Buy-In is the process by which the Department of Human Services (DHS) pays the Medicare premiums for an eligible Medical Assistance (MA) recipient. Buy-In is also known as the Medicare Savings Program (MSP). Enrollment in the Buy-In Program allows the transfer of medical costs from MA to the federally funded Medicare Program. Medicare becomes the primary payer for medical bills.
For most low-income individuals, the Medicare premiums represent a significant portion of their income. For low-income individuals who have been paying the Medicare Part B premium out of their Social Security benefits, the Buy-In Program enables individuals to receive their full benefit amount by stopping the monthly deduction from their Social Security payment. The Buy-In program ensures access to Medicare Parts A and B for those individuals who could not otherwise afford the premiums.
Medicare has three parts for which Buy-In is available:
Part A- Hospital Insurance (HI), which covers inpatient hospital care, some inpatient care in a skilled LTC facility, home health care, and hospice care.
Part B- Supplementary Medical Insurance (SMI), which covers physician services and outpatient care such as diagnostic x-rays, therapy, and the rental or purchase of medical equipment used in the home.
Part D- Stand-alone prescription drug coverage. There are various plans available through private insurance companies. Plans vary and cover different prescription drugs.
The CAO will use information found on IEVS or Data Exchange 3 to determine whether or not an individual is receiving Medicare, whether or not the individual is paying the Medicare B premium, and the monthly cost of the Medicare B premium. For more information about Medicare and Social Security income in IEVS, see Chapter 6 of Using IEVS at:
http://oimmanuals/daps/uievs/CHAPTER%2006.htm#P8_42. For more information about Data Exchange 3 see the Workload
Dashboard/ Data Exchange Desk Guide at:
http://oimweb/resources/Workload_Dashboard_Data_Exchanges/wlddx_desk_guide_table_of_conte.htm.
The Social Security Administration (SSA) is responsible for enrolling Supplemental Security Income (SSI) recipients, age 65 and older, who are eligible for Medicare (categories A, J, M) in Buy-In of Part B. In addition, SSI recipients under age 65 who also receive Social Security benefits, will start receiving Medicare 24 months after their disability is determined. For enrollment instructions see Using IEVS Chapter 10, Exchange 7 at:
http://oimmahnuals/daps/uievs/CHAPTER%2010-07.htm#P835_37213. Buy-In coverage f 8or these individuals begins the first month that the individual is eligible for both Medicare and SSI and is a resident of Pennsylvania.
NOTE:If Buy-In is closed when an individual is receiving SSI, SSA will not re-open Buy-In. The CAO will need to reopen using the manual accrete process found in Using IEVS Chapter 10 Exchange 7 at:
http://oimmahnuals/daps/uievs/CHAPTER%2010-07.htm#P835_37213.
Issued May 1, 2012