Get Application For Health Coverage For Seniors And - Mass

Filling out the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services is an important step in obtaining necessary health coverage in Massachusetts. This guide provides a clear and supportive overview of how to complete the application online, ensuring that users have all the necessary information to proceed.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin the application by identifying which health programs each household member is applying for on page 1. Ensure that all names are printed clearly.
3. Provide all required personal information for Person 1 (the applicant) in Part 1. This includes date of birth, address, and social security number.
4. If applicable, provide details for additional household members in Part 2. Ensure to fill out all fields regarding their personal information and health coverage needs.
5. Complete Part 4 regarding any previous medical bills if applicable, indicating if you or your spouse had medical expenses in the three months prior to the application.
6. Fill out Part 5, which focuses on existing health insurance coverage for household members, including Medicare and federal benefits.
7. In Part 6, describe all assets and income sources. Specify any bank accounts, real estate, or life insurance policies owned by the applicant or spouse.
8. Fill out the Personal-Care-Attendant Supplement if needed, detailing any required personal care services.
9. After reviewing the application for accuracy, sign and date the form as the applicant. If applicable, ensure that any authorized representatives have also signed.

Get started on your application for health coverage online today!