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Qualified Medicare Beneficiaries’ Cost Sharing Responsibilities

According to the Centers for Medicare & Medicaid Services (CMS) guidelines, Qualified Medicare Beneficiaries (QMB) program members are not responsible for copayments or other cost sharing for Medicare-covered services and items. These enrollees include members who are enrolled in both a Horizon BCBSNJ Medicare Advantage (MA) plan and the New Jersey state Medicaid program.

You may bill the appropriate state source for those amounts. We encourage you to establish processes to identify the Medicaid status of your Horizon BCBSNJ MA plan or Medicare patients prior to billing for items and services.

For more information, please review the CMS February 2017 Medicare Learning Network (MLN) booklet, Dual Eligible Beneficiaries under the Medicare and Medicaid Programs.

Published on: January 2, 2018, 13:01 p.m. ET
Last updated on: January 2, 2018, 13:02 p.m. ET