Family and Children's Medicaid MA-3525 MEDICARE ENROLLMENT & BUY-IN
VIII. COUNTY RESPONSIBILITY TO ASSIST WITH MEDICARE APPLICATION
A. Application for Medicare Enrollment
Except for individuals entitled to free Part A, who are automatically enrolled for Medicare Part A by Social Security, the a/r must apply for Medicare benefits. Social Security makes the determination for Medicare coverage. Upon application for Medicaid, the a/r must accept all available Medicare benefits.
1. Application for Medicare may be made anytime during the year for a Medicaid a/r if Social Security is informed of his Medicaid status. Other individuals are restricted to an open enrollment period of January, February and March if they refuse coverage at the initial enrollment period.
2. Application for Medicare is made at the local Social Security office. If eligible, the a/r receives a Medicare card, which indicates his eligibility for Part A and/or Part B. He must present the Medicare card and the Medicaid card to providers of medical services for proof of coverage and billing to the appropriate parties.
REVISED 01/01/07 – CHANGE NO. 02-07
3. If a Medicaid a/r is eligible for Part B benefits, he must apply for and accept this coverage. If he refuses, the a/r is responsible for payment of claims that would have been paid by Medicare Part B if the a/r had applied. If the a/r fails to enroll in Medicare Part B, charges which would have been paid by Medicare Part B cannot be applied to the deductible.
4. If the a/r has free Part A but has previously refused Part B, he does not need to make an application for Part B. When Medicaid submits the buy-in transaction
to CMS, SSA will automatically enroll him in Part B and send him a corrected Medicare card.
5. If the a/r has Part B only, an application for premium Part A Medicare is not required. Medicaid will pay Part A premiums for "Q" class recipients whose RSDI claim number suffix is "M." He would be eligible for MQBB regardless of whether or not Medicaid is paying the premium for Part A or he is paying for the Part A premium out of pocket.
B. Failure to Apply for Medicare
1. Medicaid a/r’s who are age 65 or older must apply for and be enrolled in Medicare Part B. If the a/r fails to enroll, Medicaid pays no portion of the costs for medical services that would have been covered by Medicare Part B. The provider may bill the recipient for the total cost of services provided.
2. At the following times, inform individuals who are potentially eligible for Medicare Part B that they must apply for Medicare Part B coverage:
a. At application for Medicaid, and
b. When the “age 65” message appears on the Case Management Report.
3. If an a/r, age 65 or older, is authorized for retroactive Medicaid, claims for medical services covered by Medicare Part B are processed based on the information below.
a. If categorically needy, and the recipient is enrolled in Part B, enter the RSDI claim number in EIS. If the recipient has paid his Part B premiums for the retroactive period, Medicaid pays the Part B premiums for the retroactive months and SSA reimburses the recipient. This requires a manual accretion using a DMA-5004, Buy-In Clerical Action, for the retroactive period.
b. If categorically needy, and the recipient is not enrolled in Part B, claims are pended for buy-in to occur. If buy-in does not occur, claims are denied with instructions to bill the recipient. If buy-in does occur, claims are denied with instructions to file with Medicare. The recipient must enroll in Part B to have coverage for the retroactive and ongoing months.
REVISED 11/01/11 – CHANGE NO. 15-11
(VIII. B. 3)
C. Apply for Medicare B for A/R Who Is Unable To Apply
D. Obtain Proof of Age
1. Ask the a/r to provide a birth certificate.
2. If the a/r has no birth certificate, the IMC must obtain the birth certificate through the local Register of Deeds or State Vital Records Office, and pay a fee.
3. If the IMC cannot obtain a valid birth certificate for the a/r, other items can be used in lieu of a birth certificate such as military records, school records, marriage license, census records, etc. Refer to the DHHS/SSA Listing of Proofs, for additional proofs
REVISED 11/01/11 – CHANGE NO. 15-11
E. Apply for Medicare Part B For a Deceased Individual
1. If the deceased a/r was 65 years of age and did not have Medicare Part B, only the county DSS can make a Medicare Part B application for him.
a. Determine that the deceased a/r is eligible for Medicare Part B coverage. For Medicare coverage groups refer to Section III.
b. Contact SSA and make application for him. See IV. C. above.
c. If SSA tells the IMC that he cannot apply for a deceased a/r, refer SSA to POMS HI 00815.051.
2. Once Medicare Part B is established, the IMC must complete a DMA-5004, Buy-In Clerical Action, to accrete the a/r for buy-in. The automatic accretion process does not take place for a deceased a/r.