Using Buy-In Data to Close Medicare A/B TPL Resources, PMA18885388 (Published April 19, 2018)
Buy-In is the process by which the Department of Human Services (DHS) pays the Medicare premium for an eligible Medical Assistance (MA) recipient. Buy-In is also known as the Medicare Savings Programs (MSP).
The Buy-In program transfers medical costs from the MA program to the federally funded Medicare program and helps with Medicare costs for low-income people who are above the eligibility limits for MA. Medicare becomes the primary payer for medical bills. Medicare providers are not allowed to bill any remaining balance to individuals that have Medicare and full MA.
Medicare has two parts:
Part A—Hospital insurance, which covers inpatient hospital care, some inpatient care in a skilled nursing facility, home health care, and hospice care.
Part B—Supplementary medical insurance, which covers physician services and outpatient care, such as x-rays, therapy, and the rental or purchase of medical equipment used in the home.
To prove the individual has Medicare, see Using IEVS, Chapter 6, Exchange #3, BENDEX. (Using IEVS is available on the Office of Income Maintenance Intranet for internal users.)
The Social Security Administration (SSA) enrolls Supplemental Security Income (SSI) recipients who are eligible for Medicare (categories A, J, and M) Buy-In for Part B. Some SSI recipients under age 65 may get Medicare 24 months or more after their disability is confirmed. (See Using IEVS, Chapter 10, Exchange #7, for Buy-In enrollment instructions.) Buy-In coverage for these individuals starts the first month that the individual is eligible for both Medicare and SSI and is a resident of Pennsylvania.
Important: If Buy-In is closed when an individual is getting SSI, the SSA will not reopen Buy-In. The CAO will need to reopen Buy-In by using the manual accrete process.
Updated April 19, 2018 Replacing November 2, 2015