A beneficiary's buy-in coverage period can end due to the following events:
Loss of eligibility in a coverage group;
Loss of entitlement to Medicare Premium-free Part A; and
Termination of buy-in agreement.
When a state ends buy-in because a beneficiary lost eligibility for a Medicaid category
included in the state’s Part B buy-in coverage group , Medicare enrollment generally
continues without interruption with the beneficiary assuming responsibility for paying
If the beneficiary receives Social Security (Old Age, Survivors and Disability Insurance
(OASDI), Railroad Retirement Board (RRB), or Civil Service Retirement benefits, the
Social Security Administration (SSA) deducts the Part B premium amount from the beneficiary's
monthly benefit payment
If the beneficiary’s monthly benefit amount is less than the Part B premium amount
due, SSA applies the beneficiary’s monthly benefits to the total premium amount due
and bills the beneficiary for the remaining balance of the premiums as described in
If the beneficiary does not receive Social Security, RRB, or Civil Service Retirement
benefits, CMS sends a bill to the beneficiary for Medicare Part A and/or Part B premiums.
Part A Premium Liability After Buy-in Ends
Part A premiums paid under a Part A state buy-in agreement: SSA treats a beneficiary who loses buy-in as if they enrolled during the Initial Enrollment
Period (IEP). Upon loss of buy-in, the beneficiary is responsible for Part A base
premium amount even if they had been paying a late enrollment penalty prior to buy-in
Part A premiums paid under a Part A group prayer arrangement:Upon loss of state payment of Part A premiums, the beneficiary becomes responsible
for the premium amount the state paid ( i.e., the Medicare Part A premium may be subject
to a late enrollment penalty if the state had been paying one).
Part B Premium Liability After Buy-In Ends
Because all states, the District of Columbia, and certain U.S. territories pay the
beneficiary’s Part B premium under a state buy-in agreement, SSA treats a beneficiary
who loses Part B buy-in as if they enrolled during the IEP. The beneficiary pays the
base premium, even if they had a late enrollment penalty before the state enrolled
them in Part B buy-in.
After Part B buy-in coverage ends, SSA may deduct from the beneficiary’s monthly benefit
payment up to three months’ worth of Part B premiums (current month plus two retroactive
months). If the beneficiary does not receive a monthly benefit payment, CMS mails
a bill, Medicare Premium Bill (Form CMS-500), to the beneficiary as described in HI 01001.030. If a beneficiary cannot afford to pay three months of Part B premiums at once, advise
the beneficiary of their two options to obtain financial relief from retroactive billing
of Part B premiums (see HI 00815.042C.).