The rule
CMS puts it plainly: Medicare beneficiaries in the QMB group "have no legal obligation to pay" Part A or Part B deductibles, coinsurance or copayments for Medicare-covered items and services. The ban comes from the Social Security Act and covers every Medicare provider and supplier, including doctors, hospitals, labs, equipment suppliers and pharmacies billing Part B items. It also applies to providers in Medicare Advantage plans. In Ohio, QMB is one of the Medicare Premium Assistance Programs; see What is QMB in Ohio?
That includes the big-ticket items, such as the Part A hospital deductible ($1,736 per benefit period in 2026), the Part B deductible ($283) and the 20 percent Part B coinsurance. The provider must accept what Medicare and Ohio Medicaid pay as payment in full.
What you can still be billed for
- Services Medicare doesn't cover, such as most routine dental care or hearing aids under Original Medicare.
- A small Medicaid copayment, if one applies, Medicare.gov notes.
- Part D drug copays, which Extra Help limits to $5.10 for a generic and $12.65 for a brand-name drug in 2026.
If you get a bill
- Don't pay it yet. Check the date of service and whether Medicare covered it.
- Show your proof. Medicare.gov says to show your Medicare card and your Medicaid or QMB card every time you get care. In Original Medicare, your Medicare Summary Notice also shows you're in QMB and that you owe nothing for covered care.
- Tell the office. Explain that you're a QMB and ask them to stop billing you and to bill Ohio Medicaid instead.
- Call 1-800-MEDICARE. If the bills keep coming, call 1-800-633-4227 (TTY 1-877-486-2048). CMS can send the provider a compliance letter.
- Ask for a refund of anything you already paid for covered care while you were in QMB.
Unwanted bills can also be a sign of fraud. If a bill is for care you never got, report it to the Ohio Senior Medicare Patrol at 1-800-293-4767. More in Medicare fraud in Ohio.
If you're in a Medicare Advantage plan and a network provider bills you, call your plan's member services too. To review your coverage, you can request a call from a licensed insurance agent.
Related questions
What is QMB in Ohio?
What it pays and who qualifies.
QMB vs. SLMB vs. QI in Ohio
Only QMB has this protection.
How do I apply for a Medicare Savings Program in Ohio?
Get QMB started.
Sources
- CMS — Qualified Medicare Beneficiary (QMB) Program Group, Billing Protections for QMBs
- Medicare.gov — Medicare Savings Programs (If you qualify for the QMB program)
- Ohio Administrative Code — Rule 5160:1-3-02.1, Medicare premium assistance programs (QMB benefits)
More questions in this guide
- How do I apply for a Medicare Savings Program in Ohio?
- How do I apply for Extra Help with Medicare drug costs in Ohio?
- What is the difference between QMB, SLMB and QI in Ohio?
- What are the Medicare Savings Program income limits in Ohio?
- What assets count for Medicare Savings Programs in Ohio?
- What is QMB in Ohio?
- What is the Medicare Premium Assistance Program in Ohio?
Part of the guide: Medicare Savings Programs in Ohio · All questions
Frequently asked questions
Does the QMB billing protection apply if my doctor doesn't take Ohio Medicaid?
Yes. CMS says the ban applies to all Medicare providers and suppliers, not just those enrolled in Medicaid. A provider who isn't enrolled with Ohio Medicaid still can't bill you for Medicare cost sharing.
Does QMB cover my prescription copays?
Not through the QMB billing ban, which covers Part A and Part B cost sharing. Your Part D copays are lowered by Extra Help, which QMB members get automatically.
What if I already paid a bill I shouldn't have?
Ask the provider for a refund and explain that you were in QMB on the date of service. If they refuse, call 1-800-MEDICARE (1-800-633-4227) for help.
Medicare in your Ohio county
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