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When a person qualifies for the state to pay his or her Medicare Part B premium, AHCCCS sends a request to the Center for Medicare and Medicaid Services (CMS) to start paying the person’s Part B premium. This is the buy-in process.
When a person no longer qualifies, AHCCCS sends a request to CMS to stop paying the person’s Part B premium. This is the buy-out process.
It normally takes three months after a person is approved for an AHCCCS program that gets the Part B buy-in for the Social Security Administration (SSA) to stop taking the Part B premium amount out of the customer’s SSA check.
AHCCCS sends buy-in requests to CMS once a month. The file goes to CMS on the 24th or 25th of each month. CMS processes the file and responds by the 5th of the following month with an acceptance or rejection for each individual request.
If the buy-in is accepted, the premium change will occur within a one month cycle. Delays may occur when there is a difference in the customer’s identifying information between CMS’ records and AHCCCS’ records. Once the discrepancy has been resolved, the request is resubmitted to CMS the following month and the buy-in is processed.
Once the Social Security Administration (SSA) has been notified of the state buy-in, the regular SSA check will be increased to repay the customer for any premiums that were deducted after AHCCCS requested the buy-in.
The rebate may come in the form of a separate check depending on when the change is processed by SSA or if the individual does not receive Social Security benefits.
NOTE If another state is paying the customer’s Medicare premiums, Arizona residency is questionable. See MA531 Resident of Arizona for more information.
To determine if a customer’s Part B buy-in has taken place, see MAP206A How to Research a Customer’s Buy-In Status.
When a person no longer qualifies to have the State pay the Medicare Part B premium or other costs associated with Medicare, the customer is responsible for those costs. AHCCCS sends a letter to the customer explaining that buy-in will stop and the date Arizona will stop paying the Medicare costs for the customer.
AHCCCS sends notification of all buy-outs to CMS on the 24th or 25th of each month.
Since it may take one to three months for the buy-out to be processed, the customer may have two or three month’s premiums withheld from one month’s Social Security benefits when SSA completes the buy-out process.
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Term |
Definition |
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Buy-in |
State payment of a customer’s Medicare Part B premium. In some instances, the State may also pay the customer’s Medicare deductibles and co-payments. |
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Buy-out |
The process of a State stopping the payment for a customer’s Medicare Part B premiums or other Medicare costs. |
This requirement applies to the following programs:
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Program |
Legal Authorities |
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Medicare Savings Program (MSP) |
42 USC § 1396a(a)(10)(E) ARS § 36-2971 – 2976 |