The rule, and why it exists
CMS says federal law prohibits Medicare providers and suppliers, including pharmacies, from billing people in the QMB program for Medicare cost sharing, and that QMB members have "no legal obligation to pay" Part A or Part B deductibles, coinsurance or copays for Medicare-covered care. NC Medicaid's own manual adds that Medicare participating providers must file all Medicare claims and accept assignment for MQB-Q members.
The bill goes to Medicare first, then to NC Medicaid for the cost sharing. NC Medicaid pays only up to its own rate for the service, and a provider may get less than the full Medicare cost sharing, or nothing more. Either way, the law says the provider can't send the difference to you. CMS adds that QMB members can't choose to pay the cost sharing either. Billing mistakes still happen: CMS's own study found QMB members are still billed wrongly.
What to do if you get a bill
- Tell the office you have QMB. Show your Medicare card and the Medicaid card NC Medicaid gives MQB-Q members. With Original Medicare, your Medicare Summary Notice also shows you're in QMB.
- Ask them to cancel the charge and refund any payment. Point to the CMS rule: Medicare providers may not bill QMB members for Medicare cost sharing.
- Call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) if the office won't fix it. CMS tells providers to recall these bills and refund any payments, and it can send a provider a compliance letter.
- In a Medicare Advantage plan, call the member services number on your plan card too; the plan must make sure its network providers follow the rule.
- Keep your MQB-Q current. If your certification lapses, the protection stops. Answer your county DSS renewal letters.
For NC Medicaid problems, the NC Medicaid Ombudsman (1-877-201-3750) and the NC Medicaid Contact Center (1-888-245-0179) can help. If you think a provider is billing you on purpose for things Medicare already paid, see Medicare fraud in North Carolina.
Who has this protection
Only MQB-Q (QMB) members, including people who have MQB-Q together with full NC Medicaid. MQB-B and MQB-E pay just the Part B premium ($202.90 a month in 2026). If your income is under 100% of the poverty level, ask your county DSS to check you for MQB-Q; it can't be backdated, so apply soon. The full guide is Medicare Savings Programs in North Carolina.
Related questions
What is MQB in North Carolina Medicaid?
The three programs.
QMB vs. SLMB vs. QI in North Carolina
Who gets billing protection.
How do I apply for a Medicare Savings Program in North Carolina?
ePASS or your county DSS.
Sources
- CMS — Qualified Medicare Beneficiary (QMB) Program Group (billing protections)
- CMS Medicare Learning Network — Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program (PDF)
- Medicare.gov — Medicare Savings Programs (QMB billing, cards and notices)
- NC Medicaid — MA-2130, Qualified Medicare Beneficiaries - Q (PDF)
- NC Medicaid — MA-2410, Medicare Enrollment and Buy-In (PDF)
- NC Medicaid — NC Medicaid Ombudsman
More questions in this guide
- How do I apply for a Medicare Savings Program in North Carolina?
- How do I apply for Extra Help in North Carolina?
- QMB vs. SLMB vs. QI in North Carolina
- What are the Medicare Savings Program income limits in North Carolina?
- What assets count for Medicare Savings Programs in North Carolina?
- What is MQB in North Carolina Medicaid?
Part of the guide: Medicare Savings Programs in North Carolina · All questions
Frequently asked questions
Can a provider charge me anything with QMB?
Medicare.gov says you may get a bill for a small Medicaid copayment, if one applies. The protection also doesn't reach care Medicare doesn't cover at all, such as most dental care. You can't be billed for Medicare deductibles, coinsurance or copays.
Does QMB billing protection apply to Medicare Advantage in North Carolina?
Yes. CMS says the federal ban covers all Medicare providers and suppliers, so it applies when you're in a Medicare Advantage plan too. Call your plan if a network provider bills you.
What if a provider says it doesn't take NC Medicaid?
CMS says the ban covers all Original Medicare and Medicare Advantage providers, not only those that accept Medicaid. A provider that doesn't bill NC Medicaid still may not bill you for Medicare cost sharing.
Does MQB-B (SLMB) protect me from bills?
No. MQB-B and MQB-E pay only the Part B premium, so you still owe Medicare deductibles and coinsurance, unless you also have full NC Medicaid.
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