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