Medicare Extra Help (Low Income Subsidy / LIS) reduces or eliminates Part D premiums, deductibles, and copays. In 2026 the income limit is $23,475/yr for an individual and $31,725 for a couple, with a resource limit of $17,600 single / $35,130 married. Apply free at ssa.gov, call Social Security at 1-800-772-1213, or call Rob Simm at (828) 761-3326 for a free eligibility walkthrough — no obligation.

What Orange County families ask

What stops people from applying for Extra Help?

These are the four concerns I hear most from Orange County residents — and the real answers.

“I own my home — does that disqualify me?”

No. Your primary home, one car, burial plots, and up to $1,500 in life insurance do not count toward the $17,600 resource limit. Most Orange County homeowners who meet the income threshold still qualify.

“Will applying affect my other benefits?”

Extra Help does not reduce your Social Security, pension, or VA benefits. It only lowers your Part D drug costs. There is no clawback and no repayment obligation.

“I was denied before — should I try again?”

Yes. Income and resource limits change annually. The 2026 limits are higher than 2025. If your income dropped (retirement, spouse passing), you may now qualify even if you were denied previously.

“Is there a deadline to apply?”

No. You can apply for Extra Help any time of year. If approved, you also get a Special Enrollment Period to switch Part D plans — no need to wait for Open Enrollment.

⚠️ Many qualified Orange County residents never apply

Social Security estimates that roughly 1 in 3 people who qualify for Extra Help never apply. In Orange County, where the cost of living is higher than the NC average, many assume their income is too high. But the 2026 limit — $23,475 single / $31,725 couple — is higher than most people expect. A 10-minute phone call to (828) 761-3326 can confirm whether you qualify.

The difference

What changes when you apply with a broker vs. alone?

What do you need to know?	Medicare.gov	Rob Simm — NC #10447418
Eligibility screening	Generic online form — no Orange County context	10-minute phone call with income + resource review
Application help	DIY at ssa.gov or 1-800-772-1213 hold times	I walk you through every field — free
Plan optimization after approval	No guidance on which Part D plan to pick	I match your drug list to the lowest-cost plan in Orange County
NC Medicare Savings Programs	Not mentioned on the federal site	I screen for QMB, SLMB, and QI simultaneously
Follow-up if denied	Generic denial letter	I review the denial, check MSP eligibility, and appeal if warranted
Cost	$0 (just your time and risk)	$0 — paid by carrier, not by you

2026 Medicare numbers

What are the key Medicare figures for Orange County in 2026?

$202.90

Part B premium per month

2026 standard rate. Higher with IRMAA surcharge based on income above $106,000.

$283

Part B annual deductible

You pay this before Medicare covers 80% of outpatient care.

$9,350

MA in-network out-of-pocket max

2026 cap on in-network Medicare Advantage spending.

$2,100

Part D out-of-pocket cap

No catastrophic Rx costs in 2026. Insulin capped at $35/month.

💡 Broker Tip — Orange County

If you qualify for Extra Help, you also qualify for a Special Enrollment Period that lets you switch Part D or Medicare Advantage plans any month of the year — not just during AEP. I see Orange County residents stay on plans that moved their medications to higher tiers because they think they’re locked in. They’re not. Call me at (828) 761-3326 and I’ll run a formulary check the same day.

— Rob Simm, Licensed Medicare Broker, NC #10447418

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Rob Simm · Licensed NC Medicare Broker · NPN #10447418

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Real scenario · Orange County

What does Extra Help actually save an Orange County resident?

Without Extra Help

$4,200+/yr

Part D premium ($34/mo = $408/yr) + $590 deductible + copays on 5 brand-name drugs averaging $267/mo = $3,204/yr. Total out-of-pocket drug costs exceed $4,200 annually.

With Full Extra Help

$134/yr

$0 premium + $0 deductible + copays capped at $4.50 generic / $11.20 brand per prescription. Same 5 drugs, same pharmacy, same coverage — $4,066 less per year.

It pays to talk to the right broker

Does it cost anything to get help applying for Extra Help?

It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.

Common questions

Frequently asked questions

What is the income limit for Medicare Extra Help in 2026?

In 2026, the income limit for full Extra Help is $23,475/year for an individual and $31,725/year for a married couple. The resource (asset) limit is $17,600 single and $35,130 married. Your home, one car, and burial plots do not count toward the resource limit.

How do I apply for Extra Help in Orange County NC?

You can apply online at ssa.gov/medicare/part-d-extra-help, call Social Security at 1-800-772-1213, or visit the Durham Social Security office at 3710 University Dr. There is no fee and no obligation. A licensed Medicare broker like Rob Simm at (828) 761-3326 can walk you through the process for free.

Does Extra Help eliminate all my Part D drug costs?

Full Extra Help eliminates the Part D premium, deductible, and reduces copays to $0–$11.20 per prescription in 2026. Partial Extra Help reduces but does not eliminate these costs. Your savings depend on your income and resource levels.

Can I get Extra Help if I have a Medicare Advantage plan?

Yes. Extra Help applies to the Part D portion of any Medicare Advantage plan that includes drug coverage (MA-PD). If you qualify, your Part D premium, deductible, and copays are reduced regardless of whether you have standalone Part D or MA-PD.

What happens if I’m denied Extra Help — do I have other options?

If you’re denied, you may still qualify for North Carolina’s Medicare Savings Programs (QMB, SLMB, QI) which pay Part B premiums and may automatically qualify you for Extra Help. Call Rob Simm at (828) 761-3326 to check your eligibility for both programs.

Related Medicare guides

Medicare Enrollment in NC – 2026 Guide Extra Help/LIS Eligibility NC 2026 Compare Medicare Advantage Plans in NC Extra Help / LIS in NC – 2026 Eligibility Guide Working Past 65 – Medicare Enrollment Special Enrollment Periods in NC Cheap Health Insurance Without Employer Coverage Free Medicare Quotes Online

Get help in nearby NC counties

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Robert Simm

Licensed Independent Medicare Broker

Helping NC families navigate Medicare since 2014. Independent — I work with all carriers and get paid the same regardless of which plan you choose. I verify provider networks with Duke Health directly and answer my own phone the next year when something changes.

📞 (828) 761-3326 📋 NC #10447418 🏥 AHIP Certified ⭐ 5.0 · 20+ reviews 📍 2731 Meridian Pkwy, Durham NC 27713 🕐 Mon–Fri 9am–7pm ET

Last Updated: 2026-05-03 | Reviewed By: Robert Simm, Licensed Medicare Broker, NC #10447418 | Next Review: October 2026

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