1805 Medicare Buy-In
| Medicaid only - 42 CFR 407.40 |
A. Purpose:
1. Medicaid will pay the Medicare premium (Part A and B), yearly hospital/medical deductions and coinsurance Payment for a Medicaid or QMB client;
2. Medicaid will pay the Medicare premium (Part B) for an SLMB #1 and #2 client;
B. Effective date:
1. QMB - begins the first day of the Month after Application or when eligible, whichever is later;
2. SLMB #1 and #2 - begins the same month as eligible;
3. SSI - begins the month eligible as determined by SSA;
4. All other Medicaid eligibles - begins the same month as eligible;
5. HCBS - begins the month the plan of care is approved by the WDH.
C. Refund:
1. Realize the client will receive a refund from HCFA for premiums deducted from their benefit checks prior to buy-in being processed.
2. Allow up to three months after eligibility is determined to receive a refund.
3. Realize it may take longer to receive a refund if matching problems occur.
4. Understand SSA/VA checks will increase by the premium amount once buy-in is processed.
D. EPICS:
1. Understand all DFS employees will have the same user ID and password;
2. Go to the TPX menu, CICS production, to view the buy-in system;
3. Select from the menu to view buy-in information;
4. Enter the client ID or SSN to view Part A or Part B buy-in history:
a. “Buy-In Flag” - an “A” will appear when buy-in has been processed;
b. “Accrete Date” - the date buy-in is effective and the date from which the refund will be calculated.
5. Refer to the buy-in booklet prepared by the WDH for additional information on the buy-in system.
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