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Medicare Part D Forms

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you are first eligible, don’t have other creditable prescription drug coverage, or you don’t receive extra help, you’ll likely pay a late enrollment penalty. To obtain Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

The form should be filled out and kept in your personal files for future reference.

Medicare - Part D Creditable Coverage

Medicare - Part D Non-Creditable Coverage