Today Is Tuesday, September 22, 2026: This Is What Happened.

 

Let see what's going on. Yesterday we took care of some medical insurance things. We got a Medicare Advantage plan....A Medicare Advantage plan (Part C) is an alternative way to receive your Medicare benefits. Instead of getting your Medicare coverage directly through Original Medicare, you choose a private insurance company to manage your Medicare coverage.

You still have Medicare, but the private plan handles most of your coverage.

Original Medicare

With Original Medicare, you generally have:

• Part A: Hospital care

• Part B: Doctor and outpatient care

• You can usually see any doctor or hospital that accepts Medicare

• You can add a Medigap (supplement) policy to help pay some of the costs Medicare doesn't cover.

• You normally need a separate Part D prescription plan.

Medicare Advantage

With Medicare Advantage, you generally get:

• Part A and Part B coverage through the private plan

• Usually prescription drug coverage (Part D) included

• A network of doctors and hospitals, depending on the plan

• A yearly limit on what you pay out of pocket for covered medical services

• Sometimes extra benefits such as dental, vision, hearing, transportation, or an allowance for certain health-related items.

The important difference

Think of it this way:

Original Medicare + Medigap:
Medicare pays its share → Medigap helps with many remaining costs → you generally have more freedom about which Medicare providers you use.

Medicare Advantage:
Private insurance company administers your Medicare benefits → you generally use the plan's network → you may have lower premiums but have more rules about where and how you receive care.

One important thing: Medicare Advantage is not the same thing as Medicaid. If you qualify for QMB, Medicaid can sometimes help with Medicare costs even if you choose Medicare Advantage.

Plus we also qualify for the QMB... QMB stands for Qualified Medicare Beneficiary.

It is a Medicaid program that helps people with limited income pay their Medicare costs.

If you qualify for QMB, Medicaid can generally help pay:

• Your Medicare Part A premium, if you have one

• Your Medicare Part B premium

• Medicare deductibles

• Medicare coinsurance

• Medicare copayments for Medicare-covered services

One especially important protection is that Medicare providers generally cannot bill you for Medicare-covered cost-sharing when you are a QMB beneficiary.

How QMB works with Medicare

QMB does not replace Medicare. You keep Medicare.

Think of it this way:

Medicare = your main health insurance
QMB = extra help paying Medicare's costs

You can have QMB while using Original Medicare or, depending on your circumstances, a Medicare Advantage plan.

Why QMB can make a big difference

Without QMB, Medicare Part B normally has a monthly premium, and you can also have deductibles and coinsurance.

With QMB, the program can take much of that financial burden off you.

There are income and resource limits to qualify, and those limits can change each year. QMB is administered through Medicaid, so you apply through your state rather than directly through Medicare.

As I believe nothing truly free in this world..I asked A.I Under the Medicare advantage and QMB program if your in accident, and end up in the emergency of a hospital. And end up with $15,000 medical bill. What would be covered, when someone has just medicare one would end up paying about $3,000....What possible would the bill cost with Medicare advantage with QMB. I know they could be all sort of factors...Yes — you are right that there are many factors, but the QMB part is the important piece.

If someone has Medicare + QMB and has a serious accident requiring an emergency-room visit and hospitalization, QMB generally pays the Medicare-covered deductibles, coinsurance, and copayments that Medicare leaves behind.

So, using your $15,000 hospital bill as an example:

• Hospital charges: $15,000

• Medicare pays its portion according to Medicare rules.

• QMB pays the Medicare cost-sharing that remains for covered services.

• The patient could potentially owe $0 for those Medicare-covered services.

That is very different from simply having Medicare alone.

What about Medicare Advantage + QMB?

It can work similarly, but the exact rules depend on the Advantage plan.

With a Medicare Advantage plan + QMB, the Advantage plan processes the hospital bill, and QMB generally helps cover the Medicare Advantage cost-sharing for covered services.

So a $15,000 emergency hospitalization doesn't automatically mean you would receive a $3,000 bill. If the services are Medicare-covered and you have QMB protection, the amount you personally owe can be little or even $0.

There are exceptions—such as services Medicare doesn't cover, certain providers, or circumstances where QMB rules don't apply.

The big takeaway: QMB is not "free healthcare." It is financial assistance that helps pay the Medicare costs that would otherwise come out of your pocket.

And this is one reason the question of Original Medicare + QMB versus Medicare Advantage + QMB is worth looking at carefully. The difference isn't simply the size of the hospital bill; it's how each system handles covered care, networks, deductibles, and cost-sharing.

Yes. That is an important distinction.

With Original Medicare alone, the common situation is that Medicare pays its approved share and the patient may be responsible for 20% of the Medicare-approved amount for Part B services, after applicable deductibles.

With QMB, however, the patient generally should not be billed for Medicare-covered deductibles, coinsurance, or copayments. So even if the hospital's bill shows amounts that Medicare didn't pay, those amounts are not necessarily amounts the QMB patient has to pay.

For example, very simply:

Situation	Possible patient responsibility
Medicare alone	Up to the applicable Medicare cost-sharing, often 20% for Part B
Medicare + QMB	Generally $0 for Medicare-covered cost-sharing
Medicare Advantage + QMB	Generally $0 for Medicare-covered cost-sharing, subject to QMB/plan rules

So yes, a patient might receive a statement or bill showing charges, but that doesn't necessarily mean they legally owe that amount. A QMB beneficiary has protections against being charged Medicare-covered cost-sharing.

The important phrase is "Medicare-covered services." That's where the details matter.

Enough about medical cost.

Still did the everyday things around the place. Murphy and I went to the senior center had Salisbury streak, mash potatoes, with gravy and mushroom was in the gravy. I had carrots, and they offered broccoli as well. I had smaller serving of potatoes because I want a home made dinner roll. And pudding with fruit on it.

Today food give away I would say we got about $60 worth. Someone brought in fresh watermelons. Plus Grocery out let donate some Halloween things. I got a few items. I might pick up some Halloween plates for my grand-girls.

In October a cousin of mine and other person will have their exhibit at the SPOKANE ART SCHOOL this October. Hopefully we can make it down. Thought I would share random work each artist.