Manual for State Payment of Medicare Premiums


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Today, the Centers for Medicare & Medicaid Services (CMS) released the updated 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 aimed at improving quality, reducing costs, and improving customer experiences.

States pay Medicare Part B premiums each month for over 10 million individuals and Part A premiums 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.

The new manual replaces a version that had not been fully updated since the 1990s.  It now clarifies various provisions of statute, regulation, and operations that have evolved over time. We also redesigned the manual content to make it easier for states to discern federal requirements and find information. It is also available online and complies with federal accessibility standards.  In addition, the new manual addresses multiple comments from states and other partners on the draft released in December 2019.

To see the manual for State Payment of Medicare premiums, visit: