Patient Responsibility

The QMB program is a State Medicaid benefit that covers Medicare deductibles, coinsurance, and copayments, subject to State payment limits. (States may limit their liability to providers for Medicare deductibles, coinsurance and copayments under certain circumstances.)

Resources

• MLN Matters® Article SE1128 (PDF) — Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program
• CMS MLN Fact Sheet — Beneficiaries Dually Eligible for Medicare & Medicaid

Last Reviewed: 3/20/2024

Medicare providers must accept the Medicare payment and Medicaid payment (if any) as payment in full for services rendered to a QMB beneficiary. Providers can’t charge patients enrolled in the QMB program for Medicare Part A or B deductibles, coinsurances, or copays for items and services Medicare covers. Medicare providers who violate these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions.

Resource: MLN Matters® Article SE1128 (PDF) — Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program.

Last Reviewed: 3/20/2024