Get 18009635337

This guide provides clear and comprehensive instructions on how to complete the 18009635337 form online. Follow the steps to ensure you provide all necessary information for eligibility in financial assistance programs available for Medicare beneficiaries.

Follow the steps to complete the form online successfully.

1. Click the ‘Get Form’ button to download the document and open it in an editable format.
2. Begin with the beneficiary information section. Enter your full name, address, city, and telephone number accurately.
3. Provide the contact details of a designated person who can assist you, including their name, city, and phone number.
4. Fill in your date of birth, citizenship status, and state of residence. Ensure accuracy in each field.
5. Input your Social Security and Medicare numbers. This information is essential for verifying your identity and eligibility.
6. List your health and life insurance policies in addition to Medicare, ensuring to include policy numbers and contact addresses for each.
7. Provide statements from all bank and retirement accounts to give a complete financial overview.
8. Include account numbers for any veteran’s benefits, pensions, and income from federal programs such as Social Security.
9. Document any annuities you hold, including their account numbers.
10. List the names and addresses of any part-time or full-time employers.
11. Compile a list of medications you take, including dosages and frequency of administration for plan comparison purposes.
12. If a family member or authorized person assists with this application, supply their name, address, and phone number for contact purposes.
13. Once all sections of the form are complete, save your changes. You can then download, print, or share the form as needed.

Begin completing your documents online today to access financial assistance for Medicare beneficiaries.