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Effective: February 1, 2009 |
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04.45.15ar2 - The Buy-In (Archive) |
Archived: October 1, 2012 |
Some people who qualify for or receive Medicare may be eligible for the Buy-In. The Buy-In is an automated process MA uses to pay for Medicare premiums and, for some people, other Medicare cost-sharing if the person meets certain criteria.
Medicare Savings Programs (MSP) are considered part of the Buy-In because these are federally funded MA programs which pay for some Medicare costs.
Buy-In Begin Date for People Turning Age 65.
A client can be on the Buy-In with or without regular MA eligibility.
l A person who qualifies for QMB or SLMB will have their Medicare premiums (and other cost-sharing if QMB) paid under the Buy-In with or without regular MA eligibility.
l A person who qualifies for QWD or QI will have their Medicare premiums (Part A if QWD and Part B if QI) paid under the Buy-In. QWD and QI enrollees cannot be enrolled concurrently in regular MA.
l A person who is eligible for the Buy-In without participating in an MSP must be enrolled in MA.
l For the Buy-In process to work correctly enter the person's Medicare claim number on the STAT/MEDI panel in MAXIS.
l The automated 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 enrollment.
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).
n Always use this letter for people age 65 or older receiving SSI or 1619a or 1619b who cannot enroll in Medicare unless a Part A premium is paid.
n Do not refer people who have Medicare Part A or Part B only or who have had Medicare previously to SSA. They are already known to SSA and do not need to reapply to get Medicare through the Buy-In.
Buy-In payments for Medicare cost-sharing are based on the enrollee's program.
The Buy-In pays for:
l The Medicare Part B premium only for MA enrollees not participating in a Medicare Savings Program.
l The Medicare Part A premium, B premium and other Part A and B cost-sharing for QMB enrollees.
l The Medicare Part B premium only for SLMB enrollees.
l The Medicare Part B premium only for QI enrollees.
l The Medicare Part A premium only for QWD enrollees.
l Premiums paid by the Buy-In are not subject to late enrollment penalties.
The Buy-In does not pay for:
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 or copays.
To be eligible for the Buy-In a person must qualify for Medicare, and:
l Be enrolled in a Medicare Savings Program (MSP). See program details for eligibility factors and program guidelines.
l Be enrolled in MA, entitled to premium-free Medicare Part A, and be enrolled in one of the following programs:
n Minnesota Supplemental Aid (MSA).
n Minnesota Family Investment Program (MFIP).
n 1619(a) or 1619(b) SSI status.
n IV-E Adoption Assistance.
n IV-E Foster Care.
n Group Residential Housing (GRH).
Evaluate QMB eligibility for people in the above programs who are not entitled to premium-free Medicare Part A.
Approve an MSP for people who receive the benefits listed above if they are eligible. They will be picked up on the Buy-In regardless of whether they are approved for an MSP if they are entitled to premium-free Medicare Part A.
Note: People who qualify for Medicare, but are not entitled to premium-free Medicare Part A, including people who receive Supplemental Security Income (SSI) only and who are age 65 or older, must be enrolled in QMB to participate in the buy-in. QMB will pay the Medicare Part A premium, the Medicare Part B premium, and other Parts A and B cost sharing. Follow the Steps for Medicare Referral.
Buy-In Begin Date for People Turning Age 65
The Buy-In for people on regular MA who qualify for Medicare because they are turning age 65 cannot begin until the month of the person's 65th birthday.
Since the Medicare Savings Programs (MSP) are part of the Buy-In, MSP eligibility also cannot start for a non-disabled person until the person turns age 65.
Example:
Joe will turn 65 on October 28. He will qualify for Medicare coverage beginning October 1.
Action:
Joe’s Buy-In or MSP eligibility cannot start until October 1.
This rule applies to people whose 65th birthday falls on the first day of a month, even though they qualify for Medicare the first day of the month preceding their birthday month. 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.