Extra Help, the Part D Low-Income Subsidy, automatically lowers prescription drug costs for dual eligibles with Alzheimer's disease. Dual eligibles — people with both Medicare and Medicaid — pay no Part D deductible and small copays for covered dementia drugs.
Part D is Medicare coverage for outpatient prescriptions taken at home. Alzheimer's symptom drugs fall under Part D, while newer amyloid-targeted infusions fall under Part B. That split decides what Extra Help can pay.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Who gets Extra Help without applying?
- What do you pay for Alzheimer's prescriptions?
- Why don't infusions work the same way?
- What limits and next steps matter?
Who gets Extra Help without applying?
People with both Medicare and Medicaid do not need to apply for Extra Help. According to Medicare.gov, full-benefit Medicaid, help with Part B premiums through a Medicare Savings Program, or SSI payments triggers automatic Extra Help Medicare's help with drug costs.
If they lack a drug plan, CMS enrolls them automatically. Check automatic status if the person: Extra Help also removes the Part D late-enrollment penalty. The Limited Income Newly Eligible Transition program gives temporary drug coverage to qualifying Medicaid beneficiaries not yet in a Part D plan.
- has full-benefit Medicaid alongside Medicare
- gets help paying Part B premiums through a Medicare Savings Program
- receives SSI payments
What do you pay for Alzheimer's prescriptions?
The National Council on Aging notes all Part D plans must cover at least two symptom drugs for Alzheimer's. Common examples are cholinesterase inhibitors such as donepezil, rivastigmine and galantamine. Memantine is a glutamate regulator that works a different way. With full Extra Help in 2026, the Part D deductible is $0 and the premium is $0 up to the regional benchmark.
NerdWallet reports covered prescriptions are capped at $5.10 generic and $12.65 brand NerdWallet's Extra Help guide. In 2027 those caps rise to $5.80 and $14.40. A dual eligible taking daily donepezil plus memantine pays only those small copays each fill. Staying in a benchmark plan avoids extra premium costs.
Why don't infusions work the same way?
Leqembi and Kisunla are not Part D drugs. CMS states Leqembi (lecanemab, July 2023) and Kisunla (donanemab, July 2024) are covered under Part B only with strict conditions CMS coverage statement for Leqembi. Coverage requires mild cognitive impairment or mild Alzheimer's dementia. It also requires documented amyloid plaques.
The prescribing clinician must take part in a CMS registry. Original Medicare charges 20% Part B coinsurance for Leqembi. Extra Help alone does not pay that medical coinsurance. Dual eligibles need Medicaid or a Medicare Savings Program for that share.
What limits and next steps matter?
Extra Help pays the Part D premium only up to the area benchmark. Choosing a costlier plan leaves the person owing the difference. Medicare.gov notes Extra Help is unavailable in Puerto Rico, Guam, Virgin Islands, Northern Mariana Islands and American Samoa.
Residents there need local drug assistance programs. Confirm benchmark status each fall during plan choice. Ask the pharmacist if both Alzheimer's drugs are on the plan formulary.
