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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHS/FIA9705
for the current year.
Form DHS / FIA9705 Mail-In Application for Qualified Medicare Beneficiary (Qmb) and Specified Low-Income Medicare Beneficiary (Slmb) Programs - Maryland
What Is Form DHS/FIA9705?
This is a legal form that was released by the Maryland Department of Human Services - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DHS/FIA9705 Mail-In Application for Qualified Medicare Beneficiary (Qmb) and Specified Low-Income Medicare Beneficiary (Slmb) Programs - Maryland?
A: DHS/FIA9705 is a mail-in application for the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs in Maryland.
Q: Who is eligible for the QMB and SLMB programs in Maryland?
A: Individuals who meet certain income and asset guidelines and are enrolled in Medicare Part A are eligible for the QMB and SLMB programs in Maryland.
Q: What do the QMB and SLMB programs in Maryland provide?
A: The QMB and SLMB programs in Maryland help eligible individuals with their Medicare Part A premiums, deductibles, and coinsurance.
Q: How do I apply for the QMB and SLMB programs in Maryland?
A: You can apply for the QMB and SLMB programs in Maryland by completing the DHS/FIA9705 Mail-In Application and submitting it by mail.
Q: What documents do I need to include with the DHS/FIA9705 Mail-In Application?
A: You may need to include documents such as proof of income, proof of assets, and proof of Medicare enrollment with the DHS/FIA9705 Mail-In Application.
Q: How long does it take to process the DHS/FIA9705 Mail-In Application for the QMB and SLMB programs in Maryland?
A: The processing time for the DHS/FIA9705 Mail-In Application can vary, but it is typically around 45 days.
Form Details:
- Released on April 1, 2021;
- The latest edition provided by the Maryland Department of Human Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form DHS/FIA9705 by clicking the link below or browse more documents and templates provided by the Maryland Department of Human Services.
Download Form DHS / FIA9705 Mail-In Application for Qualified Medicare Beneficiary (Qmb) and Specified Low-Income Medicare Beneficiary (Slmb) Programs - Maryland
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