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MEDICAL SERVICES POLICY MANUAL,SECTION O O-100 Medically Needy Program O 162 Medicare Part B “Buy In” Premium

Individuals or families whose income exceeds the MNIL will be considered for Spend Down Medically Needy. These individuals or families may qualify if their excess income (i.e., that above the MNIL) is obligated or spent for medical services.

O-162 Medicare Part B “Buy-In” Premium MS Manual 01/01/14 The Medicare “Buy-In” Premium is the premium normally paid by insured Medicare individuals for Part B Medicare (medical insurance). The Department of Human Services (DHS) pays this premium for Exceptional Medically Needy individuals through a “Buy-In” agreement with the Social Security Administration. “Buy-In” is made on the basis of the individual’s Social Security claim number (the Medicare number) which is entered in ANSWER at the time a case is certified. The Agency does not pay this premium for the Spend Down Medically Needy. The cost of Part B Medicare will be treated as follows in Medically Needy determinations: 1. Exceptional Medically Needy - The cost of Part B Medicare will not be considered as a medical expense for the Exceptional Medically Needy since the Agency will assume the cost of the premium. If the premium has been withheld from the individual’s Social Security check, it will be added back in for the eligibility determination. 2. Spend Down Medically Needy - The cost of Part B Medicare is considered a deductible expense for the Spend Down Medically Needy, since it is not paid by the Agency. The premium for Part B Medicare is included in the Spend Down as a non-covered medical expense.  NOTE: If the individual is receiving services through the Medicare Savings Programs that pays for the Part B premium, it will not be included as a non-covered medical expense as it is being paid by the Agency.

O-163 Excess Income MS Manual 01/01/14 Excess income is the dollar amount by which the individual or family net income exceeds the Medically Needy Income Level.