California Simplifies Medicare Enrollment for Low-Income Adults: Governor Signs SB 311 for Part A Buy-In

Part A Buy-In, grandma, daughter and grandchild smiling outside

In October, Governor Newsom signed SB 311 (Eggman), legislation which will simplify Medicare enrollment for low-income adults and make California a Part A Buy-In State. Becoming a “Part A Buy-In State” means California will be able to automatically enroll eligible individuals into Medicare Part A anytime during the year and eliminate the current cumbersome, time-limited two-step application process involving Social Security and one’s county Medi-Cal office.

This is a great win for low-income older Californians and persons with disabilities who rely on Medicare and Medi-Cal for health coverage but don’t qualify for free Medicare Part A. Without free Part A, the monthly premiums are prohibitively expensive – between $278 to $505 a month in 2024. Most people qualify for free Part A if they or a spouse has 40 Social Security work credits (or 10 years of work history). Yet, those who don’t meet these requirements and can’t afford the high Part A premiums have typically worked in low-wage jobs in the informal economy, were prevented from joining the workforce due to caregiving needs or discrimination, or are older immigrants, many of whom have limited proficiency in English. Many older adults leaving incarceration and returning to the community are also affected.

These beneficiaries who struggle to pay costly Medicare Part A premiums often can qualify for the Qualified Medicare Beneficiary (QMB) program which pays for both Medicare Part A and B premiums, deductibles and co-insurance. Yet the enrollment process for QMB for those who don’t qualify for free Part A is a hard-to-navigate multi-step process and limited to only three months per year (January – March). This leads to many beneficiaries who would otherwise qualify for QMB – especially those with limited English proficiency and/or disabilities, to fall through the cracks and go without coverage, and costs the state more in health care costs. Currently, California is only one of 14 states who do not have Part A Buy-In.

Yet, thanks to the Governor signing SB 311, as of January 1, 2025, California will join the other 36 states nationwide in becoming a Part A Buy-In State, allowing low-income beneficiaries without Part A a one-step process to enroll in QMB and Medicare at the same time any time of the year. California’s Department of Health Care Services will use a State Plan Amendment (SPA) allowing it to be able to directly enroll individuals into Part A at any time of year, thus bypassing the SSA enrollment process entirely.

We are thrilled that SB 311 was signed in to law and California is on it’s way to officially becoming a Part A Buy-In State. It is something we and advocates across the state have invested decades advocating for. Simplifying enrollment into Part A and QMB reduces inequities and provides much needed financial relief to low-income older adults, particularly women, people of color, those with disabilities, immigrants and formerly incarcerated older adults.

Read our support letter submitted last March for more details.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.