Mail-in Application for Payment of Medicare Part B Premium (PA 600-M) [PDF]
Authored By: Pennsylvania Department of Human Services
The PA 600M is a mail-in application for payment of the Medicare Part B premium only. It is used to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare Part B premium. A face-to-face interview is not required when using this application. The application cannot be used to apply for Medicaid (Medical Assistance), cash assistance or food stamps.