Federal law prohibits all Original Medicare and Medicare Advantage providers and suppliers from billing individuals enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare Part A and Part B cost-sharing under any circumstances. Providers who inappropriately bill individuals enrolled in QMB are violating their Medicare Provider Agreement and may be subject to sanctions.
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.
Also as a reminder:
- 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.