Qualified Medicare Beneficiary (QMB) Program

SPOTLIGHT & RELEASES

 

 

The Qualified Medicare Beneficiary (QMB) program provides Medicare coverage of Part A and Part B premiums and cost sharing to low-income Medicare beneficiaries. In 2017, 7.7 million people (more than one out of eight people with Medicare) were in the QMB program.

Billing Protections for QMBs

Federal law forbids Medicare providers and suppliers, including pharmacies, from billing people in the QMB program for Medicare cost sharing. Medicare beneficiaries enrolled in the QMB program have no legal obligation to pay Medicare Part A or Part B deductibles, coinsurance, or copays for any Medicare-covered items and services.

Despite the federal law, our July 2015 study ("Access to Care Issues Among QMBs") (PDF) found that those in the QMB program were still being wrongly billed and that confusion about billing rules continued. We have taken several steps since to help Medicare providers and beneficiaries better understand the QMB protections, including through many of the resources below. 

Information for Medicare Providers & Suppliers

Information for Medicare Advantage Plans

Information for Medicare Beneficiaries & their Advocates

Information for States

Page Last Modified:
12/17/2020 06:59 AM