Updated July 2026
Improper billing (also sometimes referred to as "balance billing") occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for co-pays, co-insurance, or deductibles.
Patients who have both Medicaid and Medicare (including Medicare Advantage) should never be charged for services covered under Medicaid or Medicare. Billing for covered services is illegal under both federal and state law.
As more and more dual eligible patients move to managed care plans, improper and illegal billing may increase due to doctor & hospital confusion. Justice in Aging wants to make sure patients are protected. In 2011 we authored a policy paper on the need to improve protections for dual eligibles, Improving the Qualified Medicare Benefit for Dual Eligibles. In early 2017 we released a new issue brief, Fighting Improper Billing of Dual Eligibles: New Strategies and created a toolkit to provide advocates with resources to help their clients who are being improperly billed. See our toolkit of resources in the tabbed sections below.
New
- State Medical Billing Protections for Dually Eligible Individuals
- Health Care Bills and Dually Eligible Individuals
- Medicare Premium Bills and Dually Eligible Individuals
Fact Sheet
FAQ
Issue Brief
- Advance Beneficiary Notices, Administrative Fees, and Dual Eligibles
- Fighting Improper Billing of Dual Eligibles: New Strategies
- QMB Identification Practices: A Survey of State Practices
- Qualified Medicare Beneficiary (QMB) Protections in Medicare Advantage: Issues, Tips and Avenues for Advocacy
Trainings
- The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 2 of 2 - July 24, 2019
- The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 1 of 2 - July 23, 2019
- Improvements to the Qualified Medicare Beneficiary Program (QMB) - Part 2 - September 25, 2018
- Improvements to the Qualified Medicare Beneficiary Program (QMB) - Part 1 - September 24, 2018
- California Balance Billing Protections: What Advocates Need to Know - July 25, 2018
- Breakthrough Changes in Improper Billing - October 2, 2017
- Protecting Dual Eligibles from Balance Billing - February 23, 2016
- Protecting Dual Eligibles from Balance Billing: What Advocates Need to Know - February 23, 2016
Model Letters
- Overview of Model Letters to Providers-National
- Model Improper Billing Letter No. 1 (Client with Original Medicare and QMB+)
- Model Improper Billing Letter No. 2 (Client with Original Medicare and QMB-only)
- Model Improper Billing Letter No. 3 (Client with Medicare Advantage and QMB+)
- Model Improper Billing Letter No. 4 (Client with Medicare Advantage and QMB-only)
- Model CA Improper Billing Letter No. 1 (Client with Original Medicare and QMB+)
- Model CA Improper Billing Letter No. 2 (Client with Original Medicare and QMB-only)
- Model CA Improper Billing Letter No. 3 (Client with Medicare Advantage and Medi-Cal or Cal Medi-Connect)
