This is a reminder to our Medicare Advantage providers about the proper treatment and billing of patients who are eligible for both Medicare and Medicaid and designated as Qualified Medicare Beneficiaries (QMBs):
- Our contracts require all our Medicare providers to see all our Medicare Advantage members, including those who are eligible for both Medicare and Medicaid (often called "dual eligible").
- The Centers for Medicare & Medicaid Services (CMS) forbids Medicare providers from discriminating against patients based on "source of payment," which means providers cannot refuse to serve members because they receive assistance with Medicare cost-sharing from a State Medicaid program.
- Federal law prohibits balance billing of these QMBs or dual eligible patients for any Medicare cost-share, including deductibles, coinsurance and copayments.
This applies to all Medicare providers, regardless of whether they accept Medicaid.
The QMB program is a Medicaid program that exempts Medicare beneficiaries from having to pay their Medicare cost-shares. If providers want to get paid a patient's cost-share, the bill of service may be submitted to Medicaid for reimbursement.
For more information, check out this Medicare Learning Network resource.
