Get Ri Mpp-1 2012-2025

The RI MPP-1 form is essential for individuals applying for the Medicare Premium Payment Program, which assists with certain Medicare expenses. This guide provides clear and supportive step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the RI MPP-1 form with ease.

1. Press the ‘Get Form’ button to access the document and open it in your designated browser.
2. Begin by filling in your personal information in the 'Applicant Information' section, which includes your last name, first name, middle initial, primary language, telephone number, social security number, date of birth, residence address, and mailing address if it differs from your residence address.
3. Indicate your entitlement to Medicare by checking the appropriate boxes for Part A and Part B.
4. Provide your Medicare claim number as it appears on your red, white, and blue card.
5. In the 'Other Medical Insurance' field, list the insurance company name and policy number for any other coverage you have.
6. If applicable, complete the 'Spouse Information' section by providing your spouse's details, including their name, social security number, Medicare entitlement, and other medical insurance information.
7. Fill out the 'Income' section with details on all sources of gross income from you and your spouse, specifying the type and monthly amount for each.
8. In the 'Resources' section, disclose your and your spouse's resources, including bank accounts, life insurance, and property other than your home.
9. Answer the question regarding substantial changes in income or resources in the past three months.
10. Read and understand the 'Declarations of Applicant, Rights and Responsibilities' section, providing your signature and date, and your spouse's signature if applicable.

Complete your RI MPP-1 application online today and take a step towards receiving essential benefits.