Pennsylvania has one of the oldest Medicare populations in the country, and thousands of eligible Pennsylvanians never apply for Extra Help simply because they assume their income or savings disqualify them. Extra Help, also called the Low-Income Subsidy (LIS), is a federal benefit that can save a Medicare enrollee more than $5,000 a year in Part D premiums, deductibles, and copays. The income and resource rules are set federally, so the base numbers are identical in Pennsylvania to every other state except Alaska and Hawaii.
Pennsylvania runs its Medicare Savings Program under the brand name Healthy Horizons, a state-administered gateway that automatically deems enrollees eligible for full Extra Help, though unlike some states Pennsylvania still applies an asset test to every Healthy Horizons tier. This guide covers the exact 2026 income limits for Pennsylvania households, the Healthy Horizons and Medical Assistance deeming shortcut, how to apply through either path, and the state-run PACE and PACENET programs that stack with Extra Help. For the broader national rules, see Extra Help eligibility nationwide. Check Pennsylvania PACE and PACENET eligibility and Medicaid vs Medicare Savings Program for the programs that pair with Extra Help.
Direct Answer: Do You Qualify for Extra Help in Pennsylvania?
Yes, Pennsylvania Medicare beneficiaries qualify for Extra Help under the same 2026 federal limits used nationwide: income below $23,940 a year for one person or $32,460 for a married couple, and resources below $16,590 single or $33,100 married. Many Pennsylvanians qualify automatically through full Medical Assistance, Supplemental Security Income (SSI), or Pennsylvania's Healthy Horizons Medicare Savings Program, which uses its own income and resource rules described below.
Pennsylvania's Healthy Horizons Medicare Savings Program and Medical Assistance
Pennsylvania administers its Medicare Savings Program under the name Healthy Horizons, offered through the Department of Human Services rather than the Social Security Administration. Any Pennsylvania Medicare enrollee approved for Healthy Horizons (QMB, SLMB, or QI) or full Medical Assistance is automatically deemed eligible for full Extra Help, with no separate SSA application and no waiting on a second determination once the County Assistance Office (CAO) approves the underlying program.
Pennsylvania has not eliminated the resource test for Healthy Horizons the way New York and some other states eliminated theirs for QMB and QI. Every Healthy Horizons tier in Pennsylvania still counts savings accounts, checking accounts, and most investments against a 2026 resource limit of $9,950 for an individual or $14,910 for a couple. The federal Extra Help resource limit, $16,590 single or $33,100 married in 2026, applies to a direct Social Security application and is more generous than the Healthy Horizons figure, so a Pennsylvanian with savings just above the Healthy Horizons limit should still apply for Extra Help directly through Social Security.
| Program | Individual monthly income limit | Couple monthly income limit | 2026 asset limit |
|---|---|---|---|
| QMB: pays Part A and Part B premiums, deductibles, and coinsurance | $1,350 | $1,824 | $9,950 individual / $14,910 couple |
| SLMB: pays the Part B premium only | $1,616 | $2,184 | $9,950 individual / $14,910 couple |
| QI: pays the Part B premium only ($202.90/month in 2026) | $1,816 | $2,455 | $9,950 individual / $14,910 couple |
| QDWI: pays the Part A premium for working disabled individuals under 65 | $2,680 (est.) | $3,597 (est.) | $4,000 individual / $6,000 couple |
| Full Medical Assistance dual-eligibility | Varies by category | Varies by category | $9,950 individual / $14,910 couple (aged/disabled categories) |
QDWI figures are estimated from the standard federal formula of 200% of the Federal Poverty Level plus the $20 general income disregard, since Pennsylvania has few QDWI enrollees. Qualifying for any Healthy Horizons tier or full Medical Assistance automatically deems a Pennsylvania resident eligible for full Extra Help. County Assistance Offices, not the Social Security Administration, decide these applications.
Source: Pennsylvania Department of Human Services Healthy Horizons Program (2026); CMS Medicare Savings Program federal guidance
Pennsylvania Extra Help Income Limits by Household Size (2026)
Pennsylvania Medicare beneficiaries use the same federal Extra Help income ladder as every other state except Alaska and Hawaii. The table above this section lists the exact 2026 annual and monthly limits for Pennsylvania households of 1 through 8 people, plus the amount added for each additional household member. Family size and household composition both matter here: a household generally includes you, your spouse, and any dependents living with you and relying on your income.
Pennsylvania income slightly above these federal figures does not automatically disqualify a resident. Households with income just over the Extra Help limit should still check the Medical Assistance and Healthy Horizons limits above, since Pennsylvania evaluates aged and disabled applicants under Non-MAGI methodology, a different income-counting approach than the Modified Adjusted Gross Income (MAGI) formula used for ACA marketplace and expansion-Medicaid applications.
What Extra Help Covers for Pennsylvania Medicare Enrollees in 2026
Pennsylvania Extra Help recipients get the exact same enhanced Part D benefit as recipients in every other state, because Extra Help is a federal subsidy paid through CMS, not a state-run benefit. Since the Inflation Reduction Act of 2022 eliminated the old partial-subsidy tier on January 1, 2024, every Pennsylvania enrollee who qualifies gets the full package below regardless of whether their income sits at 60% or 149% of the Federal Poverty Level.
- Part D premium covered up to the Pennsylvania regional benchmark plan premium
- Part D annual deductible: $0 (fully waived)
- Generic drug copay: no more than $5.10 per fill in 2026
- Brand-name drug copay: no more than $12.65 per fill in 2026
- Coverage gap (donut hole): eliminated for Extra Help recipients
- After the 2026 Part D out-of-pocket cap of $2,100 is reached: $0 copays for the rest of the year
Is Pennsylvania a Medicaid Expansion State? What That Means for Extra Help
Pennsylvania expanded Medicaid under the ACA effective January 1, 2015, after Governor Tom Wolf replaced the prior administration's modified waiver with traditional expansion, and covers adults with income up to 138% FPL through Medical Assistance. Pennsylvania has no ACA gap for working-age adults the way the 10 non-expansion states do (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming). Extra Help serves a different population: Medicare beneficiaries who are usually 65 or older or under 65 with a qualifying disability.
Pennsylvania evaluates the older and disabled group under Non-MAGI rules rather than the Modified Adjusted Gross Income (MAGI) methodology used for ACA marketplace and expansion-Medicaid applications. Under Non-MAGI rules, family size, household composition, and countable resources are assessed with different formulas than a marketplace or expansion Medical Assistance application would use, which is why the Healthy Horizons limits described above look different from the 138% FPL expansion threshold.