Reviewed August 2, 2026

Medicare Savings Program application checklist

Organize the information your state may request before applying for help with Medicare premiums and other costs.

1. Confirm the correct jurisdiction

  • Your state, District of Columbia, or U.S. territory of residence.
  • The official Medicaid or medical-assistance agency.
  • The program name used by that jurisdiction.
  • The current online, mail, phone, or in-person application channel.

2. Gather Medicare information

  • Your Medicare card and coverage information.
  • Part A and Part B enrollment status.
  • Current premium information or Medicare notices, when requested.
  • Any Medicaid or Extra Help notice you already receive.

3. Prepare identity and residence records

  • Identity information requested by the state.
  • Proof of residence or mailing address, if required.
  • Household and marital information used by the application.
  • Authorized-representative information, only when you choose to use one.

4. Organize income and resource records

  • Social Security, pension, wages, and other current income records.
  • Bank or investment records if the state counts resources.
  • Information about exclusions or disregards listed in the state instructions.
  • Do not rely only on a federal limit chart; state rules may differ.

5. Review before submitting

  • Every required question is answered.
  • Requested verification is attached in an accepted format.
  • The application is signed when required.
  • No original document is enclosed unless the agency specifically requests it.

6. Save filing proof

  • Copy of the completed application.
  • Copies of attachments.
  • Confirmation number, receipt, fax report, or mailing proof.
  • Date submitted and the office or portal used.

7. Track the decision

  • Requests for additional information and their response dates.
  • The eligibility notice and approved program category.
  • Review or hearing instructions if the application is denied.
  • Annual renewal requirements, especially for QI.
Need unbiased Medicare help?

A local State Health Insurance Assistance Program (SHIP) can provide free, personalized Medicare counseling. SHIP does not replace the state Medicaid agency that decides the application.

Official resources

Related resources