Medicare Extra Help (LIS) in 2026: New Income Limits for Houston Seniors

If you have ever set your prescriptions on the counter at the H-E-B pharmacy on Bellaire, a Walgreens on Westheimer, or a CVS in Pasadena and quietly done the math on whether you can fill all of them this month, you are carrying a weight that far too many Houston seniors carry alone. For older adults living on a fixed Social Security check, the choice between a heart medication and a full grocery cart is not a hypothetical — it is a monthly decision made at the register. There is a Medicare program built specifically to lift that weight, and many of the people who qualify for it have never heard its name: Extra Help, also called the Part D Low-Income Subsidy (LIS). It lowers what you pay for your Medicare prescription drugs — your Part D premium, your deductible, and the copay at the counter — and in 2026 the amounts it leaves you paying are strikingly small.

This guide is written for Houston and Harris County readers who want the real numbers, told with respect. We will walk through what Extra Help actually covers, the important 2024 change that opened the full benefit to more people, the 2026 income and resource limits, exactly what you pay with LIS in 2026 (the very low generic and brand copays), how Extra Help interacts with the new $2,100 Part D out-of-pocket cap and the Medicare Prescription Payment Plan, how Extra Help differs from the Medicare Savings Programs, who qualifies automatically versus by application, and how Wise Insurance Agency helps Houston beneficiaries apply and choose a Part D plan that works hand-in-hand with the subsidy. Start at our Medicare hub, and let us be the guide that turns a program most people miss into money that stays in your pocket.

1. What Extra Help (LIS) is and what it covers

Extra Help is a federal program that pays a large share of your Medicare Part D prescription drug costs. You may hear it called by two names — “Extra Help” is the plain-language term used by Medicare and Social Security, and the “Low-Income Subsidy,” or “LIS,” is the term you will see in official documents. They are the same program. Its whole purpose is to make sure that a person with limited income and savings can still afford the medications a doctor prescribes, without skipping doses or splitting pills to stretch a bottle.

It helps in three concrete places, all of them on the drug side of Medicare. First, it lowers or eliminates your monthly Part D premium, up to a regional benchmark amount. Second, it eliminates the annual Part D deductible — the amount you would otherwise pay out of pocket before the plan begins to pay. Third, and most visible at the counter, it caps your copays on covered drugs at the very low amounts CMS sets each year. For a Houston senior filling four or five maintenance medications a month, those three changes together can be the difference between affording every prescription and rationing them.

It is just as important to be clear about what Extra Help does not do. It does not lower your Part A hospital costs, your Part B doctor-visit costs, or your Part B premium — those are handled by a different set of programs we cover in section 6. And it applies to drugs covered under Part D, not to drugs administered in a hospital or doctor’s office (which fall under Part A or Part B). Understanding that boundary is the first step to using every program you are entitled to rather than just one of them.

2. The 2024 change: full Extra Help to 150% FPL

For years, Extra Help came in two strengths. There was a full subsidy for people with the lowest incomes, and a smaller partial subsidy — a sliding scale with higher deductibles and larger copays — for people whose income fell roughly between 135% and 150% of the federal poverty level. That partial tier helped, but it left people in a confusing middle zone, paying more than their neighbors just below the line for the very same medications.

That two-tier system is gone. Under Section 11404 of the Inflation Reduction Act of 2022, the full Low-Income Subsidy was expanded to reach everyone with income up to 150% of the federal poverty level who meets the resource requirement. The change took effect January 1, 2024: beneficiaries who used to receive only the partial subsidy were moved up to the full benefit, and the partial tier was eliminated. This is not a brand-new change for 2026 — it has been in place since the start of 2024 — but it continues in full force in 2026, and many people who were told years ago that they “only qualified for partial help” have never been told that they now qualify for the full benefit.

3. 2026 income and resource limits

Two things determine whether you qualify for Extra Help: your income and your resources (your countable savings and assets). Both have limits, and both are more generous than people assume — especially because the things most Houston seniors own that feel like “assets” are excluded from the count.

On the income side, the threshold is 150% of the federal poverty level. CMS releases the exact 2026 dollar income standard in early 2026, after the new poverty guidelines are published. Based on the poverty guidelines in use as this is written, that works out to roughly $23,475 a year for a single person and about $31,725 for a married couple living together — and the limits are somewhat higher in Alaska and Hawaii. Because certain income is not counted and the limits update each year, do not rule yourself out based on a rough number in your head; a small difference on paper can change the answer.

On the resource side, CMS has confirmed the 2026 figures. To qualify for the full benefit, your countable resources must be no more than $16,590 if you are single or $33,100 if you are married and living with your spouse. If you tell the Social Security Administration that you expect to use some of your savings for burial expenses, the limits rise to $18,090 (single) and $36,100 (married). These amounts went up from 2025, when the base limits were $16,100 and $32,130, reflecting a 3.01% cost-of-living adjustment.

What counts as a resource? Checking and savings accounts, stocks, bonds, mutual funds, and other assets you could convert to cash. What does not count is just as important: your primary home, one car, your personal belongings, and certain burial funds are all excluded. A Houston homeowner with a paid-off house on a modest street and a car in the driveway can still fall well within the resource limits.

4. What you actually pay with LIS in 2026

This is the part that changes lives, so let us be exact. With full Extra Help in 2026, your Part D costs are reduced across the board. You pay no monthly premium for your drug plan, up to the benchmark amount for the Houston region (choosing a benchmark plan is exactly where good guidance matters, and where we help). You pay no annual deductible — the $615 standard Part D deductible that other beneficiaries face in 2026 is waived for you. And your copays at the counter drop to the low amounts CMS sets.

Those 2026 copay amounts depend on which Extra Help category you fall into, but every one of them is a fraction of full price. If your income is below 100% of the poverty level and you also have Medicaid, you pay as little as $1.60 for a generic and $4.90 for a brand-name drug. Everyone else on full Extra Help — including those between 100% and 150% of the poverty level, people in a Medicare Savings Program, and those approved by application — pays no more than $5.10 for a generic and $12.65 for a brand-name drug. If you live in a nursing facility or receive certain home-and-community-based services as a full-benefit dual eligible, your copays are $0. And once your out-of-pocket spending reaches the $2,100 cap, every covered drug is $0 for the rest of the year.

To see why this matters, compare it with the standard Part D benefit a beneficiary without Extra Help faces in 2026: a monthly premium, a $615 deductible to clear before coverage kicks in, and 25% coinsurance on covered drugs until the out-of-pocket cap. A single expensive brand-name medication can cost that person well over a hundred dollars a fill in the early months of the year. With full Extra Help, that same fill is capped at $12.65. The chart below lays the two experiences side by side.

5. How LIS works with the $2,100 cap and the payment plan

Two newer Medicare features shape the drug-cost picture for everyone in 2026, and Extra Help fits alongside both. The first is the $2,100 annual out-of-pocket cap on covered Part D drugs. Since 2024, no one — Extra Help or not — pays more than the annual cap out of pocket for covered drugs; once you reach it, covered drugs are $0 for the rest of the calendar year. For a person with full Extra Help, the practical truth is even gentler: because your copays are already capped at $5.10 and $12.65, it takes a very high volume of prescriptions to approach $2,100 at all. Extra Help does much of its work long before the cap ever comes into play, and the cap sits behind it as a firm ceiling.

The second is the Medicare Prescription Payment Plan (sometimes shortened to “M3P”), which began in 2025. It lets any Part D enrollee spread their out-of-pocket drug costs across the calendar year in monthly installments billed by the plan, instead of paying a large amount at the pharmacy in a single month. It charges no interest and no fees. It is a payment-timing tool, not a discount — it does not lower your total, it just smooths when you pay. Extra Help, by contrast, actually reduces what you owe. For most people with full Extra Help, copays of a few dollars are already small enough that spreading them over the year offers little benefit, but the option exists if it helps your budgeting.

6. Extra Help vs. the Medicare Savings Programs

Here is where families get understandably tangled, because two different assistance programs sound similar and are often mentioned in the same breath. Extra Help (LIS) is about your Part D drug costs — premiums, deductibles, and copays for prescriptions — and it is administered through the Social Security Administration and CMS. The Medicare Savings Programs (MSPs) are about your Part A and Part B costs — most importantly the Part B premium, and depending on the program, your deductibles and coinsurance — and they are run through your state’s Medicaid agency (in Texas, the Health and Human Services Commission).

The two programs are designed to work together, and the connection is worth committing to memory: if you enroll in a Medicare Savings Program, you are automatically deemed eligible for Extra Help — you do not have to file a separate LIS application. That single fact means many Houston seniors who qualify for help with their Part B premium are also entitled to nearly-eliminated drug costs, often without realizing it. To understand where Medicare and Medicaid meet more broadly, see our guide on Medicare vs. Medicaid.

7. Automatic vs. by-application eligibility

Not everyone has to fill out a form. Medicare and Social Security automatically enroll certain people in Extra Help — they are “deemed” eligible — and mail them a notice on colored paper each fall confirming their status for the coming year. You are automatically enrolled if you have full Medicaid along with Medicare (you are a “dual eligible”), if you are enrolled in a Medicare Savings Program, or if you receive Supplemental Security Income (SSI). If any of those describe you, you already have Extra Help even if you have never applied — and the notice you receive tells you which copay level applies.

Everyone else has to apply, and this is where a great deal of available help goes unclaimed. If you have limited income and resources but do not have Medicaid, an MSP, or SSI, you can apply for Extra Help through the Social Security Administration — and there is no cost to apply and no penalty for asking. An application is also worth filing when your circumstances change: a drop in income, the death of a spouse, or a move can all change your answer. The frustrating reality is that many people who would qualify simply never apply, often because no one ever told them the program existed or walked them through the paperwork. That is a gap Wise Insurance Agency exists to close.

8. How Wise Insurance Agency helps Houston seniors

Extra Help is one of the most valuable Medicare benefits available, and one of the most under-used — not because it is hard to qualify for, but because it is easy to overlook and can feel intimidating to pursue. No one should have to navigate deemed-eligibility rules, resource limits, and Part D plan choices alone, and certainly no one should skip a prescription because they never learned a program was waiting for them. That is the entire reason Wise Insurance Agency is here: to sit down with you, look honestly at whether you qualify, and handle the details with the dignity your situation deserves.

We help Houston and Harris County beneficiaries in three practical ways. First, we screen for eligibility — walking through your income and countable resources so you know whether you likely qualify for full Extra Help, a Medicare Savings Program, or both. Second, we help you apply, so the paperwork that stops so many people never becomes a reason to give up. Third, and just as important, we help you choose a Part D plan that works with Extra Help — because your subsidy pairs most naturally with a plan whose premium sits at or below the regional benchmark and whose formulary covers your specific medications. Picking the wrong plan can leave part of the benefit on the table; picking the right one keeps your costs at those capped copay amounts all year.

Whether you are new to Medicare and want to confirm your Medicare eligibility, comparing your full range of Medicare plan options, or simply want to know if you have been overpaying for medications you could be getting for a few dollars, we are ready to help. Call our Houston offices at 832-400-6538, email sara@wisehealthins.com, book time on our appointment page, or reach out through our contact page. Extra Help is your benefit — let us make sure you actually receive it.

Frequently asked questions

Wise Insurance Agency is a licensed insurance agency in the State of Texas. The information here is general guidance and not a substitute for plan-specific, medical, or legal advice. 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, 1-800-MEDICARE, the Social Security Administration, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Extra Help rules, income and resource limits, copay amounts, and Part D parameters change and are subject to federal action; the 2026 figures in this article reflect CMS, Medicare.gov, and SSA guidance as of the date it was written, and CMS publishes the official 2026 LIS income standard in early 2026 after the federal poverty guidelines are released. Verify current figures and your specific eligibility with CMS, the Social Security Administration, or a qualified professional before making any decision.