Part A Buy-in agreements are contracts between state Medicaid offices and the Social Security Administration that allow eligible individuals with very low incomes and limited assets to enroll in Medicare outside of standard enrollment periods. Not only are Buy-in agreements helpful to beneficiaries who might otherwise face higher costs and gaps in coverage, they reduce state Medicaid costs, decrease costly reliance on emergency room care, and minimize future medical expenses by ensuring that those eligible for Medicare are enrolled in the program. Congress should require all states to enter into Part A Buy-in agreements.