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In the summer of 2009, HAP began following a persistent issue affecting access to care for beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program. SHIPs in a number of states reported that their QMB clients in both Original Medicare (OM) and Medicare Advantage (MA) plans were being improperly billed for Medicare cost-sharing amounts by health care providers, even though beneficiaries in the QMB program are entitled to full relief from Medicare cost-sharing under the law. The feedback provided by the SHIP network reinforced the pervasive and complex nature of the issue, and how much it varied from state-to-state.

HAP has developed two toolkits to help SHIP counselors troubleshoot the issue on behalf of people enrolled in the QMB program: the Counselor Toolkit, full of practical scenarios to help counsel QMB clients on their rights and benefits under the QMB program, and the soon-to-be-released Policymaker Toolkit, to help SHIP counselors bring the issue to the attention of policy makers and other influential audiences in their states.    

The QMB Counselor Toolkit is made up of counselor-friendly resources on the QMB & Medicare cost-sharing issue, including background information, glossary of key terms, as well as handouts for QMB clients. The resources are geared to help counselors explain the scope of the issue to QMB clients and provide counseling on how to troubleshoot the problems either within Original Medicare or Medicare Advantage.

What SHIPs Can Do: Education and Training Tools

Putting It into Practice: Tools to Help QMB Clients


  • Tool — Getting Started: What SHIPs Need to Know
  • Tool — Moving Forward: A Guide to CMS Policy on Cost-Sharing for Qualified Medicare Beneficiaries
  • Key Terms — QMB and Medicare Cost-Sharing
  • Conference Call — Counseling QMB Clients: A Walk through HAP's QMB Toolkit
  • Conference Call — More Strategies and Tools to Help QMB Clients
  • Conference Call — Strategies and Tools to Help Your QMB Clients


Coming Soon!

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