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Documentation required to apply

To apply for Prescription Advantage you will need to provide information about your income and health insurance. If you are under age 65 with a disability, additional information about your disability is required.

Prescription Advantage

Online

Prescription Advantage Prescription Drug Assistance 

The Details of Documentation required to apply

How to apply Documentation required to apply

1-800-243-4636 and press 2 or press 5 if calling from a cell phone; TTY at 1-877-610-0241

Prescription Advantage

P.O. Box 15153

Worcester, MA 01615-0153

508-793-1133

Next steps for Documentation required to apply

Additional information is needed to process your application.

Information you will need to have handy to complete the application includes:

  • Your Medicare number if you have Medicare
  • The name of other health insurance or prescription drug coverage you may have
  • Your Railroad Retirement number if you have one

You will be asked to send Prescription Advantage information about your income.  Acceptable income documents include:

  • Your most recently federal income tax return 1040, 1040A, or 1040EZ
  • Social Security benefit award letter or annual benefit statement (SSA-1099)

If you do not file federal income taxes, send copies of your most recent 1099 or W2 forms for any income you receive. Income may include:

  • Pensions/ Annuities
  • Railroad Benefit Income
  • Rental Income
  • Dividends/ Interest
  • Employment Income
  • Capital Gains
  • Retirement (IRA; 401K; 403B)
  • Unemployment
  • Alimony

If you do not receive W2 or 1099 or W-2 form(s), contact customer service for other documents you may submit.

 

Other Information

  • If you have Medicare Part A or B, send a copy of the front of your Medicare ID card.
  • If you have other prescription drug coverage, send a copy of the front and back of your insurance card.
  • If you applied for Extra Help, send a copy of the determination letter from Social Security. If you do not have a determination letter, send a copy of your Extra Help application receipt from Social Security.
  • If you would like to have an Authorized Representative be responsible for your Prescription Advantage benefits you can send a signed Authorized Representative form with your application.

 

Applicants under age 65

Applicants under age 65 with a disability must submit a copy of 1 of the following documents:

  • Your Medicare card
  • Current Social Security award letter for SSDI or SSI benefits
  • Certificate of blindness from the Massachusetts Commission for the Blind
  • Determination of disability from MassHealth or CommonHealth (Medicaid)
  • Written verification of SSDI or SSI benefits signed by an authorized Social Security Claims Representative on Social Security letterhead

 

 

 

More info about Documentation required to apply

A SHINE (Serving the Health Insurance Needs of Everyone) Counselor can also help you with your application. To find a SHINE Counselor near you call:1-800-AGE-INFO (1-800-243-4636) and press 3; TTY/HCO: 1-800-548-2546.

Contact for Documentation required to apply

Address
Prescription Advantage
P.O. Box 15153, Worcester, MA 01615-0153
Online
Prescription Advantage Prescription Drug Assistance 

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