Medicaid/Medicare Buy-in Program Application

The Medicaid/Medicare Buy-In Programs help people with a low income to pay their Medicare premium. Recipients can receive a substantial increase in spendable income when they no longer pay for their Medicare premium. There are three distinct Buy-in programs and each has different eligibility requirements:

Qualified Medicare Beneficiary (QMB)
Special Low Income Medicare Beneficiary (SLMB)
Qualified Individuals (QI-1)

Details of current eligibility requirements, are included in Understanding Medicaid Programs at http://www.agingcarefl.org/Medicare/Medicaid

Applications

The same application is used to apply for all three programs. It is much shorter than an application for other Medicaid programs. It is available as a paper application that can be completed and mailed to the local Department of Children and Families.

Applications are available as pdf files by clicking on the links below for applications in English, Spanish or Creole or copies are available by calling

The Senior Helpline
serving Pasco and Pinellas Counties
1-800-96-ELDER
(1-800-963-5337)
For inquiries from outside of the area call 727-217-8111


Medicaid-Medicare_Buy-In_Application_-_English.pdf

Medicaid-Medicare_Buy-In_Application_-_Spanish.pdf

Medicaid-Medicare_Buy-In_Application_-_Creole.pdf

Print and complete the application. Completed applications are mailed to the nearest office of the Department of Children and Families:

Pasco County:

New Port Richey Service Center
Counsel Square II
7601 Little Road
New Port Richey, FL 34654

Pinellas County:

North Pinellas Service Center
Mary Grizzle Building
11351 Ulmerton Road Suite 130
Largo, FL 33778-1630

South Pinellas Service Center
Sebring Building St. Petersburg
525 Mirror Lake Drive, Ste. 201
St. Petersburg, FL 33701