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West Virginia Income Maintenance Manual Chapter 25

West Virginia Income Maintenance Manual Page 1 Chapter 25 Medicaid Buy-In Procedures

INTRODUCTION

The Department of Human Services (DOHS) “buys in,” or pays, the Medicare Part A and/or Part B premium for certain Medicaid clients who are also eligible for Medicare. This procedure is referred to as the buy-in process.

The Bureau for Medical Services (BMS) Medicare Buy-In Unit is responsible for the buy-in process. This process is a joint effort of the Social Security Administration (SSA) and BMS. SSA initiates the process for Supplemental Security Income (SSI) eligibles by identifying those who qualify, and bills the DOHS monthly for the total premium. The DOHS initiates the process for individuals in all other Medicaid coverage groups who are eligible for Medicare. The Buy-In Unit ensures buy-in for all clients who qualify, and that the DOHS is not being charged for premiums for those who are not eligible, or those who are not residents of the State.

25.1.3.A Definition Medicare is a federal insurance program that helps pay health care costs for people age 65 or older, regardless of income, and certain individuals receiving Retirement, Survivors, and Disability Insurance (RSDI) benefits based on disability. Medicare is the same in all states and is administered by the SSA. SSA makes all decisions regarding eligibility for Medicare.