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Last Modified: 5/3/2020 Location: FL, PR, USVI Business: Part A, Part B

Why can’t I locate the deductible information when checking a patient’s eligibility?

If the beneficiary is enrolled as a Qualified Medicare Beneficiary (QMB), deductible information may not be available at the time of the query.
HETS (HIPAA Eligibility Transaction System) indicates periods during which the beneficiary is enrolled as a QMB, and will indicate the beneficiary owes $0 for Medicare Part A and B deductibles, coinsurance or copayments. Note: This information will be displayed under the QMB tab within SPOT.
QMB beneficiaries have no legal liability to pay Medicare providers for Medicare Part A or Part B cost-sharing. For these beneficiaries, providers may bill state Medicaid agencies which are responsible for covering Medicare cost-sharing, though the beneficiary may also have other secondary payers (e.g., VA, tribes, Medigap).
Please refer to MLN ICN 006977 external pdf file, SE1128 external pdf file, and MM9911 external pdf file for more information.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.