The CAO sets the beginning date for Buy-In of Part A and Part B as follows:
Healthy Horizons—An individual getting Healthy Horizons benefits becomes eligible for Buy-in in the month that Healthy Horizons eligibility begins.
NOTE: If an individual becomes eligible for Medicare after Healthy Horizons eligibility begins, Buy-In eligibility begins in the month the individual becomes eligible for Medicare.
QMBs – An individual becomes eligible for Buy-In in the month following the month of application.
Recipients of extended benefits after SSI closure—If NMP is approved for the month after the SSI closure, enrollment begins right away with no break in coverage. If NMP eligibility is approved later, enrollment begins the month NMP is authorized.
TANF recipients—An individual who gets TANF cash assistance becomes eligible for Buy-In in the first month in which the individual is eligible for both Medicare and cash assistance and is a state resident.
Extensions of NMP (PC/PU) for TANF recipients—An individual who loses eligibility for TANF cash assistance but remains eligible for the automatic extension of NMP also remains eligible for Buy-In. When the NMP budget is opened, enrollment in Buy-In begins right away, with no break in coverage.
NOTE: An individual whose TANF cash assistance is stopped and who later becomes eligible for NMP is enrolled in Buy-In immediately.
Specified Low-Income Medicare Beneficiaries (SLMBs)—Part B Buy-In coverage may go back up to three months. Use the manual accrete process to enroll SLMBs for past periods of Buy-In eligibility. SLMBs are not eligible for payment of the Medicare Part A premium by DHS.
NOTE: If an individual is not eligible for Premium-Free Part A or is not paying Part A premiums, the individual cannot be enrolled in Part B as a SLMB.
Qualifying Individuals (QIs)—QIs are eligible for payment of the Medicare Part B premium only. Part B coverage may be able to go back up to three months prior to the month of application. Use the manual accrete process to enroll QIs for past periods of eligibility.
Change in Category with No Break in Buy-In Coverage—An individual may still be eligible for Buy-In when a change in the MA category is required. A break in Buy-In coverage may happen if the Client Information System (CIS) close transaction sends an auto-delete transaction to the Buy-In system. When closing one category and opening a new category in CIS, the CAO will check
Buy-In as follows:
Review the Buy-In BIACTN screen the day after the CIS category closes to make sure an auto-delete transaction was posted.
Continue Buy-In with no break in coverage by removing the delete transaction on the BIACTN screen before the 23rd day of the month. (See IEVS, Chapter 10, Exchange #7, Buy-In.)
Updated February 14, 2012, Replacing November 3, 2010