Medicare Savings Programs Manual
WG-4 Medicare Part A Buy-In
Updated 6/18/20
Receiving Medicare Part A hospital insurance is an eligibility requirement for all Medicare Savings Programs (MSPs - QMB/SMB/SMF). Clients that have less than 40 work quarters may have to pay a significant premium for the coverage.
QMB clients are a required buy-in group for Oregon. That means we have to pay their Part A premium if they have less than 100% FPL in adjusted income. Oregon does not buy-in Part A for any client who has adjusted income over 100% FPL.
The Part A buy-in process for an ongoing OSIPM client is:
- Client is receiving Part B of Medicare and cannot receive Part A without a buy-in
- Worker contacts the Buy-In unit for Part A enrollment and buy-in by the 25th of the month
- Buy-in Unit processes Part A buy-in and waits for the response file from CMS
- Response file shows Part A buy-in successful
- Buy-in notifies worker to add QMB case coding (MIB=3; QMM/FS1)
The process for a new QMB client with Part B and no Part A without a payment
- If QMB-only, pend the case while the Part A buy-in process takes place
- Process OSIPM and open if eligible; if not eligible for OSIPM, wait until QMB eligibility is determined before sending notice.
- Worker contacts the Buy-In unit for Part A enrollment and buy-in by the 25th of the month
- Buy-in Unit processes Part A buy-in and waits for the response file from CMS
- Response file shows Part A buy-in successful
- Buy-In notifies worker to open QMB case or add QMM coding
- Worker sends appropriate decision notice for OSIPM and QMB
For Part A buy-in questions call the buy-in unit:
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Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
Toll-free: (800) 282-8096 (V/TTY)
