What Does Colorado QMB Cover

QMB is the most comprehensive tier of Colorado's Medicare Savings Programs, and it covers far more than most families realize. One Reddit user called it "the golden ticket" — and that's not far off.

The Full List of Costs QMB Covers

QMB (Qualified Medicare Beneficiary) pays all Medicare cost-sharing:

• Part B monthly premium: $202.90/month in 2026 ($2,434.80/year)
• Part B annual deductible: $283
• Part B coinsurance: The 20% you'd normally owe on doctor visits, outpatient procedures, lab work, and durable medical equipment
• Part A monthly premium: If your parent doesn't have premium-free Part A (usually because they don't have 40 quarters of work history), QMB pays this too — up to $565/month
• Part A inpatient deductible: $1,736 per benefit period
• Part A coinsurance: Days 61-90 in the hospital ($434/day), lifetime reserve days ($868/day)
• Copayments: Including skilled nursing facility coinsurance ($217/day for days 21-100)

In practical terms, QMB turns Medicare into something close to zero cost-sharing coverage. The beneficiary owes nothing for Medicare-covered services — not at the doctor's office, not at the hospital, not at the outpatient clinic.

QMB-Only vs. QMB with Full Medicaid

There's an important distinction Colorado makes:

QMB-Only means your parent qualifies for QMB but not full Health First Colorado (Medicaid). They get all the Medicare cost-sharing coverage listed above, but they don't get a Health First Colorado card. No dental through Medicaid, no non-emergency medical transportation, no state Medicaid-only services.

QMB with Full Medicaid means your parent qualifies for both. They get QMB's Medicare cost-sharing coverage plus the full range of Health First Colorado benefits — dental, vision, transportation, and any services covered under the state Medicaid plan.

The QMB income limits ($1,350/month individual, $1,824/month couple) sit at 100% of the federal poverty level. Full Health First Colorado for aged individuals uses different income limits depending on the specific category (Old Age Pension Medicaid, MAGI Adult Medicaid, etc.). Many QMB recipients do qualify for both.

The Billing Protection That Providers Ignore

Here's the part of QMB that creates the most real-world friction: under federal law (42 U.S.C. § 1396a(a)(25)(C)) and Colorado state rules (10 CCR 2505-10 § 8.012.2.C), Medicare-enrolled providers are prohibited from billing QMB enrollees for Part A or Part B cost-sharing. Period.

No deductibles. No copays. No coinsurance. No balance bills. The provider must accept the Medicare-approved amount as payment in full. Health First Colorado may pay some or none of the remaining cost-sharing under its lesser-of policy, but the provider cannot bill the QMB beneficiary for the balance.

In practice, billing departments routinely send QMB enrollees automated bills for the patient's "share" of costs. The billing system sees Medicare paid 80%, generates a bill for the remaining 20%, and sends it out — regardless of QMB status. These bills are illegal. The provider may not collect the prohibited balance, including through a collection agency.

If this happens, the beneficiary (or their representative) can contact the provider's billing department with their QMB status documentation, report the violation to CMS (1-800-MEDICARE) or HCPF Provider Services, or send a formal dispute letter citing the federal and state billing prohibitions.

Who Qualifies

2026 eligibility thresholds for QMB in Colorado:

• Individual: Net countable income at or below $1,350/month, resources at or below $11,450
• Couple: Net countable income at or below $1,824/month, resources at or below $17,910

Countable income is gross income minus the standard $20 monthly unearned income disregard. Resources exclude the primary home, one vehicle, burial plots, and up to $1,500 per person set aside for burial expenses.

Our Colorado Medicare Savings Programs & Extra Help Guide includes a QMB balance billing letter template, the eligibility worksheet, and the full breakdown of what QMB covers vs. what full Health First Colorado adds.

See more Colorado guides →