Indiana Part A Buy-In: Getting Medicare Without 40 Work Credits

The Work Credits Problem

Most people get Medicare Part A free at 65 because they (or their spouse) earned 40 quarters of Medicare-covered employment. But some seniors don't have enough quarters — immigrants who worked primarily in their home country, people who worked in state or local government jobs not covered by Social Security, homemakers whose spouses didn't accumulate enough credits, or people who simply didn't work long enough in covered employment.

Without 40 quarters, Part A costs up to $518 per month in 2026. Most low-income seniors can't afford that premium, which means they can't access hospital coverage and can't qualify for the full QMB benefit package.

Indiana's Part A Buy-In Solution

Indiana operates as a Part A buy-in state under an agreement with CMS. This means a low-income senior without premium-free Part A can still get QMB — and the state pays the Part A premium on their behalf.

The process works through a coordinated filing between Social Security and DFR:

Step 1 — Use the right SSA path. If you are not enrolled in Part B, visit your local Social Security office and apply for Part B with conditional Part A using Form CMS-18-F-5. If you already have Part B, skip the SSA filing and go to Step 2 to apply for QMB through DFR; Indiana can add Part A through its State Buy-In agreement.

Step 2 — MSP application at DFR. Submit a Medicare Savings Program application to DFR through fssabenefits.in.gov, by phone (1-800-403-0864), or in person. If you used the conditional enrollment process, provide the SSA filing confirmation receipt.

Step 3 — DFR evaluates QMB eligibility. DFR checks your income against the $2,015/month single limit and assets against $9,950. If eligible, DFR enters QMB status and transmits the buy-in record to CMS.

Step 4 — CMS activates Part A. CMS updates SSA's records. SSA issues Part A entitlement without billing you a premium. The state pays it through its Part A Buy-In agreement.

Year-Round Enrollment

Under SSA's POMS HI 00801.140, conditional Part A enrollment for QMB applicants is available year-round. You are not restricted to the standard General Enrollment Period (January 1 through March 31). This matters because the GEP-only restriction would force someone to wait months before they could even apply for Part A — losing hospital coverage the entire time.

No Risk If QMB Is Denied

If DFR denies the QMB application — because your income or assets are too high — the conditional Part A application does not activate Part A, and you are not billed for its premium. If SSA also enrolled you in Part B, that Part B enrollment is not conditional, so its premiums remain your responsibility unless another program pays them.

Late Enrollment Penalties Don't Apply

Normally, enrolling in Part A outside the Initial Enrollment Period triggers a 10% premium penalty for twice the number of years you delayed. The conditional enrollment pathway linked to a QMB application is exempt from these penalties under POMS guidelines.

Who This Applies To

This pathway is most relevant for:

• Seniors who worked fewer than 40 quarters in Social Security-covered jobs
• Spouses of workers who didn't earn 40 credits (and the worker has died or they've divorced after less than 10 years of marriage)
• Legal immigrants who reached 65 without enough U.S. work history
• Former state or local government employees in positions not covered by Social Security

The Indiana Medicare Savings Programs Guide walks through the conditional Part A buy-in process step by step, including what to bring to SSA and how to coordinate the filing with DFR.

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