Extra Help with Medicare drug costs in North Carolina

What Extra Help does

Extra Help is a Medicare program that Social Security and Medicare run the same way in every state. Medicare.gov describes it as help paying Part D premiums, deductibles, coinsurance and other drug costs. Since 2024 everyone who qualifies gets the full subsidy. With Extra Help in 2026:

• You pay no more than $5.10 for each generic drug and $12.65 for each brand-name drug your plan covers. If you have full NC Medicaid and income at or below the poverty level, the caps are $1.60 and $4.90.
• You don't pay a Part D late enrollment penalty while you have it.
• Medicare.gov says people with Medicaid or Extra Help may be able to change drug coverage outside the usual enrollment periods, for example to a different standalone Part D plan.
• Once your drug costs reach the Part D out-of-pocket cap ($2,100 in 2026), you pay nothing more for covered drugs that year.

Medicare.gov has already posted slightly higher copay caps and a higher out-of-pocket cap for 2027; see Medicare costs in 2027.

Who gets it automatically in North Carolina

Under 42 CFR 423.773(c), Medicare treats you as eligible, with no application, if you have:

• Full NC Medicaid, for example through NC Medicaid Direct;
• Supplemental Security Income (SSI); or
• A Medicare Savings Program: MQB-Q, MQB-B or MQB-E, North Carolina's names for QMB, SLMB and QI. See Medicare Savings Programs in North Carolina.

You get a notice in the mail. If you don't already have a drug plan, Medicare enrolls you in one so the savings start; you can pick a different plan. Medicare.gov says you keep Extra Help through December 31 even if your income changes during the year. If you qualify but aren't in a plan yet, Medicare's Limited Income Newly Eligible Transition (LI NET) program can cover drugs for a short time (1-800-783-1307, TTY 711).

2026 limits if you apply

The income limit is 150 percent of the federal poverty level. The resource limits shown are the ones Medicare.gov publishes, which include up to $1,500 per person that you expect to use for funeral or burial costs; without that, CMS lists $16,590 and $33,100. Resources include bank accounts, stocks, bonds and other investments. Your home, vehicles, personal possessions, life insurance, burial plots and irrevocable burial contracts don't count.

How to apply in North Carolina

1. Apply with Social Security. Online at ssa.gov/medicare/part-d-extra-help, by phone at 1-800-772-1213 (TTY 1-800-325-0778), with paper form SSA-1020, or at a Social Security office. You can apply any time of year.
2. Or apply at your county DSS. NC Medicaid's manual MA-2311 says county DSS offices take Extra Help applications. They usually forward them to Social Security, but the county will decide the application itself if you ask. Either way, DSS screens you for MQB too. Find your office in the local DSS directory or through the NC Medicaid Contact Center, 1-888-245-0179.
3. Leave the MQB referral on. Medicare.gov says Social Security will send your information to the state to start a Medicare Savings Program application unless you tell it not to. In North Carolina that sends your case to your county DSS for MQB.
4. Read the decision letter. If you're approved, choose or keep a Part D plan or a Medicare Advantage plan with drug coverage. If you're turned down, the letter explains how to appeal. If your income or savings drop later, you can reapply.

Step by step: How do I apply for Extra Help in North Carolina?

Other North Carolina help with drug costs

North Carolina doesn't run a general state drug-assistance program for older adults, so for most people Extra Help is the help that exists (more on that). People living with HIV can ask about the state's HIV Medication Assistance Program (HMAP). Anyone with Part D can also spread drug costs over the year through the Medicare Prescription Payment Plan.

State retirees on a State Health Plan group Medicare Advantage option should check with the Plan before joining an outside Part D plan: the Plan says that removes you from its group Medicare Advantage plan. See State Health Plan retirees and Medicare.

Choosing a drug plan in North Carolina

North Carolina is its own Part D region (Region 08). For 2027, 11 standalone Part D plans from 6 companies are offered statewide, plus Medicare Advantage plans with drug coverage that vary by county. With Extra Help, what you pay depends on the plan you choose, so check that your drugs are on the plan's list. You can compare plans with your drugs at PlanMatch, or you can request a call from a licensed insurance agent to compare plans from the companies they work with. Medicare.gov and 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) can give you information on all of your options. More in Medicare Part D in North Carolina.

Sources

• Medicare.gov — Help with drug costs (Extra Help, 2026 limits, 2027 costs, LI NET, MSP referral)
• Social Security — Extra Help with Medicare prescription drug plan costs
• CMS — CY 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (PDF)
• eCFR — 42 CFR 423.773, Requirements for eligibility (deemed eligibility)
• NC Medicaid — MA-2311, LIS Processing and Case Maintenance (PDF)
• NCDHHS — Local DSS Directory
• NCDHHS Division of Public Health — HIV Medication Assistance Program (HMAP)

Frequently asked questions

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