QMB-only Medicare recipients

QMB-only and QMB Medicare/Medicaid recipients - what is the differnent

QMB-only Medicare recipients

QMB-only Medicare recipients are identified as QMB ONLY by using the Provider Electronic Solutions software, AVRS (Automated Voice Response System) or the Provider Assistance Center.

These recipients are eligible only for crossover services and ARE NOT eligible for Medicaid only services. That is, if Medicare covers the service, Medicaid will consider for payment the deductible and/or co-insurance. Premiums and copayment will be considered for payment if the individual is enrolled in a Medicare Advantage Plan.

Category 2 QMB Medicare/Medicaid recipients

QMB Medicare/Medicaid recipients are identified as having Medicaid and QMB (QMB+) when eligibility is verified through the Provider Electronic Solutions software, AVRS, or the Provider Assistance Center.

These recipients are eligible for the same benefits as QMBonly recipients (category 1) and Medicaid/Medicare recipients (category 3).

Category 3 Medicare/Medicaid recipients

Medicare/Medicaid recipients who do not qualify as QMB are identified as having part ‘A’, ‘B’, or ‘A & B’ when their eligibility is verified through the Provider Electronic Solutions software, AVRS, or the Provider Assistance Center.

Medicare-related claims for Medicare/Medicaid recipients will be paid only if the services are covered under the Alabama Medicaid Program.