/>
Home
Apply Online
Forms
Contact
Register
Log in
Prescription Advantage is a state-sponsored prescription drug program administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs for seniors and people with disabilities.
Prescription Advantage Application
Household Information
Are you enrolled in a Medicare Drug Plan or Creditable Coverage Drug Plan? *
Yes
No
Not Sure
Plan Name: *
Do you have any other health insurance? *
Yes
No
Not Sure
Plan Name:
Not Sure
AARP
Aetna
American Pioneer American
Progressive Life
Anthem
Bankers Life
BC Bronze Benefit Plan Management, Inc
Blue Care 65
Blue Cross Blue Shield
Care Net Plan
Champ VA
Cigna
Citizen's Health
Commonwealth Indemnity Plan
Community Care Rx
Connecticare
EBPA
Express Scripts
Fallon Community Health Plan
Fallon Senior Plan
First Health - Agilent Technologies
Free Care
Free Care Deaconess Hospital
GE Prescriptions
GIC Community
Hartford
Harvard First Seniority
Harvard Pilgrim Health Care
Health New England
HMO Blue NE
Humana Insurance
Medcohealth
MedexBronze
MedexCore
MedexGold
MedexOther
MGH
Not Provided
TRICARE (Military Health Insurance)
Tufts Secure Horizons
United Health Plan
VA
Does this insurance include prescription drug coverage? *
Yes
No
Not Sure
Do you receive health coverage through Medicaid (MassHealth or CommonHealth)? *
Yes
No
Not Sure
Do you receive health coverage through a MassHealth Buy-In Program, also known as Medicare Savings Program (MSP)? *
Yes
No
Not Sure
Eligibility for MSP may impact your eligibility for Prescription Advantage.
Return to Home
