TX HHS Form H1200. Application for Assistance Your Texas Benefits
The TX HHS Form H1200, Application for Assistance - Your Texas Benefits, helps individuals who already receive Medicare benefits to pay their Medicare costs. This form is used by people aged 65 or older, those with disabilities, and others who need assistance with Medicare premiums, co-pays, and deductibles.
This application is designed to help individuals qualify for various Medicare Savings Programs, including Qualified Medicare Beneficiaries (QMB), Medicaid for the Elderly and Specified Low-income Medicare People with Disabilities Beneficiaries (SLMB), Qualifying Individuals (QI-1), and Security-Income (SSI) benefits. To apply, you must be in a nursing home or other place of care, have a disability, or be age 65 or older.
To complete the application, you will need to provide required information, including your name, address, and Medicare information. You can submit the form by mail, fax, or in person at a benefits office. If you are deaf, hard of hearing, or speech impaired, you can call 7-1-1 for assistance. Key points to keep in mind:
- Fill out the application completely and accurately
- Sign and date pages 19
- Send the form to your local benefits office or fax it to 1-877-447-2839
- Contact 2-1-1 for assistance in finding a benefits office near you