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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |116 Effective Month: July 2025 o Co-payments are fixed dollar amounts that an individual must pay each time a service is received. • Medicaid pays the Medicare Part A premiums only for recipients whose income is at/below 100% of the federal poverty level and who does not have free Medicare Part A. Payment of the Part A premium is applicable to SSI recipients, QMB-Only recipients and recipients in any other full benefits coverage group whose income is at/below 100% FPL who have a premium payable. The program that pays the Medicare premiums is the Buy-In program. Medicare deductibles and coinsurance charges are submitted to DOM by Medicare carriers as crossover claims. Categories of Eligibility that Prohibit Payment of Medicare Entitlement Certain categories of eligibility prohibit Medicare entitlement because the recipient cannot have Medicare and qualify for coverage in these COE’s: • COE-021 – Emergency Immigrant Group • COE-027 - Breast & Cervical Cancer Group • COE-029 – Family Planning Waiver • COE-045 – Healthier MS Waiver • COE’s 095 & 096 – Former SSI Widow(er) Groups If a recipient in one of these COE’s becomes entitled to Medicare, the recipient must be transferred to an appropriate COE that allows Medicare so that appropriate cost- sharing benefits can be paid. 102.13.03 WHO SHOULD APPLY & ACCEPT MEDICARE (IN ALL COE’S) Accepting Medicare is required if Medicaid will pay the premiums, deductibles and co- insurance for Medicare Part A and Part B for persons in the Medicaid eligibility group under which the individual is applying or receiving Medicaid. All Medicaid applicants/recipients who are potentially eligible for Medicare Parts A and B should apply for it unless the individual has previously applied and SSA made a decision regarding their entitlement, as addressed below. For those referred to SSA to