Apply for MedAssist
Welcome to MedAssist! We're excited to offer you unique financial assistance to reduce the burden on patients who have high out-of-pocket healthcare costs that they cannot afford. MedAssist is open to all residents of Santa Clara County, and we've made the application process easy and straightforward. Whether you're a new applicant or a returning participant, we're here to guide you through the process and help you get the most out of our program.
Apply now
Visit our portal page to begin your application today! It includes some easy to follow questions and the opportunity to submit your documents.
Do you qualify?
Eligibility criteria:
- Reside in Santa Clara County
- Have a valid prescription for diabetes medication, asthma inhaler, or epinephrine auto-injector (EpiPen)
- Have out-of-pocket expenditure for the above prescriptions in the previous calendar year
- Must not be enrolled in a federal or state health care program
- Maximum annual gross household income cannot exceed the amount below:
| Household Size* | Maximum Annual Gross Household Income |
|---|---|
| 1 | $97,890 |
| 2 | $132,860 |
| 3 | $167,830 |
| 4 | $202,800 |
| 5 | $237,770 |
| 6 | $272,740 |
| 7 | $307,710 |
| 8 | $342,680 |
*Number of people in your household including yourself, your spouse or domestic partner and dependent children under age twenty-one (21), whether living at home or not.
How do I get started?
- A valid email address
- Prescription information
- Medication name
- Copy of prescription OR pharmacy information
- Financial information
- Estimate of annual gross household income
- Estimate of individual out-of-pocket expenditure for qualified prescriptions in the previous calendar year.
- Health Insurance Information
What documents do I need?
You will be able to use a number of different documents to complete the MedAssist application process. Please review the following list of documents:
Proof of residence in Santa Clara County - provide just one of the following:
- Current Rental Contract/Lease
- Current Mortgage Statement
- Current Utility Bill (Water, Electric, Gas, Garbage)
- Homeless (Completion of patient statement form)
- Vehicle Registration
- Valid Driver’s license
- Letter of support from person with whom applicant is living and proof of residency for that person
Proof of identity (photo id required) - provide just one of the following:
- Valid Driver’s license
- Valid Passport
- Valid Government Issued ID
- Valid Work of School ID Card
- Birth Certificate along with valid photo ID
Proof of valid prescription - provide one of the following for each qualifying prescription:
- Copy of Hardcopy Prescription
- Pharmacy Contact Information
Proof of Health Insurance
Health Insurance Card
What to expect next
- Upon receipt of your complete application, MedAssist will determine if you are eligible for a grant based on our program guidelines and subject to available funding. Please understand that all approvals are based on available funding and are on a first-come-first-served basis.
- You can check the status of your application by logging into the portal here or by contacting the MedAssist office
FAQs
Got questions about MedAssist?
Check out our FAQs for answers to some of the most commonly asked questions.
Approval process
Curious about how the approval process works for MedAssist? Read on for more information about what to expect.
Forms
We have all the necessary forms ready for you to print. Visit our forms page for everything you need.
Contact us
Don't hesitate to visit our contact us page and reach out to our team for assistance.
Learn more about MedAssist
Ready to learn more about how our money back program can benefit you? Dive deeper into the program by exploring our website and discovering all the ways we can help you earn cash back. Don't miss out on this opportunity to save money and protect your health.