HFS 3120, Medicaid Payment of Medicare Cost Sharing Expenses and HFS 3757-Medicare Savings for Qualified Beneficiaries

Department of Healthcare and Family ServicesDepartment of Human Services



  • Form HFS 3120 (pdf)/3120S (pdf) (R-02-13), Medicaid Payment of Medicare Cost Sharing Expenses, has been revised.
  • Brochure HFS 3757 (pdf)/3757S (pdf) (R-02-13), Medicare Savings for Qualified Beneficiaries, has been revised. 
  • HFS 3120/HFS 3120S and HFS 3757/HFS 3757S, may be downloaded at HFS Forms (http://www2.illinois.gov/hfs/agency/Brochures%20and%20Forms/Pages/default.aspx/ ) 

[signed copy on file]

Michelle R. B. Saddler

Secretary, Department of Human Services

Julie Hamos

Director, Healthcare and Family Services

Forms referenced:

  • HFS 3120
  • HFS 3120S
  • HFS 3757
  • HFS 3757S