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Medicare Premium Payment Program

The Medicare Premium Payment program allows Medi-Cal to pay Medicare Part A and/or Part B premiums for Medi-Cal beneficiaries and others who qualify for Medi-Cal under special programs, allowing Medi-Cal to defer costs for medical care to Medicare.

The Medicare Premium Payment and the Medicare Part D State Contribution Payment programs help to ensure that Medi-Cal is the payer of last resort by paying for Medicare coverage when applicable.

What is Medicare?

Medicare is a federal health coverage program for the aged (persons age 65 or older), certain disabled individuals, and individuals with kidney failure.  Medicare coverage consists of three parts:  hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D).

Medicare Part B Buy-In Agreement

The State of California participates in a buy-in agreement with the Centers for Medicare and Medicaid Services, whereby Medi-Cal automatically pays Medicare Part B premiums for all Medi-Cal beneficiaries who have Medicare Part B entitlement.

Statutory Authority: Social Security Act, Section 1843

Medicare Part D State Contribution Payments

The Medicare Part D prescription drug program began in January 2006.  The state is required to pay a Part D premium payment for beneficiaries eligible for Medi-Cal.

State Medicare Buy-in Program Problem Report (online fillable form)

State Medicare Buy-In Problem Form 

State Buy-In Manual - Part A and Part B Transaction Codes

The buy-in transaction codes provide a concise, definitive means of communication between the Centers for Medicare and Medicaid Services (CMS) and the State of California.  Most transaction codes require no further action on the part of the State.  There are instances, however, when additional action by the State is appropriate.  Recommended State action is provided along with the explanation of the transaction code. 

Part A Buy-In/Group Payer Transaction Codes (PDF)

Part B Buy-In/Group Payer Transaction Codes (PDF)

 

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Last modified on: 3/12/2014 8:52 AM