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Medicare Premium Payment Program Application - RI Department of - dhs ri 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Applicant Information' section. Enter your last name, first name, middle initial, primary language, telephone number, Social Security number, and date of birth.
- Provide your residence and mailing addresses. If they are different, ensure you complete both fields accurately.
- Indicate your entitlement to Medicare by checking 'Yes' or 'No' for Part A and Part B. Include your Medicare Claim Number as shown on your card.
- If applicable, complete the 'Spouse Information' section with similar details about your spouse.
- In the 'Income' section, list all sources of income for both you and your spouse. Be sure to include amounts for each type of income.
- Detail any resources owned by you and your spouse in the 'Resources' section. This includes bank accounts, stocks, bonds, and other assets.
- Review the declarations at the end of the form carefully before signing. Ensure all information is accurate and complete.
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Related links
1. Self-Service - Individuals seeking initial or continuing eligibility have the option of accessing the eligibility system online using a self-service portal
Feb 4, 2026 By mail: Download and complete the application. Mail it to: RI Department of Human Services P.O. Box 8709 Cranston, RI 02920-8787; In personRead more