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1127 Chapter 7:Worker guides • Section 6: MSP worker guides (07/2026) The following people are eligible for Part B: • People age 65 or over who have Medicare Part A (Hospital Insurance). • All other people age 65 or over who are U.S. residents and are either U.S. citizens or non-citizens lawfully admitted for permanent residence who have resided in the U.S. continuously during the five years immediately preceding the month they apply for enrollment. • People under age 65 who have been receiving monthly Social Security disability benefits (Title II) or railroad disability benefits for 24 months. • People under age 65 who are eligible for Medicare because they have chronic kidney disease. In addition, the State of Oregon must pay the Part B premium for everyone who receives Medicare and full Medicaid benefits (OHP Plus). This is established in Oregon’s Medicaid State Plan that is filed with CMS. If the individual also qualifies for one of two MSP that pay the Part B premium and can coexist with OHP Plus (QMB and SMB), then the state will be reimbursed by CMS for a portion of the Part B premium. Those who are over income for QMB and SMB are categorized as State Buy-In (SBI), meaning the state will pay the Part B premium but not receive reimbursement from CMS. You will see this most commonly with Employed Persons with Disabilities (OSIPMEPD) and individuals receiving long-term care service benefits. We do this because Medicaid is always the payor of last resort, so paying the Part B premium to keep Medicaid individuals enrolled in Medicare is a good investment Note: We do allow some LTC recipients to pay their Part B premium themselves and instead receive an equivalent reduction of their service liability. This is called Client Buy-In (CBI). When an individual becomes eligible for buy-in, several other records are affected. If the individual is receiving a Social Security payment, the Part B premium will no longer be deducted from the benefit, resulting in a higher monthly Social Security payment. If the individual was not receiving a Social Security payment, but was being billed directly, direct billing will cease. In both cases, the individual will receive a refund of any premiums deducted or paid for the months they were approved for buy-in. Such premium refunds are not to be considered income when determining or reviewing eligibility for benefits. See here for more information on how buy-in works with ONE. When buy-in coverage begins Most people’s buy-in coverage will begin the first month the individual is eligible for both Medicaid and Medicare benefits, and is a resident of Oregon. Buy-in coverage does not, however, always align itself with Medicare Savings Program eligibility. The QMB effective date, for instance, is the first of the following month all eligibility requirements are met and verified, while SMB and SMF-only recipients are potentially eligible for retroactive coverage back 3 months from the effective date. Except for the SMB and SMF recipients, buy-in coverage does not extend to periods of retroactive medical eligibility unless the individual had Medicare and the Buy-In unit was unaware of it. In that case, the buy-in may go back to the original date of Medicaid/Medicare eligibility. MSP eligibility does not, however, go retro in this case at all. Under buy-in, ODHS|OHA or SSA may enroll the individual even though they do not wish to enroll. A recipient cannot