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, please call 410-887-2059. The dates for the Part D research are listed on the Medicare page entitled "Outreach."
Bring the following items to with you for your appointment:
- Your Medicare card and any other health care card that you use for coverage of your medical expenses
- 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.
- Financial information (only dollar amounts, Not account numbers or the actual documents):
a. Gross Income
- Social security before deductions
- Any pension, annuity or other retirement income
- Distributions / withdrawals from retirement accounts (ira, 401k, 403b, 457b, or sep)
- Dividend, interest income or capital gains
- Do Not Include, home, vehicles, burial plots or personal possessions (jewelry, art, etc)
- Bank Accounts (checking, savings, CD’s)
- Stocks, bonds, mutual funds, retirement accounts, other investments
- Life insurance policies with a total face value of more than $1,500 (whole, universal, etc.). This does Not refer to what the death benefit would be. For example, a $50,000 term life insurance policy would not count as part of your assets.
Revised July 25. 2013