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To apply or ask further questions, contact the DSS Community Services ... Lt may take up to 45 days from the date DSS receives your application until the ... NAME OF OWNER TYPEIACCOUNT NUMBER OF THE
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How to fill out medicare paper application form

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How to fill out dshs medicare savings program:

01
Gather all required documents such as proof of income, residency, and medical expenses.
02
Complete the application form accurately, providing all necessary information.
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Attach supporting documents according to the checklist provided.
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Review the application and ensure all sections are filled out correctly.
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Submit the completed application by mail or online as instructed.

Who needs dshs medicare savings program:

01
Individuals who are eligible for Medicare and have limited income and resources may benefit from the dshs Medicare Savings Program.
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Those who require assistance with paying for Medicare premiums, deductibles, and coinsurance may qualify for this program.
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The program is especially beneficial for individuals with high medical expenses who need financial assistance to afford their healthcare costs.
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People Also Ask about

How Much Does Medicare Cost in Arizona? Original Medicare: Part A premiums can range from $0 to $506 per month. The Medicare Part A hospital deductible is $1,600 for each benefit period. Part B, most people pay the standard premium of $164.90 per month.
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Arizona, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
Specified Low-Income Medicare Beneficiary Program (SLMB) This program pays for Medicare Part B premiums. If you receive Medicaid, you may also qualify for SLMB benefits. However, if you are eligible for SLMB, you will not receive regular Medicaid benefits or a monthly medical ID card.
Qualified Medicare Beneficiary (QMB): The income limit is $1,064 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums.
Qualifying Individual (QI) Program Your situation:Monthly income limit:*Resource limit: What counts in resource limits?Individual$1,660$9,090Married couple$2,239$13,630
Income Limits Family SizeGross Monthly Income Limit Effective 02/01/2023Applicant Only$1,641Applicant and Spouse$2,219

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The DSHS Medicare Savings Program is a state-run program that helps low-income individuals pay for Medicare costs, such as premiums and deductibles.
Individuals who are eligible for Medicare and meet specific income and asset limits are required to file for the DSHS Medicare Savings Program.
To fill out the DSHS Medicare Savings Program application, individuals can complete an online application, download a paper form, or request assistance from a local DSHS office.
The purpose of the DSHS Medicare Savings Program is to provide financial assistance to those who need help covering the costs of Medicare, thereby improving access to healthcare.
Applicants must report personal information, income details, asset information, and Medicare enrollment status on the DSHS Medicare Savings Program application.
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