[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR406.26]



[Page 258]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 406_HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT--Table of Contents

 

                  Subpart C_Premium Hospital Insurance

 

Sec. 406.26  Enrollment under State buy-in.



    (a) Enrollment of QMBs under a State buy-in agreement--(1) Effective 

date. Beginning with calendar year 1990, a State may request and be 

granted a modification of its buy-in agreement to include enrollment and 

payment of Part A premiums for QMBs (as defined in section 1905(p)(1) of 

the Act) who can become entitled to Medicare Part A only by paying a 

premium.

    (2) Amount of premium. Premiums paid under State buy-in are not 

subject to increase because of late enrollment or reenrollment.

    (b) Beginning of coverage under buy-in. The coverage period begins 

with the latest of the following:

    (1) The third month following the month in which the agreement 

modification covering QMBs is effectuated.

    (2) The first month in which the individual is entitled to premium 

hospital insurance under Sec. 406.20(b) and has QMB status.

    (3) The date specified in the agreement modification.

    (c) End of coverage under buy-in. Buy-in coverage ends with the 

earlier of the following:

    (1) Death. Coverage ends on the last day of the month in which the 

QMB dies.

    (2) Loss of QMB status. If the individual loses eligibility for QMB 

status, coverage ends on the last day of the month in which CMS receives 

the State's notice of ineligibility.

    (3) Termination of buy-in agreement. If the State's buy-in agreement 

is terminated, coverage ends on the last day of the last month for which 

the agreement is in effect.

    (4) Entitlement to premium-free Part A. If the individual becomes 

entitled to premium-free Part A, buy-in coverage ends on the last day of 

entitlement to premium Part A.

    (d) Continuation of coverage: Individual enrollment following 

termination of buy-in coverage--(1) Deemed enrollment. If coverage under 

a buy-in agreement ends because the agreement is terminated or the 

individual loses QMB status, the individual--

    (i) Is considered to have enrolled during his or her initial 

enrollment period; and

    (ii) Is entitled to Part A benefits and liable for Part A premiums 

beginning with the first month for which he or she is no longer covered 

under the buy-in agreement.

    (2) Voluntary termination. (i) An individual may voluntarily 

terminate entitlement acquired under paragraph (d)(1) of this section by 

filing, with SSA or CMS, a request for disenrollment.

    (ii) Voluntary disenrollment is effective as follows:

    (A) If the individual files a request within 30 days after the date 

of CMS's notice that buy-in coverage has ended, the individual's 

entitlement ends on the last day of the last month for which the State 

paid the premium.

    (B) If the individual files the request more than 30 days but not 

more than 6 months after buy-in coverage ends, entitlement ends on the 

last day of the month in which the request is filed.

    (C) If the individual files the request later than the 6th month 

after buy-in coverage ends, entitlement ends at the end of the month 

after the month in which request is filed.



[56 FR 38080, Aug. 12, 1991]