Description of QMB
Qualified Medicare Beneficiary (QMB) entitles low-income individuals to have Medicaid pay for their Medicare premiums, deductibles and coinsurance. An individual can have QMB only coverage or QMB coverage and full Medicaid coverage. Recipients who are only eligible for QMB coverage are not eligible
for any other Medicaid benefits.
QMB Eligibility
Qualified Medicare Beneficiary eligibility is determined by the Department of
Children and Families. A recipient must have Medicare coverage in order to qualify for QMB coverage.
QMB Program Codes
Medicaid recipients eligible for the QMB program are assigned the following program codes.
These program codes indicate that the recipient is a QMB and is not eligible for Medicaid services except for reimbursement of Medicare premiums,deductibles and coinsurance:
• QMB
• QMBR
These program codes plus Medicare coverage indicate that the recipient has full Medicaid benefits and is also QMB eligible:
• MS
• MM S
• MI M
• MI S
Prohibition on Provider’s Billing
Providers may not bill recipients who are eligible as a QMB only or Medicaid and QMB for the Medicare coinsurance or deductible.
Summary
Qualified Medicare beneficiary program (QMB) is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing. Medicare providers from charging individuals enrolled in the QMB for Medicare Part A and B deductibles, coinsurances, or copays.
