New Hampshire Medicare Part A Buy-In: How QMB Covers the Premium
The Part A Premium Problem
Most people get Medicare Part A premium-free because they or a spouse paid into Medicare through payroll taxes for at least 40 quarters (10 years). But people who didn't — immigrants who worked abroad for most of their career, homemakers whose spouse died before reaching 40 quarters, or people who worked in jobs not covered by Medicare — face a monthly Part A premium of up to $565 in 2026.
That's $6,780 a year on top of the Part B premium, just for hospital coverage. Without Part A, a hospital stay would be entirely out of pocket.
New Hampshire's Buy-In Advantage
New Hampshire is classified as a Part A Buy-In State under its Section 1843 agreement with the federal government. This designation creates a major advantage for low-income residents who need premium Part A.
In states without buy-in agreements (called Group Payer States), a person who needs premium Part A can only enroll during the General Enrollment Period (January 1 through March 31). Coverage starts July 1, and they're personally responsible for the premium if their QMB application is denied.
In New Hampshire, the process works differently through conditional enrollment, governed by SSA POMS HI 00801.140:
- Apply at any SSA office, any time of year. No waiting for the January–March enrollment window.
- SSA creates a conditional Part A record — no premium bill is generated.
- Bring the SSA confirmation to DHHS with your Form 800 application for QMB.
- If DHHS approves QMB, the state pays the Part A premium directly. The conditional record converts to active Part A entitlement.
The person never receives a premium bill and never faces personal financial liability for the Part A cost.
How to Talk to SSA About It
Social Security field office staff don't always process conditional Part A enrollments — it's an uncommon procedure. Using the right administrative language helps. At the SSA office, ask for:
"A conditional application for Premium Part A under POMS HI 00801.140. New Hampshire is a Part A Buy-In State, and we're applying for QMB through NH DHHS."
SSA should process the conditional enrollment and provide a receipt or confirmation document. Bring that document directly to DHHS with the rest of the MSP application paperwork.
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QMB Covers Both Premiums
Once approved, QMB doesn't just cover the Part A premium. It also pays:
- Part B premium ($202.90/month)
- Part A hospital deductible ($1,736)
- Part B annual deductible ($283)
- All Medicare coinsurance and copays
For someone who would otherwise owe $565 for Part A plus $202.90 for Part B — $767.90 a month — QMB approval eliminates the entire premium burden plus all out-of-pocket costs for Medicare-covered services.
Who This Applies To
Conditional Part A enrollment through buy-in is specifically for people age 65 or older who lack 40 quarters of Medicare-covered employment. It's a narrow but important group: late immigrants, people who spent careers in non-covered government jobs (though this is less common since most government employees are now covered), and surviving spouses who lost eligibility when a spouse died.
People under 65 who qualify for Medicare through SSDI already have premium-free Part A after the 24-month waiting period. The buy-in pathway doesn't apply to them.
Our New Hampshire Medicare Savings Programs & Extra Help Guide includes the exact script for SSA and DHHS, a conditional enrollment tracking checklist, and a timeline showing how the buy-in activation flows between the three agencies.
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