You have QMB and a doctor sent you a bill: what to do in New York

• Medicare.gov: if you are in QMB, "Medicare providers aren't allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments."
• CMS says this applies to all Original Medicare and Medicare Advantage providers and suppliers, including pharmacies, "not only those that accept Medicaid."
• CMS says QMBs may not elect to pay Medicare deductibles, coinsurance, and copayments. A form you signed agreeing to pay does not change this.
• The protection applies on every date of service when you were a QMB, even if your QMB is from a different state.
• You may still get a bill for a small Medicaid copayment, if one applies (Medicare.gov).

This rule is for QMB only. New York's other Medicare Savings Program, QI, pays the Part B premium but does not cover deductibles and coinsurance. Our QMB vs QI guide explains the difference.

1. Check the bill. Is it for a Medicare deductible, coinsurance, or copay on a service Medicare covers? That is the part QMB protects.
2. Get your proof of QMB. Medicare.gov says to show your Medicare card and your Medicaid card (or QMB card) each time you get care. With Original Medicare, your Medicare Summary Notice also shows you are in QMB.
3. Call the provider's billing office. Say: "I am a Qualified Medicare Beneficiary. Federal law says you cannot bill me for Medicare cost sharing. Please recall this bill and bill New York Medicaid instead." Write down the date and the name of the person.
4. If it went to collections, tell the collector the same thing. CMS tells providers to recall bills they sent to collections.
5. If you have a Medicare Advantage plan, call the plan and ask them to stop the charges (Medicare.gov).
6. If the provider won't stop, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). CMS says it can tell the provider to stop billing and to refund what you paid.

Medicare.gov says you have a right to a refund. Ask the provider for it in writing, and contact New York Medicaid (HRA in NYC, your county Department of Social Services elsewhere) to ask how the refund works. CMS's fact sheet tells providers to refund any QMB cost-sharing money they collected.

CMS and the Consumer Financial Protection Bureau (CFPB) issued a joint statement on October 31, 2024, warning providers, Medicare Advantage plans, and debt collectors about billing QMBs. The announcement says you can send a complaint about a debt collection problem through the CFPB's website or by calling (855) 411-2372.

• The bill, and any collection letter.
• Your Medicare card and your Medicaid or QMB card.
• Your MSP approval notice from HRA, your county, or NY State of Health.
• A Medicare Summary Notice for that service if you have Original Medicare.
• A log of who you talked to, and when.

• Paying the bill to keep the peace. You don't owe Medicare cost sharing as a QMB, and you can ask for money back.
• Assuming the rule only covers doctors who take Medicaid. CMS says it covers all Medicare providers.
• Mixing up QMB and QI. QI does not include the billing protection.
• Letting your MSP lapse at renewal. The protection only covers dates when you were a QMB. See our MSP renewal guide.