Main review goal Lower monthly food, medicine, utility, or health costs After a hospital, care, housing, or income change Find caregiver, respite, transportation, or meal support Plan ahead before costs become urgent
Older adult age group Age 60 or older Age 65 or older Under 60 with disability or chronic condition Not sure which category applies
Medicare status Original Medicare Medicare Advantage Not enrolled in Medicare Not sure
Medicaid or state medical help status Already has Medicaid or state medical help Applied before or was denied Has not applied Not sure
Food or nutrition help concern No current food concern Food costs are a concern Needs meals, delivery, or cooking support Not sure what help exists
Medicine or Medicare cost concern No current medicine or Medicare cost concern Prescription costs are hard to manage Premiums, deductibles, or copays are hard to manage Both drug and medical costs are hard to manage
Utility or housing cost pressure No current utility or housing pressure Heating, cooling, electric, or water bills Rent, mortgage, taxes, or home repairs Both utilities and housing are concerns
Caregiver or daily support need No current caregiver support need Family caregiver needs respite or training Older adult needs help at home Adult day, meal, or supervision support may help
Transportation or appointment access No current transportation concern Needs medical appointment rides Needs grocery, errands, or social rides Not sure which options exist locally
Documents and records status Mostly organized Scattered across papers, portals, and family members Missing notices, proof, or account access Not sure what is needed
Local help already contacted? Yes, local aging or benefits office contacted Some calls made, but the list is incomplete No local help contacted yet Not sure who to call
Application stage Not started Gathering information Applied and waiting Denied, delayed, or confusing notice
Use broad planning answers only
Do not enter Social Security numbers, Medicare numbers, birth dates, income amounts, account numbers, diagnoses, addresses, or private benefit details into this worksheet.
This planner is educational and organizational. It is not legal, tax, financial, insurance, medical, or benefits advice. Program rules, limits, applications, and waitlists vary by state and can change.
Official references:
Benefits.gov ,
Eldercare Locator ,
Medicare Savings Programs ,
USDA SNAP older adult rules .
