Extra Help in Washington State: 2026 Limits, 2027 Copays and the MSP Shortcut

$23,940 a year in income and $18,090 in savings. Those are the 2026 lines for one person in Washington to get Extra Help, the federal program (officially the Part D Low-Income Subsidy) that helps pay Medicare drug coverage premiums, deductibles and copays. For a married couple living together it's $32,460 and $36,100.

265,836 Washingtonians had it in July 2026, according to CMS enrollment data, and about 95% of them never filled out an Extra Help application. They got it automatically through Apple Health, a Medicare Savings Program or SSI. That second route deserves a close look in Washington, because the state's Medicare Savings Programs don't check your bank balance at all.

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

The 2026 limits, and why you'll see two resource numbers

Washington doesn't set its own Extra Help limits. Social Security and CMS do, and they're the same here as in Oregon, Idaho or Florida (only Alaska and Hawaii differ). Income has to be below 150% of the federal poverty level for your household size. Divided by 12, that's about $1,995 a month for one person and $2,705 for a couple (my arithmetic).

Source: Medicare.gov, Help with drug costs; SSA POMS HI 03001.020 (150% of the 2026 poverty level); Medicare & You 2027, p. 96 (what counts). Monthly figures are the annual limit divided by 12. Resource limits include $1,500 per person for burial expenses.

Now the confusing part. If you look at the Washington Health Care Authority's Apple Health income and resource chart (HCA 19-0096), it lists the Low Income Subsidy resource limit as $16,590 for a single person and $33,100 for a couple. That's not a typo, and it doesn't conflict with Medicare.gov.

Social Security's manual (POMS HI 03030.025) sets the base 2026 limit at $16,590 and $33,100, then adds a $1,500 burial allowance per person ($3,000 for a couple) for anyone who expects to use some of their savings for funeral or burial costs. Add those together and you get Medicare.gov's $18,090 and $36,100. CMS's 2027 Rate Announcement uses the same $18,090 figure "including $1,500 per person for burial expenses." Most people end up tested against the higher number, so that's the one I'd use.

A few rules decide who's actually under those lines:

• Your house and car don't count. Medicare.gov and the Medicare & You handbook leave out your home, one car, a burial plot, furniture and household items, and life insurance. What counts is checking and savings, stocks, bonds and retirement accounts. A rollover IRA you never touch still counts.
• Some income doesn't count either. SNAP, housing assistance, home energy assistance, disaster assistance, and help from family paying household bills are all left out. Social Security, pensions, annuities, wages, rental income and veterans benefits count.
• Dependents raise the line. Social Security counts you, your spouse if you live together, and relatives living with you who depend on you for at least half their support. For 2026, 150% of the poverty level is $40,980 for three people and $49,500 for four. Medicare's handbook adds that limits are higher if you still work.
• Couples are tested together. A married couple living together uses the two-person figures whether one or both of you apply.

The 2027 limits aren't published yet. CMS says the resource figures come in a separate memo after the September 2026 inflation number is out. The income lines follow the 2027 poverty guidelines, which Social Security's manual (POMS HI 03001.020) says become available for program use in late January. I'll update this page when they land. If you're close, don't wait for them; apply and let Social Security run the numbers.

The Washington shortcut: Apple Health, MSPs and SSI

Medicare.gov is clear on this: you get Extra Help automatically if you have Medicare and full-benefit Medicaid, a Medicare Savings Program that pays your Part B premium, or SSI. CMS calls these people "deemed" eligible, and Social Security's manual (POMS HI 03001.005) says they shouldn't even file an Extra Help application. Medicare mails a purple letter instead.

Source: Medicare.gov, Help with drug costs; SSA POMS HI 03001.005 (deemed groups; QDWI is not deemed); HCA 22-500 (Social Security phone).

Here's why that matters so much in Washington. Extra Help has a resource test. Washington's Medicare Savings Programs don't. HCA's MSP page says it in so many words: "There are no asset tests for MSPs," and WAC 182-517-0100 says the federal MSPs don't require a resource test. So if your income fits under one of the MSP lines below, your savings don't matter for the MSP, and the MSP carries Extra Help with it.

Source: HCA Apple Health Income and Resource Standards (HCA 19-0096), MSP standards effective April 1, 2026, which include the $20 income disregard (the Extra Help figures are the annual limits divided by 12 with no disregard added, so the rows are not exactly like-for-like); WAC 182-517-0100; HCA, Medicare Savings Program (no asset test); Medicare.gov (Extra Help annual limits, divided by 12).

Example (hypothetical). Say you're single, living in Yakima, with a Social Security benefit of $1,800 a month ($21,600 a year) and $40,000 in a savings account and an IRA. Apply for Extra Help directly and the income is fine (under $23,940), but the $40,000 is well over the $18,090 resource limit. Denied. Now apply for a Washington MSP instead. $1,800 sits between the SLMB line ($1,616) and the QI-1 line ($1,855) on HCA's chart, and nobody asks about the $40,000. On those numbers you'd likely land in QI-1, and with QI-1 comes Extra Help automatically. Two catches: QI-1 runs only until the state's federal funding allotment for the year is spent (WAC 182-517-0100), and only HCA and Social Security can make the actual call, and the $20 disregard and other details are explained in our Washington Medicare Savings Program guide.

That's not a loophole. It's two published rules sitting side by side: Medicare.gov's "automatic if you have an MSP" and HCA's "no asset test." But it's easy to talk yourself out of applying if you read the Extra Help resource limit first and stop there.

Two caveats. QDWI, the MSP for working people with disabilities who are under 65, is the exception: Social Security's manual says QDWI enrollees aren't deemed, so they apply for Extra Help like anyone else. And SSI-related Apple Health has much tighter lines ($994 a month and $2,000 in resources for one person, per HCA's chart), so for most retirees the MSP is the realistic door. Our Apple Health and Medicare guide covers how full Apple Health and Medicare work together.

What Extra Help pays in 2027

Since January 1, 2024, there's only one level of Extra Help. The Inflation Reduction Act raised the income line from 135% to 150% of poverty and ended the old partial subsidy, so everyone who qualifies gets the full benefit. What varies is your copay tier, and that depends on whether you also have full Apple Health and where your income falls.

Source: CMS CY 2027 Rate Announcement, Attachment V, Table V-2 (April 6, 2026). "Generic" covers generic and preferred multi-source drugs; "brand" is all other drugs. "Most people" includes MSP-only, SSI and approved applicants. Maximums apply up to the out-of-pocket threshold; the deductible is zero for every Extra Help group. COPES: HCA 19-0009.

Those are ceilings CMS sets, not plan prices, and they apply to covered drugs at your plan's participating pharmacies. One note if you compare sources: Medicare.gov's Extra Help page says people with full Medicaid who are also in QMB pay no more than $4.90 for each covered drug, which is the 2026 figure. CMS's table sets it at $5.00 for 2027, and I've used the table.

The rest of what 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 threshold. Once your total drug costs, counting what Extra Help pays on your behalf, reach $2,400 in 2027 ($2,100 in 2026), you pay nothing more for covered drugs that year.
• Premium help up to a regional benchmark. CMS pays the subsidized part of your premium straight to your plan. Social Security's manual says the subsidy is based on the region's benchmark premium, and if you choose a plan priced above it, you pay the difference. So plan choice still matters with Extra Help.
• No Part D late penalty while you have Extra Help.

Example (hypothetical). You fill four generics and one brand-name drug a month in 2027, in the most common tier. The most you'd pay is 4 x $5.80 + $14.40 = $37.60 a month, or $451.20 over a year. Those are maximums, and they stop once total drug costs reach the $2,400 threshold.

Insulin has its own cap for everyone with Part D, Extra Help or not: no more than $35 for a month's supply of each covered insulin, with no deductible. And the Medicare Prescription Payment Plan, which spreads drug costs across the year, may not help if you have Extra Help, according to Medicare.gov. Our Medicare Part D 2027 changes post covers next year's standard numbers.

How to apply if it isn't automatic

1. Pull your numbers. Your Social Security award letter, pension or annuity statements, recent bank statements, and IRA or brokerage balances. If you're married and living together, your spouse's too.
2. Consider the MSP first. If your monthly income is near the QI-1 line ($1,855 for one person on HCA's chart), an MSP application through Washington Connection, by phone with DSHS at 1-877-501-2233, by fax at 1-888-338-7410, or on paper (form HCA 13-691) may get you Extra Help without the asset test.
3. Apply for Extra Help with Social Security. Online at SSA.gov/extrahelp or by phone at 1-800-772-1213, any time of year. The paper form is the SSA-1020; the online version is the i1020. Unless you tell it not to on the form, Social Security sends your information to the state to start an MSP application too. If you're close to the MSP lines, leave that alone.
4. Have a drug plan. Extra Help only works through Medicare drug coverage, either a standalone Part D plan or a Medicare Advantage plan with drug coverage. If you qualify and don't pick one, Medicare enrolls you in one, and you can switch. Social Security's manual says Extra Help generally starts the month you apply if you're already in a plan, or the month after you join one.
5. Check the pharmacy charge. If you're charged more than the Extra Help amounts, contact your plan (it may ask for proof that you have Extra Help), tell them how many days of medicine you have left, and call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) if it isn't fixed.

Two things to check before you sign up for Part D. If you have employer or union coverage, joining a Part D plan can cost you that coverage, for you and your dependents, even if you qualify for Extra Help. Call your benefits administrator first. And if you qualify but aren't in a drug plan yet, Medicare's LI NET program (1-800-783-1307, TTY 711) gives temporary drug coverage and may pay you back for covered drugs you bought after you qualified. Keep the receipts.

Turned down? Medicare.gov says you can reapply any time your income or resources change. Once you're approved, you keep Extra Help through December 31 even if your income goes up mid-year.

Source: Medicare & You 2027, pp. 96-98; SSA POMS HI 03001.020 (forms); SSA POMS HI 03001.005 (start date); Medicare.gov (LI NET, proof, reapplying); HCA 13-691 (MSP application).

Changing drug coverage with Extra Help

Medicare Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027. Everyone gets that window. People with Extra Help get more.

Source: 42 CFR 423.38(c)(4), (c)(9) and (c)(35); Medicare.gov, Special Enrollment Periods; CMS 2027 state fact sheets (Open Enrollment dates); CMS guide to consumer mailings (fall letters).

The monthly change is a move into standalone drug coverage, not into a Medicare Advantage plan. And it isn't available if your plan has notified you that you're "at-risk" under a drug management program. Watch your mail this fall too: CMS sends an orange letter in October if your copays change next year, and tan or blue letters in November if your plan's premium will be above what Extra Help covers or you're being reassigned. If you get one of those, Open Enrollment is a sensible time to compare options in the Medicare.gov plan finder or with SHIBA. Our Medicare Open Enrollment 2027 guide for Washington has the full calendar.

If you lose Extra Help, join a drug plan within 2 months to avoid a late enrollment penalty.

How many Washingtonians get it

2019234,1712020235,1852021238,6032022250,4252023264,5872024262,0422025259,486

Source: CMS Medicare Monthly Enrollment, Washington, annual rows

Show the numbers

Year	Enrollees with Extra Help
2019	234,171
2020	235,185
2021	238,603
2022	250,425
2023	264,587
2024	262,042
2025	259,486

The count rose from 234,171 in 2019 to a peak of 264,587 in 2023, then eased to 259,486 in 2025. By July 2026 it was 265,836: 252,697 deemed and 13,139 who applied and were approved.

The share tells a different story. Washington's Part D enrollment grew faster than Extra Help did, so the slice with Extra Help shrank:

Source: CMS Medicare Monthly Enrollment, Washington. July 2026 share computed from that month's row (265,836 of 1,256,126 Part D enrollees).

CMS's 2027 fact sheet for Washington measures a narrower group: 21.37% of people in a standalone Medicare drug plan here get Extra Help. That figure leaves out Medicare Advantage plans with drug coverage, so it isn't the same measure as the share of all Part D enrollees in the table above. What the data can't show is how many people qualify and never apply. Only 13,139 Washingtonians have Extra Help through their own application, against 252,697 who got it automatically. My read: if you're a retiree with a modest Social Security check who has never been on Apple Health, you're in the group that has to take the first step yourself. Nobody mails you a purple letter.

Where to get help in Washington

• Social Security handles Extra Help applications: SSA.gov/extrahelp or 1-800-772-1213.
• DSHS and HCA handle Medicare Savings Programs and Apple Health (Washington Connection or 1-877-501-2233).
• 1-800-MEDICARE can confirm your Extra Help status and help fix a wrong pharmacy charge.

For the bigger picture, see how Medicare Part D works in Washington and our Washington Medicare overview.

FAQ

What is the income limit for Extra Help in Washington State in 2026?

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

What is the resource limit for Extra Help in 2026?

$18,090 for one person and $36,100 for a couple, including $1,500 per person for burial expenses. Without that allowance the figures are $16,590 and $33,100, which is what HCA's chart shows. Your home and one car don't count.

Do I get Extra Help automatically in Washington?

Yes, if you have Medicare and full Apple Health, a Medicare Savings Program that pays your Part B premium (QMB, SLMB or QI-1), or SSI. Medicare mails a purple letter. QDWI doesn't count, and 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, and nothing once total drug costs reach $2,400. People with full Apple Health 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 have Extra Help?

Yes. With Extra Help or Apple Health 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, Washington's program rules and your own income, resources and coverage decide what you qualify for. Confirm your situation with Social Security, HCA, SHIBA, 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: Special Enrollment Periods
3. Medicare.gov: Insulin
4. Medicare.gov: Medicare Prescription Payment Plan, before you sign up
5. Medicare & You 2027 handbook
6. CMS: CY 2027 Rate Announcement (Attachment V, Table V-2)
7. CMS: 2027 Medicare Advantage and Part D state fact sheets
8. CMS: Guide to consumer mailings, 2026/2027
9. CMS: Medicare Monthly Enrollment (Washington)
10. SSA POMS HI 03001.020: Eligibility for Extra Help
11. SSA POMS HI 03001.005: Medicare Part D Extra Help
12. SSA POMS HI 03010.005 (Inflation Reduction Act changes to Extra Help)
13. SSA POMS HI 03020.055: Income limits and family size
14. SSA POMS HI 03030.025: Resource limits
15. 42 CFR 423.38: Enrollment periods (eCFR)
16. HCA: Apple Health Income and Resource Standards (HCA 19-0096)
17. HCA: Medicare Savings Program
18. HCA: Medicare Savings Programs flyer (22-500)
19. HCA: Application for Medicare Savings Programs (13-691)
20. HCA: Apple Health Long-Term Services and Supports (19-0009)
21. HCA: Eligibility overview, Apple Health programs (22-315)
22. WAC 182-517-0100: Medicare savings programs
23. Washington Connection
24. Washington OIC: SHIBA