Qualified Medicare Beneficiaries
(QMBs) without other Medicaid (QMB Only – also known as QMB “partial benefit”) are enrolled in Medicare Part A (or if uninsured for Part A, have filed for premium Part A on a conditional basis), have income up to 100% of the federal poverty level (FPL) and resources that do not exceed three times the limit for supplementary security income (SSI) eligibility with adjustments for inflation, and are not otherwise eligible for full-benefit Medicaid coverage. Medicaid pays their Medicare Part A premiums, if any, and Medicare Part B premiums. Medicare providers may not bill QMBs for Medicare Parts A and B cost sharing amounts, including deductibles, coinsurance and, copays. Providers can bill Medicaid programs for these amounts, but states have the option to reduce or eliminate the state’s Medicare cost sharing payments by adopting policies that limit payment to the lesser of (a) the Medicare cost sharing amount, or (b) the difference between the Medicare payment and the Medicaid rate for the service.