Family and Children's Medicaid MA-3525 MEDICARE ENROLLMENT & BUY-IN

III. POLICY PRINCIPLES

A. Medicaid recipients who are 65 or older must enroll in Medicare Part B and Part D. If the recipient fails to enroll, Medicaid does not pay any portion of services that would have been paid by Medicare Part B and Part D. The provider may bill the recipient for those services. If a person fails to enroll in Medicare Part B, charges which would have been paid by Medicare Part B cannot be applied to the deductible. (Refer to MA-3315, Medicaid Deductible.)

B. For individuals who meet the eligibility requirements for Qualified Medicare Beneficiary – Q coverage, Medicaid will pay for:

1. Medicare Part A & Part B premiums and

2. Medicare deductibles and co-insurance.

Refer to MA-2130, Qualified Medicare Beneficiaries-Q. in the Aged Blind and Disabled Medicaid Manual.

NOTE: The individual may also be eligible for full Medicaid coverage as well as Qualified Medicare Beneficiary-Q coverage.

REISSUED 01/01/07 – CHANGE NO. 02-07

(III)

C. For individuals who meet the eligibility requirements for Qualified Medicare Beneficiary – B coverage, Medicaid pays for the Medicare Part B premium. Refer to MA-2140, Qualified Medicare Beneficiaries-B. in the Aged, Blind and Disabled Medicaid Manual.

NOTE: The individual may also be eligible for full Medicaid coverage as well as Qualified Medicare Beneficiary-B coverage.

D. For individuals who meet the eligibility requirements for Qualified Disabled Working Individuals, Medicaid pays for the Medicare Part A premium.

NOTE: The payment of the Part A premium for a Qualified Disabled Working individual is a manual process. These cases are not entered into EIS. The policy found in this section for enrolling them and paying the Part A premium do not apply. They will not be mentioned again in this section. Refer to MA-2150, Medicaid-Working Disabled, in the Aged, Blind and Disabled Medicaid Manual.

E. For individuals who meet the eligibility requirements for Qualifying Individuals 1, Medicaid pays for the Medicare Part B premium. Refer to MA-2160, Qualifying Individuals 1. in the Aged, Blind Disabled Medicaid Manual.

NOTE: Individuals eligible as Qualifying Individuals 1 are not eligible for full Medicaid coverage.

F. Always use the recipient’s name, 1st, middle initial, and last and the same SSN that is shown on the Social Security records.

G. Buy-in will not process electronically for open-shut cases. The IMC must send a DMA-5004, Buy-In Clerical Action.