The Qualified Medicare Beneficiary Program, also referred to as the QMB Program, helps Medicare recipients who have lower incomes to cover the costs of all of their premiums, deductibles, and copayments.
The Qualified Medicare Beneficiary Program Explained
Participants of the Medicare QMB Program can receive money from their states to help them cover Medicare premiums.
To enroll, program participants must meet particular eligibility criteria, including:·
- Participants must be enrolled in Medicaid
- Participants must be eligible for Part A
- The participant’s monthly income must be at or below 100% of the annual federal poverty level.
What is the Income Limit for the QMB Program
For 2019, the federal poverty level for an individual is $12,490. In 2019, an individual monthly income limit of $1,060 applies.
The income guidelines for the QMB Program change on April 1st of each year.
The QMB Program provides Medicare participants with a number of benefits that make it easier to cover their financial obligations that Medicare doesn’t cover.
The QMB Program helps to cover:
- Part A monthly premiums, co-insurance, and deductibles for services that are covered
- Part B monthly premiums, co-insurance, and deductibles for services that are covered
In 2016, over 7.5 million people with Medicare were also enrolled in the QMB Program.
Enrolling in the QMB Program
In order to enroll in the QMB Program, start by calling your state Medicare program to find out if you qualify for the QMB Program.
You will also need to fill out an application to start the process of applying for the QMB Program. Be sure to visit Medicare.gov for the QMB application.
Billing Requirements for the QMB Program
Medicare providers and suppliers are not permitted to bill people enrolled in the QMB program for items such as Medicare copays, deductibles, or coinsurance. Instead, state Medicaid programs cover those costs.
In some cases, states are permitted to limit how much they pay providers for Medicare cost-sharing under federal law.
Even when states limit how much they will pay providers, QMB participants still are not legally obligated to pay Medicare providers for the costs incurred under Part A or Part B.
Unfortunately, there is still plenty of confusion around billing and the QMB program. This means that program participants are sometimes wrongly billed.
The below information is important when understanding the QMB Program’s billing rules
- October 2, 2017 – Medicare RA’s started to identify QMB status and identified their zero liability for cost-sharing. See MM9911 and MB RA Issue for additional information.
- December 8, 2017 – Because of unforeseen problems that affected the processing of QMB claims, the Centers for Medicare & Medicaid Services temporarily suspended systematic changes.
- March 2018 – Medicare Administrative Contractors started to issue replacement Medicare RA’s for claims that had not been voided or replaced. These claims were from the period after October 2, 2017, and up to December 31, 2017. See MM10494 for additional information.
- July 2018 – The Centers for Medicare & Medicaid Services will reintroduce information about the QMB Program in the Medicare RA. See MM10433 for additional information.
- June 2019 – CMS will further modify the Medicare Summary Notice (MSN) for QMBs to reflect zero cost-sharing liability only for paid claims, not for claims that are denied. (MM11230)
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