Alaska QMB Balance Billing: Federal Law Protects You From Provider Bills
A doctor's office sent your parent a bill for a Medicare deductible or copay for a Medicare-covered service during their QMB coverage. Federal law bars providers from collecting those QMB cost-sharing amounts.
The Federal Balance Billing Ban
Under 42 U.S.C. § 1396a(n)(3)(B) and 42 C.F.R. § 447.15, healthcare providers are prohibited from billing QMB enrollees for Medicare Part A and Part B cost-sharing. That means no bills for the Part A hospital deductible ($1,736 per benefit period in 2026), the Part B annual deductible ($283), or any coinsurance and copayments.
This ban applies to every Medicare-enrolled provider nationwide — hospitals, doctors, labs, imaging centers, home health agencies. The provider does not need to be in Alaska's Medicaid network. If they accept Medicare, they cannot balance-bill a QMB patient.
Why Alaska Providers Sometimes Bill Anyway
Alaska Medicaid uses a "lesser-of" payment system. When the Medicare approved amount exceeds Alaska's Medicaid fee schedule for that service, Medicaid pays $0 toward the cost-sharing balance. Some billing offices see that $0 Medicaid payment and assume the patient owes the difference.
They don't. Even when Alaska Medicaid pays zero, the provider must accept the Medicare payment as payment in full and write off the cost-sharing balance. Billing the QMB patient violates their Medicare provider agreement and can trigger federal sanctions.
What to Do If You Get a Bill
Take these steps in order:
Check the dates first. QMB only protects against bills for services on or after the QMB effective date shown on the DPA Notice of Eligibility. QMB does not protect against bills for services from before that date.
Contact the billing office. Send a copy of the DPA QMB approval notice and the Medicare Summary Notice showing QMB status. Ask them to zero out the balance and remove any collection referrals.
Call 1-800-MEDICARE. If the provider refuses to stop billing, call 1-800-633-4227. CMS will contact the provider directly and issue formal warnings about improper billing.
Contact Alaska Legal Services Corporation. If a provider files a court action or sends the debt to collections, call ALSC at 1-888-478-2572 for free legal help.
The Alaska Medicare Savings Programs & Extra Help Guide includes a fill-in billing dispute letter template that cites the specific federal statutes, ready to send to any provider's billing department.
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