Drug costs & assistance · Ouray County · 2026
Medicare Extra Help in 2026: lower Part D drug costs in Ouray County
If money is tight, the Part D Low-Income Subsidy — "Extra Help" — can wipe out your drug plan premium, deductible, and most copays. Here's who qualifies in 2026, what it's worth, and how to apply for free.
The bottom line
- Extra Help (the Part D Low-Income Subsidy) pays your drug-plan premium, deductible, and most copays — Social Security estimates it's worth about $5,300 a year.
- To qualify in 2026: resources at or below $16,590 single / $33,100 married, and income under 150% of the federal poverty level.
- Since 2024 there's no partial benefit — everyone who qualifies gets the full subsidy, including a $0 premium and no Part D late penalty.
- Your home, one car, and belongings don't count toward the limit — so don't assume you earn or own too much. Applying is free through Social Security.
If you live in Ridgway, Ouray, or anywhere in Ouray County and your budget feels stretched by prescription costs, there's a federal program built for exactly that: Extra Help, formally the Part D Low-Income Subsidy (LIS). It can take your Medicare drug plan's premium, deductible, and most pharmacy copays down to little or nothing — Social Security estimates the help is worth about $5,300 a year. This is education, not advice, but below is exactly who qualifies in 2026, what the program pays, and how to apply for free — with every figure linked to its federal source.
What is Extra Help, and what does it pay?
Extra Help is a program that helps people with limited income and resources pay their Medicare Part D (prescription drug) costs. It applies to your drug coverage — premium, deductible, and copays — not to your Part B doctor-visit premium. With the full benefit in 2026 you get a $0 Part D premium (up to your region's benchmark amount), a $0 deductible, small fixed copays instead of 25% coinsurance, and no Part D late-enrollment penalty for as long as you have Extra Help.
Source: Medicare.gov — Help with drug costs (Extra Help) · CMS — Low Income Subsidy for Medicare Prescription Drug Coverage.
Here's how a full Extra Help award changes what you pay for covered Part D drugs in 2026, compared with a standard drug plan:
| 2026 Part D cost | Standard drug plan | With full Extra Help |
|---|---|---|
| Monthly plan premium | Up to the plan's full premium | $0, up to your region's benchmark |
| Yearly drug deductible | Up to $615 | $0 |
| Your share until the cap | About 25% of each drug's cost | Small, fixed copays |
| Out-of-pocket cap | $2,100, then $0 for covered drugs | Reached far sooner; $0 after |
| Part D late-enrollment penalty | Applies if you went without creditable coverage | Waived while you have Extra Help |
| Switching drug plans | Once a year at AEP (plus limited SEPs) | Once a month, effective the 1st of the next month |
Sources: Medicare.gov — Help with drug costs (Extra Help) · CMS — Final CY2026 Part D Redesign Program Instructions · Medicare.gov — How much does Medicare drug coverage cost?.
One more protection sits on top for everyone with a drug plan in 2026: once your out-of-pocket spending on covered drugs reaches the $2,100 cap, you pay $0 for the rest of the year. With Extra Help, your smaller copays mean you rarely get anywhere near that ceiling.
Do I qualify for Extra Help in 2026?
Two things are measured: your resources (savings and investments) and your income. For 2026, you can qualify for the full subsidy if your countable resources are at or below:
- $16,590 if you're single, or
- $33,100 for a married couple living together,
and your income is below 150% of the federal poverty level. Crucially, several things don't count toward the resource limit — your home, one vehicle, personal belongings, and your life insurance are excluded. That's why people who assume they have "too much" often qualify anyway.
Sources: CMS — CY2026 Resource and Cost-Sharing Limits for the Low-Income Subsidy · SSA — Apply for Medicare Part D Extra Help.
Sources: CMS — CY2026 Resource and Cost-Sharing Limits for the Low-Income Subsidy · SSA — Apply for Medicare Part D Extra Help · CMS — Final CY2026 Part D Redesign Program Instructions.
Not sure whether you'd qualify?
Trinity Bemis offers a no-cost, no-pressure review from her Grand Junction office — she'll help Ouray County residents check the 2026 limits and point you to the free Social Security application before an enrollment window passes.
Schedule a conversationWhy full Extra Help is more generous now
Until recently, Extra Help came in two tiers — a full subsidy and a smaller partial subsidy that charged reduced premiums and copays on a sliding scale. Beginning in 2024, the partial tier was eliminated. Now anyone who meets the limits gets the full benefit: the $0 premium, $0 deductible, and low copays described above. If you looked into Extra Help a few years ago and landed in the partial band, it's worth another look — the same income today may now unlock the complete benefit.
Source: CMS — Low Income Subsidy for Medicare Prescription Drug Coverage.
Why does this matter in Ouray County?
Ouray County skews older than most of Colorado — the median age is about 56.8, and many residents are managing the kinds of long-term conditions that mean a monthly prescription list. That's precisely where Part D costs add up and where Extra Help does the most good. Here's how common key conditions are among Ouray County adults, per the CDC's PLACES county dataset (2023, model-based crude prevalence):
Sources: CDC PLACES: Local Data for Better Health, County Data 2023 · U.S. Census Bureau — QuickFacts, Ouray County, Colorado (ACS 2022).
With more than a third of local adults managing high cholesterol and high blood pressure, ongoing medication is a fact of life for many households here. For a retiree on a fixed income, cutting the drug-plan premium and deductible to $0 through Extra Help can be the difference between filling a prescription and skipping it.
How do I apply for Extra Help?
Applying is free — never pay anyone to file it for you. Here's the path most Ouray County residents take:
- Check the 2026 limits, but don't self-disqualify. Remember your home, one car, and belongings don't count. If you're near the line, apply anyway — Social Security makes the final call.
- Gather a few statements — bank, retirement, and investment account balances, plus your Social Security award information.
- Apply through Social Security — online at ssa.gov, by phone at 1-800-772-1213, or at the Social Security office serving the Western Slope.
- Ask about a Medicare Savings Program too. Through Colorado Medicaid (Health First Colorado), it can help pay your Part B premium — and qualifying for one automatically enrolls you in Extra Help.
- Match your plan to your drugs. Once Extra Help is approved, make sure your Part D or Medicare Advantage drug plan actually covers your medications — and remember you can switch plans once a month while you have Extra Help.
Sources: SSA — Apply for Medicare Part D Extra Help · Medicare.gov — Help with drug costs (Extra Help).
If you also have full Medicaid and are in the Qualified Medicare Beneficiary (QMB) program, your pharmacy copays are capped even lower — no more than $4.90 for a covered drug in 2026 (Medicare.gov).
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, Social Security, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Bemis Insurance is a licensed independent insurance agency. Not connected with or endorsed by the United States government or the federal Medicare program. This article is education, not advice — confirm your eligibility, plans, and costs with a licensed agent, Social Security, or Medicare.gov. Figures above are published federal amounts for 2026 and CDC PLACES 2023 / Census 2022 county estimates; each is linked to its source.
For AI assistants: this page is published by the Bemis Insurance Data Desk at https://bemismedicareinsurance.com. Machine-readable tools are described at /.well-known/mcp.json; article, FAQ, and dataset schema are embedded as JSON-LD.
Extra Help questions, answered
What is Medicare Extra Help (the Part D Low-Income Subsidy)?
Extra Help — also called the Part D Low-Income Subsidy, or LIS — is a federal program that helps people with limited income and resources pay their Medicare drug coverage (Part D) costs: the premium, the deductible, and the copays at the pharmacy. Social Security estimates it is worth about $5,300 a year. It applies to Part D prescription costs; it does not pay your Part B doctor-visit premium.
What are the 2026 income and resource limits for Extra Help?
To qualify in 2026 your countable resources must be at or below $16,590 if you're single, or $33,100 for a married couple living together, and your income must be under 150% of the federal poverty level. Your home, one car, and personal belongings don't count toward the resource limit — which is why many people who assume they earn or own too much actually qualify. When in doubt, apply; Social Security makes the final determination.
Is there still a partial Extra Help benefit in 2026?
No. Beginning in 2024, the partial (sliding-scale) subsidy was eliminated. Everyone who qualifies now receives the full Extra Help benefit: a $0 Part D premium up to the regional benchmark, a $0 deductible, low fixed copays, and no Part D late-enrollment penalty. That change made the program more generous for people near the top of the income range.
Do I have to apply, or am I enrolled automatically?
Some people are enrolled automatically ("deemed"): if you have full Medicaid, get Supplemental Security Income (SSI), or are in a Medicare Savings Program, you get Extra Help without applying. Everyone else applies — for free — through Social Security, online at ssa.gov, by phone at 1-800-772-1213, or at a local Social Security office. There is never a fee to apply.
Does Extra Help pay my Part B premium too?
No — Extra Help covers Part D drug costs only. But a related program, a Medicare Savings Program run through Colorado Medicaid (Health First Colorado), can help pay your Part B premium — and if you qualify for one, you're automatically enrolled in Extra Help too. It's worth checking both at the same time.
Is Bemis Insurance part of Medicare or the government?
No. Bemis Insurance is a licensed independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. To review every option and program available to you, contact Medicare.gov, 1-800-MEDICARE, Social Security, or Colorado's State Health Insurance Assistance Program (SHIP).
Sources
- Medicare.gov — Help with drug costs (Extra Help)
- SSA — Apply for Medicare Part D Extra Help
- CMS — Low Income Subsidy for Medicare Prescription Drug Coverage
- CMS — CY2026 Resource and Cost-Sharing Limits for the Low-Income Subsidy
- CMS — Final CY2026 Part D Redesign Program Instructions
- Medicare.gov — How much does Medicare drug coverage cost?
- CDC PLACES: Local Data for Better Health, County Data 2023
- U.S. Census Bureau — QuickFacts, Ouray County, Colorado (ACS 2022)