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.

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How To Apply

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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 today and start earning cash back on your healthcare expenses!


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 household out-of-pocket healthcare expenses from the previous calendar year. Out of pocket healthcare expenses include:
      • Medical co-payments
      • Prescription co-payments
      • Insurance premiums

We're Here to Help You Every Step of the Way!

Don’t let some simple paperwork get in your way of getting money back. In person application assistance is available.

Reach out to us
Please call (408) 970-2001 to make an appointment. We are open Monday - Friday, 9:00am - 5:00pm.
Our office address is:
Santa Clara Valley Health
777 Turner Dr, Suite 330
San Jose, CA 95128

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


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 income - provide all that apply for your entire household:

  • Recent Tax Return (must include if applicable)
  • Check Stubs (at least two(2)
  •  W-2 Form
  • Award Letter (Social Security, Disability, Unemployment, Worker's Compensation)
  • Cash Income Statements (including tips)
  • Military Benefits Statement
  • Rental Income Receipts


Proof of valid prescription - provide one of the following for each qualifying prescription:

  • Copy of Hardcopy Prescription
  • Pharmacy Contact Information


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.

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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.

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Got questions about MedAssist?
Check out our FAQs for answers to some of the most commonly asked questions.

Get Answers

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Approval Process

Curious about how the approval process works for MedAssist? Read on for more information about what to expect.

Follow Along

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We have all the necessary forms ready for you to print. Visit our forms page for everything you need.

Stay Organized

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Contact Us

Don't hesitate to visit our contact us page and reach out to our team for assistance.

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