Qualified Medicare Beneficiary 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 3
for instructions on providing ABNs for a beneficiary enrolled in the QMB program.
Determining if Your Beneficiary Is Enrolled in QMB
- Check the Eligibility screen in the myCGS Web Portal.
- Check the CMS HIPAA Eligibility Transaction System (HETS)
system. - Ask the beneficiary for proof, such as their Medicaid identification card, Medicare Summary Notices (MSNs), or other QMB status documentation.
- Review the Medicare Remittance Advice and Medicare Summary Notice (MSN)
messages. MLN Matters Article 11230 Medicare Summary Notice Changes to Assist Beneficiaries Enrolled in the QMB Program
explains how to identify QMBs status in these messages.
Resources
- myCGS User Manual
- myCGS Registration and Account Management Guide
- CMS Qualified Medicare (QMB) Program Group Web page

Updated: 10.30.2025

