Form MC176-2A QMB / SLMB / QI Qualified Medicare Beneficiary (Qmb) / Specified Low-Income Medicare Beneficiary (Slmb) / Qualifying Individual (Qi) Income Eligibility Work Sheet, Couple or Applicant With an Ineligible Spouse, With or Without Child(Ren) - California

What Is Form MC176-2A 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 MC176-2A?
A: Form MC176-2A is the Income Eligibility Worksheet for QMB/SLMB/QI qualified Medicare beneficiaries.

Q: Who is Form MC176-2A for?
A: Form MC176-2A is for couples or applicants with an ineligible spouse who are applying for QMB/SLMB/QI benefits in California.

Q: What are QMB/SLMB/QI benefits?
A: QMB stands for Qualified Medicare Beneficiary, SLMB stands for Specified Low-Income Medicare Beneficiary, and QI stands for Qualifying Individual. These are programs that help low-income individuals pay for Medicare costs.

Q: What is the purpose of the Income Eligibility Worksheet?
A: The Income Eligibility Worksheet helps determine if an individual or couple meets the income requirements for QMB/SLMB/QI benefits.

Q: Are there different versions of the Income Eligibility Worksheet for different states?
A: Yes, this particular form is specific to California. Other states may have their own versions of the worksheet.