States may execute a Medicare Part A buy-in agreement with the Centers for Medicare & Medicaid Services (CMS) to facilitate access to Medicare Part A and dual eligible status under the Qualified Medicare Beneficiary (QMB) eligibility group. This access is beneficial to individuals and could also reduce administrative burden and costs for providers and states. However, as of November 2021, fourteen states do not have a Part A buy-in agreement.
Executing a Part A buy-in agreement with CMS may produce both new potential state costs and new forms of savings, which vary based on the current Medicare and Medicaid enrollment status of a state’s QMB-eligible individuals. For a particular state, the costs and savings of executing a Part A buy-in agreement will depend on the size and ratio of these different populations. This tool is designed to help states without Part A buy-in agreements – known as “group payer” states – understand how to use their own data to analyze the potential costs and benefits of entering into such an agreement.
States can also use the accompanying Excel spreadsheet to calculate potential costs and savings of a Part A buy-in agreement.