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Effective: December 1, 2006 |
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04.45.15ar1 - The Buy-In (Archive) |
Archived: February 1, 2009 |
Some people who are eligible for or receiving Medicare may qualify for the Buy-In. The Buy-In is the process of having some of the client’s Medicare costs paid by state and federally-funded MA if they meet certain criteria.
Medicare Savings Programs (MSP) are considered part of the Buy-In because these are state and federally funded programs which pay for some of a client’s Medicare costs.
Buy-In Begin Date for People Turning Age 65.
l A client can be on the Buy-In with or without regular MA eligibility.
Example:
Joseph receives RSDI in excess of the income limit for regular MA but he is within the income limits of SLMB. He meets all other criteria.
Action:
Joseph is eligible for SLMB only.
l The Medicare costs paid by the Buy-In vary depending on the client’s Medicare eligibility and whether the client is on a MSP or meets other criteria.
l For the Buy-In process to work correctly the client must have an available Medicare number.
l The actual process is a monthly data exchange between MHCP (MMIS) and the Center for Medicare and Medicaid Services (CMS). The data exchange contains requests to add or delete a person from the State of Minnesota’s Buy-In system.
l People must be enrolled in Medicare before payments can begin through the Buy-In. Use the Medicare Buy-In Referral Letter (DHS-3439) to refer people who are eligible for the Buy-In to the Social Security Administration (SSA) if necessary outside the open enrollment period.
The Buy-In pays for the Part B premium.
l Clients enrolled in QMB or QWD will have the Part A premiums, co-insurance and deductible costs paid for as well.
l Premiums paid by the Buy-In are not subject to late enrollment penalties.
The following Medicare parts are not paid for by the Buy-In:
l Part C Medicare Advantage plan premiums. Premiums are paid directly to the plans and may include Part D premiums.
l Part D plan premiums.
To be eligible for the Buy-In a client must:
l Be eligible and approved for an MSP. See program details for information on Medicare costs paid:
n QMB.
n SLMB.
n QI.
n QWD.
l Be enrolled in the following programs and not enrolled in an MSP:
n Supplemental Security Income (SSI). Recipient of SSI must be age 65 or over.
n Minnesota Supplemental Aid (MSA).
n Minnesota Family Investment Program (MFIP).
n 1619(a) or 1619(b) SSA status and receive RSDI.
n IV-E Adoption Assistance.
n IV-E Foster Care.
n Group Residential Housing (GRH).
Clients who receive the benefits listed and who:
n Are receiving regular MA, will have the Medicare Part B premium paid by the Buy-In.
n Are not receiving regular MA, if enrolled in Medicare Part A, will have the Medicare Part B premium paid by the Buy-In.
Buy-In Begin Date for People Turning Age 65
The Buy-In for people on regular MA or GAMC who begin receiving Medicare because they are turning 65 cannot begin until the month the person is actually turning 65.
Reminder: The Medicare Savings Programs are part of the Buy-In and cannot start for a non-disabled person until the person turns age 65.
Example:
Joe will turn 65 on October 28th and will be begin Medicare coverage in October due to his age.
Action:
Joe’s Buy-In eligibility cannot start until October.
This rule applies to people whose 65th birthday falls on the first day of a month. However, Medicare coverage for people whose 65th birthday falls on the first of a month, begins in the month before their birthday.
Example:
Linda turns 65 on September 1.
Action:
Linda’s Medicare coverage will begin August 1.
These people are not eligible for the Buy-In until the actual month they turn 65. The Medicare premium for these people is considered cost-effective insurance and should be paid following those requirements for the month before the client turns 65. A referral to Benefit Recovery at DHS is not required.
Example:
Linda turns 65 on September 1.
Action:
Linda’s Medicare coverage will begin August 1. She is not eligible for QMB, SLMB, QI or other manner of the Buy-In until September. The Medicare Part B premium that she is paying for August is considered cost effective and Linda must be reimbursed that expense.