Iowa Admin. Code r. 441-78.58

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-78.58 - Qualified Medicare beneficiary (QMB) provider services

(1)Payment. Payment will be made to QMB providers for a QMB-eligible member's coinsurance, copayment, and deductible for Medicare-covered services. The eligible member may be responsible for copayments pursuant to 441-subrule 79.1(13).

(2)Definitions.

"Coinsurance" means a percentage of costs of a covered health care service that has to be paid.

"Copayment" means a fixed amount a member pays for a covered health care service.

"Deductible" means the amount paid for covered health care services before the insurance plan will effect payment.

"Medicare cost sharing" means the Medicare member's responsibility for a Medicare-covered service. "Medicare cost sharing" includes coinsurance, copayments, and deductibles.

"Qualified Medicare beneficiary" or "QMB" means an individual who has been determined eligible for the QMB program pursuant to 441-subrule 75.1(29). Under the QMB program, Medicaid pays the individual's Medicare Part A and B premiums; coinsurance; copayment; and deductible (except for Part D).

This rule is intended to implement Iowa Code section 249A.4.

Iowa Admin. Code r. 441-78.58

Adopted by IAB December 6, 2017/Volume XL, Number 12, effective 1/10/2018