Medicaid can pay the Medicare Part A premium for certain individuals who do not qualify for free Part A; however, people who need this help can sometimes have trouble getting it. Last month, the Department of Human Services issued a policy clarification about the benefit that pays the Medicare Part A premium, called “buy-in”. Another name for the buy-in program is Medicare Savings Program.
Medicaid has a Medicare Part A buy-in program as well as a Medicare Part B buy-in program. The Medicare Part B buy-in is a more common benefit than the Medicare Part A buy-in. Most Medicare beneficiaries get Medicare Part A for free, but some people do not have enough of a qualifying work history and must pay a Medicare Part A premium to get that coverage.
PHLP and our partners at PA MEDI (formerly APPRISE), continue to hear from people who should be getting help with the Medicare Part A premium but are not. Without this help, they do not get enrolled in Medicare Part A because they cannot afford the premiums. Most of the individuals having this problem are people who recently turned 65 and who get Supplemental Security Income (SSI) instead of Social Security retirement or disability benefits. These individuals do not have the work history to get premium-free Medicare Part A. They get enrolled in Medicare Part B with the Part B buy-in, but they are not getting enrolled in the Part A buy-in and therefore don’t get Medicare Part A coverage.
The recently issued guidance clarifies that someone does not need to be enrolled in Medicare Part A before the Part A buy-in can be entered in the system; however, someone does have to have Medicare Part B coverage. The guidance also clarifies that the County Assistance Office caseworker is responsible for enrolling any Qualified Medicare Beneficiary, including people on SSI, into the Part A buy-in program if they have Medicare Part B but do not also have Medicare Part A.
Even without Medicare Part A, people on SSI who get Medicare Part B are fully covered and can use their Medicaid coverage for any care that would otherwise be covered by Medicare Part A, such as hospital care or after hospital care. Their Medicare coverage choices are more limited when they only have Medicare Part B. Lack of Medicare Part A coverage also makes Medicaid the primary payer for these services instead of the secondary payer.
Hopefully the issuance of the policy clarification eases the difficulty people have getting the Medicare Part A buy-in (and Medicare Part A coverage). Readers can view the policy clarification here. More information about the Medicare Part A buy-in benefit can be found here. People who are having problems getting the Medicare Part A buy-in can contact PHLP’s Helpline at 1-800-274-3258 or email@example.com