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Get Medicare Savings Program Application Dphhsmtgov Form

DPHHS-HCS-250 (Rev07/09) STATE OF MONTANA Department of Public Health and Human Services If you need assistance completing this application, please ask an Office of Public Assistance staff member.

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To qualify for the giveback, you must: Be enrolled in Medicare Parts A and B. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible). Live in a service area of a plan that offers a Part B giveback.

All applications for the Medicare Savings Program must be mailed to the local Department of Social Services where you live. If you have questions, the phone number to call for the Medicaid Helpline is 1-800-541-2831.

There are four parts of Medicare: Part A, Part B, Part C, and Part D. Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternate way to receive your Medicare benefits (see below for more information). Part D provides prescription drug coverage.

Medicare Savings Programs (MSPs) are Medicaid-administered programs for people on Medicare who have limited income and resources. These programs help those qualified to afford Medicare.

Great! Let's get the basics. If your monthly income is below $2280 (or below $3077 if married) you may qualify for several Medicare cost-savings benefit programs. The following information will help us determine which programs you might be eligible for.

On July 1st, 2022 the asset test to qualify for a Medicare Savings Program increased. These changes apply to the things you own, including bank accounts, cash, second homes and vehicles, and other financial resources. The new limit is $130,000 for one person and an additional $65,000 for each additional family member.

If your income is slightly too high for you to qualify for QMB benefits, you may still be eligible for another state medical assistance program: Specified Low-Income Medicare Beneficiary (SLMB). The resource limits for SLMB eligibility are the same as for a QMB, but the income limits are 20% higher.

To qualify for the giveback, you must: Be enrolled in Medicare Parts A and B. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible). Live in a service area of a plan that offers a Part B giveback.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232