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:
-
-
–
Specified Low-Income Medicare Beneficiary (SLMB); and
-
–
Qualifying Individual (QI).
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.