The CAO sets the beginning date for Buy-In of Part A and Part B as follows:
QMBs eligible for Healthy Horizons cost-sharing benefits – Buy-In eligibility begins the first day of the month following the month in which MA was authorized. There is no retroactive coverage under this program.
Example: Client is authorized PG00 effective 3/1/18. Buy-In should be authorized effective 04/2018.
QMBs eligible for Healthy Horizons categorically needy benefits – If the individual is already eligible for Medicare, Buy-In eligibility begins in the month that Healthy Horizons eligibility begins. Retroactive Buy-In coverage may go back up to three months prior to the date of application.
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.
Example: Client was authorized PH00 effective 10/1/17. Exchange 3 indicates Part A and/or Part B entitlement date 03/2018. Buy-In should begin 03/2018.
SSI recipients – Buy-In eligibility begins in the month that Medicare eligibility begins. The SSA will auto-accrete SSI recipients when they become eligible for Medicare at age 65.
NOTE: If the SSA has not enrolled the individual in Buy-In after three months of Medicare eligibility, the CAO will process a manual accrete to enroll the individual. To confirm Buy-In enrollment, the CAO must set an alert to check Exchange 7. The alert should be set for three months after the date of Medicare eligibility.
Special SSI recipients—If NMP is approved for the month after the SSI closure, Buy-In eligibility begins immediately with no break in coverage. If NMP eligibility is approved later, Buy-In eligibility begins the month that NMP is authorized.
TANF recipients – Buy in eligibility begins in the first month that the individual is eligible for both Medicare and TANF cash assistance and is a resident of Pennsylvania.
Transitional Medical Assistance recipients—An individual who loses eligibility for TANF cash assistance, but remains eligible for extended NMP benefits, also remains eligible for Buy-In. When the TMA budget is opened, Buy-In eligibility begins immediately, with no break in coverage. If TMA eligibility is approved later, Buy-In eligibility begins in the month that TMA is authorized.
Specified Low-Income Medicare Beneficiaries (SLMBs)—Retroactive Part B Buy-In coverage may be authorized up to three months prior to the date of application. SLMBs are eligible for payment of the Medicare Part B premiums only. The CAO will use the manual accrete process to enroll SLMBs for past periods of Buy-In eligibility. (See Section 388.62, Manual Accrete.)
Qualifying Individuals (QIs)—Retroactive Part B Buy-In coverage may be authorized up to three months prior to the date of application. QIs are eligible for payment of the Medicare Part B premium only. The CAO will use the manual accrete process to enroll QIs for past periods of eligibility. (See Section 388.62, Manual Accrete.)
Qualified Disabled Working Individuals (QDWIs) – Buy-In eligibility begins in the first month that the individual is identified by the SSA as a QDWI. QDWIs are eligible for payment of the Medicare Part A premium only.
Updated August 31, 2018, Replacing February 14, 2012