State Payment of Medicare Premiums
Guidance for a manual of state payment of Medicare premiums, including updated information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums for individuals dually eligible for Medicare and Medicaid.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 08, 2020
| 02-09-2024: CMS released updated instructions on eligibility and enrollment processes for the Medicare Savings Programs (MSPs) and the state payment of Medicare premiums (“state buy-in“). More information is available below. |
States pay Medicare Part B premiums each month for over 10 million individuals and Part A premium for over 700,000 individuals. This process promotes access to Medicare coverage for low-income older adults and people with disabilities, and it helps states ensure that Medicare is the first and primary payer for Medicare covered services for dually eligible beneficiaries.
Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”)
The Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) includes instructions and information to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid.
On February 9, 2024, CMS updated chapter one of the manual to reflect streamlined enrollment processes for the Medicare Savings Programs eligibility groups found in the final rule, the Streamlining Medicaid; Medicare Savings Program Eligibility and Enrollment Final Rule (CMS 2421-F). The chapter one revisions also incorporate updated buy-in policies from the final rule, the Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules (CMS 4199-F).
The manual is part of the CMS Manual System, specifically Pub. 100-24. It is divided into the following sections:
Chapter 1: Program Overview and Policy (PDF) (NEW UPDATES!)
Chapter 2: State Buy-in Data Exchange Processes (PDF)
Chapter 3: State Input and CMS Response File Formats (PDF)
Chapter 4: Buy-in Code Descriptions (PDF)
Chapter 5: Premium Billing (PDF)
Chapter 6: Problem Cases and Resources (PDF)
Related Materials & Training
Frequently Asked Questions (FAQs) about Medicare Savings Programs (MSPs) for the Medicare Part B Immunosuppressive Drug (Part B-ID) Benefit (PDF): These FAQs are intended to assist states in implementing MSP coverage for individuals enrolled in the Part B-ID benefit (MSP Part B-ID), by addressing operational and systems changes. On October 28, 2022, CMS published a Final Rule entitled “Implementing Certain Provisions of the Consolidated Appropriations Act (CAA), 2021 and other Revisions to Medicare Enrollment and Eligibility Rules.” This Final Rule contains changes related to state payment of Medicare premiums (“buy-in”) related to the Medicare Part B-ID benefit. Effective January 1, 2023, certain individuals who lose Medicare entitlement on the basis of end stage renal disease (ESRD) 36 months after the month in which they received a successful kidney transplant are eligible for the limited Medicare Part B-ID benefit under section 402 of the CAA. MSPs can help cover the costs for qualified individuals.
Frequently Asked Questions (FAQs) about Medicare Part A and B "Buy-in" (PDF): The main policy questions, & responses, submitted to CMS to date on the updated Manual for State Payment of Medicare Premiums released on September 8, 2020.
Five Key Policy Topics From the Updated Manual on State Payment of Medicare Premiums: CMS designed this webinar (via YouTube (released 11/24/2020) for state policy staff to introduce five key policy topics addressed in the updated Manual for State Payment of Medicare Premiums released on September 8, 2020.
State Buy-in File Webinar: Troubleshooting Code 21XX Series Accretion Rejections (09/03/2020)
Overview of the CMS State Buy-In File Exchange: A webinar, with associated slides, available as a resource to support states moving to daily exchange submission.
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