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OMB No. 09381378 Expires: 7/31/2023 INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) OR MEDICARE PRESCRIPTION DRUG PLAN (PART D) Who can use this form? Reminders:
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How to fill out or medicare prescription drug
How to fill out or medicare prescription drug
01
Make sure you have your Medicare card and prescription drug plan information ready.
02
Contact your healthcare provider to obtain a prescription for the medication you need.
03
Research and compare different Medicare prescription drug plans to find one that best fits your needs.
04
Enroll in the selected plan either online, over the phone, or by mail.
05
Review your plan's formulary to ensure that your prescribed medication is covered
06
Follow the instructions provided by your plan for filling out and submitting your prescription.
Who needs or medicare prescription drug?
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Individuals who have Medicare coverage and require prescription medications on a regular basis.
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What is or medicare prescription drug?
Medicare prescription drug coverage helps cover the cost of prescription drugs for Medicare beneficiaries.
Who is required to file or medicare prescription drug?
Medicare beneficiaries who want prescription drug coverage are required to file for Medicare prescription drug coverage.
How to fill out or medicare prescription drug?
Medicare beneficiaries can fill out the Medicare prescription drug application online, by phone, or by mail.
What is the purpose of or medicare prescription drug?
The purpose of Medicare prescription drug coverage is to help Medicare beneficiaries afford prescription medications.
What information must be reported on or medicare prescription drug?
Information such as the beneficiary's personal information, Medicare number, prescription drug coverage preferences, and current medications must be reported on the Medicare prescription drug application.
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