What documents do I need to apply for a Medicare Savings Program in Florida?

What you usually don't need

If you receive any part of Medicare, DCF's manual exempts you from proving citizenship (ESS 1440.0103) and identity (ESS 1440.0400).

Document checklist

• Signed form CF-ES 2613 (Financial Information Release), or written permission for DCF to check your financial records. It's required.
• Income other than wages: your Social Security benefit letter, pension or annuity letters (for example, from the Florida Retirement System), VA award letters. DCF can confirm Social Security and SSI from Social Security's data (ESS 1840.0901).
• Wages, if you work: pay stubs, wage statements, a W-2, or a tax return if you're self-employed (ESS 1840.0207).
• Bank accounts: your current statement, showing the type of account, the bank, the balance and any joint owners (ESS 1640.0506).
• Life insurance: who owns it, who's insured and the cash value, if any (ESS 1640.0555).
• Vehicles: owner, make, model and year of each, and what you owe on any loan (ESS 1640.0592).
• Burial arrangements: your prepaid funeral contract or burial trust, if you have one. If you set money aside for burial, you can say so on form CF-ES 2302.
• If you're not a citizen: your immigration document. DCF verifies your status with USCIS, and an expired card doesn't necessarily mean you lost your status (ESS 1440.0114).

If you live with your spouse, bring your spouse's papers too: DCF counts both of your income and assets. DCF accepts your word about cash, and asks for proof of assets mainly when your total is close to the limit (ESS 1640.0206).

How and when to send them

1. Wait for DCF's list. After you apply, DCF sends a written list of what it needs and the due date, normally 10 days after the interview or the notice (ESS 0640.0401).
2. Upload them in MyACCESS. Sign in to MyACCESS and upload clear copies, or send them by mail or fax.
3. Ask for more time if you need it. DCF extends the date if you ask and can help you get what's missing. Its call center is (850) 300-4323 (Florida Relay 711).

A family member can help as your designated representative (ESS 0640.0109). Follow the other steps in how to apply for a Medicare Savings Program and read the full guide, Medicare Savings Programs in Florida.

Related questions

Sources

• Florida DCF — ESS Program Policy Manual, Chapter 1400, Technical Requirements (1440.0103, 1440.0114, 1440.0400) (PDF)
• Florida DCF — ESS Program Policy Manual, Chapter 1800, Income (1840.0207, 1840.0901) (PDF)
• Florida DCF — ESS Program Policy Manual, Chapter 1600, Assets (1640.0206, 1640.0506, 1640.0555, 1640.0592) (PDF)
• Florida DCF — ESS Program Policy Manual, Chapter 0600, Application Processing (PDF)
• Florida DCF — Public Benefits and Services (MyACCESS, call center)

More questions in this guide

• Will Florida Medicaid take my house after I die if I get a Medicare Savings Program?
• How do I apply for Extra Help with Medicare drug costs in Florida?
• How do I apply for a Medicare Savings Program in Florida?
• What are the Medicare Savings Program income limits in Florida?
• Does Florida count my house or car for Medicare Savings Programs?
• What is QMB in Florida?

Part of the guide: Medicare Savings Programs in Florida · All questions

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