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HFS 3120 Medicaid Payment of Medicare Cost Sharing Expenses

What are Medicare cost sharing expenses?

Medicare cost sharing expenses are Medicare premiums (Part A - hospital insurance, Part B – medical insurance), deductibles and coinsurance amounts.

How do I apply for Medicaid payment of my Medicare cost sharing?

You may apply at your local Department of Human Services (DHS) Family Community Resource Center (FCRC). If you apply for cash or medical assistance, we will also decide if you qualify for help to pay your Medicare costs. If you don't want cash or medical assistance, you may apply only for Medicaid to pay your Medicare premiums, deductibles and coinsurance.

Do I have to go to the local FCRC to apply for Medicaid to pay my Medicare premiums, deductibles and coinsurance amounts?

No, you do not have to go to your local FCRC to apply. You may apply online on at, you may request an application by mail or telephone. The application may be downloaded from the HFS Medical Forms page. Look for Form 2378M, Application for Payment of Medicare Premiums, Deductibles and Coinsurance. After you complete the application, mail it to your local FCRC. You may also apply through the Social Security Administration (SSA) if you apply to them for Extra Help to help to pay your premium for Medicare Part D prescription drugs.

Who is eligible to have Medicaid pay their Medicare cost sharing expenses?

To be eligible, you must meet three requirements:

You must also tell us about any other health insurance if you have it.

How will I find out if I qualify?

We will send you a notice to tell you if you can get help with your Medicare cost sharing expenses. If you do not qualify, we will also send a notice and tell you why not. You may appeal our decision.

HFS 3120 (R-2-15)