Find an Assistance Program

Privacy: The information you provide here will be used to identify program(s) that may be right for you. Your answers will not be stored or used for any other purpose.

Step 1 of 3: Tell us about yourself

Step 1 of  3
To find the right program(s) for you, we just need a little information.
 1. Are you unemployed?    
 2. If yes, did you become unemployed on or after January 1, 2009?  
 3. Do you currently have insurance coverage

Insurance coverage

Insurance coverage includes Medicaid/Medicare prescription drug coverage; state-sponsored prescription drug assistance programs and employee, military, retirement, or pension program drug coverage.

for your prescription medicines?  		  
 4. Are you eligible for Medicare?    
 5. What is your marital status?    
 6. What is your total yearly household income?

Household income

Household income includes all money that comes into your household. If you are married and live with your spouse, you must include both of your incomes. You must also include income earned by dependents living with you.

       		$  
(ex: 20,000)
 7. How many people are in your household?
(Include yourself, your spouse, and any dependents you claim on your tax return.)     		   
 8. In what state do you live?      
 9. What is your date of birth?  
  / /
(ex:
12 31 1955)
 10. How did you learn about this Web site? (optional)  

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