What is the Medicare Extra Help Program?
The Extra Help program, officially known as the Low-Income Subsidy (LIS), is a federal initiative designed to help Medicare beneficiaries with limited financial resources pay for their Prescription Drug Plans (Medicare Part D). It is administered by the Social Security Administration, not Medicare itself, which is a point of confusion for many. Think of it as a significant discount program specifically for your drug coverage. It can help pay for your monthly Part D premium, your annual Part D deductible, and your prescription copayments. For many people in New Philadelphia who qualify for the full subsidy, their monthly Part D premium can become zero, and their drug costs can be reduced to just a few dollars per prescription. It does not replace your Part D plan; rather, it works alongside it to make that plan much more affordable. Having helped thousands of families across Northeast Ohio, we've seen how this program can dramatically improve a person's ability to afford the medications their doctors prescribe, preventing the difficult choice between paying for medicine and paying for other essential living expenses.
2026 Estimated Income and Asset Limits for Extra Help
To qualify for Extra Help, you must meet certain income and asset limits set by Social Security. These limits typically adjust each year. The figures below are our conservative estimates for 2026 to give you a general idea. The official amounts may be slightly different.
What counts as income? This includes your Social Security benefits, wages, pensions, and withdrawals from retirement accounts. What counts as assets? This includes money in checking or savings accounts, stocks, and bonds. Your primary home, car, and personal possessions do not count as assets.
Full Extra Help (Estimated 2026 Limits): - Individual: Monthly income below about $1,950; assets under $11,300. - Married Couple: Monthly income below about $2,650; assets under $17,800. With full help, you typically have no Part D premium or deductible and small copays for prescriptions.
Partial Extra Help (Estimated 2026 Limits): - Individual: Monthly income below about $2,160; assets under $17,300. - Married Couple: Monthly income below about $2,930; assets under $34,400. With partial help, you pay a reduced premium and deductible on a sliding scale, with slightly higher copays than the full subsidy.
It is always worth applying even if you think you are slightly over these limits, as certain types of income and expenses may not be counted.
How to Apply for Extra Help in New Philadelphia, Ohio
There are three primary ways to apply for the Extra Help program. The easiest for many is to apply online through the official Social Security Administration website. The online application is straightforward and can be completed at your own pace. You can also apply by calling Social Security directly and having them mail you a paper application or, in some cases, complete it over the phone. For those who prefer to handle things in person, you can visit a local Social Security office. The office for Tuscarawas County residents is located right in New Philadelphia at 350 Cookson Ave SE. You may want to call ahead to see if an appointment is needed. Another way people qualify is by being enrolled in other state programs. For example, if you are approved for a Medicare Savings Program (MSP) or Medicaid through the Tuscarawas County Department of Job and Family Services, you will often be automatically enrolled in Extra Help. You will receive a notification letter in the mail if this happens. There are also counselors at the Ohio District 5 Area Agency on Aging who provide OSHIIP services and can offer assistance with the application process.
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What the Program Covers and What It Doesn't
Extra Help is powerful, but it's important to be clear about what it does and does not cover. Its focus is entirely on Medicare Part D prescription drug costs. If you qualify, the program will significantly reduce or completely eliminate your monthly Part D plan premium. It also reduces your annual Part D deductible to $0 for most people who qualify. Finally, it establishes a low, fixed copayment for your medications. This means instead of paying a percentage of a drug's cost, you’ll pay a small, predictable amount for each generic and brand-name drug you are prescribed. Let's take a person living in Bolivar who just had a procedure at Cleveland Clinic Union Hospital. With Extra Help, the new prescriptions they need to fill afterward would cost just a few dollars each, instead of potentially hundreds. What Extra Help does not cover are your Original Medicare costs. It will not pay for your Medicare Part B premium, nor will it cover copayments for doctor visits or hospital stays. Those costs are addressed by separate programs, called Medicare Savings Programs (MSPs), or by Medicare Supplement (Medigap) or Medicare Advantage plans.
Common Reasons for Application Denial
It can be disheartening to have an Extra Help application denied, but it's often due to correctable issues. The most common reason, of course, is that an applicant's income or resources are over the established limits. Sometimes this is a small amount, and a change in circumstances later in the year could make you eligible. Another frequent problem is an incomplete application. Forgetting to sign the form or leaving sections blank can lead to an automatic denial. Likewise, making errors in reporting income can be an issue. For instance, people sometimes forget to include small pensions or interest from a savings account, which Social Security's systems will find, causing a mismatch. It is also critical to be truthful about assets like stocks or savings bonds. Sometimes, an application is denied because of a misunderstanding about who is in the household. For example, a married individual must include their spouse's income and assets, even if the spouse is not on Medicare or applying themselves. If you are denied and believe it was in error, you have the right to appeal the decision. For free, unbiased help, you can contact the trained OSHIIP counselors at the Ohio District 5 Area Agency on Aging. If you're looking for help choosing a specific Part D drug plan that is compatible with Extra Help and covers your pharmacy and doctor preferences in the New Philadelphia area, please fill out the callback form on this page. We can provide personalized guidance once we have your specific details.
Frequently asked questions
Is Extra Help the same thing as a Medicare Savings Program (MSP)?
No, they are different programs that help with different costs. Extra Help (or LIS) is a federal program that helps pay for your Medicare Part D prescription drug plan costs, like the premium, deductible, and copays. Medicare Savings Programs (MSPs) are state-run programs that help pay for your Original Medicare costs. Depending on your income, an MSP can help pay your monthly Medicare Part B premium and, in some cases, your Part A and B deductibles and coinsurance. You apply for MSPs through your county's Job and Family Services office, not Social Security.
If I get Extra Help, do I still need to enroll in a Part D plan?
Yes, you absolutely do. Extra Help is not a drug plan itself; it's a subsidy that lowers the cost of a plan. If you qualify for Extra Help but don't choose a Part D plan, Medicare will likely enroll you in a random plan in your area so you can use the benefit. However, this randomly assigned plan may not cover all your specific medications or include your preferred pharmacy in its network. It's always better to proactively choose a plan that fits your health needs and provider network in Tuscarawas County.
What happens if my income or assets change during the year?
You are required to report significant life changes to the Social Security Administration. This includes changes in income, marital status, or assets. If your income goes down, you might become eligible for Extra Help or qualify for a higher level of assistance. If your income goes up and exceeds the limits, you may lose your eligibility for the following year. Reporting these changes promptly ensures you are receiving the correct level of benefit and helps you avoid any potential issues with Social Security down the road. You can report changes online, by phone, or at the New Philadelphia SSA office.
Do I have to reapply for Extra Help every year?
Generally, no. Social Security automatically reviews your eligibility each year using information from the IRS and other government agencies. If you still qualify, you'll continue to receive the subsidy. You'll receive a letter in the mail in the fall letting you know your status for the upcoming year. However, sometimes Social Security cannot verify all your information and may send you a form to review and complete. It is very important to fill out and return this form by the deadline to avoid a gap in your assistance.
Does my house or one car count as an asset for the Extra Help application?
No, Social Security does not count your primary residence or one primary vehicle as assets when determining your eligibility for Extra Help. They also do not count personal belongings, jewelry, or furniture. The asset test is focused on liquid resources—things that can be easily converted to cash. This includes money in checking and savings accounts, cash at home, stocks, bonds, mutual funds, and non-primary real estate. This is why many people who own a home but have a modest income can still qualify for the program.
Can you help me find a Part D plan in New Philadelphia that works with Extra Help?
Yes. Once you are approved for Extra Help, our role is to help you select a compatible Medicare Part D or Medicare Advantage plan that best fits your specific needs. We can check which plans that serve the 44663 ZIP code have low or zero premiums for LIS recipients and also ensure your specific medications are on that plan's formulary. We verify that your preferred pharmacy is in the network, helping you make the most of your Extra Help benefit. Our guidance is provided at no cost to you.
Serving New Philadelphia and nearby communities
We help Medicare-eligible residents across New Philadelphia, Dover, Bolivar, Tuscarawas, and the rest of Tuscarawas County. Major hospital networks in this area include Cleveland Clinic Union Hospital. When you fill out the callback form, a licensed Ohio agent will check which plans cover your specific doctors and prescriptions.
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