What rules protect Qualified Medicare Beneficiaries (QMBs) from bills for Medicare cost-sharing charges?
According to Title 42 of the United States Code, section 1396a (n), neither providers nor Medicare Advantage (MA) plans can bill Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing. Therefore, providers cannot balance bill QMBs for any Original Medicare deductibles and coinsurance charges or for MA plan copayments for office visits, consultations with specialists, and Durable Medical Equipment (DME). QMBs are not liable under Medicare law to pay providers for these charges. In addition, states do not need to have a special agreement, or contract, in place for the provider to bill Medicaid on a QMB-eligible patient’s behalf. This includes providers both in Original Medicare and Medicare Advantage (MA). Some MA plans may have a contract to bill the state, and those that do usually process claims more smoothly. However, the provider does need a contract to bill the state for a QMB’s copayments but the simple act of submitting the bill to the state by the provider creates an
