NC MedAssist Assistance Program

Requirements for uninsured applicants

• Applicants must be at or below 200% federal poverty level to qualify
  • View federal poverty guidelines
• This company requires a copy of the applicants 1040 tax form
  • If the applicant did not file taxes they must sign a 4506-T document to submit with their application
• Medications are shipped directly to the patients home
• Applications are good for 1 year from the date approved by the program

Requirement for Medicare Part D applicants

• Medicare Part D enrollees can apply if they meet the financial guidelines of being under 200% federal poverty level and are currently in the coverage gap
  • 1099 SSA form is not acceptable to show social security benefits, applicant must submit the social security benefits letter
• Applications for Medicare Part D enrollees are valid until December 31st of the current enrollment year