QMB Program Helps Medicare Beneficiaries With Limited Income Pay For Services


young woman helping male senior citizen with computer

Social workers who work with clients in the Qualified Medicare Beneficiary Program have a tool available at NASW.

The document, “Qualified Medicare Beneficiary Program: Billing Guidelines for Clinical Social Workers,” is in response to member inquiries and provides guidance and resources for clinical social workers working with QMB beneficiaries.

The QMB program is a federal- and state-funded program administered by the Centers for Medicare & Medicaid Services. It helps individuals who are Medicare beneficiaries pay for their Medicare Part A and B premiums, deductibles, co-payments, and co-insurance. To be eligible, individuals must meet specific income and resource requirements, which may vary depending upon the state, Johnson notes.

The program is designed to ensure that Medicare beneficiaries who have limited income and assets do not have to pay out-of-pocket costs for their Medicare-covered services.

Clinical social workers should have a routine process for identifying beneficiaries with QMB before rendering services. Providers can use the Medicare 270/271 HIPAA Eligibility Transaction System and the Medicare Remittance Advice to determine if a beneficiary has QMB and does not owe any Medicare cost-sharing.

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