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SHIP Information Request Form

Check each item that you would like us to mail to you and complete the spaces below with your name and address.  Then click once on the submit button.

If you would like to request information by phone, please call us at 1-800-452-4800.
All of these materials are free. 

 Extra Help Packet:  This packet includes brochures and applications for help paying for Medicare costs.  It includes the following materials: 

  • Feeling Lost in a Sea of Health Insurance and SHIP Local Site List
  • Medicare Important Telephone Numbers Brochure
  • Medicare Savings Program Brochure and Application
  • Indiana's HoosierRx application
  • SSA's Show Someone You Love How Much you Care Brochure and LIS Application

Prescription Information Packet: This packet includes information on the Medicare Part D Prescription Drug programs in Indiana. It includes the following materials:

  • Yearly Medicare Enrollment Review
  • Medicare Prescription Drug Plans for Indiana
  • Medicare Advantage Plans in Indiana
  • Finding Help with Prescriptions Guide
  • Medicare Important Phone Numbers
  • SHIP Brochure & Local Site List

  Finding Help With Prescriptions: This booklet contains information about prescription programs including Medicaid, HoosierRx, Pharmaceutical Manufacturers' Patient Assistance, Veterans Benefits, Discount Cards, Discount Programs, and Mail Order Programs.

  Medicare Supplement Packet:  This packet includes information on how to supplement Medicare and includes the following materials: 

  • Guide to Health Insurance for People with Medicare
  • Questions You Should Ask When Considering a Supplement to Medicare
  • A List and Description of Medicare Managed Care Plans in Indiana
  • Companies Approved to Sell Medicare Supplements in Indiana
  • Medicare Important Telephone Numbers Brochure
  • Help with Paying for Medicare Costs (QMB/SLMB) Brochure
  • SHIP Local Site List

Long Term Care Packet:  This packet describes long term care insurance and how it helps protect your assets.  It includes the following materials: 

  • The Shopper's Guide to Long Term Care Insurance
  • What You Should Know About Long Term Care Insurance Booklet (includes a list of insurance companies which sell Indiana Partnership policies)
  • Differences Between Traditional Long Term Care Insurance and Indiana Partnership Policies
  • Long Term Care Insurance Self-Assessment Guide
  • Nursing Home Resident with a Spouse at Home Brochure
  • Medicare Important Telephone Numbers Brochure
  • SHIP Local Site List