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Medicare Part D Screening Checklist

Baltimore County Department of Aging SHIP (State Health Insurance Assistance Program) provides one-on-one assistance with Part D research for Medicare beneficiaries at Baltimore County Senior Centers during the Annual Part D Open Enrollment from October 15 to December 7. To schedule an appointment for the 2015 Open Enrollment, please call 410-887-2059 no earlier than September of 2015. The dates for the Part D research will be listed on the Medicare page entitled "Outreach."

Bring the following items to with you for your appointment:

  1. Your Medicare card and any other health care card that you use for coverage of your medical expenses
  2. A list of all medications that you take. Include correct spelling, dosage, and how frequently you take it. If you use medications from a vial, inhaler, tube or jar, write down the size of the container (may be listed as cc, ml, gm on the label) or bring the container with you.
  3. Financial information (only dollar amounts, not account numbers or the actual documents) to determine eligibility for financial assistance with Medicare Prescription Drug costs. The Extra Help program does count assets, whereas the Maryland Senior Prescription Drug Assistance Program does not.

a. Gross Income

  • Social security before deductions.
  • Any pension, annuity or other retirement income
  • Distributions / withdrawals from retirement accounts (IRA, 401(k), 403(b), 457(b) or SEP)
  • Dividend, interest income or capital gains

b. Assets if applying for Extra Help

  • Does not count:primary residence, vehicles, burial  expenses, life insurance policies or personal possessions (jewelry, art, etc.)
  • Bank accounts (checking, savings, CDs)
  • Stocks, bonds, mutual funds, retirement accounts, other investments
  • Real estate (other than primary residence); however Extra Help may not count rental property whose income is needed for self-support
  • Cash

Revised December 16, 2014

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