Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 8 - MEDICARE SAVINGS PROGRAM [BUY-IN]
Section 144-332-8-3 - FINANCIAL ELIGIBILITY REQUIREMENTS
Current through 2024-38, September 18, 2024
SSI - Related Categorically Needy MaineCare budgeting rules are used to determine Buy-In eligibility.
Buy-In is a separate benefit within Medicaid. As a result, one spouse of an eligible couple can choose to be an ineligible spouse to give Medicaid eligibility to the other, and at the same time the couple will both be considered for Buy-In eligibility.
Example
Mr. and Mrs. Mazure apply for MaineCare. Both have Medicare. Mr. Mazure has Social Security income of $920. Mrs. Mazure has Social Security income of $600. Using SSI - Related Categorically Needy budgeting for an eligible couple, both are eligible for Buy-In but over income for Medicaid. Mrs. Mazure has to see a specialist, and Mr. Mazure does not. Mr. Mazure can choose to be counted as an ineligible spouse for MaineCare. We then use the exclusions to deeming found in Part 7, Section 2.2.2, resulting in Mrs. Mazure being eligible for Medicaid, and both of them being eligible for Buy-In.
There is usually a delay between the time an individual is eligible for the Buy-In and the time the Buy- In premium payment begins. During this time, the individual continues to have premiums deducted from their Social Security benefits (See Appendix A).
Section 3.1 : Individual Who Opted Out of Medicare
Individuals who are not automatically enrolled in Medicare Part A or B, are not entitled to premium-free Medicare Part A (such as those individuals over age 65 but who did not pay enough Medicare taxes), or who opt out of Medicare Part A and/or B coverage when it is first offered, are considered entitled to enroll in Medicare. These individuals are eligible to apply for Buy-In. The Department will start their coverage without waiting for open enrollment. The Medicare Part A and/or B start date will be the effective date of the Buy-in.
