TX HHS Form H1200-MSP-C. Medicare Savings Program Notice

The Medicare Savings Program Notice (Form H1200-MSP-C) is a crucial document that helps individuals pay their Medicare Part A and Part B costs. This form is typically used by individuals who are eligible for the Texas Medicare Savings Program, which assists with premiums, deductibles, and co-insurance expenses.

The notice explains that the Social Security Administration (SSA) has referred the individual's case to the Texas Health and Human Services (HHS) for further review. To determine eligibility, the individual must fill out the attached Form H1200-EZ, sign it, and mail it back within 13 days from the print date using the pre-paid envelope provided.

Key requirements for completing the form include providing application information such as name, address, and date of birth. The notice also emphasizes the importance of prompt action, as failure to respond may result in delayed or denied benefits. By following these steps, individuals can take advantage of the Medicare Savings Program and receive assistance with their healthcare costs.

• The form is used by individuals who are eligible for the Texas Medicare Savings Program.
• The program assists with Medicare Part A and Part B costs, including premiums, deductibles, and co-insurance expenses.
• The SSA refers cases to HHS for further review.