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MAGI rules to determine eligibility. See the Senior Guide for more information. APPLICATION FOR HEALTH COVERAGE FOR SENIORS AND PEOPLE NEEDING LONG-TERM-CARE SERVICES SACA-2 Rev. 06/16 WHAT YOU NEED WHEN YOU APPLY The following MUST be sent with the application when applying for MassHealth the Health Safety Net and the Massachusetts Health Connector SOCIAL SECURITY NUMBER SSN PROOF OF CITIZENSHIP/NATIONAL STATUS You must give us an SSN or proof that one has been applied for for every household member who is applying unless one of the following exceptions applies. Application for Health Coverage for Seniors and People Needing Long-Term-Care Services HOW TO APPLY Please identify which program each household member is applying for on page 1 of the application* You can submit your application in any of the following ways. Mail or fax your filled-out signed application to Hand deliver your filled-out signed application to MassHealth Enrollment Center Central Processing Unit P. O. Box 290794....

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How to fill out the MA SACA-2 online

This guide provides step-by-step instructions for filling out the MA SACA-2 application form online. It aims to assist users in accurately completing their application for health coverage, ensuring that individuals and households can obtain the necessary benefits.

Follow the steps to complete your MA SACA-2 application online.

  1. Click ‘Get Form’ button to obtain the MA SACA-2 form and open it in your browser or PDF viewer.
  2. Provide your personal information. Begin with the first section, where you'll input your details such as your full name, date of birth, and address. Make sure to provide accurate contact information to facilitate communication.
  3. Identify each program for which you are applying. On page 1 of the application, indicate which health coverage programs each household member is applying for by checking the appropriate box.
  4. Complete the income and asset sections. Provide details about all sources of income for each household member and document any assets, such as bank accounts or property. This information helps determine eligibility for health coverage.
  5. Sign and date your application. After completing the form, ensure that all fields are filled out as required, then sign the document to confirm the accuracy of the information provided.
  6. Submit your application. You can choose to save, print, or share your completed application online as needed. Make sure to keep a copy for your records.

Start your MA SACA-2 application online today to ensure you receive the health coverage you deserve.

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