The Centers for Medicare & Medicaid Services set the 2026 resource ceiling for the Extra Help drug subsidy at $16,590 for a single applicant, rising to $18,090 once someone tells the Social Security Administration they are setting aside burial-expense money. A married couple sees the same shift, from $33,100 to $36,100, once each spouse claims a $1,500 burial allowance. Extra Help covers most of a Medicare Part D enrollee’s premiums and copayments, so an applicant who reports savings without flagging burial funds can be counted out of the subsidy by a few hundred dollars. CMS published both figures in an October 31 memo to Part D plan sponsors.
How CMS Recalculates the Extra Help Ceiling Each Year
The increase from 2025 follows a formula written into the Medicare Prescription Drug, Improvement, and Modernization Act, which requires CMS to adjust the Extra Help resource limits every year by the percentage change in the Consumer Price Index for All Urban Consumers. CMS compared the September 2025 index reading of 324.800 against September 2024’s 315.301, producing a 3.01 percent increase that the agency then rounded to the nearest $10. That single percentage moved the base single-person limit from $16,100 in 2025 to $16,590 in 2026, and the married-couple limit from $32,130 to $33,100, changes CMS laid out inside the same guidance sent to Part D sponsors.
Those base numbers describe only the ceiling for the full Extra Help benefit, the version that erases nearly all of a beneficiary’s drug costs rather than trimming them. Anyone whose countable resources sit above the limit but still qualifies for a partial subsidy faces a separate calculation CMS did not update in this particular memo, since the agency said it will not release the 2026 income standards until early next year, after the federal poverty level for the year is finalized. The resource ceiling and the income test are evaluated together, but only one half of that pair is locked in for now.
CMS defines a countable resource under 42 CFR 423.772 to include checking and savings account balances, stocks, bonds, and other assets a beneficiary could convert to cash within 20 days, along with any real estate other than a primary residence. A car, a primary home, and personal belongings are excluded from the count entirely, which is why the ceiling captures liquid savings and investment accounts far more often than it captures the value of what an applicant owns outright.
Inside the kit: 51 state Medicare cost-help packs, the new Part D out-of-pocket cap, the prior-authorization appeal steps and a medication and cost tracker. Open The Medicare Cost & Coverage Protection Kit.
The Burial-Expense Set-Aside That Adds $1,500 Per Person
The $1,500 increase built into the higher figures is not automatic. Federal rules at 20 CFR 416.1231 require a beneficiary to actively notify the Social Security Administration that a specific amount of savings is earmarked for burial costs before that money stops counting against the Extra Help resource test. Someone who simply keeps cash in a designated funeral fund without making that notification is still assessed against the lower $16,590 or $33,100 ceiling, meaning the notification step, not the intent behind the savings, is what determines which limit applies to an applicant’s file.
CMS’s table shows the set-aside is counted per person rather than per household, which is why a married couple’s protected amount doubles the single figure. A single applicant who notifies SSA moves from a $16,590 ceiling to $18,090, a $1,500 swing, while a married couple in which both spouses make the notification moves from $33,100 to $36,100, a $3,000 swing built from two separate $1,500 allowances. A couple in which only one spouse reports burial funds receives only half that protection, since the allowance follows the individual rather than the marriage.
The distinction can decide eligibility outright for applicants sitting close to the line. Someone with $17,200 in countable savings, checking balances, and non-primary-residence property would fail the standard $16,590 test and be denied the full subsidy, yet the same applicant would clear the $18,090 threshold simply by telling SSA that $1,500 of that balance is reserved for burial expenses. CMS’s guidance does not require proof the money will ultimately be spent that way, only that the beneficiary designate it before the resource count is run.
What the Ceiling Doesn’t Yet Settle
The resource limit is only one gate in a two-part test, and CMS’s October 31 memo, signed by Jennifer R. Shapiro, director of the agency’s Medicare Plan Payment Group, is explicit that the companion income standards are still pending. Those figures depend on the 2026 federal poverty level, a number the Department of Health and Human Services has not yet published, which means an applicant can confirm their savings clear the resource bar months before they can confirm their income clears the corresponding test, leaving a real planning gap for anyone assembling documents ahead of a filing.
The same memo sets the maximum copayments full-subsidy beneficiaries will pay at the pharmacy counter in 2026, and pairs them with a $2,100 out-of-pocket threshold above which no Part D beneficiary owes any cost-sharing at all under the Inflation Reduction Act’s phased-in drug-spending cap. A full-benefit dual-eligible beneficiary with income at or below the poverty line pays no more than $1.60 for a generic and $4.90 for a brand-name drug per prescription below that threshold, figures CMS ties directly to the same resource test that governs the burial set-aside.
For a non-full-benefit applicant qualifying through a state Medicare Savings Program, CMS’s table sets the resource ceiling at exactly $18,090, or $36,100 if married, the burial-inclusive figure rather than the base one, which means the set-aside is not a footnote for that group but the actual number written into the eligibility table itself. Shapiro’s memo directs plan sponsors and beneficiaries with further questions to the Medicare Plan Payment Group’s own Part D policy contact, underscoring that the resource math behind Extra Help remains CMS’s determination to make, not an estimate assembled secondhand.
Counting Resources Before an Extra Help Filing
The resource ceiling above decides whether an application clears the first test, but nothing in that number tells a beneficiary which state Medicare Savings Program to file with next, what a Part D plan’s appeal deadline looks like, or how the new out-of-pocket cap changes what the subsidy is actually worth month to month. That gap between passing the resource test and using the benefit is where most Extra Help paperwork actually stalls.
The Medicare Cost & Coverage Protection Kit is a 10-page kit with 51 state Medicare cost-help packs and the new Part D out-of-pocket cap.
See The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
