EPS 34 – What Is a Dual Eligible Medicare Plan? Medicare made simple—without the sales pitch

In this episode of Pink Money, Jerry Williams cuts through the noise of nonstop commercials about “dual eligible” Medicare plans and explains what’s really going on during open enrollment. He breaks down the difference between Medicare and Medicaid, what “dual eligible” actually means, and the key parts of Medicare—A, B, C, and D—so you can better understand your options.

Jerry also explains the role of Medicare Supplement plans, how Advantage plans work, and why timing matters when it comes to signing up or switching coverage. With clear explanations of enrollment windows, penalties, and cost factors, this episode gives you the practical knowledge you need to make informed healthcare decisions for yourself—or to help someone you love.

💬 Have a question or comment? Contact Jerry here

Transcript

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I'm your host, Jerry Williams, and we talk about all things related to money from a gay perspective. And today I wanted to talk about some commercials that I've been seeing about dual eligible Medicare supplement plans and They're running these like nonstop. And I think the main reason is, of course, we are now in the open enrollment period, which means that you can make changes to your Medicare Advantage plan or even make changes to switch back to original Medicare if you want it. And that's the reason that I think they're doing so much advertising. But it seems like they advertise this all year long. But I think for the average person, just a little bit of information sometimes, again, like always goes a long way. And it's always a good idea to talk with somebody about your unique and particular situation especially as it relates to a medicare advantage plan or medicare in general or going to a medicare supplement plan etc because there are some moving parts in it it can be kind of confusing if you've never done this before or if you're not familiar with all the terms and i get that and really you want to make the best decision for yourself you know from the get-go and so when you get to the 65 you You know, age of 65 and all these things are going to come at you fast and furious. You really, like I said, want to make the decision, you know, from the get-go the right way so you don't have to fool with it later on or be disappointed with what you have and then wonder why I can't switch or what is it going to take to switch or am I stuck with this and for how long. And all that just, you know, can be a little alarming and unsettling when you get into that situation. But from the very beginning, let me just clarify that. Medicare and Medicaid are two different things. I think I've mentioned this before, but it's worth reiterating. So Medicare is health care for when you reach 65. It's more or less government-provided. It's what they call an entitlement program. And you hear a lot of times about, you know, we're going to cut back entitlements like Social Security and Medicare. But here nor there, and I'm not going to talk about all that because that's another story for another day. But these... plans are essentially what you're able to sign up for when you need health care and you're essentially retired okay whether or not you're 100% retired at 65 or not kind of doesn't matter what really matters is do you need health care or not and the reason that you would not need it is because essentially you're either working right and you're covered by an employer-sponsored health care plan so you don't necessarily per se have to sign up for medicare or you are indigent or you have some other reasons that you can qualify for Medicaid, again, a government-sponsored plan that, again, provides you health care. So when they're talking about a dual-eligible Medicaid plan or Medicare plan, what they're just talking about is you're eligible for both Medicaid and Medicare. If you are not in the indigent world, then Medicaid really isn't going to apply to you. Hence, a dual-need plan is not going to apply to you either. The way that they advertise these though makes it seems like everybody's eligible for it and you should you're missing out if you don't call well that's just a call to action out of fear trying to get you to dial them right away and talk to them again not a bad thing but if you don't need it no reason to call and you can talk to a million different companies because there's a bunch out there and we're talking about insurance companies that provide health insurance plans like Medicare supplements and Medicare Advantage plans. Some offer both. Some offer just one or the other. It really just depends. But if you speak to a licensed insurance agent who's healthcare licensed, then they should be able to guide you through both. And usually these people just talk about this all day long, every day, and so they're pretty well versed in the ins and outs of it. And in a nutshell, what it really boils down to is signing up when you are eligible and not signing up after the fact when you will be penalized and have a monetary penalty that will be attached to your premiums forever. And so you don't want to miss your open enrollment. Now, if you're covered by an employer-sponsored plan and you're still working and let's say you're 65, oftentimes they will require, your health care plan will require that you sign up for Medicare. The reason why is because when you are not on Medicare, then that health care plan is the primary payer. They pay for everything. So if they can shift some of that cost burden to you and to the government, then that's what they're going to require you to do. So signing up for Medicare is often what happens in that Medicare then pays first, and your health care plan becomes the secondary payer, the supplement, if you will. Now, let's say you're still working, but you don't have health care, or they dropped you at 65. Who knows, right? All kinds of things can happen. Okay, so if you do sign up for Medicare itself, then you will sign up during the... initial enrollment period. That's three months before your 65th birthday, the month of your birthday, and three months after your birthday. That's how long you have to sign up. And they will start peppering you with all sorts of things, reminding you that you should sign up because, again, if you skip that and you miss it, then you're going to incur a forever penalty. So when you initially sign up for Medicare, it has... four parts, essentially, A, B, C, D. A is hospitalization. That covers 80% of your healthcare costs in terms of health when you go to the hospital. Part B, again, covers 80% of the costs when you go to see the doctor, and that's how he or she gets paid. And then there's Medicare Part C, which is Medicare Advantage, which, for all intents and purposes, let's just call that an HMO plan. And then you have Medicare Part D, which is how your prescription drug plan are priced separately outside of A and B. You have Part D, and you sign up, and you buy a Medicare prescription drug plan that you pay for separately. So if you've worked 40 quarters or your spouse has worked 40 quarters, then most people get Medicare Part A free, so to speak. And I say that in terms of, is it really free? because yes and no, right? You've been paying into this all along, and so you do get it free in the sense that you don't have to... you're not going to be sent a bill, right? However, if you've never worked 40 quarters or you're shy of 40 quarters, then you are going to be paying monthly. So let's just say that you only worked 30 quarters, okay? So you didn't have 10 years of working time, which is 40 quarters. So in that case, you could pay up to $506 a month in 2024 if you worked fewer than 30 quarters. If you worked between 30 and 39 quarters, Then the premium is $278 a month. But again, as long as you work the 40 quarters, then you're not going to see a bill. But then that again just pays 80%. And then we go into part B and the part B again is essentially how your doctors get paid. And that is a monthly premium or a bill that you're going to see. And for 2024, you're going to pay $174.70. All that generally just comes directly out of your Social Security check. And so you're not going to, again, essentially see it. Now, again, most likely you're going to have to have Part A and B because why would you have Part A and then you have to pay for Part B? That doesn't make sense, right? And vice versa. So you're going to sign up for A and B. Now, you're not required to get what's called a Medicare Supplement Plan, and that covers the 20% that Part A and B do not cover. But it only makes sense that you should get it, right? Because who knows how expensive that could be. Let's say you're hospitalized for an extended period of time, then those bills can be just enormous So getting a Medicare supplement plan is certainly the way to go. Now, there are a bunch of plans that exist out there, and they go from A, B, C, D, all the way down to Plan K, I believe. But for the most part, years ago, people got Plan F, like Frank. But the main reason why they got Plan F is because it pretty much covered everything, and it also covered the Medicare Part B premium. A couple of years ago, Medicare changed the rules and they said, no, Medicare supplement plans cannot pay for the Medicare part, be deductible any longer. I guess the idea was that if people have more skin in the game, then they're going to use their health care more judiciously, and then rather they get everything for quote-unquote free. And again, I don't really like that word free because, again, you are paying for it. You just may not see it per se, but you're going to have, let's say, again, Part A, which is paid for. because you earned it. And then you're going to have that $174 that you're going to be paying out of your Social Security check monthly. And then you're going to have to pay for your prescription drug plan, so whatever that might be. And that just really depends on which plan you want to get, etc. And that depends on all the medications you're going to possibly need. You may not need any right now, right? So you might not want to take one, but there could come the time that all of a sudden you need a bunch of drugs all of a sudden and now you're left with no prescription drug plan you got to pay for all that out of pocket so yeah it's a necessary expense if you just want to be rather safe than sorry but again that's kind of up to you so if you take you know the current most popular medicare supplement supplement plan that would be plan g like golf and that really depends on The cost of it depends on where you live, your gender, whether you smoke or not, and what your age is, if it's community rated or issue rated or attained age rated. All those factors go into how much the plan is. And it can range anywhere from somewhere between $100 to $300 a month. And this is per individual. So if you and your husband are married, then you're both reaching that age. That's two plans per, you know, one for each of you, right? So it's not a community plan per se. There's nothing like that. So each of you is going to have to shoulder your own Medicare costs and come out of your own Social Security check. And then, like I said, you have your Medicare Advantage plan, which you can take that as well. Now... Sometimes people will go down the path of the Medicare Advantage plan because, as I described, you have the cost for, you know, the Medicare Part B, which again is the $174, and then you have the prescription drug plan, and then you have to pay for the Medicare supplement plan on top of that. So let's just say you're paying, I don't know. $250 a month for the Medicare supplement plan, and let's say you pay another, you know, $150 for your prescription drug plan, right? So right there, boom, you got almost $400 a month that you're paying, you know, just for the plans alone. And then you have the $174 on top of that. So, you know, again, this can add up, and it can be kind of pricey in a lot of ways. You know, so if you're paying, you know, close to... $575, $600 a month, it's not necessarily free, right, in that sense. So sometimes people look at that and they go, well, I don't want to pay that. I just don't. I'm really healthy. I don't have any problems. I don't take any medications. And, you know, I really don't want to pay that. Okay, that's okay, right? That's certainly fine. So you could take part A and B and just go on about your merry way and not take a prescription drug plan and not take a Medicare supplement plan and just wing it. Probably not the wisest thing to do, but you could, right? Or maybe an alternative is to take the Medicare Advantage plan, which is Medicare Part C. Now, if you go down that road, it combines Medicare Part A and B and D. It's all together. So you get into this plan, and it's a managed health care plan, which means that you have a primary care physician, and then you have generally to get a referral if you want to go see a specialist. And so the costs are managed. That can be beneficial to you in a lot of ways because these plans are also a heck of a lot less expensive than if you buy the Medicare supplement plan route and go with a separate prescription drug plan. So sometimes you can find these for as little as zero bucks a month, which sounds, what, crazy? Yeah, because people are like, how's that possible? Well, because the government pays these companies to sell these plans, and it's just another ability for them to, to provide healthcare to you in a different way. So they're not directly associated with the government, right? These are not government plans, but they have to follow government rules. So Medicare rules are followed by doctors, hospitals that provide these services and agree to a Medicare assignment, meaning they're going to accept the costs that Medicare is providing for these services. And same thing with the Medicare Advantage plans, that they have to follow Medicare rules. So you're not going to get substandard care in the sense that, you know, this is some flunky, funky, you know, off the shelf kind of fly by night organization. No, I mean, this is a legitimate doctors, hospitals, et cetera. But again, in the Medicare system, like when you have regular healthcare, you have PPO plans, right? Where you can go to any doctor you want at any time. And, you know, you don't need a referral and people just like that freedom of choice, whether you go down the path of the HMO plan, then again, you have the managed healthcare system and all the associated parts that go with that. So again, It just depends on where you want to go. Now, some of the Medicare Advantage plans do have a zero. Some of them have a monthly cost. Some of them don't have prescription drug plans. Most of them do. So again, it would probably behoove you to get one that has it included or has one included at a very small cost. Now, if you go to the Medicare Advantage plans, oftentimes they do also have some cost sharing. So meaning you go to the doctor and there's maybe, I don't know, a $20, $30 cost out of pocket for doctor visits. There's, you know, $100, $200, whatever, if you get checked in the hospital, etc. And on and on and on. So, again, if you don't mind that, fine. You know, then that's just an option for you. And, again, whether you decide that it's well worth your time or not is strictly up to you. Again, the dual eligible does not really apply to anybody unless you are in that situation where you qualify for Medicaid. and you also qualify for Medicare. So you're 65, and let's just say, for all intents and purposes, you're indigent, okay? Or you have some healthcare reasons that maybe you qualify for Medicaid, like you're on dialysis or something, okay? So those are things that you can look at if you want to, but again, all these commercials, you can just pretty much ignore them. But one thing that you can't ignore is... when you fall into these open enrollments, the annual enrollments, and your initial enrollment period. Like I explained, the initial enrollment period is pretty cut and dried, right? Three months before your 65th birthday, the month of your birthday, three months after your birthday, okay? So that's pretty straightforward. And that can happen at any time of the year, right? Because your birthday could be, you know, January, June, August, whatever it is, right? However... If once you're in these plans, then it kicks in these certain times of year when you can make changes. Now, that's not 100% foreign to a lot of people, right? Because often when you have your regular health care and you're under 65, you cannot generally make changes until the annual enrollment period, which is usually October. So now that we're hitting October 1, then most healthcare companies now are opening the gates, if you will, and allowing you to make changes. So does this last forever? Of course not, right? It's only going to run from October until December, I think. Let's see. October 15th through December 7th. That's the annual enrollment period. So you have a small window of time to make these changes. You can switch from Medicare Parts A and B to the Medicare Advantage Plan, the Part C. You can switch from one Medicare Advantage Plan to another. You want to go from Humana to, I don't know, you know, whomever else offers one. You can do that at any time during the annual enrollment period, okay? So there are some times that you can switch from certain plans if you have some special circumstance, like if you quit your company, you retire, and you're no longer going to have health care that's employer-sponsored, then it opens a special enrollment window, and generally then you can join one of these plans. But it's pretty strict, again, when you're going from one Medicare Advantage plan, especially back to original Medicare, because sometimes... It definitely happens when people are like, I don't like the gatekeeper concept. I don't like the fact that I have to get a referral whenever I want to go see someone. And I don't like everybody who's on this network. And I just want to have my freedom of choice. And I want to switch back. Well, again, you can't just switch whenever you feel like it. You have to wait for these annual enrollment periods or the open enrollment period. And then you can make those changes. So it's just... It's just one of those things. It's just one of those things. So those are the times that you really want to be aware of what you're doing. If you're in a Medicare Advantage open enrollment period, those dates are from January 1 to March 31 every year. And that's just a specific time that if you're enrolled in a Medicare Advantage plan and you want to make some changes, then you can switch. You can switch from one Medicare Advantage plan with or without a drug coverage to one that has one or, you know, vice versa. You can drop the original Medicare Advantage plan or drop your Medicare Advantage plan and return to original Medicare with the option, again, of having a standalone Medicare Part D plan, the standalone prescription drug plan. So it sounds kind of confusing because you have all these letters, et cetera, et cetera. But again, it's really pretty cut and dry. It's A and B. A covers your hospitalization. B covers your doctor visits. A and B together only pays 80% of your costs. There's no prescription drug plan. If you choose to have your prescriptions covered through any kind of a plan, you have to sign up for a standalone Medicare prescription drug plan. You pay that separately. If you want to have that 20% picked up that's not covered by original Medicare, then you buy a Medicare supplement plan. And there's, again, any number of companies that can provide you one. And similarly, if you don't want to pay those costs for the Medicare supplement plan and the separate costs for the prescription drug plan, then look for a Medicare Advantage plan. So that may be, you know, again, a route that is appealing to you and it just all depends. But again, you want to be aware of those timeframes when you can switch if the time comes or the situation arises that you want to make some changes and you want to go to something that's either more cost effective or one that just provides you with a broader range of coverage. So I hope that makes sense. Again, these, um, All these ads that are always flying around just make me think about, you know, all the confusing parts that I think a lot of people don't really understand. And this isn't meant to be all encompassing, of course not. It's just to give you a little bit more information so that you have a little bit more information to work with, or especially if you're helping someone else, you know, you can make them aware of some of these rules and some of these terms so that they can be a little bit better versed in them, and you as well, because at some point, you know, this is going to affect you as well and the more you know the better off you're going to be and we're all going to hit it someday unless something else occurs where you don't need to have health care at all or you can pay for it because you got a lot of money and you just can pay for it all out of pocket hey more power to you I hope that is your situation anyway I hope that helps and as always just seek some competent advice you know when you need some money in your corner okay have a great day and I will talk to you next time

Unknown: 22:38

Bye.