To be non-financially eligible for Buy-In, an individual must be entitled to Medicare Part A and/or Part B. See section 488.2, Buy-In of Medicare Part A and section 488.3, Buy-In of Medicare Part B for entitlement information. To be financially eligible for Buy-In, an applicant or recipient of HCBS must meet the income and resource guidelines found in Appendix A.
By entering a ‘Y’ in the three ‘Entitled to and Receiving Medicare/ Buy-in’ fields on the Individual Attributes screen in the IVB environment, the CAO will ensure that the system will review for Buy-In eligibility. A ‘Y’ must be entered in these fields for all individuals who are entitled to Medicare whether the individual is financially eligible for Buy-In or not.
NOTE: For married applicants or recipients of HCBS, the resources and income of the non-applicant/non-recipient spouse must be used to determine buy-in eligibility. The resources and income of the married couple are compared to the two-person Buy-In resource and income limits.
To be resource eligible for Buy-In, an applicant or recipient of HCBS must have total countable resources equal to or less than the Buy-In Program resource limits and the resource limits for HCBS. See Appendix A for the Buy-In resource limits.
Example One: Mr. A is a single individual applying for payment of HCBS. He owns a checking account valued at $6,000.00 and a $900.00 savings account. Because the $6,900.00 value of Mr. A’s total countable resources is less than the 2017 one-person Buy-In resource limit of $7,390.00 ($7,280.00 in 2016) and less than the HCBS resource limit of $2,000.00 (with a standard $6,000.00 disregard), Mr. A is resource eligible for Buy-In and payment of HCBS.
Example Two: Mr. B is a married individual applying for payment of HCBS. He owns a checking account valued at $6,000.00 and a savings account valued at $900.00. Mrs. B owns a checking account valued at $3,000.00. Mr. and Mrs. B’s countable resources total $9,900.00. Because the couple’s total countable resources are less than the 2017 two-person Buy-In resource limit of $11,090.00 ($10,930.00 in 2016) and because Mr. B’s total countable resources of $6,900.00 are less than the HCBS resource limit of $2,000.00 (with a standard $6,000.00 disregard), Mr. B is resource eligible for Buy-In and payment of HCBS.
Example Three: Mr. C is a married individual applying for payment of HCBS. He owns a checking account valued at $8,500.00. Mrs. C owns a savings account valued at $1,000.00. Mr. and Mrs. C’s countable resources total $9,500.00. Although the couple’s total countable resources are less than the 2017 two-person Buy-In resource limit of $11,090.00; Mr. C is not eligible for Buy-in or payment of HCBS because his total countable resources exceed $2,000.00 (with a standard $6,000.00 disregard). Mr. C must reduce resources before being determined resource eligible for payment of HCBS.
To be income eligible for Buy-In, an applicant or recipient of HCBS must be within the Buy-In Program income limits. See Appendix A for the Buy-In income limits.
An individual applying for or receiving payment of HCBS may be eligible for Buy-In as either a QMB or a SLMB:
QMB: In order to be eligible as a QMB, gross monthly income (after the $20.00 unearned/earned income deduction) must be equal to or less than 100% of the Federal Poverty Income Guidelines (FPIGs) found in Appendix A.
Example One: Mr. A is a 70 year old single individual applying for payment of HCBS. He receives RSDI income of $690.00 and a pension of $230.00 for a total gross monthly income of $920.00.
Gross Income: $920.00
Income Deduction: - $20.00
Net Income: $900.00
The $900.00 net income is less than the $1,005.00 Buy-In income limit in 2017 for one-person, ($990.00 in 2016) so Mr. A is income eligible for payment of HCBS as a QMB in category PAW 80.
Example Two: Mrs. B is a 59 year old married individual applying for payment of HCBS. She receives RSDI income of $336.00. Mr. B receives RSDI income of $900.00. The total gross monthly income is $1,236.00.
Gross Income: $1,236.00
Income Deduction: - $20.00
Net Income: $1,216.00
The $1,216.00 net income is less than the $1,354.00 two-person Buy-In income limit for 2017, ($1,335.00 in 2016) so Mrs. B is income eligible for payment of HCBS as a QMB category PJW 80.
SLMB: In order to be eligible as a SLMB, gross monthly income (after the $20.00 unearned/earned income deduction) must be more than 100% but less than 120% of the FPIGs found in Appendix A.
Example One: Mr. C is a 50 year old single individual applying for payment of HCBS. He receives RSDI income of $899.90 and a pension of $195.00 for a total gross monthly income of $1,094.90.
Gross Income: $1,094.90
Income Deduction: - $20.00
Net Income: $1,074.90
The $1,074.90 net income is less than the $1,205.99 Buy-In limit in 2017 ($1,187.99 in 2016) for one-person,so Mr. C is income eligible for payment of HCBS as a SLMB in category PJW 66.
Example Two: Mrs. D is a 70 year old married individual applying for payment of HCBS. She receives RSDI income of $400. Mr. D receives RSDI income of $1,080.00. The total gross monthly income is $1,480.00.
Gross Income: $1,480.00
Income Deduction: - $20.00
Net Income: $1,460.00
The $1,460.00 net income is less than the $1,623.99 two-person Buy-In income limit in 2017, ($1,601.99 in 2016) so Mrs. D is income eligible for payment of HCBS as a SLMB in category PAW 66.
NOTE: The $20.00 unearned/earned income deduction is limited to $20.00 per budget group.
If the individual is not entitled to Medicare and/or the individual is not financially eligible for Buy-In then eligibility for payment of HCBS without Buy-In must be determined. When determining eligibility for payment of HCBS without Buy-In, only the income of the individual applying for HCBS is used. The income of the individual applying for or receiving payment of HCBS must be equal to or less than the NMP Special Income Limit which is 300% of the Federal Benefit Rate (FBR), currently $2,205.00 in 2017. found in Chapter 468 Appendix A
NOTE: The $20 unearned/earned income deduction is not used to determine eligibility for payment of HCBS. The deduction is only used to determine eligibility for the Buy-In Program.
Example One: Mr. E is a 70 year old single individual applying for payment of HCBS. He receives RSDI income of $1,404.90 and a pension of $800.00 for a total gross monthly income of $2,304.90.
Gross Income: $2,304.90
The $2,304.90 gross income is greater than the NMP Special Income limit, currently $2,205.00 in 2017, ($2,199.00 in 2016) so Mr. E is not eligible for payment of HCBS.
Example Two: Mrs. F is a 55 year old married individual applying for payment of HCBS. She receives RSDI income of $900.00. Mr. F receives Railroad Retirement Benefits of $1,900.00. The total gross monthly income of Mrs. F is $900 but because the net income of the married couple exceeds the two-person Buy-In income limits, Mrs. F is reviewed for income eligibility without Buy-In. Mrs. F has income below the NMP Special Income Limit, currently $2,205.00 in 2017, ($2,199.00 in 2016) so she is income eligible in a PJW 00 category.
Gross Income of the Married Couple: $2,800.00
Income Deduction: -$20.00
Net Income: $2,780.00
The $2,780.00 net income is greater than the $1,623.99 two-person Buy-In income limit in 2017 ($1,601.99 in 2016), so eligibility for payment of HCBS without Buy-In must be determined. Mrs. F’s $900.00 gross income is less than the NMP Special Income Limit, currently $2,205.00 in 2017 ($2,199.00 in 2016) so Mrs. F is income eligible for payment of HCBS in category PJW 00.
Updated February 21, 2017, Replacing January 4, 2017