States that include Premium-Part A in their State Buy-in agreements are known as “Part
A Buy-in States.” In Part A Buy-in States, individuals can complete the conditional enrollment process
at any time (without regard to enrollment periods). Late enrollment penalties do not apply.
Below is a list of the Part A Buy-in States and the effective date of the State Buy-in
agreement modification, if later than 1/90:
Alaska
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Maryland
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Oregon (7/08)
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Arkansas
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Massachusetts
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Pennsylvania
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Connecticut
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Michigan
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Rhode Island
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Delaware
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Minnesota
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South Dakota
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District of Columbia
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Mississippi
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Tennessee (7/90)
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Florida
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Montana
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Texas (7/93)
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Georgia
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Nevada
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Vermont (9/90)
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Hawaii
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New Hampshire
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West Virginia
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Idaho
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New York (07/04)
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Washington (7/90)
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Indiana
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North Carolina
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Wisconsin (7/90)
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Iowa
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North Dakota
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Wyoming (11/90)
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Louisiana
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Ohio
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Maine
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Oklahoma
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Example of person requesting Premium-Part A and Part B enrollment outside an enrollment
period: A person resides in Ohio (a Part A Buy-in State) and does not have Medicare. This
person contacts the local Field Office (FO) in April 2017 to apply for the QMB Program.
This person is not eligible for Premium-Free Part A, but qualifies for Premium-Part
A. This person may file an application for Part B and “conditional enrollment” in
Premium-Part A. Because this person resides in a Part A Buy-in State, the conditional
enrollment can be filed at any time. The FO takes the application and processes it
according to instructions in HI 00801.140E.4 of this section.
Example of person requesting Premium-Part A and Part B enrollment during an enrollment
period: This person resides in Pennsylvania (a Part A Buy-In State) and does not have Medicare.
This personcontacts the local FO in January 2018 looking for Medicare coverage but
can’t afford the premiums. This person may file an application for “conditional enrollment”
in Premium-Part A. Because this person resides in a Part A Buy-in State, the Part
B and conditional Part A enrollment can be filed at any time. The application is not
processed as a General Enrollment Period (GEP) application. The FO takes the application
and processes it according to instructions in HI 00801.140E.4 of this section.
Example of beneficiary with Part B enrollment and not eligible for Premium-Free Part
A
requesting enrollment: the beneficiary resides in Maryland (a Part A Buy-in State),has Medicare Part B only
and is not eligible for Premium-Free Part A. The beneficiary contacts the local FO
in September 2017 to get help paying premiums. The beneficiary does not need to file
an application for Premium-Part A when resides in a Part A Buy-in State. The FO refers
case to the State to file for the QMB Program, according to instructions in HI 00801.140E.3 of this section. (Note: If Maryland approves the application for the QMB Program,
the State will enroll in State Buy-in because already has Part B and will automatically
get Premium-Part A, and the State will pay all premiums.)