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Medicare Part D Assistance

A prescription inside a pill container

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Western Reserve Area Agency on Aging

Do you need to enroll in Medicare Part D prescription drug coverage or make changes to your plan?

The Benefits Enrollment Center can help you choose the right plan, as well as fill out and submit your applications. We can also assist with exceptions, appeals and complaints. Our Benefits Enrollment Center has helped thousands of Medicare beneficiaries and people age 55 and older in Northeast Ohio and beyond.

Schedule your free appointment today! Email us at esopreceptionist@benrose.org or call us at 216.791.8000 to schedule your FREE assessment.

External Request Form

Medicare Part D Assistance Enrollment Request

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First Name Required

Last Name Required

Date of Birth Required

Gender Required

Home Address

Address 1 Required

Address 2

City Required

State Required

Zip Code Required

Mailing Address (if different)

Same as Home Address

Address 1 Required

Address 2

City Required

State Required

Zip Code Required

Phone Numbers

Home Phone Required

Primary Number

Cell Phone Required

Primary Number

Work Phone Required

Primary Number

Email Addresses

Personal Email Required

Primary Email

Work Email Required

Primary Email

Other Email Required

Primary Email

Income

Income Amount Required

Income Type Required

Income Period Required

House Size Required

Other

Notes Required

Leadership

Leadership

Cynthia Walker

Medicare and Benefit Enrollment Counselor

Contact: esopreceptionist@benrose.org | (216) 373-1650