Effective Dates: 01/12/2024 - Present Previous | Next

TN 49 (01-24)

HI 00815.018 When State Payment of Medicare Premiums (State Buy-In) Begins

A. Background

In general, an individual’s state buy-in coverage start date depends on the Medicaid eligibility group in which an individual is enrolled.

The exception is for individuals covered by a new or modified buy-in agreement. Buy-in coverage can begin no sooner than three months after the effective date of a new or modified buy-in agreement.

For more information about the start date of buy-in coverage, see CMS Manual for State Payment of Medicare Premiums, chapter 1, sections 1.13.1 and 1.14.1 and appendix 1.C.

B. Beginning of State Payment of Part A Premiums (Part A Buy-in) for Qualified Medicare Beneficiaries

Part A Buy-in for the Medicare Saving Program (MSP) Qualified Medicare Beneficiary (QMB) eligibility group begins the month the individual is enrolled in premium Part A and QMB.

C. Beginning of State Payment of Part B Premiums (Part B Buy-in)

See also the chart in Section D. for an explanation of these provisions.

Individuals who Receive or are Deemed to Receive Cash Assistance or are Enrolled in an MSP.

Part B buy-in generally begins the first month in which the individual meets the requirements both for eligibility in the buy-in coverage group (i.e., the start date of the individual’s Medicaid coverage) and eligibility for Medicare Part B for:

  • •

    Medicaid beneficiaries who are cash assistance recipients or who are deemed to be recipients of cash assistance; and

  • •

    Individuals enrolled in the following three MSP groups:

    • –

      QMB;

    • –

      Specified Low-Income Medicare Beneficiary (SLMB); and

    • –

      Qualifying Individual (QI).

Note for SSI recipients: 

In states with 1634 agreements (1634 states or auto-accrete states), Part B buy-in starts no later than the first month an individual is entitled to SSI and Part B. SSI recipients are automatically eligible for Medicaid based on their receipt of SSI.

Example: If the individual is eligible for Part B and SSI in January, Part B buy-in is effective January 1.

In alert states, Part B buy-in may begin later than the first month the individual is entitled to SSI and eligible for Part B. Alert states separately determine SSI recipients eligible for Medicaid.

Example: If the individual is eligible for SSI and Part B in January and their Medicaid effective date is March 1, Part B buy-in is effective March 1.

Other Medicaid Beneficiaries who do not receive or are Deemed to Receive Cash Assistance or are Enrolled in an MSP.

Part B buy-in begins the second month after the individual meets the requirements for both:

  • •

    eligibility in the buy-in group (i.e., the start date of the individual’s Medicaid coverage) and

  • •

    eligibility for Medicare Part B for all other Medicaid eligibility groups included in the buy-in agreement.

Example: If an individual is eligible for Medicaid and Part B in January, buy-in is effective March 1.

An individual can be simultaneously enrolled in the QMB or SLMB MSP group and a full-benefit Medicaid eligibility group. For an individual who is simultaneously enrolled in one of these MSP groups and a full-benefit Medicaid eligibility group, Part B buy-in begins on the earlier of the buy-in start applicable to the MSP or Medicaid eligibility group.

Exception: State liability for retroactive Medicare Part B premiums for full-benefit Medicaid beneficiaries under a buy-in agreement is limited to a period of no greater than 36 months prior to the date of the Medicare enrollment determination pursuant to 42 CFR § 407.47(f) beginning January 1, 2024. CMS may approve shorter or longer retroactive buy-in periods upon state request.

D. Summary of Buy-in Start Dates

See the chart below for buy-in start dates as outlined in the CMS Manual for State Payment of Medicare Premiums, chapter 1, appendix 1.C.

Start dates may be adjusted if:

  • •

    the individual is covered by a new or modified buy-in agreement (coverage can start no sooner than three months after the effective date of a new or modified buy-in agreement); or

  • •

    to avoid retroactive payments beyond 36 months (or different limits approved by CMS) after January 1, 2024.

    Medicaid Eligibility Group

    Part A Buy-in Start Date

    Part B Buy-in Start Date

    Cash assistance (SSI/SSPs) and deemed recipients of cash assistance who are categorically needy

    N/A

    Part B buy-in starts the first day of the month an individual qualifies for Medicare Part B and is eligible for Medicaid.

    In auto-accrete states, Part B buy-in starts the first month the individual is both entitled to SSI and eligible for Part B. In alert states, Part B buy-in starts the first month an SSI recipient is eligible for Medicaid and Part B.

    42 CFR § 407.47(b)

    QMB

    Part A buy-in starts the month an individual is enrolled in premium Part A and has QMB status. 42 CFR § 406.26(b)

    In Group Payer states only: If an individual enrolls during the General Enrollment Period or later, as early as the first day of the month after enrollment in either actual or conditional Part A.

    Part B buy-in starts the first day of the month an individual qualifies for Medicare and has QMB status.

    42 CFR § 407.47(c)

    SLMB

    N/A

    Part B buy-in starts the first day of the month an individual qualifies for Medicare and is a member of the coverage group.

    42 CFR § 407.47(c)

    QI

    N/A

    Part B buy-in starts the first day of the month an individual qualifies for Medicare and is a member of the coverage group.

    42 CFR § 407.47(c)

    Other Full-benefit Medicaid Eligibility Categories[1]

    [2]

     

    N/A

    Part B buy-in starts the first day of the second month after an individual qualifies for Medicare and is a member of the coverage group.

    42 CFR § 407.47(d)

E. Effect of Incorrect Report of Buy-In Eligibility

If a state erroneously reports an individual as a member of its buy-in coverage group, buy-in coverage nevertheless begins in accordance with HI 00815.018B and HI 00815.018C.

Once a State enrolls an individual in buy-in, the State cannot cancel the enrollment retroactively. (A cancellation of the entire enrollment may only occur during the same Current Operating Month (COM) that buy-in was established). However, the state can subsequently terminate the individual’s buy-in coverage as described in HI 00815.021, which outlines when buy-in ends.

Please refer to SM 03040.245 for Special Situations and HI 00815.030 for Procedures to Develop buy-In Coverage in Initial Claims.

Footnotes:

[1]

The Part B buy-in start date can be no greater than 36 months prior to the date of the Medicare enrollment determination beginning January 1, 2024, pursuant to 42 CFR § 407.47(f).

[2]

If an individual is eligible for a full-benefit Medicaid group and the QI or SLMB group, the buy in coverage starts on the earlier of the start date applicable to the MSP group or full Medicaid coverage group.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600815018
HI 00815.018 - When State Payment of Medicare Premiums (State Buy-In) Begins - 01/12/2024
Batch run: 01/12/2024
Rev:01/12/2024