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This document outlines the confidentiality policy for Alabama's MEDCAP, detailing the sharing of information for eligibility and the medication distribution process.
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How to fill out Alabama’s Medicare Part D Cost Assistance Plan (MEDCAP) Client Certification Statement

01
Obtain the Alabama Medicare Part D Cost Assistance Plan (MEDCAP) Client Certification Statement form.
02
Read the instructions carefully to understand the requirements and steps.
03
Fill in your personal information, including full name, address, date of birth, and Social Security number.
04
Indicate your current Medicare plan details, including the name of your Part D plan.
05
Provide information about your income and household size as requested.
06
Ensure you have any necessary documents ready, such as income verification.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form where indicated.
09
Submit the form through the designated submission method, such as mailing or online submission.

Who needs Alabama’s Medicare Part D Cost Assistance Plan (MEDCAP) Client Certification Statement?

01
Individuals in Alabama who are enrolled in Medicare and need financial assistance to help pay for their Medicare Part D prescription drug costs.
02
Those with limited income and resources who qualify for additional help with their Medicare prescription drug coverage.
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All Part D plans must include at least two drugs from most categories and must cover all drugs available in the following categories: HIV/AIDS treatments. Antidepressants. Antipsychotic medications. Anticonvulsive treatments for seizure disorders. Immunosuppressant drugs.
If your monthly income is up to $1,976 in 2025 ($2,664 for couples) and your assets. are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details). These limits include a $20 income disregard that the Social Security Administration (SSA)
Starting with the month you reach full retirement age, there is no limit on how much you can earn and still receive your benefits. You work and earn $32,320 ($8,920 more than the $23,400 limit) during the year.
Some people with Medicare won't automatically qualify for Extra Help next year, because they no longer qualify for Medicaid, no longer belong to a Medicare Savings Program (help from their state Medicaid program to pay Medicare Part B premiums), or no longer get Supplemental Security Income (SSI).
To be eligible for Extra Help, your annual income must be limited to $23,475 for a person or $31,725 for a married couple living together. Even if your annual income is Page 7 3 higher, you may still be able to get some help.
Understanding the costs of original Medicare can help you choose the right coverage options. Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

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Alabama’s Medicare Part D Cost Assistance Plan (MEDCAP) Client Certification Statement is a document used to verify a client's eligibility for financial assistance with their Medicare Part D prescription drug costs.
Individuals who are seeking cost assistance for their Medicare Part D prescription drug plan are required to file the Alabama’s Medicare Part D Cost Assistance Plan (MEDCAP) Client Certification Statement.
To fill out the MEDCAP Client Certification Statement, applicants must provide personal information, including their Medicare number, income details, and relevant documentation that supports their financial status and eligibility.
The purpose of the MEDCAP Client Certification Statement is to assess and document an individual's eligibility for receiving financial assistance to help reduce their out-of-pocket costs for Medicare Part D prescription drugs.
The information that must be reported includes personal identification details, Medicare information, household income, family size, and any other required documentation that supports the application for cost assistance.
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