What is QMB?

The QMB group provides Medicare coverage of Part A and Part B premiums and cost sharing to low-income Medicare beneficiaries (QMBs). In 2023, more than 8 million individuals (more than 1 out of 8 Medicare beneficiaries) were in the QMB group.

It is important to note that Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing individuals in the QMB group for Medicare cost sharing. Medicare beneficiaries enrolled in the QMB group have no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered items and services.

Despite the federal law, those in the QMB group are still wrongly billed and confusion around billing rules continues. As such we want to make sure that we (pharmacy) do not bill for Medicare cost-sharing.