What Extra Help Covers

$0 premium on benchmark plans

With full Extra Help, the government pays your Part D premium up to the regional benchmark amount. Any plan priced at or below that benchmark costs you $0 per month. If you pick a more expensive plan, you only pay the portion above the benchmark — so most people on Extra Help can find a $0-premium plan in their area.

$0 deductible

Standard Part D plans charge an annual deductible before coverage begins. With full Extra Help, your deductible is $0, so your coverage starts with your first prescription.

Small, capped copays

Instead of paying a percentage of each drug’s price, people with Extra Help pay fixed, capped copays. In 2025 those caps are about $4.9 for a generic drug and $12.15 for a brand-name drug. These amounts are set each year, and many people with Medicaid pay even less or nothing.

No coverage gap

The Part D coverage gap (the “donut hole”) does not apply to people with Extra Help. Your capped copays stay the same all year, so you never hit a stretch of higher out-of-pocket costs. To see how drug coverage works in general, see our Medicare Part D guide.

A continuous enrollment period

Most people can only change Part D plans during the fall Annual Enrollment Period. Extra Help gives you a continuous special enrollment period: you can switch your drug plan once per quarter during the first three quarters of the year, which is helpful if your medications or pharmacy change.

Part D only — not your Part B premium

It is important to be clear about what Extra Help does not do. Extra Help applies only to Part D prescription drug costs. It does not pay your Part B premium, deductibles, or coinsurance. Help with those comes from a Medicare Savings Program, which is a separate, state-run benefit. Many people qualify for both — see Extra Help vs. Medicare Savings Programs to compare.