The Qualified Medicare Beneficiary (QMB) program pays for nearly all of your out-of-pocket Medicare costs, including Part A premiums, Part B premiums, deductibles, coinsurance, and copayments for services and items that Medicare covers. If you have QMB, you should pay nothing when you see a Medicare provider for a Medicare-covered service.
What QMB Covers
QMB is a Medicaid program, but it doesn’t work like traditional Medicaid. Instead of covering its own set of services, QMB wraps around your existing Medicare coverage and picks up the costs that Medicare normally leaves to you. Specifically, it pays for:
- Part A premiums if you don’t qualify for premium-free Part A (which can run over $500 per month)
- Part B premiums, which in 2025 are $185 per month for most people
- Part A and Part B deductibles
- Coinsurance and copayments for all Medicare-covered services
This means hospital stays, doctor visits, lab work, outpatient procedures, durable medical equipment, and any other service covered under Medicare Part A or Part B should cost you $0 at the point of care.
Prescription Drug Benefits Through Extra Help
QMB doesn’t directly cover prescription drugs, but it triggers automatic enrollment in Medicare’s Extra Help program (also called the Low-Income Subsidy), which dramatically reduces what you pay for medications under a Part D plan. If you have QMB along with full Medicaid coverage, your copay is capped at $4.90 per covered drug. You also pay $0 for your Part D plan premium and $0 for the plan deductible.
If you have QMB without full Medicaid, you still qualify for Extra Help, but your copays are slightly higher: up to $5.10 for generic drugs and up to $12.65 for brand-name drugs (2026 figures). Either way, you won’t pay a plan premium or deductible.
What QMB Does Not Pay For
QMB only covers cost-sharing on services that Medicare itself covers. If Medicare doesn’t cover something, QMB won’t either. The most common gaps include routine dental care, routine vision exams and eyeglasses, hearing aids, and most long-term custodial care. Whether you have coverage for those services depends on whether your state’s full Medicaid program covers them separately. Many states do offer dental, vision, and hearing benefits through Medicaid, so it’s worth checking with your state Medicaid office if you need those services.
Services that fall outside of Medicare’s scope, like cosmetic procedures, can still be billed to you because QMB’s protections only apply to Medicare-covered items.
Billing Protections Under Federal Law
One of the most valuable parts of QMB is the federal billing protection. Every Medicare provider and supplier, including pharmacies, is prohibited from billing you for Medicare Part A or Part B cost-sharing. This isn’t optional for the provider. It applies to all Medicare providers, not just those who accept Medicaid. A doctor who refuses Medicaid patients still cannot charge a QMB beneficiary for Medicare copays or deductibles.
Providers who bill QMB patients for cost-sharing are violating their Medicare provider agreement and can face sanctions. You also cannot voluntarily agree to pay these charges. Federal law is clear that QMB beneficiaries “may not elect to pay” Medicare deductibles, coinsurance, or copayments, even if a provider’s office asks you to.
If a provider does bill you, you can report it. Contact 1-800-MEDICARE or your state Medicaid office. Keep in mind that some billing offices may not immediately recognize your QMB status, so carrying documentation or your Medicaid card alongside your Medicare card helps prevent problems at check-in.
How QMB Works With Medicare Advantage
If you’re enrolled in a Medicare Advantage plan rather than Original Medicare, QMB protections still apply. Your plan’s copays and coinsurance for covered services should be $0. The billing prohibition covers both Original Medicare and Medicare Advantage providers and suppliers. Your Medicare Advantage plan may also offer extra benefits like dental or vision that go beyond what Original Medicare covers, and QMB would handle the cost-sharing on any Part A or Part B services within that plan.
How to Qualify and Apply
QMB is available to Medicare beneficiaries with limited income and resources. Income limits vary slightly by state because some states use more generous calculations, but the federal baseline is 100% of the federal poverty level. For 2025, that’s roughly $1,300 per month for an individual and about $1,750 for a married couple, though your state may allow somewhat higher income after certain deductions.
You apply through your state Medicaid agency, not through Medicare. The application typically requires proof of income, bank statements, and documentation of any other assets. Processing times vary by state, but most applications are decided within 45 days. Once approved, your QMB benefits are applied to your Medicare account, and providers can verify your status through their billing systems. Some states backdate coverage to the month of application, while others start benefits the month after approval.
If you’re already receiving Supplemental Security Income (SSI), you may be enrolled automatically in some states. Otherwise, you’ll need to apply directly. Your local State Health Insurance Assistance Program (SHIP) offers free counseling and can help with the application process.