By Bill Wilkie, Licensed Medicare Advisor | ABCD Health Plans | Port St. Lucie, FL
Bill Wilkie has over 10 years of experience helping people understand Medicare, and has been in the insurance business since 2001. He is licensed in more than 30 states and certified by every company he represents. He started ABCD Health Plans to give people on the Treasure Coast a real local expert they can call — not a 1-800 number that changes every time you call.
Did you know there is a program that can save you up to $5,700 a year on your Medicare drug costs — and millions of people who qualify never even apply because they think they earn too much?
It is called Extra Help. And if you live in Port St. Lucie, Stuart, Fort Pierce, Jensen Beach, Palm City, Hobe Sound, Vero Beach, Sebastian, or anywhere on the Treasure Coast, this guide is for you.
This guide is written in plain, simple language. No confusing terms. Just the facts you need right now.
KEY TAKEAWAYS
Extra Help — also called the Low Income Subsidy (LIS) — is a federal program that helps people with Medicare pay for their prescription drug costs. Source: SSA.gov
In 2026, Extra Help is worth an average of $5,700 per year in savings on drug premiums, deductibles, and copays. Source: NCOA.org
The 2026 income limit is $23,940 per year for a single person and $32,460 for a married couple. Source: MedicareResources.org
If you qualify, your drug copays are capped at just $5.10 for generics and $12.65 for brand-name drugs. Source: Medicare.gov
Extra Help also wipes out the Part D late enrollment penalty — permanently. Source: Medicare.gov
A local advisor can check if you qualify and help you apply for free — call 844-900-1468.
WHAT IS EXTRA HELP?
Extra Help is a federal program run by the Social Security Administration and the Centers for Medicare and Medicaid Services. It helps people with Medicare Part D — the prescription drug plan — pay for their medication costs.
Without Extra Help, Medicare Part D can include premiums, deductibles, and copays that add up to thousands of dollars a year. Extra Help covers most or all of those costs for people who qualify.
According to Medicare.gov, the program reduces or eliminates your Part D premium, your deductible, and your copays at the pharmacy. And it wipes out the Part D late enrollment penalty entirely — even if you already have one.
WHO QUALIFIES FOR EXTRA HELP IN 2026?
You must have Medicare Part A or Part B, live in one of the 50 states or Washington D.C., and meet the income and asset limits below.
2026 Income Limits Single person: up to $23,940 per year Married couple: up to $32,460 per year
2026 Asset Limits Single person: up to $18,090 Married couple: up to $36,100
Assets that do NOT count toward these limits include your home, one car, personal belongings, and life insurance. Source: SSA.gov
You may qualify automatically if you: Already have Medicaid Receive Supplemental Security Income (SSI) Are enrolled in a Medicare Savings Program
If you fall into any of those groups, you may be enrolled in Extra Help already and not even know it.
Here is the most important thing most people miss: many people assume they make too much to qualify. But Social Security applies an earned income exclusion for people who are still working. That means your countable income for Extra Help purposes may actually be lower than your real income. If you are close to the limits, apply anyway. There is no penalty for applying and being turned down. Source: SSA.gov
WHAT DOES EXTRA HELP PAY FOR?
If you qualify for Extra Help in 2026, here is what it covers:
Your Part D premium: Covered up to the benchmark amount set by Medicare.
Your Part D deductible: Reduced or eliminated entirely.
Your drug copays: Capped at $5.10 for generic drugs and $12.65 for brand-name drugs per fill. Source: Medicare.gov
Your late enrollment penalty: Eliminated permanently while you remain enrolled in Extra Help.
Your coverage gap costs: With Extra Help you are protected from the high costs that other Part D enrollees face when their spending reaches certain thresholds.
And remember — in 2026, all Medicare Part D enrollees have a $2,100 annual out-of-pocket cap. For Extra Help recipients, your lower copays count toward that cap. Once you hit $2,100 in out-of-pocket costs, all covered drugs are $0 for the rest of the year. Source: CMS.gov
HOW MUCH CAN EXTRA HELP SAVE YOU?
The Social Security Administration estimates that Extra Help is worth an average of $5,700 per year in savings. Source: SSA.gov
Here is a simple example of what that means in real life.
Without Extra Help, a Port St. Lucie resident on Medicare Part D might pay: A monthly premium of $40 to $60 or more An annual deductible of up to $615 Full retail copays on their medications
With Extra Help, that same person pays: $0 premium (up to the benchmark amount) $0 deductible $5.10 per generic drug fill $12.65 per brand-name drug fill
For someone taking multiple medications every month, that difference can easily be thousands of dollars a year — money that stays in your pocket.
HOW TO APPLY FOR EXTRA HELP
Applying is free and takes about 10 to 15 minutes. You have three ways to apply:
Online: Go to SSA.gov/medicare/part-d-extra-help and complete the Extra Help application. This is the fastest way.
By phone: Call the Social Security Administration at 1-800-772-1213. They can mail you an application or take it over the phone.
In person: Visit your local Social Security office. Appointments are recommended.
When you apply, have the following information ready: Your Medicare card Your Social Security number Information about your income (pay stubs, tax returns, or Social Security award letter) Information about your savings and assets (bank account balances, investment accounts)
SSA usually makes a decision within 2 to 4 weeks. If you are approved, you will get a letter telling you when your Extra Help starts. Source: SSA.gov
EXTRA HELP AND THE PART D LATE ENROLLMENT PENALTY
This is one of the most powerful parts of Extra Help that most people do not know about.
Normally, if you miss your window to sign up for Part D and go 63 days or more without creditable drug coverage, you face a permanent penalty added to your premium for life. That penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for every uncovered month. It adds up fast and never goes away.
Extra Help eliminates this penalty entirely for as long as you remain enrolled in the program. Source: Medicare.gov
If you have been avoiding signing up for Part D because of a penalty you are worried about — Extra Help may be the solution that makes it affordable anyway.
EXTRA HELP AND MEDICARE ADVANTAGE PLANS
Extra Help works with both standalone Part D drug plans and Medicare Advantage plans that include drug coverage. If you are on a Medicare Advantage plan in the Port St. Lucie, Stuart, or Fort Pierce area that includes drug coverage, Extra Help can still reduce your drug copays. Source: Medicare.gov
Popular Medicare Advantage carriers serving the Treasure Coast — including Humana, Aetna, United Healthcare, and Devoted Health — all work with Extra Help. Bill Wilkie at ABCD Health Plans can check which plan in your area gives you the best value when combined with Extra Help.
LOCAL HOSPITALS THAT SERVE THE TREASURE COAST
Cleveland Clinic Martin Health — Stuart Cleveland Clinic Indian River Hospital — Vero Beach HCA Florida Tradition Hospital — Port St. Lucie HCA Florida St. Lucie Hospital — Fort Pierce Holmes Regional Medical Center — Melbourne
COMMON QUESTIONS
Does Extra Help automatically renew every year? If you qualify automatically through Medicaid, SSI, or a Medicare Savings Program, your Extra Help renews automatically. If you applied directly through SSA, you may receive a renewal notice each year. Always watch for mail from SSA or CMS in the fall. Source: SSA.gov
Can I have Extra Help and a Medicare Supplement plan at the same time? Yes. Extra Help covers your Part D drug costs. A Medicare Supplement plan covers your Part A and Part B costs. They work together and do not conflict.
What if I already have a Part D plan — can I still apply? Yes. You can apply for Extra Help at any time, before or after you enroll in Part D. If you are approved, your savings start from the date SSA approves your application. Source: SSA.gov
Does Extra Help cover all my drugs? Extra Help reduces your copays for drugs that are on your Part D plan’s formulary. It does not add new drugs to your formulary. This is why choosing the right Part D plan matters — a local advisor can check your specific medications before you enroll.
What if I am close to the income limit? Apply anyway. Social Security applies exclusions for earned income, burial expenses, and other factors that may lower your countable income below the limit. There is no penalty for applying and being found ineligible. Source: SSA.gov
I am already on Medicare Advantage — can I still get Extra Help? Yes. If your Medicare Advantage plan includes drug coverage, Extra Help applies to your drug costs in that plan.
SERVING THESE COMMUNITIES ON THE TREASURE COAST
Port St. Lucie, Stuart, Jensen Beach, Fort Pierce, Palm City, Hobe Sound, Vero Beach, Sebastian, Tradition, and the entire Treasure Coast.
TALK TO BILL — YOUR LOCAL MEDICARE EXPERT
Do not leave $5,700 a year on the table. Millions of people on the Treasure Coast qualify for Extra Help and never collect it simply because nobody told them about it. That stops today.
Bill Wilkie at ABCD Health Plans is your local, licensed, certified Medicare advisor right here in Port St. Lucie. Bill has been in the insurance business since 2001 and has over 10 years of Medicare experience. He is certified by every company he represents and licensed in more than 30 states. He knows the Treasure Coast, he knows the carriers, and he knows how to get you every dollar of savings you are entitled to.
Bill will check if you qualify for Extra Help, help you apply, and find the right Part D plan for your specific medications — all completely free. No pressure. No obligation. Just straight answers from a local expert you can trust.
Call or text: 844-900-1468 Website: abcdhealthplans.com Facebook: facebook.com/profile.php?id=61564562317330 YouTube: youtube.com/@ABCDHealthPlans Nextdoor: nextdoor.com
Set up your free appointment today. Call 844-900-1468. Bill Wilkie is ready to help you right now.
Sources: SSA.gov — Extra Help, Medicare.gov — Help with Drug Costs, CMS.gov, NCOA.org — Extra Help Eligibility Chart 2026, MedicareResources.org — Extra Help 2026
DISCLAIMER: ABCD Health Plans is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or call 1-800-MEDICARE to get information on all of your options.