Missouri Rx Plan Enrollment

Enrollment begins November 1, 2006 for eligible low-income Medicare beneficiaries. Benefits for new enrollees begin January 1, 2007. There are no costs associated with enrolling in or belonging to MoRx. You can apply for MoRx at any time throughout the year. Once enrolled, you never need to re-apply.

• You May Be Eligible If You Are:
• A resident of the State of Missouri; and
• 65 years of age or older and enrolled in Medicare; or age 18 – 64, disabled and enrolled in Medicare; and
• Single with an annual gross income of $19,600 or less; or married with an annual gross income of $26,400 or less; and
• Enrolled in a Medicare Prescription Drug Plan (Part D). To learn more about the Part D or to choose and enroll in a Part D plan that's best for you, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) toll-free.
• How Do I Get An Application?

Applications are available in English and Spanish. You will need Acrobat Reader to view and print the documents.

• English
• Spanish

Complete the application by printing clearly with black or blue ink. Be sure to sign and date the application and include the required documentation listed below.

• What Do I Need To Send With My Application?
1. Proof of Missouri residency
   PROOF OF RESIDENCE (choose one and send a copy with your application)
   • Valid driver's license
   • Valid MO state identification card
   • Voter registration card (current or within the past year)
   • Utility bill with name and address (issued within the past year)
   • Doctor or hospital bill showing name and address (issued within the past year)
   • Notarized letter of residency from applicant or their Power of Attorney
   • Certification of residency in a skilled nursing, assisted living or residential care facility (letter on facility stationery signed by the administrator)
2. A copy of your Medicare Health Insurance card
   
3. A copy of your Social Security card
   

These copies do not need to be in color.

If you do not include the required documents your application will be returned as incomplete. Please send copies only. DO NOT SEND ORIGINAL DOCUMENTS.

• How Much Does It Cost To Enroll In or Belong To MoRx?

Nothing - the program is free. MoRx does not have an enrollment fee, deductible or monthly premium.

• Do Current MoRx Members Need To Apply?

Current MoRx members should not fill out an application. Once you are enrolled in MoRx, you will not need to re-apply again. However, notices may be sent periodically requesting updated information.

If you have a change in address, income, marital status or any other situation that you feel may affect your MoRx membership, please call us at 1-800-375-1406. The call is free. Persons with hearing or speech disabilities may call our TTY number toll-free at 1-800-375-1493.

• How Do I Know When I'm Enrolled?

Once we receive and process your completed MoRx application with required documents, we will send you a membership card along with a letter explaining your benefits and how the plan works.

• How Can I Save Even More On My Prescription Costs?

In addition to your Part D plan and MoRx benefits, you may be eligible for extra help with prescription costs from the Social Security Administration. To learn more about this extra help, visit www.socialsecurity.gov or call 1-800-772-1213 toll-free.