QMB Members Exempt From Part A/B Cost-Sharing

The Qualified Medicare Beneficiary (QMB) program put in place by the Centers for Medicare and Medicaid Services (CMS) assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost-sharing, including deductibles, coinsurance and copayments. As a reminder, under the QMB program enrollees are exempt from cost-sharing liability, so all providers are prohibited from charging QMB members for Medicare cost-sharing for covered Parts A and B services.

Identifying Members With QMB status

CMS’s HIPAA Eligibility Transaction System (HETS) provides Medicare eligibility data to providers and their authorized billing agents (including clearinghouses and third-party vendors) to help verify a patient’s QMB status and exemption from cost-sharing charges. Contact your third-party eligibility verification vendor to ask how their products reflect the new QMB information from HETS.

The Explanations of Payment that CarePartners of Connecticut sends to providers include an alert that the notice may contain claims covered by the QMB program and reminding providers to review their records for any wrongfully collected cost-sharing, which may be billed to a subsequent payer.

For more detailed information about CMS’s QMB program, please refer to this document from the Medicare Learning Network.