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MI Form 8965: What You Should Know

A certified letter from your health care provider is needed to certify that you did not qualify for the health care tax exemptions in previous years or the same year. If you have no doctor or care facility listed, contact your health care provider as soon and frequently as you can.  You may contact your health care provider at any time to verify your exemption status, but you need not complete this initial visit. If you have other needs, including ongoing medical issues or treatment, you will need to schedule a follow-up with your health care provider with your completed Forms 8965.  Treatment Request — Spectrum Health In-Person Visits — Spectrum Health Treatment Request — Spectrum Health You may begin treatment anytime within 24 hours of your completed Form 8965. If you begin treatment after your completed Form 8965, the following must be submitted with your completed Form 8965: A certified statement of your health care needs (such as a statement about your current medical needs or your medical procedure status) from a health care provider (such as your doctor or chiropractor). The statement must indicate that you need treatment before you become eligible for Medicare benefits (but, as you may have medical needs after the date you receive this statement, see Treatment Request — Spectrum Health, above). If you do not have a health care provider, you must complete a Form 8965C, Affidavit to Establish that Coverage is Eligible for Cost-Sharing or Community Rating Payment, listing your provider information. A statement explaining why providing you with health care is important to your health care status, such as stating a diagnosis (for people who have lost their health insurance). If you need treatment, it needs to be administered within 20 days after the date you receive this statement.

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