Rhode Island MPP-1 Form Instructions: Medicare Premium Payment Application

MPP-1 vs. DHS-2: Which Form to Use

Rhode Island has two forms that can start a Medicare Savings Program application:

Form MPP-1 (Medicare Premium Payment Form, Rev. 01-26) is the dedicated form for the Medicare Premium Payment Program. It's shorter and purpose-built for QMB and QI applicants. Download it from the EOHHS website.

Form DHS-2 (Application for Assistance) is the general application that covers Medicaid, SNAP, and other DHS programs. It works for Medicare Savings too, but it's longer and collects information you may not need to provide for an MPPP-only application.

If your only goal is Medicare premium and cost-sharing help, the MPP-1 is the simpler path. If you're also applying for Medicaid long-term care, food assistance, or other programs, the DHS-2 covers everything in one submission.

Key Sections of the MPP-1

Personal information and Medicare status: Enter your full legal name, date of birth, Social Security number, and Medicare Beneficiary Identifier (MBI) from your Medicare card. Confirm you have both Part A and Part B. If you lack premium-free Part A (fewer than 40 work quarters), note that — Rhode Island is a Part A buy-in state, and you can still qualify for QMB.

Income reporting: List your gross monthly Social Security benefit — the amount on your award letter, not the deposit in your bank account. The gross figure includes the Part B premium that's withheld before deposit. If you report the net deposit instead, DHS will catch the discrepancy when they pull your SSA records, which delays processing.

Include all other income: pensions, annuities, retirement account distributions, and any earned income from work.

Asset reporting: List all checking and savings account balances, CDs, stocks, mutual funds, and the cash surrender value of whole life insurance policies (if total face value exceeds $1,500). You don't need to list your home, one vehicle, burial plots, or irrevocable prepaid funeral contracts — these are exempt.

Authorized representative (Section 2): If an adult child or other person will handle correspondence and speak with DHS on the applicant's behalf, both parties must sign this section. Without it, DHS can't discuss the case with anyone but the applicant. A separate Power of Attorney also works, but the form's built-in designation is faster.

Common Mistakes That Delay Processing

Reporting net income instead of gross. This is the most frequent error. Your bank deposit is $202.90 lower than gross because Part B is withheld. DHS uses the gross figure.

Leaving the authorized representative section blank when someone else will manage the case. If your adult child submitted the application, DHS can't call them back about missing documents unless this section is completed.

Not attaching bank statements. DHS needs one to three months of statements for every account. Joint accounts with a non-spouse (like an adult child) require proof showing whose money is in the account, since DHS presumes all funds belong to the applicant unless shown otherwise.

Submitting through HealthyRhode without selecting "Medicare Premium Payment." Starting a general application routes the case through MAGI evaluation, which isn't the correct pathway for MSP. If you already made this mistake, call DHS at 1-855-697-4347 for instructions.

Where to Submit

• Mail: RI DHS, P.O. Box 8709, Cranston, RI 02920-8787
• Drop box: Any DHS field office (Providence, Pawtucket, Woonsocket, Wakefield, Middletown, or Cranston). Most have 24/7 exterior drop boxes.
• Online: Upload through healthyrhode.ri.gov under the Medicare Premium Payment option.

DHS must respond within 45 days. Keep a copy of everything you submit — if documents go missing in processing, having duplicates saves weeks.

The Rhode Island Medicare Savings Programs, Extra Help & RIPAE Guide includes a line-by-line walkthrough of the MPP-1 and a printable document checklist that tracks what you've gathered and what's still needed.

See more Rhode Island guides →