Qualified Medicare Beneficiary (QMB)

QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing. In 2015, more than one out of every ten Medicare beneficiaries were enrolled in the QMB program. Patients must apply and be accepted into the program.

Doctors should not collect the Medicare deductibles, coinsurance, or copayments from a QMB eligible patient under any circumstances.

If a patient is QMB eligible it will be reflected on the Remittance Advice with new Claim Adjustment Reason Codes (CARC).

Complete details and specifics may be found by clicking these links:

Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service
Claims Processing System

Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified
Medicare Beneficiary (QMB) Program