Medicare Prescription Drug Plan Finder

2017 Medicare Prescription Drug Plan Finder Worksheet

PDP Worsheet image    PDP Worksheet additional page 2

Medicare Prescription Drug Plan Finder Worksheet Instructions   

Please complete the confidential worksheet (above) by clicking on the image and completing the form if you would like HICAP to assist you in comparing and/or selecting a Medicare Prescription Drug Plan for 2017. The enrollment period for 2017 plans is October 15th through December 7th. 

In order to serve you better, please complete all information requested on the both pages of the worksheet. This form must be returned to HICAP no later than November 23, 2016. You may return it to us prior to November 23, just no later. Incomplete forms will not be processed. There are several ways to receive help in comparing plans:
  • You mail or drop off your completed worksheet. The HICAP offices are located at: 434 7th Street in Eureka and 1765 Northcrest Drive in Crescent City (at the Del Norte Senior Center). A HICAP counselor will enter your information in the Medicare website and mail you printouts of the best choices for you. You call Medicare or the Insurance Company to enroll yourself before December 7th.
  • You call Medicare at 1-800-633-4227 (1-800-MEDICAR) and ask for assistance in comparing and/or enrolling yourself in a new plan.
  • You go to to enter your prescriptions, compare plans then enroll yourself. You can also change your enrollment to a different plan online.

If you do not have an appointment scheduled with us and need to talk to someone immediately, you may call Medicare directly. That number is: 1-800-MEDICARE or 1-800-633-4227

You can also go on line to the Medicare web page:

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The production of this document was supported by a federal grant from the Administration for Community Living (ACL). Its contents are solely the responsibility of Area 1 Agency on Aging and do not necessarily represent the official views of ACL