Medicare Buy-In

Colorado Medicaid pays the Medicare Part B (Supplementary Medical Insurance (SMI)) premiums for ALL clients who are on any Medicaid or any Medicare Savings Program (MSP). 

Most people get Medicare Part A (Hospital Insurance (HI)) for free. Colorado only pays the Part A premiums for individuals who need it if they meet the criteria for the Qualified Medicare Beneficiary (QMB) program. There are approximately 100,000 clients on Part B Buy-In and approximately 200 clients on Part A Buy-In.  Medicare Part A & B Cost Avoidance saves Medicaid over $300 million per year. 

Training Documents

CBMS User's Guide To Medicare Buy-In

  • The first 20 pages are the Buy-In Basics.
  • Appendix A can be ignored, unless you are techie-minded and curious about the various RIC types and record layouts of the files going back and forth between the State and CMS.
  • Appendix B should be used like a dictionary.  It contains all the Part B Buy-In transactions and their definitions from CMS’ State Buy-In Manual.
  • Appendix C contains some troubleshooting tips.

Medicare Buy-In Handout

  • Training guide for Buy-In Basics and common scenarios

Medicare Buy-In 202 Training Draft

  • Advanced tips

Medicare Part A Buy-In Steps

  • Three steps needed to do Part A Buy-In

Frequently Asked Questions

When in doubt, contact the State Buy-In Officer.

Why did my client’s Buy-In stop?

Buy-in stops when the client’s medical eligibility spans (med spans) in MMIS indicate the client has lost eligibility for Buy-in.

I reopened my client’s case but Buy-In did not restart within a month. Why?

Things to check:

  1. CBMS Med Spans: Is the current med span open? Is the TPL Code 01-26? Does the coding combination indicate a Buy-In-eligible program?
  2. Buy-In Summary screen:  What is the most recent row (by date sent/received)? Refer to one of the training guides for a translation of what it means. Is the most recent RIC B a 1728? Did your client move back to Colorado from another state? If yes, contact the State Buy-In Officer.
  3. Demographic Data: Does CBMS individual demographic data match SSA Title 2 data on the 7 match criteria?

The Part B Buy-In payer code in SVES/SOLQ is not CO (060). How do we get it changed?

Verify the client is currently a Colorado resident and notify the State Buy-In Officer.

Contact: Sharon Brydon, State Buy-In Officer: 303-866-5402 /