All Medicare physicians, providers, and suppliers who offer services and supplies to Qualified Medicare Beneficiaries (QMBs) must be aware that they may not bill QMBs for Medicare cost-sharing. This includes deductibles, coinsurance, and copayments, known as balance billing.
QMBs have no legal obligation to make further payment to a provider or Medicare-managed care plan for Part A or Part B cost-sharing. Providers who inappropriately bill QMBs for Medicare cost-sharing are subject to sanctions. Please ensure staff is aware of the current policies.
QMBs are persons who are entitled to Medicare Part A and are eligible for Medicare Part B; have incomes below 100 percent of the Federal Poverty Level; and have been determined to be eligible for QMB status by their State Medicaid Agency.
- Medicaid pays the Medicare Part A and B premiums, deductibles, co-insurance and co-payments for QMBs.
- At the State’s discretion, Medicaid also may pay Part C Medicare Advantage premiums for joining a Medicare Advantage plan which covers Medicare Part A and B benefits and Mandatory Supplemental Benefits.
- Regardless of whether the State Medicaid Agency opts to pay the Part C premium, the QMB is not liable for any coinsurance or deductibles for Part C benefits.