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  • Senior Medical Benefit Request Ma Form

Get Senior Medical Benefit Request Ma Form

Before you fill out the application. Dear Applicant: This is your application for MassHealth and the Health Safety Net* if you live in Massachusetts and: are aged 65 or older and living at home; are any age and need long-term-care services in a medical institution; are eligible under certain programs to get long-term-care services to live at home; or are a member of a married couple living with your spouse and both you and your spouse are applying for MassHealth; and there are no childr.

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MassHealth may provide health and dental care for people who are age 65 and older and individuals who need long-term-care services.

Who can use this application? Aged 65 or older and living at home, and: Not the parent of a child under 19 years of age who lives with you, or. Not an adult relative living with and taking care of a child younger than 19 years of age when neither parent is living in the home, or.

What you need Social Security numbers, if you have them, for every household member who is applying. Federal tax returns, if you file. Information about citizenship or national status or immigration status. Employer and income information for everyone in your household (for example, from paystubs or wage statements)

Most dependents age 19 to 26 are covered under the insured's family health plan. The Affordable Care Act allows coverage for your dependent up to age 26, whether or not they are married.

MassHealth Limited coverage is available to people 65 and older who meet the income and asset rules for MassHealth Standard or MassHealth Family Assistance, but have an immigration status that keeps them from getting MassHealth Standard or Family Assistance. MassHealth Limited doesn't pay for long-term-care services.

Who can use this application? Aged 65 or older and living at home, and: ... Age 65 or older and are disabled and are either working 40 or more hours a month, or are currently working and have worked at least 240 hours in the 6-months immediately before the month of the application, or. Not working.

2023 MassHealth Income Standards and Federal Poverty Guidelines Family Size200% Federal Poverty Level300% Federal Poverty LevelMonthlyYearly1$2,430$43,7402$3,287$59,1603$4,144$74,5806 more rows

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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