Traditional MedicareCoverageMedium impact
Newsletter Vol. 32, No.09
New Jersey Medicaid·NJ·Reimbursement
We identified it
Jun 20, 2026
Summary
Medicare will now cover deductibles, coinsurance, and copayments for Qualified Medicare Beneficiary (QMB) individuals who are not dually-eligible for Medicaid. This affects billing practices for QMB patients where Medicare Part A/Part B cost-sharing obligations must be handled differently.
Action Required
Immediately: Billing team must update patient eligibility verification processes to identify QMB-only status (not dually-eligible). Update billing system to ensure QMB patients who are not dually-eligible have their Medicare deductibles, coinsurance, and copayments properly processed according to new coverage rules. Train front desk staff to distinguish between QMB-only and dually-eligible patients during registration.