Section 49.468. Expanded medicare buy-in.

 

(1)  

(a) In this subsection and sub. (1m) :

1. “Disabled" means blind, as defined under 42 USC 1382c (a) (2) and disabled, as defined under 42 USC 1382c (a) (3).

2. “Elderly" means 65 years of age or older.

3. “Entitled to coverage under part A of medicare" means eligible for and enrolled in part A of medicare under 42 USC 1395c to 1395f .

4. “Entitled to coverage under part B of medicare" means eligible for and enrolled in part B of medicare under 42 USC 1395j to 1395L .

(b) For an elderly or disabled individual who is entitled to coverage under Part A of Medicare, entitled to coverage under Part B of Medicare, and who does not meet the eligibility criteria for Medical Assistance under s. 49.46 (1) , 49.465 , 49.47 (4) , or 49.471 but meets the limitations on income and resources under par. (d) , Medical Assistance shall pay the deductible and coinsurance portions of Medicare services under 42 USC 1395 to 1395zz that are not paid under 42 USC 1395 to 1395zz , including those Medicare services that are not included in the approved state plan for services under 42 USC 1396 ; the monthly premiums payable under 42 USC 1395v ; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under Part A of Medicare. Payment of coinsurance for a service under Part B of Medicare under 42 USC 1395j to 1395w and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.

(c) For an elderly or disabled individual who is only entitled to coverage under Part A of Medicare and who does not meet the eligibility criteria for Medical Assistance under s. 49.46 (1) , 49.465 , 49.47 (4) , or 49.471 but meets the limitations on income and resources under par. (d) , Medical Assistance shall pay the deductible and coinsurance portions of Medicare services under 42 USC 1395 to 1395i that are not paid under 42 USC 1395 to 1395i , including those Medicare services that are not included in the approved state plan for services under 42 USC 1396 ; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty for premiums under Part A of Medicare, if applicable. Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.

(d) Benefits under par. (b) or (c) are available for an individual who has resources that are equal to or less than 200 percent of the allowable resources as determined under 42 USC 1381 to 1385 and income that is equal to or less than 100 percent of the poverty line.

(e) In determining under this subsection the income of an individual who is entitled to a monthly social security benefit under 42 USC 401 to 433 , the department shall exclude, from December until the month after the month in which the annual revision of the poverty line is published, the amount of the social security benefit attributable to a cost-of-living increase under 42 USC 415 (i).

(1m)  

(a) Beginning on January 1, 1993, for an elderly or disabled individual who is entitled to coverage under part A of medicare and is entitled to coverage under part B of medicare, does not meet the eligibility criteria for medical assistance under s. 49.46 (1) , 49.465 , 49.47 (4) , or 49.471 but meets the limitations on income and resources under par. (b) , medical assistance shall pay the monthly premiums under 42 USC 1395r .

(b) Benefits under par. (a) are available for an individual who has resources that are equal to or less than 200 percent of the allowable resources determined under 42 USC 1381 to 1385 and income that is greater than 100 percent of the poverty line but less than 120 percent of the poverty line.

(2)  

(a) Beginning on January 1, 1991, for a disabled working individual who is entitled under P.L. 101-239 , section 6012 (a), to coverage under part A of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1) , 49.465 , 49.47 (4) , or 49.471 but meets the limitations on income and resources under par. (b) , medical assistance shall pay the monthly premiums for the coverage under part A of medicare, including late enrollment fees, if applicable.

(b) Benefits under par. (a) are available for an individual who has resources that are equal to or less than 200 percent of the allowable resources under 42 USC 1381 to 1385 and income that is equal to or less than 200 percent of the poverty line.

1989 a. 31 , 336 ; 1991 a. 39 , 269 ; 1993 a. 16 ; 2001 a. 16 ; 2007 a. 20 ; 2011 a. 32 .