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The Qualified Medicare Beneficiary (QMB) Program is a State Medicaid
benefit that pays Medicare premiums and cost-sharing for certain low-income
Medicare beneficiaries. For enrollees who are eligible for both Medicare and
Medicaid, you may bill the State for applicable Medicare cost-sharing. However,
such payments are subject to individual State payment limits.
Federal law states that Medicare providers may not collect Medicare Part A
and Medicare Part B cost-sharing (i.e., copayments, coinsurance, or
deductibles) from those enrolled in the QMB program, regardless of whether the
State reimburses the provider in full for the cost-sharing. Therefore, we would
like to remind you that when billing Independence for services rendered to
these members, you must accept our reimbursement, according to your Agreement
with Independence, as payment in full. All Original Medicare and Medicare
Advantage providers ? not only those that accept Medicaid ? must abide by these
billing prohibitions. Medicare providers who do not follow these billing
prohibitions may be violating their Medicare Provider Agreement and may be
subject to sanctions.
In addition, providers are reminded that discrimination against
beneficiaries based on their payment status is prohibited.
To learn more, read the Prohibition on Balance Billing Dually Eligible Individuals
Enrolled in the QMB Program article on the Centers for Medicare &
Medicaid Services' website.
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