If you have Medicare and you take prescription drugs, 2026 brings the best news in years. There is now a firm yearly limit on what you pay out of pocket for covered medicines. And if your income is modest, a separate program called Extra Help can lower your drug costs even further — sometimes to just a few dollars per prescription. Best of all, a trained counselor right here in New York City can walk you through it for free.
This guide explains the new $2,100 out-of-pocket cap, who qualifies for Extra Help, and exactly how to get free, one-on-one help in any borough. You have earned these benefits. Here is how to use them.
The New $2,100 Cap on Drug Costs
Starting in 2026, no one with a Medicare Part D drug plan pays more than $2,100 out of pocket for covered prescriptions in a single year. This cap came from the Inflation Reduction Act, a federal law passed in 2022. The savings are now fully in effect.
Here is what the cap means in plain terms. Once the money you have spent on covered drugs adds up to $2,100 for the year, you pay $0 for the rest of that year on any drug your plan covers. That $2,100 total includes your deductible, your copays, and your coinsurance — all of it counts toward the limit.
A few other 2026 numbers are worth knowing:
- No Part D plan can charge a yearly deductible higher than $615.
- After you meet any deductible, you generally pay 25% of the cost of your drugs until your spending hits $2,100.
- After $2,100, you reach what Medicare calls “catastrophic coverage,” and your covered drugs are free for the rest of the year.
If you take expensive medicines, this cap can save you thousands of dollars compared to past years, when there was no firm ceiling at all.
What Is Extra Help, and Why It Matters
Extra Help is a federal program, run by Social Security, that lowers prescription drug costs for people with limited income and savings. It is also called the Low-Income Subsidy, or LIS. If you qualify, Extra Help can pay for much of your Part D plan’s monthly premium, lower or erase your deductible, and cut your copays down to a small amount.
People who get Extra Help reach that $2,100 yearly cap faster, too, because certain payments made on their behalf count toward the limit. For many older New Yorkers, Extra Help is the single biggest way to bring drug costs down.
Who Qualifies for Extra Help in 2026
Extra Help is based on two things: your income and your resources (money and certain assets you own). For 2026, the limits are:
- Income: at or below $23,475 per year for one person, or $31,725 per year for a married couple living together.
- Resources: at or below $18,090 for one person, or $36,100 for a married couple. These amounts include a $1,500-per-person set-aside for burial expenses.
“Resources” means things like money in checking and savings accounts, stocks, and bonds. Some things do not count: the home you live in, one car, household items, and up to $1,500 set aside for burial costs.
Two important notes. First, if you already have both Medicare and Medicaid, get Supplemental Security Income (SSI), or are in a Medicare Savings Program, you usually qualify for Extra Help automatically — you do not need to apply. Second, the numbers above can change, and your own situation may differ, so always confirm the current requirements before you decide you do or do not qualify.
Free One-on-One Help in NYC: HIICAP
Choosing a Part D plan and applying for Extra Help can feel confusing. You do not have to figure it out alone. New York has a free, unbiased counseling program built for exactly this.
It is called HIICAP — the Health Insurance Information, Counseling, and Assistance Program. HIICAP counselors are trained to answer Medicare questions, compare Part D drug plans, and help you apply for Extra Help. They do not sell insurance and they do not push any plan. The service is free and confidential.
In New York City, you reach HIICAP through NYC Aging (the Department for the Aging). You can meet a counselor in person or talk by phone. To get started, call Aging Connect at 212-AGING-NYC (212-244-6469). You can also use the statewide HIICAP helpline at 1-800-701-0501, which will route you to a local counselor.
How to Get Started
Here is a simple, step-by-step path to lower your drug costs.
- Gather a few papers. Have your Medicare card, a list of the prescription drugs you take, and a rough idea of your income and savings nearby.
- Call for free help. Phone Aging Connect at 212-244-6469 and ask to speak with a HIICAP counselor about Part D and Extra Help. Lines are open on weekdays.
- Apply for Extra Help. You can apply directly with Social Security online at ssa.gov or by calling SSA at 1-800-772-1213 (TTY 1-800-325-0778). A HIICAP counselor can also help you complete the application.
- Review your Part D plan each fall. Plans change every year. Medicare’s Open Enrollment runs from October 15 to December 7. Use that window to make sure your plan still covers your drugs at the best price.
- Confirm current rules. Income and resource limits update over time. Ask your counselor to verify the latest figures for your situation.
A Note on Avoiding Scams
Real Medicare help never comes from an unexpected phone call asking for your Medicare number, bank details, or a payment to “sign you up.” HIICAP and Social Security do not work that way. If someone pressures you, hang up and call Aging Connect or Social Security yourself using the numbers above. When in doubt, talk to a HIICAP counselor before sharing any personal information.
Where Else to Turn
Lowering drug costs is one piece of staying healthy and independent in New York City. Our NYC elder care guide covers caregiver support, home care, and who to call for help. And if you need affordable medical care, the city runs free and low-cost Gotham Health clinics in every borough. Pairing free drug-cost help with these services can make a real difference in your monthly budget.
Frequently Asked Questions
Do I have to pay $2,100 before my drugs become free?
You pay your normal deductible, copays, and coinsurance as you fill prescriptions during the year. Once those out-of-pocket costs add up to $2,100 in 2026, your covered drugs cost $0 for the rest of the year. You do not pay the $2,100 all at once.
Can I spread my drug payments out over the year?
Yes. Medicare now offers a payment plan that lets you spread your out-of-pocket drug costs across the calendar year in monthly amounts instead of paying a large sum at the pharmacy at once. Ask your Part D plan or a HIICAP counselor how to sign up.
What if my income is a little above the Extra Help limit?
It is still worth applying. The rules about what counts as income and resources can work in your favor, and a HIICAP counselor can check whether you qualify. You may also be eligible for a Medicare Savings Program, which can help with other Medicare costs.
How much does HIICAP counseling cost?
Nothing. HIICAP help is free, confidential, and unbiased. Counselors do not sell insurance or earn commissions. Reach them through Aging Connect at 212-244-6469.
When can I change my Part D plan?
For most people, the main window is Medicare Open Enrollment, October 15 through December 7 each year. People who qualify for Extra Help often have extra chances to switch plans during the year. A counselor can explain your options.
The Bottom Line
In 2026, you have stronger protection against high drug costs than ever before: a firm $2,100 yearly cap, plus Extra Help that can lower your costs even more if your income is modest. The application is free, the counseling is
