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 H1200 Form 2015

H1200 Form 2015

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Form to use if any of these apply to you You no longer get SSI and you aren t applying for the Medicaid Buy-In Program* H1200-EZ You are applying only for a Medicare Savings Program* H1200-EZ You live in a state supported living center. H1200-PFS H1200-PFS To ask for these forms call 2-1-1 or 1-877-541-7905. Medicare Savings Programs pay Medicare costs. Costs can include Medicare premiums co-pays and deductibles. These programs also are known as Qualified Medicare Beneficiaries QMB. Specified...
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