Eligibility Online Manual

M1810 Medicare Buy-In

Purpose: This section will provide information on Medicare Buy-In.

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: September 4, 2014

Previous Policy: April 1, 2003


1. Medicaid Pays Medicare Part A & B Premiums For Medicaid Eligible Individuals

Medicaid pays the Medicare Part A and part B Premiums for all Medicaid Eligible individuals, with the exception of:

    • SLMB- Medicaid will pay the Medicare Part B premium only

    • QI- Medicaid will pay the Medicare Part B premium only.

    • QDWI-Medicaid will pay the Medicare Part A premium only.

2. Medicaid Pays Medicare Premiums Beginning The Month Eligibility Is Determined

Medicare Buy-In benefits begin in the month eligibility is determined for all programs, with the exception of QMB. QMB clients will have Medicare premiums paid beginning the first of the month after eligibility is determined.

3. Clients May Receive Refund

If premiums are deducted from a client’s SSA benefit prior to buy-in being processed, a refund will be issued by the Centers for Medicare and Medicaid Services (CMS). This refund may take approximately three months to be processed.


Defining Requirement: 42 CFR 407.40

Clarifying Information:

Worker Responsibilities: