The information you provide will be used to determine whether or not you will be eligible to receive assistance.

You cannot have:

  • Medicaid Prescription coverage
  • Medicare Prescription coverage
  • Veteran’s Prescription coverage
  • Any other type of Prescription coverage

You can have:

  • Other health insurance or no health insurance at all
  • Medicare A & B
  • Supplemental Insurance
  • Medication discount card
  • Medicaid QMB, SLMB
  • Medicare Discount card