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Form MC176 P-A QMB / SLMB / QI Qualified Medicare Beneficiary (Qmb) / Specified Low-Income Medicare Beneficiary (Slmb) / Qualifying Individual (Qi) Property Work Sheet - Adult (18 Years of Age and Older or Married) - California
What Is Form MC176 P-A QMB/SLMB/QI?
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 form MC176 P-A?
A: Form MC176 P-A is a Property Worksheet for Adult (18 Years of Age and Older or Married) in California for QMB/SLMB/QI (Qualified Medicare Beneficiary/Specified Low-Income Medicare Beneficiary/Qualifying Individual) program.
Q: What is the purpose of form MC176 P-A?
A: The purpose of form MC176 P-A is to gather information about an adult's property for determining eligibility for the QMB/SLMB/QI program in California.
Q: Who should fill out form MC176 P-A?
A: Adults who are 18 years of age and older or married and applying for the QMB/SLMB/QI program in California should fill out form MC176 P-A.
Q: What is the QMB/SLMB/QI program?
A: The QMB/SLMB/QI program is a program in California that provides assistance with Medicare costs for individuals with low income and limited resources.
Q: What information is required on form MC176 P-A?
A: Form MC176 P-A requires information about the adult's property, including the value of the property and any debts or liens on the property.
Q: Is form MC176 P-A required for eligibility in the QMB/SLMB/QI program?
A: Yes, form MC176 P-A is required for determining eligibility in the QMB/SLMB/QI program in California.
Q: Are there income limits for the QMB/SLMB/QI program?
A: Yes, there are income limits for the QMB/SLMB/QI program in California. It is best to check the specific income limits set by the program.
Q: What are the eligibility criteria for the QMB/SLMB/QI program?
A: The eligibility criteria for the QMB/SLMB/QI program include meeting income and resource limits, being enrolled in Medicare Part A, and being a U.S. citizen or qualified immigrant.
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 fillable version of Form MC176 P-A QMB/SLMB/QI by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
