Medicare Savings Program


You can apply for these benefits by completing a state application form. This form can be done online, mailed, or dropped off at a local DSS Regional Office. For a list of local offices, please follow this link.  You can also authorize someone else to do the application paperwork for you.

To apply online, please visit, under ‘Apply for Benefits.’

If you wish to apply for Medicare Savings Plan ONLY, please complete application titled “Medicare Savings Programs Application/Redetermination” below:

Medicare Savings Program Application (W-1QMB)

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

If you wish to apply for the Medicare Savings Program and additional programs such as: SNAP (food stamps), Medicaid for Employees with Disabilities (MED-Connect), Medicaid for the Aged/Blind/Disabled (HUSKY C), and/or cash assistance, you can download this application: 

W-1E Application for Benefits

W-1ES Solicitud de Beneficios

You have the right to a copy of the completed application. You can request a copy from DSS at any time in either in electronic or paper format.

For additional information on how to apply, please visit