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Qualified Medicare Beneficiary Fact Sheet

Fact Sheet

What is the Qualified Medicare Beneficiary (QMB) program?

The QMB program is a state Medicaid benefit. Beneficiaries enroll in the QMB Program through their state. It assists low-income Medicare beneficiaries with Medicare premiums and cost-sharing.

Billing for QMB Beneficiaries

Federal law prohibits suppliers and providers from billing beneficiaries in the QMB eligibility group for Medicare Part A or B cost-sharing including:

  • Deductibles
  • Coinsurance
  • Copays

Regardless of participation status, suppliers must accept assignment on all claims for services provided to beneficiaries enrolled in the QMB program.

Advance Beneficiary Notices (ABNs) for QMB Beneficiaries

Special instructions apply when providing an ABN to a beneficiary enrolled in the QMB Program. See Section 50 of the CMS Internet-Only Manual, Pub. 100-04, Chapter 3External PDF for instructions on providing ABNs for a beneficiary enrolled in the QMB program.

Determining if Your Beneficiary Is Enrolled in QMB

Resources

Updated: 10.30.2025

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