Medicaid Policy
Medicaid Policy
A. QMB for Medicare Parts A and B
The benefits for QMB pays Medicare premiums for Part A (if applicable), premiums for Part B and deductibles and co-payment amounts for Part A and Part B Medicare-covered services. If an individual meets all the criteria for QMB coverage and they pay a premium to receive Part A Medicare, call the OEP Medicaid Program Specialist. Payment of a Part A Medicare premium is not automatic.
QMB members may be eligible for other Medicaid programs (except AEM or TAM).
The TPL process is required (225).
The effective date for QMB coverage is the first of the month after the month it is determined the member meets all the eligibility criteria for QMB. The member must also continue to meet all the same criteria in the month coverage begins.
The member must be entitled to Medicare Part A benefits for at least one month before QMB coverage begins.
There is no retroactive coverage. Coverage cannot begin in any month prior to or in the same month the case is processed.
B. QMB for Medicare Part B-ID
The benefits for QMB pays the Medicare premiums for Part B-ID which reduces the deductibles and co-payment amount for immunosuppressant drugs only through Medicare.
If a QMB member is eligible for other Medicaid programs, Marketplace insurance or, employer insurances that cover immunosuppressant drugs are not eligible for the QMB Part B-ID program.
The TPL process is required (225).
The effective date for QMB coverage is the first of the month after the month it is determined the member meets all the eligibility criteria for QMB. The member must also continue to meet all the same eligibility criteria in the month coverage begins.
There is not retroactive coverage. Coverage cannot begin in any month prior to or in the same month the case is procesed.