*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: October 1, 2012 |
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04.45.15 - The Buy-In |
Archived: June 1, 2016 (Previous Versions) |
Some people who qualify for or receive Medicare may be eligible for the Buy-In. The Buy-In is an automated process within MMIS that MA uses to pay Medicare premiums. A person who is not enrolled in the Buy-In through the automated process is added to the Buy-In when enrolled in a Medicare Savings Program (MSP) on MMIS.
The Buy-In is an automated monthly data exchange between the Minnesota Health Care Programs (MHCP) (MMIS) and the Centers 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 enrollment.
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).
Buy-In Eligibility and Payments.
Buy-In Begin Date for People Turning Age 65.
For the Buy-In process to work correctly, a client must:
l Be categorically eligible, not enrolled in an MSP, or
l Be categorically eligible, and enrolled in an MSP, or
l Be enrolled in an MSP only, or
l Be enrolled in an MSP and in MA.
The worker must:
l Enter the Medicare claim number and Medicare Part A and Medicare Part B start dates on the MEDI panel in STAT in MAXIS.
l Approve eligibility in MAXIS.
l Enter an MSP span on RELG in MMIS.
The Medicare claim number in interfaced from MAXIS to the RMCR screen in MMIS.
Buy-In Eligibility and Payments
Buy-In payments are based on the enrollee's program.
l QMB only: provides for payment of both Medicare Part A and Medicare Part B premiums and all cost-sharing.
l QMB and MA: provides for payment of both Medicare Part A and Medicare Part B premiums; payment of cost-sharing is covered through the Buy-In or by MA, depending upon the service provided.
l SLMB: provides for payment of the Medicare Part B premium only. Enrollees can be on SLMB only or enrolled concurrently in MA.
l QI: provides for payment of the Medicare Part B premium only. Enrollees cannot also be enrolled concurrently in MA.
l QWD: provides for payments of the Medicare Part A premium only. Enrollees cannot also be enrolled concurrently in MA.
l Categorically eligible persons receive payment of the Medicare Part B premium. These enrollees are entitled to premium free Medicare Part A and are enrolled in one of the programs:
n Minnesota Supplemental Aid (MSA)
n Minnesota Family Investment Programs (MFIP)
n 1619(a) or 1619(b) while receiving Social Security Disability Insurance (SSDI)
n IV-E Adoption Assistance
n IV-E Foster Care
n Group Residential Housing (GRH)
Note: The above will be picked up on the Buy-In regardless of whether they are approved for an MSP. However, continue to evaluate MSP eligibility for people who also receive these benefits.
l Enrollees age 65 or older receiving Supplemental Security Income (SSI) only:
n These clients are not entitled to free Medicare Part A and have a premium.
n If meeting SSA requirements for enrollment in Medicare, they must be enrolled in QMB; the Buy-In will pay for both Medicare Part A and Medicare Part B premiums. Cost-sharing will be covered by either the Buy-In or MA based on the type of service received.
Note: The Buy-In only pays the base premium cost even if the Buy-In eligible enrollee has accumulated late enrollment penalties.
The Buy-In does not pay for:
l Medicare Part C Medicare Advantage health care plan premiums. Premiums are paid directly to the plans and may include Medicare Part D premiums.
l Medicare Part D prescription plan premiums or copays.
Buy-In Begin Date for People Turning Age 65
The Buy-In for people on basic MA who qualify for Medicare because they are turning age 65 begins the first day of the month of the person's 65th birthday.
Exception: SSA deems persons who turn age 65 on the first day of the month to be eligible for Medicare the first day of the preceding month; however, the Buy-In cannot enroll these persons until the month of their actual birthday when they can be enrolled in an MSP. See When Does Medicare Start?
Treat the Medicare Part B premium as cost effective insurance for the month before the client turns 65 by reimbursing the client for the cost of the Part B premium. A referral to Benefit Recovery at DHS is not required.
Example:
Linda turns 65 on September 1. She qualifies for Medicare beginning August 1.
Action:
Linda is not eligible for the Buy-In or an MSP until the actual month she turns age 65. She is eligible for the Buy-In effective September 1. The county agency reimburses her August Medicare Part B premium as cost effective.