Qualified Medicare Beneficiary (QMB) Program


We welcomed public comments on the State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) Draft through February 29, 2020. We are reviewing those comments currently. More information is available (State Payment of Medicare Premiums page).

What is the QMB Program?

People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. In 2017, 7.7 million people (more than one out of eight people with Medicare) were in the QMB program.

What are the Billing Requirements Affecting People in the QMB Program?

Medicare providers and suppliers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Under some circumstances, federal law lets states limit how much they pay providers for Medicare cost-sharing. Even when that's the case, people in the QMB program have no legal obligation to pay Medicare providers for Medicare Part A or Part B cost-sharing.

Despite these billing rules, our July 2015 study ("Access to Care Issues Among QMBs") (PDF) found that those in the QMB program are still being wrongly billed and that confusion about billing rules continues. We're sharing this information to help you understand the QMB program and its billing rules. 

Additional Information for Medicare Providers & Suppliers

 Additional Information for Medicare Advantage Plans

 Additional Information to Share with People with Medicare & their Advocates

 Additional Information for States

 Additional Resources

Page Last Modified:
05/18/2020 07:23 AM