Traditional MedicareAdministrativeMedium impact
Reminder: QMB members exempt from Part A/B cost-sharing
Harvard Pilgrim Health Care·Provider Newsletter
We identified it
Jun 20, 2026
Summary
This is a reminder that Qualified Medicare Beneficiary (QMB) program enrollees are exempt from all Medicare Part A and Part B cost-sharing including deductibles, coinsurance, and copayments. Providers are prohibited from charging QMB members for any Medicare cost-sharing and must verify QMB status through HETS or Point32Health's Explanations of Payment.
Action Required
Immediately: Billing team must contact third-party eligibility verification vendor to confirm how their products reflect QMB information from HETS. Review Point32Health Explanations of Payment for QMB alerts and check records for any wrongfully collected cost-sharing from QMB members, which may be billed to a subsequent payer. Update billing procedures to verify QMB status before collecting any Part A/B cost-sharing.