility for Extra Help
12. SSA POMS HI 03001.005: Medicare Part D Extra Help
13. SSA POMS HI 03010.005: Interviewing for Extra Help (IRA changes)
14. SSA POMS HI 03020.055: Income limits for subsidy eligibility
15. SSA POMS HI 03030.025: Resource limits for subsidy eligibility
16. SSA POMS HI 03030.020: Resource exclusions
17. SSA POMS HI 03050.020: Redetermination of eligibility for Extra Help
18. 42 CFR 423.38: Enrollment periods (eCFR)
19. Florida DCF: Appendix A-9.1, MSP and LIS financial standards, April 2026
20. Florida DCF ESS Program Policy Manual, chapter 2000 (coverage groups)
21. Florida DCF: Economic Self-Sufficiency FAQ (how to apply)
22. Florida SHINE