Individuals may qualify for the following benefits, as outlined in the chart below:

• Medicare benefits and NH Medicaid benefits
• QMB Medicare benefits and NH Medicaid benefits (QMB-Plus)
• QMB-only benefits without NH Medicaid benefits

Medicare & NH Medicaid Benefits (no QMB eligibility)

The NH Medicaid Program pays coinsurance and deductible on Medicare crossover claims for services that are both Medicare and Medicaid benefits and pays for all regular Medicaid Program benefits not covered by Medicare.

QMB & NH Medicaid Benefits (QMB-Plus)

The NH Medicaid Program pays coinsurance and deductible on Medicare crossover claims for services that are both Medicare and Medicaid benefits and pays for all regular Medicaid Program benefits not covered by Medicare.

The NH Medicaid Program also pays the monthly Medicare premiums for the Medicare beneficiary.

QMB-only Benefits

The NH Medicaid Program pays monthly Medicare premiums, coinsurance and deductibles on crossover claims for Medicare covered benefits.

• There is no coverage for NH Medicaid Program benefits that are not covered by Medicare.
• QMB-only clients may not be billed for crossover balances (i.e., the costs remaining for a Medicare covered service after Medicare makes a payment).
• QMB-only members are financially responsible for services that are not covered by Medicare.

Reference

New Hampshire Medicaid

General Billing Manual § 13.1