Mc14a 2025

See details

4.8 out of 5

62 votes

The document is an application form for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals (QI-1) programs in California. It outlines eligibility criteria, including income limits and property restrictions, for individuals seeking assistance with Medicare premiums, deductibles, and coinsurance fees. The form requires personal information from applicants and provides instructions on how to apply through local county social services agencies.

Here's how it works

01. Edit your mc14a online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send mc 14a via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out mc14a with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the mc14a application in the editor.
Begin by filling in your personal information, including your name, Social Security Number, Medicare Number, and contact details. Ensure accuracy as this information is crucial for processing your application.
Indicate your date of birth, sex, and marital status by selecting the appropriate options provided in the form.
List all household members living with you. If there are more than three individuals, attach a separate page with their details.
Complete the income section by detailing both unearned and earned income for yourself and your spouse if applicable. Be sure to add up totals accurately to determine eligibility.
Fill out the property section by providing values for checking accounts, savings accounts, and other assets. Remember that certain properties do not count towards limits.
Review all entered information for completeness and accuracy before submitting. Once satisfied, save your changes and download or print the completed form.

Start using our platform today to easily fill out mc14a online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between full Medicaid and QMB quiz?

QMB follows the SSI (Supplemental Security Income) guidelines on what income should be counted, which means roughly half of your income from work is not counted. But Social Security benefits do count as income for QMB, including disability and retirement benefits.

What does full Medicaid cover?

How is the QMB program different from Medicaid? Medicaid, also known as Medical Assistance or QMB Plus, provides benefits for services not normally covered by Medicare. QMB, which is partial Medicaid, helps pay for services only if they are covered by Medicare.

What is the difference between full Medicaid and QMB?

Starting January 1, 2024, the asset test to qualify for a Medicare Savings Program was eliminated. This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles.

Is QMB the same as Medicaid?

Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.