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Home › Paying for Care › QMB Balance Billing: Why a QMB Member Cannot Be Billed for Medicare Cost-Sharing

Paying for Care

QMB Balance Billing: Why a QMB Member Cannot Be Billed for Medicare Cost-Sharing

If you are in QMB, Medicare providers cannot bill you for Medicare deductibles, coinsurance, or copays. Here is the rule, the 2026 QMB limits ($1,350 income, $9,950 resources), and what to do with a wrong bill.

Updated November 5, 2026 · 5-minute read

Key takeaways

  • QMB is a Medicare Savings Program. Your state Medicaid program pays your Part B premium and, if you owe one, your Part A premium. It also covers Medicare deductibles, coinsurance, and copays for you (Ledger J1).
  • The 2026 federal income limit for QMB is $1,350 a month for one person and $1,824 for a couple. The resource limit is $9,950 for one person and $14,910 for a couple (Ledger J1).
  • A Medicare provider cannot bill a QMB member for covered Medicare cost-sharing. That bar covers the deductible, the coinsurance, and copays.
  • A small Medicaid copay may still apply to some services. That copay is set by your state, and it is small by rule.
  • States decide who qualifies, and some states use higher limits. Apply through your state Medicaid office even if you look over the limit (Ledger J note).
  • QMB members also get Extra Help with drug costs, with no separate sign-up.

If you are enrolled in the Qualified Medicare Beneficiary program, called QMB, a bill for a Medicare deductible or copay should stop you cold. Federal rules bar Medicare providers from billing QMB members for Medicare cost-sharing. Yet bills still arrive, often from a billing office that does not know your status. This guide states the rule, shows the 2026 QMB limits, and gives the steps to fix a wrong bill. Our Paying for Care section holds more guides on help with Medicare costs.

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What QMB pays

QMB is the broadest of the Medicare Savings Programs. It pays the Part B premium each month. If you owe a Part A premium, QMB pays that too. Past the premiums, QMB covers the cost-sharing that Medicare leaves to you on covered care. That means the deductible, the 20% share on many Part B services, and set copays are paid by the program, not by you.

Two other programs pay less. SLMB pays the Part B premium only. Its 2026 income limit is $1,616 a month for one person and $2,184 for a couple (Ledger J2). QI also pays the Part B premium only. Its limit is $1,816 for one person and $2,455 for a couple (Ledger J3). Both share the same resource limit as QMB: $9,950 for one person and $14,910 for a couple (Ledger J2, J3). Only QMB carries the no-billing shield, because only QMB covers the cost-sharing itself.

Our guide on checking Medicare Savings Programs and Extra Help walks through all four programs and how to apply.

The no-billing rule

The rule is short. If Medicare covers the service and you are in QMB, the provider must not bill you for the Medicare cost-sharing on it. The provider takes the Medicare payment plus the state payment as the full payment for that cost-sharing. A bill that asks you to pay the deductible or the coinsurance breaks the rule, even if the billing office sent it by habit.

The rule holds for doctors, clinics, hospitals, and other Medicare providers. It holds in Original Medicare. Medicare Advantage plans must also protect QMB members from cost-sharing bills for covered care. If a bill shows up, your QMB status is the fact that ends the talk.

One narrow point stands apart. A state may charge a small Medicaid copay on some care. If your state does, that copay is the only charge of this kind you may owe. It is far below the Medicare cost-sharing it replaces. If a bill is large, it is not that copay.

Why wrong bills still arrive

Most wrong bills are office errors, not bad faith. Your QMB status may not show in the provider's system. The office may bill you the way it bills each other patient. Or the state may not have paid its share yet, and the office turns to you first. None of those reasons makes the bill yours.

Keep each bill you get. Note the date, the service, and the amount. That record helps your state office fix the billing at the source.

Who pays for what

  • Medicare pays its share of each covered service first, as it does for any member.
  • Your state Medicaid program, through QMB, pays your Part B premium and your Medicare cost-sharing on covered care (Ledger J1).
  • A Medicare Advantage plan, if you are in one, must not shift covered cost-sharing to you while you hold QMB status.
  • Medicaid may charge a small copay on some services under state rules. That is the one charge you may still see.
  • Private pay covers care Medicare does not cover at all. The QMB shield guards Medicare cost-sharing. It does not turn a non-covered service into a covered one.

Sample situation

Rosa is in QMB. Her monthly income is $1,200, which sits under the 2026 QMB limit of $1,350 for one person (Ledger J1). After a clinic visit, a bill arrives asking her to pay the Part B cost-sharing for the visit. Rosa calls the clinic and states that she is a QMB member and cannot be billed for Medicare cost-sharing. She also calls her state Medicaid office and reports the bill. The clinic drops the charge. Rosa pays nothing on that bill.

Steps if you get a bill as a QMB member

  • Do not pay the bill while you check it. Paying first makes the fix slower.
  • Find your QMB proof. Your state notice or your Medicare card record shows your status and its start date.
  • Call the billing office. Say you are a QMB member, give the start date, and ask the office to drop the cost-sharing charge.
  • If the office will not drop it, call your state Medicaid office and report the bill. The state can contact the provider.
  • If bills keep coming, ask your state health insurance help line to step in. The help is free.
  • If you paid a wrong bill in the past, ask the provider for a refund and tell your state office what you paid.

If you think you may qualify

Look at the limits with care. The 2026 QMB limits are $1,350 a month in income and $9,950 in resources for one person (Ledger J1). Counted resources are cash, bank funds, and stocks or bonds. Your home, one car, a burial plot, and funds set aside for burial up to a set amount do not count. Limits are higher in Alaska and Hawaii. Some states use higher limits or skip the resource test. Apply through your state Medicaid office even if you think you are over. The state, not a guess, makes the call.

Our guide on how to compare Part D plans by total yearly cost shows how QMB and Extra Help status can cut drug costs as well.

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