Stop! Don’t Pay That Medicare  20% Balance Bill If You’re a QMB

How QMB Beneficiaries Are Still Getting Charged for Services They Shouldn’t Have to Pay For

If you or someone you love is enrolled in the Qualified Medicare Beneficiary (QMB) program, here’s something you should know — you are legally protected from paying any out-of‑pocket costs for Medicare Part A or Part B services: no deductibles, no copays, no 20% coinsurance. Yet despite this federal rule, too many QMB recipients are still getting billed — and paying.

What Is QMB and What Does It Cover?

The QMB program is part of Medicaid’s Medicare Savings Programs. It helps low‑income Medicare recipients by:

• Paying Medicare Part A premiums
• Paying Medicare Part B premiums
• Protecting them from liability for Medicare deductibles, coinsurance, and copayments

Importantly, Medicaid does not pay those cost‑sharing amounts to providers. Instead, federal law prohibits providers from billing QMB recipients for them — providers must accept the Medicare payment as full payment and write off any remainder.

This protection applies whether you are enrolled in Original Medicare or a Medicare Advantage plan.

The Law Is Clear: You Don’t Owe It

Under Sections 1902(n)(3)(B) and 1866(a)(1)(A) of the Social Security Act, providers who accept Medicare cannot bill QMB recipients for any Medicare cost‑sharing, regardless of whether Medicaid pays anything. This includes:

• Part B 20% coinsurance
• Part A hospital deductible
• Other Medicare copays or fees

Even if Medicaid pays nothing, providers must accept Medicare’s payment in full — and cannot send you a bill for the rest.

But the Billing Still Happens — A Lot

A national CMS study found nearly 45% of QMB beneficiaries were improperly billed at least once — and about one‑third actually paid those bills.

From my own practice, I’ve worked with many clients who are QMB recipients and were still getting billed for the Part B 20% coinsurance — and some actually paid it. In many cases, these were good-faith errors by providers unfamiliar with the law. But sometimes, billing departments simply assume the patient is responsible for the unpaid balance.

You May Be Paying for a Medicare Supplement You Don’t Need

If you’re a QMB beneficiary and enrolled in Original Medicare, you likely do not need a Medicare supplement (Medigap) plan, because QMB already protects you from cost-sharing.

However, keep the following in mind:

• QMB does not pay your Medigap premium — if you choose to keep a Medigap plan, you are responsible for paying that premium out of pocket.
• Some states may allow small copayments under their own laws, even for QMB beneficiaries. These are usually minimal, and the vast majority of your Medicare-covered costs will still be paid by Medicare and Medicaid.

I’ve had several clients who were QMB recipients and had been paying for Medigap coverage for years, unaware that they didn’t need it. If this sounds familiar, you may want to review your current coverage and see if dropping a Medigap plan could save you money.

How to Know If You’re a QMB Recipient

Not sure if you're enrolled in QMB? Here's how to find out:

• State-issued Medicaid notice of action — Your QMB status is typically listed on your determination letter.
• QMB or Medicaid ID card — Many states issue a card showing QMB eligibility that can be presented to providers.
• Medicare Summary Notice (MSN) — Your MSN may note that you are a QMB beneficiary.
• Call your state Medicaid office — They can confirm your current QMB status.

Additional details for our region:

• Maryland: A state survey shows that QMB-only recipients receive a gray-and-white card clearly marked “Qualified Medicare Beneficiary,” whereas QMB-plus (dual-eligibles) receive a regular Medicaid card that does not identify QMB status explicitly.
• District of Columbia: Officials confirm that DC Medicaid issues a QMB card, clearly labeled as proof of QMB status, which recipients are instructed to show along with their Medicare card at healthcare visits.
• Virginia: Card images available through the state’s Medicaid/DMS website mostly show new Medicaid and managed care ID cards (including the Cardinal Care designs), but do not distinguish or label QMB status visibly on the cards. It appears Virginia issues standard Medicaid ID cards; any QMB indication would need to be printed in eligibility systems rather than on the card and should appear on the original Notice of Action you received when your Medicaid QMB status was approved.

Always bring both your Medicare card and any QMB-related ID or notice when visiting a provider.

QMB Eligibility: Who Can Apply?

To qualify for the QMB program, you must:

• Be eligible for Medicare Part A
• Have income at or below 100% of the Federal Poverty Level (FPL)
• Have limited financial resources (asset limits vary slightly by state)

As of 2025, general federal guidelines are:

• Monthly income below $1,275 for an individual or $1,724 for a couple
• Resources below $9,430 for an individual or $14,130 for a couple
(These figures can vary slightly by state and may not include all income and assets.)

If you are eligible for the Medicaid QMB program, you should apply to maximize your health benefits. This program provides significant financial support and can make a major difference in the healthcare individuals receive — especially when it comes to avoiding surprise bills.

What To Do If You Get a Bill

If you receive a bill for a Medicare-covered service and you’re enrolled in QMB:

Do not pay it.

Call the provider and inform them you are a QMB recipient.

Provide proof — such as your Medicaid or QMB card or notice.

Still being pressured? Call 1-800-MEDICARE and file a complaint.

Related Resources

• CMS: Qualified Medicare Beneficiary (QMB) Program Overview
• MLN Matters SE1128 – Billing Requirements for QMBs (PDF)
• Medicare.gov – QMB Program Fact Sheet (PDF)

Stay proactive. Stay prepared. Stay healthy.