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Providers are Prohibited from “Balance Billing” Patients Enrolled in the QMB Program

Feb 11, 2016

The Qualified Medicare Beneficiary (QMB) Program is a state Medicaid benefit that covers Medicare deductibles, coinsurance, and copayments, subject to state payment limits (states may limit their liability to providers for Medicare deductibles, coinsurance, and copayments under certain circumstances).

Medicare providers may not balance bill QMB individuals for Medicare cost sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers—not only those that accept Medicaid—must refrain from charging QMB individuals for Medicare cost sharing. Providers who inappropriately balance bill QMB individuals are subject to sanctions. For additional information, please see the revised Med Learn Matters Article.