WAG 22-07-02.
Supplementary Medical Insurance Benefits (SMIB) are provided by the federal government through Part B of the Medicare Program. Medicare pays a part of medical costs for people who pay a monthly premium. An agreement with the Centers for Medicare &
Medicaid Services (CMS) allows the Department to pay the SMIB premiums for certain eligible clients. This is called SMIB Buy-in.
The following people are potentially eligible for SMIB:
- a person who is eligible for Medicare Part A, Hospital Insurance (HIB), or age 65 or older; or
- a person under age 65 who has received Social Security disability (RSDI) benefits for at least 2 years; or
- a person being treated for end stage renal disease (ESRD); or
- a person under age 65 who has received Railroad Retirement (RRB) benefits based on disability for at least 24 consecutive months; or
- a U.S. resident who has attained age 65 and is a citizen, or an alien lawfully admitted for permanent residence and who has resided in the U.S. for 5 consecutive years; or
- a person otherwise ineligible for SMIB, but who is eligible for the SMIB Buy-in Program on the basis of receiving AABD, or SSI and Regular Medical (see PM
22-07-02-a).
A person must apply at SSA to receive SMIB. If they are approved, they are "enrolled for SMIB."
A person can apply for SMIB when they:
- apply for Social Security (RSDI) Benefits; or
- apply for SMIB Only; or
- apply for Railroad Retirement Benefits (RRB).
The Department may enroll persons who receive RSDI or RRB, or if they receive renal dialysis, if they are eligible for the SMIB Buy-in Program and have not enrolled for SMIB themselves.
Because SSA will pay part of the medical bills for people enrolled for SMIB, it's important for all eligible persons to apply.
AABD and TANF clients may be eligible for SMIB Buy-in even if they aren't eligible for SMIB on their own because:
- they failed to pay premiums; or
- they failed to enroll at the right time.
A person does not have to be eligible for Hospital Insurance Benefits (HIB) to be eligible for SMIB Buy-in.
The Department pays the premium for QMB clients beginning the month after the month of the QMB eligibility determination. The Department continues to pay the premium for as long as the person retains QMB status. The Department may pay SMIB premiums
for SLIB clients retroactive to 3 months before the month of the SLIB application.
