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PA MEDI Screening Intake Form

PA MEDI Beneficiary Intake Form

This worksheet provides the necessary information that PA MEDI volunteers and staff need to prepare a personalized comparison report for you. PA MEDI does not endorse any Medicare Advantage or Part D Prescription Drug Plan. Any information provided on this form will not be sold, shared, or used for any other purpose besides providing you with a plan comparison.

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Appointment Preference

Medicare Login

A Medicare account login is needed for your appointment. If you would like a personalized search and already have a account login, please provide your account information below. If you do not have a account, or are not sure, your PA MEDI counselor will call you to help create an account for you. You will need to have your Medicare card to create the account.
Medicare Login

Health Insurance Information: Do you have any of the following coverages?

Health Insurance Information

Do you currently have a stand-alone Part D Drug Plan or a Medicare Advantage Plan?

Current Part D Plan

Do any of the following apply to you?

Any of the following Apply
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​Harrisburg, PA – The Pennsylvania Department of Aging today announced that older adults who will soon be turning 65 and are not yet enrolled in Medicare can attend a free virtual event to learn about their healthcare coverage options when enrolling for Medicare.


The "Welcome to Medicare" event on June 23, open from 3 p.m. to 7 p.m., will feature national presentations from the State Health Insurance Assistance Programs on Medicare eligibility, enrollment and coverage options. Representatives will be available to answer questions and assist older adults with information to enable them to make choices on Medicare coverage that best meets their needs and lowers their costs.


In Pennsylvania, this program is known as APPRISE. Throughout the national presentation, staff from APPRISE will host an exhibit for Pennsylvania and will respond to Medicare questions and provide information about the program. The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) – Pennsylvania's Senior Medicare Patrol – also will join APPRISE to discuss Medicare fraud prevention.


"We encourage anyone who is turning 65 soon to join our Virtual Welcome to Medicare Fair. Pennsylvania's Medicare Counseling Program is here to help older adults learn about signing up and navigating the complexities of Medicare, avoiding late enrollment penalties, and preventing fraud," said Susan Neff, APPRISE director. "We also invite those who attend to visit the Pennsylvania-specific virtual exhibit at any time during the event. The APPRISE and CARIE staff look forward to chatting with seniors about their Medicare enrollment concerns."


Older adults can register for this event here


The APPRISE Program has nearly 800 trained counselors in the commonwealth who provide free, confidential, objective, and easy-to-understand information about original Medicare, Medicare Advantage Plans, prescription drug plans, and Medicare Supplement plans, and allows Medicare beneficiaries to compare plans and determine what best meets their needs and save them money.

To learn more about the APPRISE Program or becoming a volunteer, click here or call the APPRISE Helpline at 1-800-783-7067 .



Department Of Aging: June 23 Medicare Event Welcomes Future Beneficiaries With Information On Eligibility, Coverage Options