Is your parent in QMB? They probably shouldn't be getting medical bills
By the Folkswise team · Updated · 5 min read · How we write these guides
QMB is one of the most valuable protections in Medicare, and one of the most often ignored by billing offices. If your parent is in it, many of the bills they receive shouldn't have been sent at all.
What QMB is
The Qualified Medicare Beneficiary (QMB) program is a Medicare Savings Program run by each state's Medicaid office. For people with limited income and savings, it pays Medicare Part A and Part B premiums, and it covers Medicare deductibles, coinsurance and copays.
The billing rule
Federal law says providers and suppliers who serve Medicare patients can't bill a person in QMB for Medicare deductibles, coinsurance or copays. The protection applies even if the provider doesn't accept Medicaid. In some states, a person in QMB may owe a small Medicaid copay, but not the Medicare cost-sharing amounts.
How to tell if your parent has QMB
- Look at their Medicare Summary Notice: it may say they're in QMB and owe nothing for the services listed.
- Check their state Medicaid card or letters from the state Medicaid office.
- Call 1-800-MEDICARE and ask, with your parent's permission.
When a bill arrives anyway
- Don't pay it yet.
- Call the provider's billing office and explain your parent is in QMB. Have the Medicare and Medicaid cards ready.
- Ask them to bill Medicaid instead and send a corrected statement showing $0 for Medicare cost-sharing.
- If the provider keeps billing, call 1-800-MEDICARE. They can confirm QMB status to the provider.
- If your parent already paid, ask the provider for a refund.
Not in QMB yet?
If your parent has limited income and savings and isn't enrolled, they may qualify. Each state's Medicaid office handles applications, and your State Health Insurance Assistance Program (shiphelp.org) can help for free.