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Medicare vs Medicaid What You Need to Know | The Difference + Who Qualifies - YouTube
Channel: Strive Medicare-Making Medicare Simple.
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You may have heard of terms
like Medicare and Medicaid,
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but don't know too much about them.
Common questions consist of who qualifies?
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How does it differ by state?
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Is it federally or state funded?
And can you qualify for both? Hi,
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I'm Rick Teska with strive Medicare and
today we'll talk about Medicare versus
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Medicaid and the similarities
and the differences between them,
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as well as answer some
common questions about them.
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We will also talk about options for
people who qualify for both Medicare and
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Medicaid, as well as options for
people who qualify for Medicare,
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but not Medicaid.
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Remember if only part of
this video applies to you,
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you can always skip forward by
looking at the chapters at the bottom.
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A lot of people,
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I talk to know that Medicare
is the federal health
insurance program for people
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who are 65 or older and certain
younger people with disabilities.
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Eligibility is regardless of income,
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and typically most people pay a premium
out of their social security check.
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And in addition to that may pay
deductibles and co-insurance.
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It consists of four parts,
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A B, C, and D,
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which cover various aspects
of beneficiaries medical care.
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Medicare generally covers
80% of the hospital, doctor,
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and prescription drug expenses.
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To help cover the cost that
Medicare does not cover,
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a person has two options,
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a Medicare advantage plan or
a Medicare supplement plan.
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These plans can cover
some or all of that 20%.
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Many have heard the term
Medicaid, but beyond that,
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it is not as widely known as
the federal Medicare program.
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Medicaid is not a federal program and
it is ministered by each individual
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state and unlike Medicare,
where most people,
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65 and older are automatically eligible.
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Medicaid is based on income and other
state specific requirements to meet
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eligibility requirements.
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Generally speaking in 2022,
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the individual income limit for Medicaid
and home community based services HCBS
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via Medicaid waiver is $2,523 a month and
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asset limit is $2,000.
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There is some variation in
income and asset limits by state.
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If you do meet the requirements
of your state eligibility,
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the program is free and you may qualify
to have your deductibles, co-insurances,
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And other out of pocket expenses
paid for by the Medicaid program.
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If you are wondering whether or not you
qualify or want to get more information
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on either of these programs, there's a
lot of helpful information available.
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For the federal Medicare program,
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visit medicare.gov for the
latest information to apply
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for Medicare, visit the website
for social [email protected].
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Just like Medicare, the Medicaid
program has its own dedicated website,
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which is medicaid.gov.
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Here you'll find a listing of each
state's Medicaid offices contact
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information. You can also
learn more about the program,
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view income limitations, and
other eligibility requirements,
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as well as start enrollment
process with your state.
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Other resources for both the Medicare
and Medicaid programs include your local
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aging and disability or department
of health and human services offices.
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Many states also have
a program called ship,
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which stands for state
health insurance program.
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And there you can get help with
Medicare eligibility, enrollment costs,
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plan options, programs that
can lower costs, and more. Now,
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maybe you are watching this video and
you already have Medicare or Medicaid,
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or are just joining either one or both
programs and you need more information.
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Well, here,
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we're gonna dive in and talk about
some of the folks that we have recently
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helped in one, or both
of these situations.
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Cheryl recently came in because she is
turning 65 in August and is retiring,
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so she'll be losing her health
insurance through her employer.
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She has a healthy income now and will
into her retirement and will only qualify
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for federal Medicare
program and not Medicaid.
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Cheryl wanted to know more about
Medicare and what it covers,
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and if she really needed to purchase all
the additional insurance that she keeps
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getting mail, email, and all those
phone calls about. Cheryl's not alone,
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her situation is common and her
questions are ones we hear every day.
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To get a handle on all of
this it's important to first
understand what Medicare
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is, what it covers,
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and then what options are available to
ensure you have the insurance coverage
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you need. Medicare part a,
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which is your hospital insurance
covers inpatient hospital stays,
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care in a skilled nursing facility,
hospice care, and some home healthcare.
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Medicare part B,
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which is your doctor or medical
insurance covers certain doctor services,
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outpatient care, medical supplies,
and preventative services.
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And part D helps cover the
cost of prescription drugs,
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including many recommended
shots or vaccines.
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Parts A and B only cover about
80% of your expenses and part D
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minus deductibles and co-payments
help to significantly reduce the
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retail costs of medications and vaccines.
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To help eliminate and limit
these out-of-pocket costs,
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a Medicare eligibility beneficiary
has these two options that I mentioned
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earlier.
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They can choose to enroll in a private
Medicare advantage prescription drug plan
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and receive all of their part A, B,
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and D benefits under that plan
instead of original Medicare.
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Or they can enroll in a
Medicare supplement plan,
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which works in conjunction with
original Medicare's parts A and B.
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Medicare will pay its share of the
Medicare approved amount for covered
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healthcare costs.
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Then your Medicare supplement insurance
will pay its share of those costs it
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covers. If you choose to
enroll in a supplement plan,
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you will also need to enroll in a
separate standalone part D plan as the
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chart shows us here.
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A less common situation is when
someone like Dan comes to see us and he
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qualifies for both Medicare
and the Medicaid program.
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If you qualify for Medicare and Medicaid,
this is known as dual eligibility.
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Once you become dual
eligible most, if not,
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all of your outta pocket
healthcare costs will be covered.
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Dual eligible beneficiaries,
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able to get their Medicare coverage
through original Medicare or via Medicare
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advantage prescription drug plan, which
is administered by a private plan,
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but they are unable to purchase a
Medicare supplement insurance policy.
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If a person chooses to enroll
in a Medicare advantage
prescription drug plan as
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dual eligible beneficiary, the plan will
coordinate with the Medicaid program.
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This will result in a number of extra
benefits for the beneficiary for things
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that aren't covered or are only
partially covered by Medicare.
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This includes dental benefits,
dentures, glasses, vouchers,
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hearing aids, home health
services, nursing home care,
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transportation to and from
doctors, and meals on wheels.
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So in Dan's case,
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we set them up with a five star Medicare
advantage prescription drug plan
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specifically designed for
those who are dual eligible.
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Based on his Medicaid eligibility,
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he pays nothing out of pocket for
this plan or his other out of pocket
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healthcare expenses,
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and he is eligible for all of
those benefits I just mentioned.
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A lot of folks we talk to here think they
don't need anything else because they
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have Medicaid. And while they don't,
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there's definitely a plus to choosing
to enroll in a Medicare advantage
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prescription drug plan and use it
along with their Medicaid coverage
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as Dan is now doing.
For those who qualify,
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navigating Medicare can be
extremely tricky to do on your own,
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whether you're Cheryl or Dan,
you don't have to do it alone.
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Here at Strive Medicare, we can help
you with all of your Medicare needs.
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For free help call the number on
the screen or visit our website.
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Avoid making Medicare mistakes.
Reach out to us today.
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