A. Benefits for MCSP
QMB pays the Medicare premiums for Part A (if applicable), the premiums for Part B and the deductibles and co-payment amounts for Part A and Part B Medicare-covered services. If an individual who meets all the criteria for QMB coverage, they must pay a premium to receive Part A Medicare, call the OEP Medicaid Program Specialist. Payment of a Part A Medicare premium is not automatic.
B. Benefits for Medicare Part B-ID MCSP
QMB pays the Medicare premiums for Part B-ID which will reduce the deductibles and co-payment amount for immunosuppressant drugs only through Medicare.
C. QMB and Other Medicaid Programs
QMB members may be eligible for other Medicaid programs. If member is eligible for other Medicaid Programs, they are not eligible for the Medicare Part B-ID MCSP.
D. TPL
TPL process is required (225).
E. Effective Date
The effective date for QMB coverage is the first of the month after the month you determine the member meets all of the criteria for QMB. The member must meet all QMB eligibility criteria in the month before the month you begin QMB coverage. In addition, the member must still meet all the criteria the month you authorize coverage to begin. The member must be entitled to Medicare Part A benefits for at least one month before QMB coverage begins. There is no retroactive coverage.
F. Effective Date for Medicare Part B-ID MCSP
The effective date for QMB coverage is the first of the month of the application month. There is no retroactive coverage.