2911.7 Part A Buy In

Individuals who must pay a premium for Medicare Part A and who meet QMB and QWD eligibility requirements must enroll in premium Part A through the Social Security Administration (SSA) before the state can assume responsibility for the Part A premium. For applicants who are not already enrolled in Part A, SSA will establish conditional Part A enrollment while the QMB determination is pending. Conditional enrollment is identified by a Z-99 code and effective date on the SSA record, which represents the earliest potential Part A entitlement date, pending state buy-in.

Kansas is a group payer state, which means that the state may only initiate Part A buy-in for individuals who have established either actual or conditional Part A enrollment with SSA. Enrollment in Part B alone is not sufficient to meet the Medicare entitlement requirement for QMB or QWD.

Beginning January 1, 2023, individuals who enroll (or conditionally enroll) in premium Part A during the General Enrollment Period (GEP) (January through March) receive a Part A entitlement date of the first day of the month following the month of enrollment. QMB or QWD coverage may begin no earlier than the first month of Part A entitlement.

Part A buy-in cannot be completed unless the individual is also enrolled in Part B buy-in. It may be necessary to adjust coding in the eligibility system to ensure that Part A and Part B buy-in actions are submitted correctly to CMS and processed without delay.