Medicaid Can Pay Medicare Part A Premiums for Those Who Qualify – An Update
As we have previously reported, Medicaid can pay the Medicare Part A premium for certain individuals who do not qualify for free Part A; however, people who need this help can sometimes have trouble getting it. Over the last few years, PHLP and our partners at PA MEDI heard from many people who should have been getting help with their Medicare Part A premiums but were not.
Most Medicare beneficiaries get Medicare Part A for free, but some people do not have enough of a qualifying work history and must pay a Medicare Part A premium to get that coverage. People with limited incomes and resources who have to pay a premium to get Part A coverage may be able to get help through a Medicaid program called the Part A buy-in. Without the Part A buy-in, people who don’t qualify for free Part A often do not enroll in Medicare Part A because they cannot afford the premiums.
Most of the people who have had trouble getting help through the Part A buy-in are people who recently turned 65 and who get Supplemental Security Income (SSI) instead of Social Security retirement or disability benefits. They were enrolled in Medicare Part B with the Part B buy-in, but often they were not enrolled in the Part A buy-in and therefore did not get Medicare Part A coverage.
In October 2022, the Pennsylvania Department of Human Services performed a data sweep that caught over 7,300 people who were eligible for, but not enrolled in, the Part A buy-in and successfully enrolled them into that program. Since the data sweep was done, the state has been doing monthly checks to identify and enroll people in Part A buy-in.
As a reminder, someone does not need to be enrolled in Medicare Part A before the Part A buy-in can be entered in the system; however, someone does have to have Medicare Part B coverage. The County Assistance Office is responsible for enrolling any Qualified Medicare Beneficiary, including people on SSI, into the Part A buy-in program if they have Medicare Part B but do not also have Medicare Part A. People seeking the Part A buy-in do not need to apply for Part A before the Part A buy-in can be authorized.
Even without Medicare Part A, people on SSI who get Medicare Part B are fully covered and can use their Medicaid coverage for any care that would otherwise be covered by Medicare Part A, such as hospital care or after hospital care. Their Medicare coverage choices are more limited when they only have Medicare Part B. Lack of Medicare Part A coverage also makes Medicaid the primary payer for these services instead of the secondary payer.
Readers can view a policy clarification about the Part A buy-in benefit issued in February 2022 here and can see the Medicare Part A buy-in eligibility rules here. We recently updated our publication about the programs that pay Medicare Part A and Part B premiums with the 2023 guidelines. You can access that updated guide here.
People who are having problems getting the Medicare Part A buy-in can contact PHLP’s Helpline at 1-800-274-3258 or staff@phlp.org.
