Medicare Savings Program

Apply

Application for the Medicare Savings Programs

It’s easy to apply for the Medicare Savings Programs. All you need to do is complete an application titled “Medicare Savings Programs Application/Redetermination,” which is also available in Spanish. It does not cost anything to apply for this program. 

Medicare Savings Program Application (W-1QMB) - Word

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS) - Word

 Please mail the application/redetermination to:

DSS ConneCT Scanning Center

PO Box 1320

Manchester, CT 06045-1320