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West Virginia Income Maintenance Manual Chapter 25
West Virginia Income Maintenance Manual Page 2 Chapter 25 Medicaid Buy-In Procedures
25.1.3.B Medicare Parts A, B, and D The following benefits are available to Medicare enrollees: • Medicare Part A – Hospitalization Insurance Benefits (HIB) The Buy-In Unit controls the purchasing and payment of Part A premiums for all uninsured eligibles. The State is billed for the Part A premiums for all Medicare eligibles who are not eligible for premium-free Medicare Part A because they lack the necessary quarters of coverage, have enrolled voluntarily, and pay a premium. • Medicare Part B – Supplementary Medical Insurance Benefits (SMIB) An individual enrolled in Part B pays a monthly premium. If he is receiving RSDI or Railroad Retirement Board (RRB) Benefits, the premium is deducted from his benefit; otherwise, he must pay the premium from his income. See Chapter 25.2 below for a list of those for whom the DOHS buys in. • Medicare Part D – Medicare Prescription Drug Benefit An individual who is already enrolled in Medicare Part A or Part B may receive the Medicare Prescription Drug Benefit. The Part D Prescription Drug Benefit is not administered by the SSA. The benefit is obtained by enrolling in a Prescription Drug Plan (PDP). Enrollees must pay a monthly premium, unless financially qualified for extra help, also known as the Low Income Subsidy (LIS). The LIS pays all or part of the drug benefit premium, co-pays, and deductibles that may be required. Workers must assist individuals who request it to complete an application for the LIS. The application must be submitted on an original Social Security form (SSA-1020-OCR-SM) or submitted on the internet using the SSA website. Medicaid clients enrolled in Medicare automatically qualify for LIS and are automatically enrolled in a PDP. With a few exceptions, Medicaid will not pay for prescription drugs for individuals age 65 or over who are eligible for, and do not enroll in, a PDP. This also applies to Medicare enrolled individuals under age 65 who are identified by DOHS. Additional information about the PDP and LIS are available at the SSA and Medicare websites.