State Buy-In Agreements. Footnotes: [1]. Commonwealth of the Northern Mariana Islands. District of Columbia. New Hampshire. New Jersey. New Mexico. North Dakota. Puerto Rico. Rhode Island. South Carolina. South Dakota. If you paid Medicare taxes for 40 quarters or about 10 years and qualify for Social Security or Railroad Retirement Board benefits, your Part A coverage is free. This amount applies to everyone who has Part A.
Medicare Part B is the second part of original Medicare. It covers medical and outpatient services. This amount could be higher, depending on your income level. On the other hand, if your income is below a certain level, you may be eligible to apply for an MSP.
If you qualify, your premium will be paid by the state through the buy-in program. State buy-in programs help with premiums through the MSP eligibility process. These are federally funded programs that allow states to help pay premiums, deductibles, coinsurance, and other medical expenses for those with financial needs.
Most state Medicaid programs can enroll eligible individuals into the state buy-in program under the Supplementary Medical Insurance trust fund to cover premiums for people in any MSP or Medicaid program. In some cases, you can qualify for both Medicare and Medicaid to help pay for different healthcare costs. This is known as dual eligibility , and more than 9 million Americans qualify for this status.
To be eligible for the Medicare buy-in program, you must qualify for one of the four MSPs described below. The Medicare buy-in program uses the same financial resource limits as the Supplemental Security Income SSI program, but with different qualification amounts for income.
Eligibility and application rules vary by state. To qualify, individuals and couples must meet income and resource needs based on the federal poverty level and state guidelines for the MSPs. You can also apply if you have Part A and need help with Part B premiums. Remember only a LDSS worker can determine which income deductions you may be eligible for.
Earned income is a payment received as a result of work activity. Examples of earned income are wages and salaries, tips, commissions, bonuses, earned income credit and income from casual employment. This would include any earnings from self-employment. Refer to the enclosed "Medicaid Documentation List" for examples of proof of income i. Unearned income is any income that you receive that you have not worked for. This includes any bank interest, annuity payments, lottery winnings or any other income that you are receiving that is not connected to work activity including Social Security Disability, Veterans benefits or retirement benefits.
The last number is your approximate net available income. Only the Medicaid eligibility worker can tell you for sure. Countable Resources include stocks, bonds, vacation homes, bank accounts, etc. Their value is determined and then added up. Exempt resources are not counted.
These exempt resources include:. Retirement accounts that previously would have been counted as a resource will no longer be counted when eligibility for the MBI-WPD program is determined. Retirement accounts that will no longer be counted are annuities or work-related plans for providing income when employment ends.
There are other resources that are not counted. It is best to check with your Local Department of Social Services to see which resources are exempt. PASS allows an individual to set aside money for short-term objectives like saving money for education, vocational training, starting a business or for a work-related item such as a computer or even a custom van.
A PASS plan is simply a way to get the services and items needed for work, not the way to make income available for everyday expenses. It may even allow individuals to receive higher SSI payments as they work towards self- sufficiency. Bob is an SSDI recipient who is a paraplegic. Bob has decided that he would like to start his own business.
He applied for a PASS account and was approved. This money will be put toward the initial start-up costs for his business, which will include the purchase of office equipment, the rental of office space, advertising, etc. Jan is an SSDI recipient who has muscular dystrophy and is confined to a wheelchair.
Jan would like to attend college and become a teacher. These examples illustrate how a PASS can benefit an individual by making it possible for the individual to pursue a work goal and eventually move from benefit dependence to financial independence. Learn all you can about the program. Be Prepared - A personal interview is no longer required for application; however, if you would like an interview, you may request one by calling your LDSS. You may also call your LDSS with any questions you have regarding the application form and ask them for assistance if you need it.
Carefully review the "Medicaid Documentation List" found in this document or the list in the Access New York DOH form to determine the documents that you will need to submit with your application. You may bring the required documents when you go to the Local Department of Social Services or you may contact the LDSS to find out how to submit the documentation by mail with your application.
Document Your Actions. Make sure you take names of everyone you speak with, or meet with, and make sure that you write down any problems you experience along with the dates and times they occur. Try to get the problem resolved with your eligibility worker, if necessary, ask to speak with a supervisor. Know your rights. An applicant should not accept a verbal decision from a worker.
A Medicaid eligibility determination must be in writing. An applicant has the right to:. Make sure that your application is complete. It is recommended that you follow-up with your eligibility worker 10 days after your application is submitted to make sure that nothing further is required. If you need help with the process, contact your Local Department of Social Services. If you already have assistance with your benefits, go to the person with whom you are the most comfortable.
Instructions on how to ask for a Fair Hearing are on the denial form issued by the local Medicaid office. An applicant can ask for a Fair Hearing in writing, in person, over the internet or by calling the State-wide toll-free number at If you have not been determined to have a disability, the State Disability Review Team will have to review medical information about you that supports your disability claim.
When talking with someone involved with your application process for the MBI-WPD program, it is important to document everything, including phone calls.
If you experience any kind of problem applying for the MBI-WPD program, it is essential to have proper documentation of all the actions you have taken.
This form allows you space to document all the phone conversations you have with people involved with your application process.
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