An individual with Medicare Part B must pay a monthly premium unless he or she is getting Medicare Part A and is eligible for Buy-In of Medicare Part B. The individual does not have to apply for and get Part B before Buy-In can begin. If the individual is in “withdrawn” or “refused” status for Medicare, the CAO can reopen his or her Medicare at any time. (See Section 388.6, Authorizing Buy-In.)
Buy-In of Part B is available to an individual who is eligible for Part B and meets one of the following conditions:
The individual gets benefits in category A, J, or M.
NOTE: If the SSA has not enrolled the individual in Buy-In after three months of Medicare eligibility, the CAO will enroll the individual in Buy-In by completing a manual accrete action.
The individual gets benefits in category PA, PJ, PM, PAW, PJW, PMW, PAN, PJN, PMN, C, U, PC, PU, PH, PG, PW, TA, TJ, TAW, TJW, TAN, or TJN and meets a state coverage group requirement.
The individual is a Specified Low-Income Medicare Beneficiary (SLMB) who is eligible for Premium-Free Part A under Title II of the Social Security Act or pays his or her own Part A premiums. If the individual is not enrolled in Premium-Free Part A or is not paying the Part A premiums, then the individual is not eligible for payment of the Part B premium. (For more information about SLMBs, see Chapter 319, Healthy Horizons, Section 319.1, General Policy.)
The individual is a Qualifying Individual (QI) who is eligible for Premium-Free Part A or pays his or her own Part A premiums under Title II.
The individual is in a D-50 budget. This individual is considered a Qualified Medicare Beneficiary (QMB) if he or she is entitled to Medicare Part A. The individual stays in the D-50 budget in CIS, for financial reasons. Use IEVS, Chapter 6, Exchange #3, BENDEX to confirm the individual’s Medicare eligibility before enrolling the individual in Part B Buy-In. Use PG/00 to enter a manual accrete action into the Buy-In system for a D-50 budget.
An individual may be eligible to enroll in Medicare Part B:
The individual is age 65 or older and getting Part A regardless of immigration status.
The individual is age 65 or older, is a resident of the United States, and is:
A U.S. citizen.
An alien admitted for permanent residence who has lived in the U.S. non-stop for five years right before the month of enrollment.
The individual is under age 65 and has been entitled to Social Security Disability under Title II or Railroad Disability benefits for more than 24 months.
The individual is eligible because of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s Disease). The individual must also meet the income and resources requirements for Buy-In coverage.
NOTE: Children in categories such as PH/95 may need to be enrolled in Buy-In because of ESRD. The CAO must add them by completing manual accrete actions.
Buy-In of Medicare Part B is available to an individual who (a) is entitled to Part B; (b) is getting MA benefits in category A, J, M, PA, PJ, PM, PAW, PJW, PMW, PAN, PJN, PMN, PW, C, U, PC, PU, PH, PG, TA, TJ, TAW, TJW, TAN, or TJN category; and (c) is in one of the following state coverage groups:
Qualified Medicare Beneficiaries (QMBs). QMBs include the following:
Healthy Horizons recipients.
NOTE: Healthy Horizons benefits include categorically needy benefits and cost-sharing benefits. Cost-sharing benefits are Buy-In of Medicare Part A and B, if the individual must pay for Part A and B, and the payment of Medicare deductibles and coinsurance.
NOTE: NMP and MNO recipients are eligible for Buy-In of Part B if they meet the Healthy Horizons eligibility criteria. These individuals are enrolled in Buy-In with program status code 80.
State Blind Pension (SBP) recipients.
SSI Recipients (A, J, or M).
NMP or MNO recipients who are eligible for Buy-In of Part B as Specified Low-Income Medicare Beneficiaries (SLMBs). These individuals are enrolled in Buy-In with program status code 66.
Recipients of category PA, PJ, or PM benefits whose NMP was extended after their SSI benefits were closed. This includes the following:
Lynch v. Rank Pickle amendment individuals.
SSI special recipient status individuals.
Certain Disabled Adult Children (DAC) who are eligible for NMP are also eligible for Buy-In if they get Medicare.
NOTE: For more information, see Chapter 387, Supplemental Security Income.
Recipients of TANF who are eligible for SSI but have chosen to get TANF and are:
Getting extended NMP benefits after their TANF benefits were closed because of higher earnings, increased support, or end of the earned income incentive; or
Eligible for a TANF cash payment but do not get it because the amount is less than the $10 minimum monthly payment.
Recipients of Placement Maintenance or Adoption Assistance under Title IV-E of the Social Security Act.
Recipients of TANF who at the same time got a pension from the Veterans Administration in December 1978.
The following groups are eligible for Buy-In of Medicare Part B only. These groups do not receive other MA services.
Specified Low-Income Medicare Beneficiaries (SLMBs). Program Status Code 65 identifies SLMBs.
NOTE: If an individual is also eligible for MA, the CAO will enroll the individual in SLMB by using program status code 66 with the MA category.
Qualifying individuals (QIs). Program status code 67 identifies QIs. QIs cannot be eligible for MA in other ways.
Updated February 14, 2012, Replacing November 3, 2010