State Payment of Medicare Premiums




States pay Medicare Part B premiums each month for over 10 million individuals and Part A premium for over 700,000 individuals. This process promotes access to Medicare coverage for low-income older adults and people with disabilities, and it helps states ensure that Medicare is the first and primary payer for Medicare covered services for dually eligible beneficiaries.


Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”)

On September 8, 2020, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”). The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid. The update to the manual is part of CMS’ Better Care for Dually Eligible Individuals Strategic Initiative (PDF) aimed at improving quality, reducing costs, and improving customer experiences.

The prior version of this manual had not been fully updated since the 1990s. The updated manual clarifies various provisions of statute, regulation, and operations that have evolved over time. We redesigned the manual content to make it (1) easier for states to discern federal requirements and find information, (2) compliant with federal accessibility standards and (3) fully available online for the first time.

The manual is part of the CMS Manual System, specifically Pub. 100-24. It is divided into the following sections:

Table of Contents (PDF)

Chapter 1: Program Overview and Policy (PDF)

Chapter 2: State Buy-in Data Exchange Processes (PDF)

Chapter 3: State Input and CMS Response File Formats (PDF)

Chapter 4: Buy-in Code Descriptions (PDF)

Chapter 5: Premium Billing (PDF)

Chapter 6: Problem Cases and Resources (PDF)


Related Training & Materials

Frequently Asked Questions (FAQs) about Medicare Part A and B "Buy-in" (PDF): The main policy questions, & responses, submitted to CMS to date on the updated Manual for State Payment of Medicare Premiums released on September 8, 2020.

Five Key Policy Topics From the Updated Manual on State Payment of Medicare Premiums: CMS designed this webinar (via YouTube (released 11/24/2020) for state policy staff to introduce five key policy topics addressed in the updated Manual for State Payment of Medicare Premiums released on September 8, 2020. 

State Buy-in File: Troubleshooting Code 21XX Series Accretion Rejections (09/28/2020) (PDF)

Overview of the CMS State Buy-In File Exchange: A webinar, with associated slides, available as a resource to support states moving to daily exchange submission.


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Page Last Modified:
11/30/2022 04:19 PM