Aged, Blind, Disabled (ABD): Buy-In – How Does the Buy-in Work?

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  1. Buy-in is certified (QMB, SLMB, or QI-1) and OKDHS sends Buy-In (accretion) requests to CMS in Baltimore, MD.
    • Client must be on Medicare, or going on the next month, before a Buy-In benefit can be coded on the case. If a worker adds a client to a buy-in benefit when the client is not yet on Medicare, Buy-In may not work when client actually needs it.
  2. If OKDHS buy-in request is accepted by CMS, CMS will notify SSA and SSA will update with Oklahoma as TPP (third party payer) for premiums and client will not stop being charged the premiums.
    • It takes about 30 days for Buy-In to process and for the premiums to no longer be charged to the client.
    • Any refunds due back to the client will be issued by SSA.
  3. If OKDHS buy-in request is rejected by CMS, SSA is NOT notified about buy-in. CMS only sends SSA the buy-in information if the request from OKDHS to CMS was successful.
    • If premium is still taken out of client’s SSA benefit or there is no BIL on PY after 30 days check: Certification period is 12, Demographic information, Claim Number and DOB match Bendex record, and Buy-in benefit (QMB, SLMB, or QI-1) is added to the case.
    • The Buy-In won’t work if what is entered into FACS does not match Medicare information (Bendex Record) which can cause a rejection back from CMS.
  4. If OKDHS submits a deletion request (case closes and buy-in stops), CMS will stop buy-in and SSA will remove Oklahoma as the third party payer and client will start being charged for the Medicare premiums.
  5. All Buy-in communications between OKDHS and CMS updates on BIL.
    • BIL will show if buy-in request was accepted, rejected or deleted.
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