Who does everyone turn to for help understanding Medicaid and Medicare?
I've called to try and get the run around. For having both and QMB, I shouldn't be getting sued for Dr. bills. I have had these for years and didn't know it. I need so much help from a doctor but can't figure out insurances. Please help!!
thank you!! Do you know if you get a medicaid card? Ive never gotton one. Also, how do I go about getting eye exams and glasses? I havnt gone in 5 years and really need to. Cant they assign someone to me to talk thru all this?
In the state of NJ, yes my nephew has a card. He has to chose a PCP so the doctor is on the card. He shows the card to an eye doctor and dentist that Medicaid approves. Call ur Social Service dept. And see if you need a card.
Of course u probably know, that Medicare is your primary. As such they pay 80% of what they approve. Medicaid pays the balance of 20%. My nephew has special needs medicaid so no deductables or copays. Which you may have to meet. If deductables are met, then you owe nothing. If not, you r responsible for the balances.
Ex: lets say a doctor bills $100, Medicare approves $80, 80% of that is $64 leaving a balance of $16 for Medicaid to pick up if you have met deductibles.
Your problem may be that for Medicaid to pay you must use their doctors in the state you live in. Meaning a doctor needs to be able to bill Medicaid. Same with Medicare, if doctor doesn't except Medicare he can't bill them so you owe the balances.
Where I live the Office of Aging has someone who can help you understand how this all works.
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It looks like it is a program that pays your premiums and deductibles.
So, as JoAnn said, you shouldn’t owe anything BUT you do have to go to a doctor who participates in this program. AND, when you go for services, you need to make sure the doctors called in accept your type coverage. Someone else will have to explain how you do that, I’m not aware.
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.html
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Ex: lets say a doctor bills $100, Medicare approves $80, 80% of that is $64 leaving a balance of $16 for Medicaid to pick up if you have met deductibles.
Your problem may be that for Medicaid to pay you must use their doctors in the state you live in. Meaning a doctor needs to be able to bill Medicaid. Same with Medicare, if doctor doesn't except Medicare he can't bill them so you owe the balances.
Where I live the Office of Aging has someone who can help you understand how this all works.