Georgia Medicare Buy-In (State Buy-In Agreement) Guide

Your Georgia Medicare Savings Program (MSP) approval letter is not what stops your Medicare premium from coming out of your Social Security check. A second, largely invisible step, the State Buy-In Agreement, is what actually does that. Also called the Medicare Buy-In, it is what turns a QMB, SLMB, QI, or QDWI approval into real premium relief by having Medicaid pay Medicare directly.

Georgia Medicare Buy-In: the federal-state mechanism (Section 1843 of the Social Security Act, 42 CFR Part 407) that turns an MSP approval into Medicaid paying your Medicare premium to CMS. It activates automatically 30 to 60 days after Georgia approves your MSP.

What the Georgia Medicare Buy-In is and who runs it

The Medicare Buy-In is authorized under Section 1843 of the Social Security Act, codified at 42 USC 1395v. The federal Medicaid matching authority comes from Section 1903(a)(1) of the SSA (42 USC 1396b(a)(1)). The federal regulations are at 42 CFR Part 407 (Medicare State Buy-In) and 42 CFR Part 431 Subpart C (Medicaid administration). Through this framework, Georgia DCH enters into a written agreement with CMS under which the state pays your Medicare premiums (the $202.90/month Part B premium in 2026, plus any Part A premium) directly to CMS on your behalf. CMS in turn coordinates with the Social Security Administration to stop premium withholding from your Social Security check. The result is that you never see a premium bill and the relief is fully automatic from your perspective.2

The Buy-In also does several other important things that beneficiaries rarely know about. It exempts MSP enrollees from the Part B Late Enrollment Penalty under Section 1839(b) of the SSA, meaning that if a low-income beneficiary delayed Part B enrollment because they could not afford the premium and later qualified for MSP, the months of Buy-In enrollment do not count against them in the LEP calculation. It coordinates Part A buy-in for QMBs who do not have premium-free Part A through their own or a spouse's work history, and for QDWIs who are in the Section 226(b) extended Medicare entitlement window after losing Social Security Disability Insurance (SSDI). And it handles the deletion process when an MSP enrollee loses eligibility, including the SSA notification to resume premium withholding.

This guide explains the federal framework for the Medicare Buy-In, the six-step activation timeline from DFCS approval through the moment SSA stops withholding your premium, how the Buy-In works for each of the four MSPs (QMB, SLMB, QI, and QDWI), the Section 1839(b) Late Enrollment Penalty exemption, the Coordination of Benefits Agreement (COBA) data exchange between Georgia DCH and CMS, common Buy-In failures and how to fix them, how Georgia DCH and DFCS split the work, and worked examples for typical Georgia scenarios.

Where does the Buy-In come from? Section 1843 and its history

Most beneficiaries do not need the history, but it explains why the Buy-In behaves the way it does. Section 1843 of the Social Security Act dates to 1965, when Medicare was created: it let states "buy in" to Part B on behalf of low-income people on public assistance, who were entitled to premium-free Part A automatically but could not afford the Part B premium. Over the decades Congress layered the Medicare Savings Programs on top of that machinery, QMB in 1986, SLMB and QDWI in 1988, and QI (with its full federal funding) in 1997, so that the same Buy-In pipe that once served welfare recipients now delivers premium relief to all four MSP groups.

The core federal authorities a Georgia beneficiary or advocate may need to cite are Section 1843 (42 USC 1395v, the Buy-In itself), Section 1903(a)(1) (federal matching for the state's payments), Section 1839(b) (the Late Enrollment Penalty exemption), Section 1902(a)(10)(E) (MSP authority), Section 1905(p) (the QMB definition), and 42 CFR Part 407 (the Buy-In regulations). Today, Georgia's 2026 MSP income limits run from 100% of the federal poverty level for QMB up to 135% for QI, with a shared federal resource standard of $9,950 for an individual.1 Neither figure is an absolute cutoff: states can effectively raise both by disregarding certain income and resources, so someone somewhat over should apply rather than rule themselves out.2

How the federal government helps pay for Buy-In

Federal Medicaid matching applies to Buy-In premium payments under Section 1903(a)(1). The federal government reimburses Georgia for a share of every Buy-In premium dollar at Georgia's Federal Medical Assistance Percentage (FMAP), which CMS recalculates each federal fiscal year; the state pays the remainder. For the current Georgia FMAP, check the annual CMS/HHS FMAP notice published in the Federal Register.

For the QI program, the funding structure is different. Section 1933 of the SSA creates a federal block grant that covers the full cost of QI Buy-In. Georgia receives an annual QI allotment from CMS and uses it to pay QI Part B premiums, with no state share. The QI block grant is subject to an annual cap; if Georgia exhausts its allotment in a given year, new QI enrollments may be limited.

What does the Buy-In pay for under each MSP?

The four Medicare Savings Programs each have distinct Buy-In structures. The table below summarizes what Medicaid pays through the Buy-In for each one, using the 2026 Medicare premium amounts.2

The sections below walk through each program in detail.

QMB (Qualified Medicare Beneficiary)

QMB is the most comprehensive MSP. The Buy-In for QMB covers the Part B premium ($202.90/month in 2026), paid directly to CMS for every QMB, and the Part A premium ($311 or $565/month in 2026) for the minority of QMBs who are not entitled to premium-free Part A through their own or a spouse's work history and instead enroll voluntarily under Section 1818. QMB also brings Medicare cost-sharing protection (deductibles, coinsurance, and copays), which is technically a separate Medicaid responsibility under Section 1905(p)(3) and 42 CFR 447.45 but is administered through the same coordination machinery, so beneficiaries often call the whole QMB package "Buy-In."2

SLMB (Specified Low-Income Medicare Beneficiary)

The SLMB Buy-In covers only the Part B premium ($202.90/month in 2026). SLMBs are typically entitled to premium-free Part A and do not need Part A Buy-In. SLMB does NOT include cost-sharing protection, so deductibles, coinsurance, and copays are paid out of pocket by the SLMB (or through other coverage like Medigap or Medicare Advantage).2

QI (Qualifying Individual)

The QI Buy-In is similar to SLMB but funded through the federal QI block grant under Section 1933. It covers only the Part B premium ($202.90/month in 2026), with no state share, so the entire cost is federally funded.2

QDWI (Qualified Disabled and Working Individual)

The QDWI Buy-In covers only the Part A premium ($311 or $565/month in 2026) under Section 1818A, for disabled individuals in the Section 226(b) extended Medicare entitlement window. QDWIs pay their Part B premium out of pocket; the Buy-In does not cover Part B for QDWIs.2

The Georgia Medicare Buy-In activation timeline, step by step

Understanding the Buy-In activation timeline is essential for beneficiaries because timing problems are the most common source of complaints. The timeline involves four entities (DFCS, Georgia DCH MMIS, CMS, and SSA) and typically takes 30-60 days from MSP application to actual premium-withholding cessation.

Step 1: DFCS or DCH Approval of the MSP Application

The Buy-In process begins when DFCS approves the MSP application. The applicant submits the application through Georgia Gateway (gateway.ga.gov), in person at a DFCS county office, or by phone at DFCS Customer Service. DFCS reviews the application against the MSP criteria and issues an approval or denial letter.

Federal regulations at 42 CFR 435.912 require a determination within 45 days of application (or 90 days for disability-based cases). Georgia typically meets this timeline.

Timeline: 30-45 days from application date.

Step 2: MMIS Buy-In Coding

Once DFCS approves the MSP, the approval is entered into the Georgia Medicaid Management Information System (MMIS). The MMIS includes a Buy-In flag for each MSP-enrolled member. The MMIS produces:

• A daily accretion file listing new MSP enrollees (typically generated overnight)
• A daily deletion file listing MSP terminations
• A daily premium payment file
• Other supporting data files

Timeline: same day or 1 business day after DFCS approval.

Step 3: COBA Transmission to CMS

The Coordination of Benefits Agreement (COBA) governs the data exchange between Georgia DCH and CMS. The MMIS accretion file is transmitted to CMS through COBA. CMS processes the file and updates its Medicare enrollment records.

Timeline: 1-3 business days from MMIS coding.

Step 4: CMS Confirmation and Reconciliation

CMS confirms receipt of the accretion file with Georgia DCH and updates its records. CMS also forwards the Buy-In status to the Social Security Administration (SSA), which is the agency that actually withholds Part B premiums from Social Security checks.

CMS may issue a reconciliation report identifying any data mismatches between Georgia DCH and CMS records. Georgia DCH and CMS work to resolve mismatches.

Timeline: 1-5 business days.

Step 5: SSA Premium Withholding Cessation

SSA processes the Buy-In notification and stops withholding Part B premiums from the beneficiary's Social Security check. Withholding cessation typically occurs the first day of the second month following SSA notification.

This is the step that beneficiaries actually experience. They notice that their Social Security check is suddenly $202.90 higher each month, the amount of the 2026 standard Part B premium that was previously being withheld.2

Timeline: 30-60 days from Buy-In activation (depending on the calendar cycle).

Step 6: Beneficiary Reimbursement for Gap Months

If the beneficiary paid Part B premiums out-of-pocket during the gap between MSP approval and Buy-In activation, SSA processes a reimbursement. The reimbursement is typically:

• Issued as a one-time direct deposit to the beneficiary's bank account, or
• Issued as a paper check mailed to the beneficiary
• Equal to the number of months of out-of-pocket premiums during the gap

For SLMB and QI, which can be retroactive up to 3 months prior to the application month under 42 CFR 435.915, the beneficiary can also recover premiums paid during that retroactive period. QMB is the exception: it is prospective only and begins the month after approval, so there is no pre-approval QMB period to reimburse.4

Timeline: 60-90 days from Buy-In activation.

Does the Buy-In protect me from the Part B late-enrollment penalty?

A critical feature of the Buy-In is the protection against the Part B Late Enrollment Penalty (LEP). Without this protection, low-income beneficiaries who delayed Part B enrollment because they could not afford the premium would face a permanent penalty for the rest of their lives.

The Standard Part B LEP Rule

Under Section 1839(b) of the SSA, the standard Part B Late Enrollment Penalty applies to anyone who does not enroll in Part B during their Initial Enrollment Period or a qualifying Special Enrollment Period. The penalty:

• Is 10% of the standard Part B premium for each full 12-month period of delay
• Is added to the Part B premium permanently
• Continues for as long as the beneficiary has Part B
• For example, a beneficiary who delayed Part B for 3 years would pay 130% of the standard premium for life2

For the 2026 standard Part B premium of $202.90, a 3-year delay would add about $60.87/month permanently, for a total of roughly $263.77/month.2

The Section 1839(b) Buy-In Exemption

Section 1839(b) provides that months of enrollment in a State Buy-In Agreement do NOT count toward the LEP delay calculation. This means:

• A beneficiary who is in Buy-In for X months has those X months excluded from the LEP penalty calculation
• The LEP penalty is recalculated based only on months when the beneficiary was eligible for Part B but not enrolled and not in Buy-In
• For many low-income beneficiaries, the exemption eliminates the LEP entirely

Practical Example

Consider a beneficiary who:

• Turned 65 in 2018 and was eligible for Part B
• Did not enroll because she could not afford the premium
• Applied for QMB in 2024 and was approved
• Buy-In activated in 2024

Without the exemption, the LEP calculation would treat 2018-2024 as 6 years of delay, resulting in a 60% LEP added to her Part B premium permanently (roughly $121.74/month in 2026, on top of the standard premium).2

With the Section 1839(b) Buy-In exemption, the calculation excludes Buy-In months. Because she is now in Buy-In and Medicaid is paying the premium, the entire post-2024 period is excluded. The pre-2024 delay (2018-2024) still counts, but in practice many beneficiaries also qualify for various exclusions and the practical LEP can be smaller than the raw calculation suggests. Beneficiaries should consult SSA or GeorgiaCares SHIP for case-specific calculations.

The key point: Buy-In months never count against the LEP. If the beneficiary loses MSP eligibility in the future and has to pay Part B out-of-pocket, the LEP calculation will not include the Buy-In months.

Why does the timing feel uneven? The COBA data exchange

The Coordination of Benefits Agreement (COBA) is the technical data exchange standard between state Medicaid agencies and CMS for Buy-In administration. It is the pipe through which Georgia tells CMS which enrollees to add and how much premium (the $202.90/month Part B premium in 2026, plus any Part A premium) to bill against the state. Understanding COBA helps explain why Buy-In timing can be uneven.2

Each business day, Georgia sends CMS an "accretion" file (new enrollees to add) and a "deletion" file (enrollees to remove), along with the premium amounts to bill, and the two systems reconcile the differences on a weekly, monthly, and annual cycle. Delays usually trace to a data mismatch, most often a name, Social Security number, or date-of-birth discrepancy between the state and CMS records; an effective-date difference; or a QMB-versus-SLMB classification error. Fixing a mismatch takes staff at Georgia DCH and CMS working together, so a beneficiary who sees a Buy-In delay should call DCH Member Services to request a case review.

Common Buy-In Failures and How to Resolve Them

Even when the Buy-In machinery works correctly, errors can occur. The following are the most common Buy-In failures in Georgia and the recommended resolution paths.

Failure 1: MSP Approved but Buy-In Not Activated

The DFCS approval letter says "QMB," "SLMB," "QI," or "QDWI," but the $202.90/month Part B premium (2026) keeps coming out of the beneficiary's Social Security check. The most common cause is that the MMIS Buy-In flag was not set correctly after DFCS approval.2

Resolution:

1. Contact DCH Member Services at 1-866-211-09503
2. Request a "Buy-In case review"
3. Provide the DFCS approval date and the MSP category
4. DCH staff investigates the MMIS record and manually triggers the accretion if needed
5. Allow 4-6 weeks for the manual accretion to flow through to SSA

If DCH does not respond timely, escalate to DFCS Customer Service at 1-877-423-4746 or contact Atlanta Legal Aid Senior Citizens Law Project at 404-377-0701 for advocacy support.5

Failure 2: CMS Receives Accretion but Does Not Process

The MMIS accretion file goes to CMS through COBA, but CMS does not process it timely. The cause is usually a CMS system error or data mismatch.

Resolution:

1. Contact 1-800-MEDICARE
2. Request to speak with the "Medicare Buy-In customer service line"
3. Provide the Medicare number, the MSP category, and the approval date
4. CMS investigates and processes the accretion manually if needed

Failure 3: SSA Continues Withholding After Buy-In Active

Buy-In is active at CMS but SSA continues to withhold Part B premiums from the Social Security check. The beneficiary is effectively paying twice (Medicaid pays the premium, but SSA also deducts it).

Resolution:

1. Contact SSA at 1-800-772-12136
2. Request a "premium refund for Buy-In overlap"
3. Provide the Medicare number and the Buy-In activation date
4. SSA processes a refund typically as a one-time direct deposit or paper check

Failure 4: Buy-In Termination but Premium Withholding Resumes Late

When a beneficiary loses MSP eligibility (income increase, asset increase, marriage, etc.), the deletion file should trigger SSA to resume premium withholding. Sometimes there is a lag of 1-3 months during which Medicare premiums accumulate as a debt to CMS.

Resolution:

1. Set aside the premium amount each month during the transition period to avoid a large bill
2. Contact CMS at 1-800-MEDICARE to pay any accumulated balance
3. Confirm with SSA that withholding will resume
4. Avoid Medicare premium debt that could result in Part B termination

Failure 5: Retroactive Coverage Period Not Reimbursed

SLMB and QI can be retroactive for up to 3 months prior to the application month under 42 CFR 435.915 (QMB is prospective only).4 If a beneficiary paid premiums out-of-pocket during an SLMB or QI retroactive period, reimbursement should occur but sometimes does not.

Resolution:

1. Contact SSA directly with proof of premium payment (bank statements, SSA premium deduction records)
2. Request "retroactive premium reimbursement for Buy-In coverage period"
3. Provide the retroactive coverage start date from DFCS
4. SSA processes the retroactive reimbursement

Failure 6: Provider Improperly Bills QMB for Cost-Sharing

QMBs are protected from cost-sharing under Section 1902(n)(3)(B) of the SSA, 42 CFR 447.205, and 42 CFR 422.504(g) for Medicare Advantage plans. Providers cannot bill QMBs for Medicare deductibles, coinsurance, or copays. Sometimes providers improperly bill QMBs.

Resolution:

1. Show the provider proof of QMB status (Medicaid card showing QMB, DFCS approval letter)
2. If billing continues, contact 1-800-MEDICARE to report "QMB improper billing"
3. File a complaint with the CMS Medicaid Beneficiary Improper Billing reporting system
4. Atlanta Legal Aid Senior Citizens Law Project at 404-377-0701 can help with persistent improper billing

Who does what: Georgia DCH and DFCS

Georgia administers the Medicare Buy-In through the Department of Community Health (DCH) and the Division of Family and Children Services (DFCS). DFCS determines whether you qualify for an MSP under Georgia's 2026 income and resource limits, and DCH runs the machinery that pays your premium to CMS. Their roles:1

DCH Role

The Department of Community Health is the single state Medicaid agency under federal Medicaid rules. DCH:

• Maintains the State Plan Amendment that defines Georgia's Buy-In agreement with CMS
• Operates the MMIS that codes Buy-In status and generates daily files
• Maintains the COBA data exchange with CMS
• Pays premiums to CMS each month
• Receives federal matching funds for Buy-In payments
• Resolves data mismatches and operational issues with CMS

DFCS Role

The Division of Family and Children Services administers the eligibility determination process. DFCS:

• Receives and processes MSP applications through Georgia Gateway and county offices
• Determines eligibility based on income, assets, and Medicare entitlement
• Issues approval or denial letters
• Records approvals in the MMIS, which triggers Buy-In coding
• Handles redetermination and renewal of MSP eligibility
• Processes adverse action notices when eligibility is lost

MMIS Contractor

Georgia DCH contracts with a third-party MMIS contractor that operates the technical infrastructure for Medicaid claims processing, eligibility maintenance, and Buy-In data exchange. The MMIS contractor is responsible for daily accretion and deletion file generation, premium payment processing, and reconciliation with CMS.

The Georgia Gateway portal

Georgia Gateway (gateway.ga.gov) is the public-facing portal for MSP applications. Beneficiaries use Gateway to:

• Submit initial MSP applications
• Upload supporting documentation
• Check application status
• Respond to DFCS requests
• Complete annual renewals
• View benefit cards

Gateway also displays Buy-In status once activated. Beneficiaries can verify that Buy-In is active for their account.

How the Buy-In plays out: four Georgia scenarios

The following examples illustrate how the Medicare Buy-In works in practice. Names and details are illustrative.

Example 1: Doris, 72, Atlanta: QMB Approval to Buy-In Activation Timeline

Doris is a 72-year-old retiree with $1,200/month Social Security and $5,500 in savings. She has Medicare Part A (premium-free) and Part B with $202.90/month premium deducted from her Social Security check. She heard about QMB from her senior center and applied through Georgia Gateway in March.2

Day-by-day timeline:

• March 5: Doris submits QMB application through Georgia Gateway
• April 18: DFCS approves QMB; approval letter mailed
• May 1: QMB coverage begins. Unlike SLMB and QI, QMB is prospective only, so it starts the first day of the month after approval, not retroactively.4
• April 19 to April 24: MMIS sets the Buy-In flag, the COBA accretion file goes to CMS, and CMS notifies SSA
• June 1: SSA premium withholding stops; Doris's June Social Security check is $202.90 higher
• July 15: SSA reimburses the May Part B premium ($202.90) it withheld before Buy-In took hold2

Because QMB is prospective, Doris cannot recover premiums she paid before her May 1 QMB start date, only the withholding that lagged the Buy-In activation. Going forward, Doris pays no premiums, and her Medicare cost-sharing (deductibles, coinsurance, copays) is fully covered through QMB cost-sharing protection.

Example 2: Henry, 70, Savannah: SLMB Buy-In Activation

Henry has $1,500/month Social Security, slightly above the QMB income limit (100% FPL = $1,350 single) but below the SLMB limit (120% FPL = $1,616 single). He applies for SLMB through Georgia Gateway.1

DFCS approves SLMB. The MMIS Buy-In flag is set for Part B only (SLMBs do not get Part A Buy-In or cost-sharing protection). The COBA accretion file transmits to CMS. SSA stops withholding the $202.90 Part B premium from Henry's check the second month following Buy-In activation.2

Henry's net monthly cash flow increases by $202.90/month, about $2,434.80 over a full year. He still pays Medicare deductibles, coinsurance, and copays out of pocket because SLMB does not include cost-sharing protection.2

Example 3: Joyce, 68, Macon: Buy-In Failure and Recovery

Joyce applies for QMB in January. DFCS approves in February. Joyce expects premium withholding to stop, but March and April Social Security checks still show the $202.90 deduction.2

In May, Joyce calls DCH Member Services at 1-866-211-0950. She explains the situation. The DCH worker investigates the MMIS record and discovers that the Buy-In flag was not properly set due to a coding error. The worker manually corrects the record and triggers an accretion to CMS.3

By June, SSA stops withholding. By July, Joyce receives a reimbursement of $608.70 (the $202.90 premium times the three months, March, April, and May, that she paid out of pocket). Total resolution time: 5 months from DFCS approval, 4 months longer than the typical Buy-In timeline.2

If the issue had been more difficult, Joyce could have escalated to:

• DFCS Customer Service: 1-877-423-47465
• Atlanta Legal Aid Senior Citizens Law Project: 404-377-0701
• A state hearing request

Example 4: Charles, 75, Augusta: Dual Eligible QMB-Plus with Full Medicaid

Charles is 75 and has both Medicare and full Georgia Medicaid (ABD Medicaid with QMB). He resides in a Georgia nursing facility. His Buy-In covers:

• Part B premium ($202.90/month in 2026) paid to CMS
• Medicare cost-sharing through QMB rules (deductibles, coinsurance)
• Full Medicaid wrap-around for services Medicare does not cover (nursing facility room and board, etc.)2

The Buy-In here is one component of a comprehensive dual-eligible coordination. Medicare is primary for hospital, physician, and prescription drug services. Medicaid pays for the nursing facility, and Charles keeps only a small monthly personal needs allowance (PNA) from his Social Security for personal expenses; federal law sets a floor of at least $30/month, and states may set a higher institutional PNA, so confirm Georgia's current amount with the Georgia Department of Community Health. The Buy-In keeps Medicare active without premium payments from Charles.7

For Georgia's exact institutional nursing-facility PNA, verify with the Georgia Department of Community Health, since the federal figure is only the minimum states must meet.

Special situations: Part A Buy-In, Medicare Advantage, self-payers, and spouses

Conditional Medicare Entitlement and State Part A Buy-In

A small number of Georgia beneficiaries have "conditional" Medicare entitlement under Section 1818 voluntary enrollment. These are typically:

• Individuals who turn 65 without 40 quarters of Medicare-covered employment
• Individuals who became disabled but did not accrue 40 quarters before disability

For these individuals, Part A is not premium-free. The Part A premium is $311/month (with 30-39 quarters) or $565/month (under 30 quarters). If the individual qualifies for QMB, the Part A Buy-In pays this premium.2

State Part A Buy-In is administratively more complex than Part B Buy-In because it involves additional CMS verification of the individual's quarters of coverage and Section 1818 eligibility. Beneficiaries who need Part A Buy-In should work with GeorgiaCares (1-866-552-4464) for counseling.8

Coordination with Medicare Advantage and D-SNPs

For QMBs enrolled in Medicare Advantage plans (including D-SNPs), the Buy-In premium payments and cost-sharing protections still apply. The Medicare Advantage plan receives the Medicare capitation payment from CMS, and the plan in turn provides services with zero cost-sharing for QMB enrollees under 42 CFR 422.504(g).

The Buy-In administrative pathway is unchanged. The plan's enrollment information is captured in CMS systems alongside the Buy-In status, ensuring coordination.

Premium Reimbursement for Self-Paying Beneficiaries

Some beneficiaries have no Social Security check (for example, they retired without enough quarters for retirement benefits, or they deferred retirement) and pay their Part B premium directly to Medicare each quarter. For them, Buy-In means Medicaid pays the premium directly to CMS, with no SSA withholding-cessation step. If they prepaid quarterly premiums, they should request a refund from Medicare for any post-Buy-In months.

Spouses are evaluated one at a time

The Buy-In is individual, not household. If one spouse qualifies for an MSP and the other does not, only the qualifying spouse's premiums are covered, and if the two spouses qualify for different programs (one QMB, one SLMB), the Buy-In handles each separately.

How to get Buy-In activated: the steps from your side

From the beneficiary's perspective, activating Buy-In means applying for the underlying MSP, waiting out the processing time, and stepping in if the premium does not stop. The 2026 MSP income and resource limits are the eligibility screen you have to clear at step one.1

Common mistakes to avoid

1. Not understanding the gap between MSP approval and Buy-In activation. Buy-In takes 30 to 60 days after DFCS approval. Keep paying the $202.90/month Part B premium (2026) during the gap and seek reimbursement once Buy-In activates.2

2. Continuing to pay premiums out-of-pocket after Buy-In should have activated. If 60 days have passed and premiums are still being withheld, contact DCH Member Services immediately.

3. Not requesting retroactive reimbursement when entitled. SLMB and QI can be retroactive up to 3 months (QMB is prospective only).4 If you had SLMB or QI, request retroactive reimbursement for premiums paid during that period.

4. Confusing Buy-In activation with MSP approval. They are sequential. MSP approval is the first step; Buy-In activation is downstream.

5. Not knowing the Section 1839(b) LEP exemption exists. Buy-In months never count against the Part B Late Enrollment Penalty calculation. Apply for MSP/Buy-In even if you delayed Part B initially.

6. Allowing providers to improperly bill QMBs for cost-sharing. QMBs are protected from cost-sharing under federal rules. Show your Medicaid card and report improper billing to 1-800-MEDICARE.

7. Not knowing that QDWI Buy-In is Part A only. QDWI beneficiaries continue to pay their Part B premium out of pocket.

8. Assuming Buy-In is permanent. Buy-In is tied to your MSP eligibility. If you lose the MSP (an income increase, an inheritance, a change in household), Buy-In deactivates and premium withholding resumes.

Where to get help with your Georgia Medicare Buy-In

If you are enrolled in a Medicare Savings Program but are still being billed for Medicare premiums, or you need help applying for QMB, SLMB, QI, or QDWI, these free Georgia and federal resources can help.

Find personalized help navigating Georgia Medicare Buy-In at brevy.com.

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Find personalized help understanding your Georgia Medicare Buy-In status at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.