2025 MEDICARE DRUG OR ADVANTAGE PLAN COUNSELING TOOL

State Health Insurance Assistance ProgramMEDICARE DRUG OR ADVANTAGE PLAN COUNSELING TOOL
Get improved help with your Medicare choices by creating a MyMedicare.gov account:

Medicare is improving and modernizing the new Medicare Plan Finder, the tool the SHIP Benefits Assistance Program at the Area Agency on Aging uses to compare Medicare Prescription Drug Plans and Medicare Advantage Plans. To provide a personalized plan comparison, you will need to create a MyMedicare.gov account. The goal is to provide a seamless and transparent experience to help you get the information you need to make good health care choices.
Already have a Medicare.gov account?

This will be used to complete your 2025 Medicare Drug Plan or Medicare Advantage Plan Comparison
Don’t have a MyMedicare.gov account yet?

Create your account at MyMedicare.gov and click “Log in or create an account” OR a SHIP counselor can help you create an account. For a personalized plan comparison, you will need a MyMedicare.gov account.

Authorization: I authorize the SHIP Benefits Assistance Program to use my Medicare.gov account to complete my plan comparison and or create an account if I don’t have one.
Signature
Date

MonthDayYear
Date
Your name*
Date of Birth*

MonthDayYear
Date
Address*

Your Address

Street Address Line 2

CityState / Province

Zip
County*
Phone Number*
Your email address*
example@example.com
Gender

MaleFemale
Your SHIP counselor name (if none assigned, leave blank)
Please provide your Medicare number exactly as it is shown on your red, white & blue card that you received from Social Security:
Medicare Number
Part A

MonthDayYear
Date
Part B

MonthDayYear
Date
Married

YesNo
Total Gross Household Monthly income
Do you have savings or investments of more than $17,220 as a single person or $34,360 as a couple?

YesNo
Do you want assistance with selecting a:

Prescription Drug PlanMedicare Advantage Plan
Preferred pharmacy 1
Preferred pharmacy 2

Instructions: Give the complete name of each medication, including any suffixes, such as Hcl, ER, HFA, etc. Indicate whether drug is a tablet, capsule, ointment, etc. Daily Strength Example: Metformin HclCapsule, etc.Dosage (10 mg)

	Name of Medication Example: Metformin Hcl	Tablet, Capsule, etc.	Strength (10 mg)	Daily Dosage
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Information will be limited to only the top 3 Drug Plans or Health Plans that meet your specific needs. Results will be completed and given to you within 10 business days. Please indicate how you want to receive the results:

EmailPostal Mail
The SHIP Benefits Assistance Program does not recommend or endorse any drug plan or Medicare Advantage Plan and is not responsible for the service provided by these companies. Your information is confidential and will be securely stored in your SHIP file Revised: 09/18/2025
Please verify that you are human*
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State Health Insurance Assistance ProgramMEDICARE DRUG OR ADVANTAGE PLAN COUNSELING TOOL

Already have a Medicare.gov account?