Maryland QMB Approved but Still Paying Part B Premium

Why the Premium Keeps Coming Out After Approval

Your parent got the approval letter from Maryland DHS. QMB or SLMB is active. But the next Social Security deposit still shows the $202.90 Part B deduction. Nothing seems to have changed.

This is normal. Three separate federal systems need to update before the premium stops coming out of the Social Security check:

1. Maryland Department of Health submits the state buy-in transaction to CMS through the State Buy-In File Exchange
2. CMS processes the transaction and coordinates the state buy-in with SSA
3. SSA updates its Master Beneficiary Record and stops withholding the premium

This chain takes 60 to 90 days to complete. During that entire window, the Part B premium continues being deducted from Social Security as if nothing happened.

The Refund Comes as a Lump Sum

Once SSA processes the state buy-in, it calculates every Part B premium withheld between the MSP effective date and the date the system actually stopped the deduction. That total comes back as a one-time retroactive payment — either by direct deposit to the same bank account that receives Social Security, or by check.

For QMB: coverage starts the first of the month after the approval decision. The refund covers from that effective date forward.

For SLMB or QI: coverage can be backdated up to three months before the application month. The refund may cover those retroactive months too, making the lump sum larger.

At $202.90/month, a 90-day processing lag means roughly $609 in retroactive reimbursement. If SLMB was backdated three months, the refund could be over $1,000.

What to Do While You Wait

Keep paying any direct Medicare Part B bills. If your parent pays Part B by direct bill rather than Social Security withholding, continue paying during the processing period. Missing a Part B payment can trigger coverage termination — and untangling a termination that happened during a pending buy-in is significantly harder than getting the refund.

Track the timeline. Note the MSP effective date from the approval letter and count forward. If 90 days pass with no change to the Social Security deposit and no refund, it's time to follow up.

Call SSA at 1-800-772-1213 if the premium hasn't stopped after 90 days. Have the MSP approval notice ready. Ask the representative to verify whether the state buy-in record has been received and processed. If SSA hasn't received it, contact Maryland DHS to confirm the state buy-in transaction was submitted to CMS.

Check myMDTHINK to verify that MSP coverage shows as active. An approval that was later reversed (due to missing renewal documentation, for instance) would explain why SSA never received the buy-in.

When Something Goes Wrong

The most common problem isn't a system failure — it's a coverage gap at renewal. If your parent's MSP lapses for even one month because a renewal form wasn't returned on time, SSA restarts the Part B withholding immediately. The premium starts coming out of Social Security again, and getting it stopped requires the state to re-transmit the buy-in after the coverage is reinstated.

Maryland provides a 90-day post-closure reconsideration window for missed renewals. If the renewal packet is returned within 90 days of termination, coverage can be restored retroactively without a new application — and the premium refund process starts over for the gap period.

The Maryland Medicare Savings Programs, Extra Help & SPDAP Guide includes a premium refund tracking worksheet for logging each Social Security deposit and flagging when the deduction should have stopped.

See more Maryland guides →