The Qualified Medicare Beneficiary program, known as QMB, covers your Medicare Part A and Part B premiums along with the deductibles, coinsurance, and copayments you would otherwise owe for Medicare-covered services. Enrollment also triggers automatic eligibility for Extra Help, which cuts your Part D prescription drug costs. In practical terms, QMB reduces out-of-pocket spending on Medicare-covered care to zero.1Centers for Medicare & Medicaid Services. Qualified Medicare Beneficiary (QMB) Program Group
Medicare Premiums
QMB pays the monthly Part B premium, which is $202.90 in 2026 for most beneficiaries. That alone is $2,434.80 a year back in your pocket.2Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
Most people get Part A without a premium because they or a spouse paid Medicare taxes for at least 10 years. If you don’t qualify for premium-free Part A, QMB covers that premium too — either $311 or $565 per month in 2026, depending on your or your spouse’s work history.3Medicare. What Does Medicare Cost
Deductibles, Coinsurance, and Copayments
Beyond premiums, QMB pays every cost-sharing charge Medicare would normally leave to you under Parts A and B. For 2026, that means:
- The Part A hospital deductible of $1,736 per benefit period for inpatient stays.2Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- Hospital coinsurance of $434 per day for days 61 through 90 of an inpatient stay.2Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- Skilled nursing facility coinsurance of $217 per day for days 21 through 100.4Medicare. Skilled Nursing Facility Care
- The Part B annual deductible of $283.2Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- The 20% Part B coinsurance for outpatient services like doctor visits, lab work, and durable medical equipment.
A single hospital stay followed by rehab can otherwise leave you with several thousand dollars in bills. With QMB, your share of Medicare-covered services is nothing.1Centers for Medicare & Medicaid Services. Qualified Medicare Beneficiary (QMB) Program Group
Providers Cannot Bill You for Those Charges
This is the strongest protection in the program, and also the one most often violated. Federal law prohibits every Medicare provider and supplier from billing a QMB enrollee for Part A or Part B deductibles, coinsurance, or copayments.5CMS. MLN7936176 – Prohibition on Billing Qualified Medicare Beneficiaries The ban applies to all Medicare providers, not only those enrolled in Medicaid, and it holds even when the state pays the provider nothing toward the cost-sharing amount. You cannot waive the protection by agreeing to pay. It also follows you across state lines: a provider in another state still cannot charge you.
If a bill arrives anyway, show the provider both your Medicare card and your Medicaid or QMB card, and ask for a refund of anything you already paid. If the billing continues, call 1-800-MEDICARE (1-800-633-4227) and Medicare can confirm your status with the provider and demand they stop and refund you. If a debt collector contacts you about a QMB-covered charge, file a complaint with the Consumer Financial Protection Bureau at (855) 411-2372.6Consumer Financial Protection Bureau. What to Do if Youre Wrongfully Billed for Medicare Costs
Prescription Drugs Through Extra Help
QMB itself does not pay Part D premiums, but qualifying for QMB automatically enrolls you in Extra Help, the federal Low-Income Subsidy for prescription drugs.7Medicare. Help With Drug Costs Extra Help eliminates the Part D deductible and cuts copays to a few dollars.
In 2026, if you have QMB together with full Medicaid coverage, you pay no more than $4.90 per covered drug. With QMB and income at or below 100% of the federal poverty level, copays are $1.60 for generics and $4.90 for brand-name drugs. Above that income line, copays run up to $5.10 for generics and $12.65 for brand-name drugs.8Medicare. Medicare Savings Programs Extra Help also waives the Part D late enrollment penalty.7Medicare. Help With Drug Costs Many Part D plans charge a $0 premium for Extra Help enrollees, though not all do.
What QMB Does Not Cover
QMB is a payment assistance program tied to Medicare, not health insurance on its own. It pays only for services Medicare covers, which leaves several gaps that catch people off guard:
- Routine dental care, most vision care, hearing aids, and long-term custodial care are outside Original Medicare, so QMB does not pay for them either.
- Cosmetic procedures and experimental treatments Medicare won’t cover fall outside QMB’s reach.
- Part D plan premiums are not directly paid by QMB, though Extra Help often reduces them to zero.
- Coverage is not retroactive. Benefits begin the first day of the month after approval and do not reach back to bills you incurred earlier.9Medicaid.gov. Implementation Guide – Medicaid State Plan Eligibility – Qualified Medicare Beneficiaries
Some QMB enrollees also qualify for full Medicaid through their state, which can add dental, vision, hearing, and long-term care benefits. That extra coverage comes from full Medicaid eligibility, not from QMB, and it depends on separate state rules.
QMB With Medicare Advantage
If you receive your Medicare benefits through a Medicare Advantage plan rather than Original Medicare, QMB still protects you. The billing prohibition applies to Medicare Advantage providers on the same terms, so they cannot charge you deductibles, coinsurance, or copayments for covered services.5CMS. MLN7936176 – Prohibition on Billing Qualified Medicare Beneficiaries Because QMB already pays the cost-sharing a Medigap policy is designed to cover, a Medigap plan is unnecessary once you’re enrolled.