What Does QMB Cover in Nebraska?

QMB Is the Most Comprehensive Medicare Savings Program

Qualified Medicare Beneficiary status is the top tier of Nebraska's Medicare Savings Programs. Where SLMB and QI only cover the Part B premium, QMB covers nearly every out-of-pocket Medicare cost a beneficiary would otherwise owe.

Here's the full list of what QMB pays in 2026:

• Medicare Part B monthly premium: $202.90/month ($2,434.80/year)
• Medicare Part A monthly premium: $565/month for those with fewer than 30 work quarters, $311/month for 30–39 quarters (only applies to people who don't get premium-free Part A)
• Medicare Part A hospital deductible: $1,736 per benefit period
• Medicare Part B annual deductible: $283/year
• Part A coinsurance: days 61–90 at $434/day, days 91–150 (lifetime reserve) at $868/day
• Part B coinsurance: typically 20% of the Medicare-approved amount for outpatient services
• Part A and Part B copayments: fixed-dollar amounts for certain services

For a Nebraska senior on a fixed Social Security income, QMB effectively eliminates the gap between what Medicare pays and what the patient owes. A single hospital stay without QMB could generate a $1,736 deductible bill that takes months to pay off on $1,300 a month.

What QMB Does Not Cover

QMB wraps around Original Medicare. It covers the cost-sharing that Medicare itself leaves behind. But it does not expand what Medicare covers in the first place.

Services that Medicare doesn't cover — routine dental, vision exams for glasses, hearing aids, most long-term custodial care — remain uncovered under QMB. QMB pays the patient's share of Medicare-covered services. It doesn't add new services to the list.

Prescription drugs are handled separately through Medicare Part D, not QMB. However, QMB recipients are automatically deemed eligible for Extra Help (the Low-Income Subsidy), which sharply reduces Part D premiums and copays.

The Balance Billing Protection

This is the part that catches families off guard. Under federal law — 42 U.S.C. § 1396a(n)(3)(B) and the Balanced Budget Act of 1997 — Medicare-participating providers cannot bill QMB beneficiaries for Medicare deductibles, coinsurance, or copayments. Period.

The protection applies to every doctor, hospital, lab, imaging center, and skilled nursing facility that accepts Medicare. Nebraska Medicaid may make a secondary payment under its lesser-of method, but providers cannot bill QMB beneficiaries for any remaining Medicare cost-sharing.

Yet billing departments routinely send balance bills to QMB enrollees. Automated billing systems don't always check Medicaid eligibility before generating statements. The bill arrives, the senior panics, and many pay it — even though the provider is legally prohibited from collecting.

If your parent receives a bill for Medicare cost-sharing while enrolled in QMB:

1. Don't pay it
2. Call the billing department and state that the patient has QMB status
3. Provide the Medicaid ID number (the Nebraska DHHS eligibility card)
4. If the provider refuses to withdraw the bill, report it to CMS at 1-800-MEDICARE or contact Nebraska SHIP at 1-800-234-7119 for free help

The Nebraska Medicare Savings Programs Guide includes a ready-to-send dispute letter template that cites the federal statute and demands the balance be cleared.

How QMB Interacts With Medicare Advantage

QMB works with both Original Medicare and Medicare Advantage plans. If your parent is enrolled in a Medicare Advantage plan, QMB covers the plan's cost-sharing amounts — copays for doctor visits, coinsurance for hospital stays, any deductibles the plan charges.

Some Medicare Advantage plans marketed to dual-eligible beneficiaries (D-SNPs) already reduce cost-sharing to zero. In those cases, QMB serves as a backstop: the plan covers cost-sharing as a benefit, and QMB guarantees it legally.

The Part B premium is still paid by QMB regardless of whether the beneficiary is in Original Medicare or Medicare Advantage.

QMB Plus vs. QMB Only

Nebraska DHHS doesn't advertise a separate program called "QMB Plus." The distinction is simple: when someone has QMB and also qualifies for full Medicaid (through the Aged, Blind, and Disabled pathway or nursing home coverage), they're sometimes called QMB Plus. They get everything QMB covers plus full Medicaid benefits — prescription drugs through Medicaid, dental through the Heritage Health managed care plan, and potentially long-term care services.

QMB Only means the person has QMB but does not qualify for full Medicaid. They still get all the Medicare cost-sharing coverage listed above, plus automatic Extra Help for Part D. They just don't get the additional Medicaid wraparound services.

Eligibility at a Glance

To qualify for QMB in Nebraska in 2026, the published gross income limit is $1,350 per month for a single applicant, and the countable resource limit is $9,950. For married couples filing together, the published income limit is $1,824 and the resource limit is $14,910. The published income limits already include the $20 general disregard.

For a full breakdown of how Nebraska calculates income, including the disregards and exclusions that often make people eligible when they assumed they weren't, see the income calculation explainer.

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