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.
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