May 13, 2010
New QMB and Medicare Cost-sharing Tools for SHIPs
Since early last year, HAP has been closely following an important and persistent access to care issue affecting people enrolled in the Qualified Medicare Beneficiary (QMB) program as part of its Troubleshooting Medicare project. SHIPs in a number of states reported that their QMB clients in both Original Medicare and Medicare Advantage (MA) plans were being improperly billed for Medicare cost-sharing by health care providers even though QMB enrollees are entitled to full relief from these amounts, including co-insurance and co-payments, under the law.
In response, HAP developed and released education and counseling tools for SHIPs, and launched a series of national and in-person trainings to help SHIPs better assist their QMB clients.
We also began advocacy on the underlying systemic issue with Congress and the Centers for Medicare & Medicaid Services (CMS) on the need for better coordination between Medicare and Medicaid in addressing the access to care needs of low-income people.
We’re excited to once again share new tools – one from CMS, and two from HAP – to support your advocacy efforts to protect the rights of your QMB clients:
- Recently released by CMS, a fact sheet for health care providers on dual-eligibles, including the QMB benefit, as part of its Medicare Learning Network (MLN) series.
- A model provider letter for SHIPs to customize and use when seeking reimbursements from providers for inappropriate Medicare cost-sharing amounts.
- A PowerPoint presentation for SHIPs to customize and use as a training tool to help counselors better understand the issue and assist QMB clients. The presentation is intended as a training companion to HAP’s Counselor Toolkit and other resources on the QMB and Medicare cost-sharing issue. It can also be used to help raise awareness about the QMB and Medicare cost-sharing issue in the community, or as a public education tool to help coordinate efforts with key stakeholders at the state or regional level.
