Starting January 1, 2025, California has introduced the Medicare Part A Buy-In Program to make healthcare more affordable and accessible for eligible low-income residents. This program is a partnership between California and the Centers for Medicare & Medicaid Services (CMS) to cover Medicare Part A premiums for individuals who don’t qualify for free Part A due to limited work history.
This initiative provides much-needed financial relief, ensuring eligible individuals can access vital healthcare coverage without worrying about hefty costs. At Skyline Benefit, we are here to guide you through everything you need to know about this new program and how it can benefit you.
What Is the California Medicare Part A Buy-In Program?
The Medicare Part A Buy-In Program allows the state to pay the Medicare Part A premiums, coinsurance, and deductibles for eligible residents. It targets low-income individuals who qualify for Medi-Cal but have not earned enough work credits to receive free Part A coverage.
By covering these costs, California ensures that more residents gain access to Medicare’s primary hospitalization and inpatient care benefits without relying solely on Medi-Cal.
Who Qualifies for the Medicare Part A Buy-In Program?
To be eligible for the program, you must meet the following criteria:
- Be enrolled in full-scope Medi-Cal.
- Have Medicare Part B coverage.
- Qualify for the Qualified Medicare Beneficiary (QMB) program.
- Have been previously ineligible for free Medicare Part A due to insufficient work credits.
Eligible individuals include both Supplemental Security Income (SSI/SSP) Medi-Cal members and non-SSI/SSP members who qualify for the QMB program.
How Does It Work?
Here’s a breakdown of how the program functions:
- Automatic Enrollment for SSI/SSP Members: Starting January 1, 2025, SSI/SSP full-scope Medi-Cal members enrolled in Medicare Part B and qualified for the QMB program will automatically be enrolled in Medicare Part A.
- Manual Enrollment for Non-SSI/SSP Members: Non-SSI/SSP Medi-Cal members must apply for Medicare Part B through the Social Security Administration (SSA) and the QMB program through their local county office. Once approved, the state will enroll them in Medicare Part A under the Buy-In program.
- Notice of Action: Eligible Medi-Cal members will receive a Notice of Action in the mail confirming their enrollment in the QMB program and their Medicare Part A benefits.
What Are the Key Benefits of the Buy-In Program?
The program offers several significant advantages for eligible members:
- Financial Relief: The state pays your Medicare Part A premiums, coinsurance, and deductibles, reducing out-of-pocket costs.
- Dual Eligibility: You’ll receive comprehensive healthcare benefits through both Medicare and Medi-Cal.
- Improved Coverage: Medicare becomes your primary coverage for hospitalization and inpatient care, providing broader access to medical services.
- Ease of Enrollment: SSI/SSP members are automatically enrolled, eliminating the need for complex applications.
How Can Skyline Benefit Help You Maximize These Benefits?
At Skyline Benefit, we partner with top carriers, including SCAN Health Plan, to offer a wide range of Medicare Advantage options tailored to meet your unique needs. Whether you’re looking for dual-eligible benefits, specialized plans for chronic conditions, or comprehensive coverage that includes hospital, medical, prescription drug, dental, and vision care, we’ve got you covered.
Here’s how SCAN Health Plan stands out among our offerings:
- SCAN Connections Plan: This plan offers robust dual-eligible benefits and is ideal for individuals eligible for both Medicare and Medi-Cal.
- Chronic Condition Special Needs Plans (C-SNPs): These plans are specifically for members managing chronic health conditions, ensuring personalized care and support.
While SCAN provides exceptional options, our partnerships with other leading carriers allow us to offer a variety of plans that suit your healthcare and budget needs.
Frequently Asked Questions About the Medicare Part A Buy-In Program
1. Do I Need to Apply for the Program?
- You’ll be automatically enrolled if you’re an SSI/SSP Medi-Cal member. Non-SSI/SSP members must apply for Medicare Part B and the QMB program.
2. What Happens if I Don’t Qualify for the QMB Program?
- Unfortunately, you won’t be eligible for the Buy-In program. However, you can explore other financial assistance options for Medicare costs.
3. Can SCAN Plans Work With the Buy-In Program?
- Yes! SCAN’s Medicare Advantage plans are designed to integrate seamlessly with the Buy-In program, providing comprehensive coverage and added benefits.
Need Help with California Medicare Part A Buy-In Plans?
Skyline Benefit is an independent Medicare insurance broker specializing in affordable and flexible Medicare options. Selecting the right plan can feel overwhelming, but our mission is to simplify the process and support you every step of the way.
If you have questions about California Medicare Part A Buy-In Program or need assistance enrolling in the right Medicare Advantage plan, we’re here to help.
Schedule a consultation today. Call us at: (714) 888-5112