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Form MC176 QMB-3 Qualified Medicare Beneficiary (Qmb) Referral - California
What Is Form MC176 QMB-3?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is a QMB-3 Qualified Medicare Beneficiary (Qmb) Referral?
A: A QMB-3 Qualified Medicare Beneficiary (Qmb) Referral is a form used in California to refer individuals who qualify for the QMB program.
Q: What is the QMB program?
A: The QMB program is a Medicaid program that helps pay for Medicare premiums, deductibles, and coinsurance for individuals with limited income.
Q: Who is eligible for the QMB program?
A: Individuals who have Medicare Part A and meet certain income and resource limits are eligible for the QMB program.
Q: What does the QMB-3 Qualified Medicare Beneficiary (Qmb) Referral form do?
A: The QMB-3 Qualified Medicare Beneficiary (Qmb) Referral form is used to refer eligible individuals to the QMB program and help them access the benefits.
Form Details:
- Released on May 1, 2007;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form MC176 QMB-3 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
