Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi)

Notification Icon 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 (Punjabi)

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 Punjabi. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the MC14 A form?
A: The MC14 A form is an application for Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals (QI) programs.

Q: Who is eligible for QMB, SLMB, and QI programs?
A: Low-income individuals who receive or are eligible for Medicare can be eligible for these programs.

Q: What is the purpose of QMB, SLMB, and QI programs?
A: These programs help eligible individuals pay for their Medicare premiums and other medical costs.

Q: Is the MC14 A form specific to California?
A: Yes, the MC14 A form is specifically for California residents.

Q: Is the MC14 A form available in Punjabi language?
A: Yes, the MC14 A form is available in Punjabi for those who prefer to communicate in that language.

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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 (Punjabi)

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  • Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi), Page 1
  • Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi), Page 2
  • Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi), Page 3
  • Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi), Page 4
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