Traditional MedicareReimbursementMedium impact
Medicare Co-payments for Qualified Medicare Beneficiaries
Illinois Medicaid - HFS·IL · Geriatrics·Provider Notice
Effective date
Oct 1, 2005
We identified it
Jun 21, 2026
Summary
Medicare coinsurance for Qualified Medicare Beneficiaries (QMB) is now calculated based on actual Medicare payment amounts rather than per diem rates, effective October 1, 2005. QMB residents in long-term care facilities cannot be required to apply their income toward care costs during Medicare coverage periods.
Action Required
Immediately: Billing teams at long-term care facilities must verify QMB status for Medicare residents and ensure QMB residents are not billed for any portion of their income during Medicare coverage periods. Update billing procedures to calculate Medicare coinsurance based on actual Medicare payment amounts rather than per diem rates. Contact Bureau of Long Term Care at 217-782-0545 for questions.