QMB Medicare Savings Program: Help With Costs and Billing Protection

The Qualified Medicare Beneficiary program, or QMB, is a state-administered Medicare Savings Program. It can help eligible people with Medicare premiums and covered medical cost sharing. It is not a separate Medicare Advantage plan.

What QMB helps pay

Apply through your state

The state evaluates income, resources and other eligibility rules. Limits change, and states may use more generous rules than federal examples. Do not rule yourself out from an old article's income chart. Ask your state Medicaid office to evaluate your application and identify the program for which you qualify.

Keep the application confirmation, requests for documents and written decision. Confirm the effective date rather than assuming protection applies to every earlier bill.

If a provider bills you

For Medicare-covered services, providers cannot charge a person with QMB the Medicare deductibles, coinsurance or copayments. This protection also matters in Medicare Advantage. A small Medicaid copayment may apply where permitted.

• Show your Medicare and Medicaid or QMB cards.
• Tell the billing office that you have QMB.
• Keep the bill and proof of your status.
• Contact your plan if you have Medicare Advantage.
• Call 1-800-MEDICARE if improper billing continues.

If you already paid an improper charge, ask the state Medicaid office about obtaining a refund.

Keep related programs distinct

QMB also qualifies you for Extra Help with Part D costs, but full Medicaid services involve separate state rules. Do not assume that every Medicare Savings Program provides QMB's cost-sharing protection; some assist with premiums only.

Related coverage questions

• Medicare Coverage Database: How to Read NCDs and LCDs
• Medicare and Medicaid: Different Programs, Coordinated Help
• Medicare Extra Help: Automatic Eligibility, Applications and Notices

Official sources

• Medicare Savings Programs
• Help with drug costs
• Compare Original Medicare & Medicare Advantage