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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 MC14 A
for the current year.
Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Lao)
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Lao. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form MC14?
A: The purpose of Form MC14 is to apply for the Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals (QI) programs in California.
Q: Who is eligible to apply for QMB, SLMB, and QI programs?
A: Low-income individuals who are enrolled in Medicare may be eligible to apply for these programs.
Q: What are the benefits of QMB, SLMB, and QI programs?
A: These programs help low-income individuals with Medicare cover their Medicare costs, such as premiums, deductibles, and coinsurance.
Q: Are there any income or asset limits for QMB, SLMB, and QI programs?
A: Yes, there are income and asset limits that applicants must meet to be eligible for these programs.
Form Details:
- Released on March 1, 2021;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form MC14 A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Lao)
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