Medicare Medicaid Dual Eligibility

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all right friends this is a special

edition of the Josh gammon podcast

you probably remember Jo and I we have a

state-by-state a guide to Medicare

planning and and J night to have a lot

of off-camera so to speed discussions

and and he was making me aware of an

opportunity for Medicaid and Medicare

and some of you may not be interested in

this something because your Medicaid is

not in your ball of wax but my

inclination is there a lot of folks who

might be find this beneficial and the

reason I bring that up to your attention

because I know there are people who are

Medicaid eligible throughout the land

and there are also Medicare eligible as

well and there are rules and regulations

and programs that I can guarantee you

are not familiar with and I think this

podcast will be relatively short here

but I think it will get a lot out of it

so what I'm going to do is I'm just

going to turn over to Jay to share with

us and a you know the viewing population

or the listening population how a

Medicare Medicaid partnership can work

and how that might be of interest to you

or at least benefit to you for sure so

Jay if you don't mind real quick as

always go to maximize your Medicare com

to sign for Jays weekly newsletter so

Jay if you don't mind take it away I'd

love to love to be educated here please

sir absolutely I think that what we a

trend we see is nationwide across all of

our investigations and our clients is

that the availability of Medicare

Advantage has increased in virtually

every location throughout the country

part of that I think a very significant

substantial part of that is wider

distribution wider availability of

something called dual eligible and what

ends up happening in order to be

eligible for these plans you need to be

both Medicare and Medicaid

you must separately apply to your

state's Medicaid program and every state

will apply the rules differently so

that's why we're not making a specific

set of you know criteria because we've

got 50 states in Puerto Rico all 50 plus

Puerto Rico will have a different

application of the rules or Medicaid

qualification that said when you have

Medicare and Medicaid these dual

eligible plans can be important now

something that people who are on

Medicaid must be aware and they have

probably already aware which is here you

are dealing with a set of networks which

is generally speaking tighter more

restrictive meaning that your doctor

your clinic your Diagnostics lab your

podiatrist may or may not accept

Medicaid right they need to very

carefully very carefully check the

network because not only are there a

fewer number of providers that accept

Medicaid at all but then a subset for

each of these plans these dual eligible

Medicare Advantage plans that all said

if you do qualify then these plans

generally speaking have extra benefits

which are enormous ly valuable to the

policyholder for example transportation

very important for Medicaid for the

Medicaid population transportation to

the doctor transportation depending on

which plan maybe even transportation to

the dentist for example extra dental and

vision which may include hearing aids

dentures very important which are very

high cost items nevertheless if you

qualify for Medicare and Medicaid and

our policyholder of one of these

Medicare the dual eligible plans then

you can see that there are these very


extra benefits inmate and maybe most

importantly some have monthly stipends

which can be used for health-related

products literally it's a voucher where

you send in on mail order and you can

get important things to floss for

example dental floss mm-hmm toothpaste

toothbrush cotton swabs vitamins vitamin

supplements so you can see that and this

is not a small amount I've seen cases

for example eighty dollars a month is

possible that's over a thousand dollars

a year health-related product vouchers

that can be redeemed by the policyholder

on a monthly or quarterly basis so very

important so you can hear from this that

in base case many people to say okay

well I have Medicare and that is primary

when your Medicare and Medicaid eligible

and then Medicaid will pick up the

balance but that does not necessarily

include these extra benefits that I've

mentioned here once you've done your

diligence on the network to make sure

that the providers that you want to see

will accept the plan so I thought that

we would have this special podcast the

special you know kind of session

together because what is happening is

that these plans must be offered in your

County in what we see nationwide is that

the number of counties where these are

being offered has improved and in some

cases substantially where they did not


last year they do exist coming in 2019

no good oh man yes exactly and so this

is part of the umbrella of there is

wider availability of Medicare

advantage plans I thought to add a

couple of other things for those persons

where these plans do not exist Medicare

Advantage plans if you coordinate with

the Medicaid provider and they do accept

Medicaid then you can have Medicare

Advantage plans that are not these dual

eligible plans which can still limit

your out-of-pocket expenses so all is

not lost even if you do if you live in a

county which does not offer Medicare

Advantage dual eligible plans okay

that's that so I encourage persons that

are dual eligible irrespective of where

you live to check these out because the

extra benefits here are above and beyond

Medicare and Medicaid by themselves will

allow and what they offer you have care

coordination you have the idea of people

checking up on your household I'll make

sure that everything is being taken care

of that you're getting your

prescriptions etc these extra features

for those persons who require the extra

the extra assistance is very value-added

and depending on who you are and if you

can qualify for these types of plans

very valuable and we're hopeful for the

last point which is that your audience

may not specifically qualify well but is

inconceivable that someone in your

community doesn't qualify

meals-on-wheels recipient absolute

members for example or whatever your

local organization theirs

somebody that you know that does qualify

for these dual eligible plans is unaware

and you're helping them you're helping

the system if they at least are aware

and they can choose or not choose if one

of these types of plans fits for them

like you always say though if you choose

not to partake in a benefit that's your

choice and we're not gonna argue for

your choice you do whatever you want if

you choose not to partake because you're

ignorant that's not the right answer

though ignorance would solve that with

some education and you can make the

choice that you want to do then we're

not going to you know challenge your

choice it's up to you but this would be

a perfect sample of what you always say

about that now say one thing about dual

eligible people the normal enrollment

rules do not apply to dual eligibles

meaning that if you're on Medicare and

Medicaid you're called dual eligible and

in addition to that you have expanded

enrollment rights in 2019 you'll be able

to enroll in a plan even mid-year

meaning that it's not only the annual

election period but in addition that

you'll be able to change your dual

eligible plan or enroll in a dual

eligible plan once every quarter during

the first three quarters so this is that

instance that someone can call me in May

and even though it's outside of the

annual election period even though it's

outside the Medicare open enrollment

period you can still enroll in a dual

eligible plan to be effective on June

1st for the person who calls me in May

so it's another one of those examples if

you understand the rules the rules for

Medicare are generally speaking largely

in favor of the applicant I think that

that is a general statement which is

largely true if you understand the rules

on real quick so how does someone know

again if they're duly eligible and what

Willie how would you know well the

person first has to have a medic must go

to their state office ok Department of

Health and Human Services generally it

was call that the generic umbrella the

different states will have slightly

different labels for it they would have

to apply for Medicaid oka

they would have they would be assigned a

state specific individual specific

number oh gosh is not the Medicare

number not the Medicare number what ends

up happening is the dual eligible

Medicare Advantage plan carrier they

will be able to verify what the state

knows that person so let's call it mrs.

Jones right in Missouri so once mrs.

Jones in Missouri is registered at the

state Medicaid office they come to us we

verify their eligibility for not only

Medicare but also for Medicaid ok gotcha

all right then once you are are verified

for both then you will know whether or

not the Med the dual eligible plan is

right for mrs. Jones so again the first

step is to make sure you say make sure

but to qualify for Medicaid and that's

the first step in the dual enrollment

thing that is correct ok that is correct

Marty do that with your whole team but

not not the fence so that you go through

your state HHS Health and Human Services

whatever there acraman is to qualify


yeah that's correct yeah and that's why

I'm not specifying specific rules

because every state will have their own

separate set of rules right process for

the application and and if you don't

qualify this year you certainly could

quietly so you say you're 67 this you

don't qualify but you certainly could

qualify as 71 I mean that can always

change if you qualify or not so be if

you're thinking you might qualify be

Vijay I think to to revisit your state

to see if you do qualify yes and that's

also another thing that some persons

right on the borderline who do not

qualify you still may qualify for extra

help for prescription drug coverage and

beyond the beyond the scope of this

podcast that can help persons with their

prescription drugs which can either mean

lower premiums for Part D plans

it can mean lower premiums for their

Medicare Advantage plans it can lower

the co-pays for generic and brand name

prescriptions so it is worthwhile to at

least find out whether or not you

qualify for Medicaid and to refresh in

other words to have your status for

extra helps for prescription drug plans

which is calculated separately and is

determined separately the money comes

from a different source it is not the

state and is a federal program and

you'll want to know that as well because

it can lower your prescription drug

costs as well so that number program

which do help is that the name of the

sins of the program extra help it is

actually the formal name it may have

been known as limited income subsidy in

the in the past oh god but it is the

same program alright so now if someone

does qualify for dual enrollment maybe

we'll do it another podcast on extra

help specifically but some it does

qualify for dual enrollment they could

get literally vouchers worth you know

just done you know almost OtterBox or

something like that to buy all kinds of

things you don't say I mean literally a

voucher it's like there here comes a

check about your leg a coupon a sensor

in the mail to go purchase Oh whatever

vitamins like you say absolutely and

this is very

powerful while I would for example I

would like to have a voucher for myself

right but so and this is very important

for a persons like I said a dental floss

so that that type of item is going to be

on these meal it's generally mail order

where you send in or you print out a

form you fill it out and then you send

it in and then you get your items so

very important and these extra things do

not come part of just generic Medicaid

eligibility you'd have to do something

specific meaning to enroll in one of

these types of plans and many states

many counties and in an increasing

number of counties throughout the

country have these plans available oh

that's that sounds like and this is

gonna sound like a disparaging and I

actually made the exact opposite but

sounds like the insurance companies are

using the old banking toaster thing

remember the tote and I are old enough

to kind of remember that the banks would

incentivize you to get a toaster if you

open it you know passbook savings

account back in the 70s and 80s this

kind of sounds like that so obviously

the insurance company values that that

applicant or a beneficiary for sure

enough to incentivize them by sending

them a voucher I mean I don't see why

would they do that if they it wasn't

profitable for the insurance company and

that's a win-win I mean insurance

company gets a little bit of profit the

government is reduced to some degree on

their you know what they got to come out

of pocket for and then the client the

beneficiary can receive some extra

benefits that otherwise they wouldn't

have they would have had to pay out of


I actually especially would like to

point out the transportation because

what ends up happening is the medic

every state Medicaid office will very

likely have a specific transportation

vendor that they use in your location

well in addition to the

you can have where the dual-eligible

plan provider is also having a

transportation contract something with a

different transportation company so for

example if you're your state or local

Medicaid provider that transportation

provider is too busy or the schedule

doesn't run in a convenient way you can

have your dual eligible plan Medicare

Advantage plan provider provide that

transportation for many people in the

Medicare Medicaid population the

transportation to the medical provider

is vital no kiddin is vital righty they

don't have they don't of cars they don't

have access it's hard to get to public

transportation for example so it gets to

the clinic to get to the doctor for your

checkup or resole for prescriptions is

very important well here is a way to get

extra transportation benefits that may

not have existed or may not have been

able to be available to you based on you

know their scheduling for example or

their availability at a particular time

that's that's incredible I would have

never ever ever had put two and two

together in that regard and that's I

think a drawback by the financial

advisory business as a whole we're

dealing with a certain different group

of people and because that were ignorant

about the needs of a huge subset of the

population United States but yet here

comes Jay with his experience and this

stuff and he knows exactly what some of

the issues are facing this subset of

population who is not a small minority I

might add that's a big big subset of the

population for sure and Jay just brings

me to a I'll never forget this this guy

when I lived in Harrisonburg Virginia

and if you're familiar with the

Shenandoah Valley a huge Mennonite


well Mennonites don't keep cars at least

the old order Mennonites that keep

horses literally horse and buggies and

but as they get older they also have

much income so they're all you know just

they're all you know poor you know and

long story short there's a guy who's

trying to start a taxicab company in

Harrisonburg and one of

as reasons was because he these men and

I met women in particularly could had no

method of transportation back and forth

to the hospital because they lived on

these farms these dairy farms and they

don't have cars and that they're getting

older whatnot and you know they couldn't

take their horse and buggy in town and

it sounds you know quaint but it's not

and long story short so he was offering

that as a way for the Mennonite

community to build to two broad

transportation form and is you know if

that was 15 years ago I don't know what

happened with that but it's just

interesting that transportation would be

such a big deal I absolutely can see

that without question it's interesting

you brought that it's not limited to the

countryside no probably not

absolutely not not every urban area has

the same issue especially if it's in a

rough area - and your grandma and you

know you just got bad characters out

there slinging rocks I mean that's just

you know you don't you don't want a

grandma I have to be happy to negotiate

through that all right this is good stop

Jay so what's the gist you in terms of I

guess you know the order of operations

qualify for Medicare or Medicaid excuse

me get a proof by your state then look

to see if your preferred doctors accept

Medicaid is that another you know

operating procedure here it's going to

be for the dual eligible plans that the

provider the healthcare provider the

hospital will have to need to accept

that dual eligible plans over some care

caution is required you know may need an

expert to be able to guide you to make

sure that these facts are true that the

actual doctors and the actual clinic the

hospital in your area does accept not

only Medicaid but more specifically

domenica the Medicare Advantage plan

which is a dual eligible plan

okay that's the critical part so seek

help I know the way around this I mean

my goodness this is just another reason

why getting professional guidance is

critical from a broker a broker not a

captive a

but someone actually can represent you

in all aspects of the various providers

that are out there for sure and maybe

has access to the best voucher systems I

mean like you said you get a voucher for

dental floss it might not seem like much

to the average client of a financial

adviser but I'm telling you right now

for those folks who are trying to squeak

out another $200 a month of resources

free dental floss free transportation

can go a heck a long way to letting them

sleep better at night that's just a fact

and if you think not you J but it's a

the listening audience thinks that this

is not a big deal for a lot of your

citizens like you like Jane was saying

at your church at your you know just

whatever you're involved with as a

community the more you know the better

you can help your fellow man there's

just no other way around that and at the

end of the day in my opinion that's just

me we're put on earth to help our fellow

man and if you can do so in a way that

can help them you know just live a

little bit more comfortable you're doing

God's work and you know you don't have

to be one who believes in a Christian

God to believe that you don't even have

to believe in a God but you're doing

good things for people and that's uh no

one's gonna say that's a bad thing any

last thoughts on this Jay I mean again

I'm so ignorant about I don't even know

where to a stop here but you know I know

you said it might not be a long

conversation but ain't anything that

jumps out at you that we need to digest

no just to repeat what you said right

which is that we don't need to but even

if you don't think that this applies to

you specifically there's almost zero

chance that you know absolutely nobody

or you're not in touch with a community

a set of people whatever organization

that is whether that can be you could be

a volunteer and non-for-profits and

assess other people you could be part of

any type of subset of people someone not

very far away one degree of separation

is going to be Medicare Medicaid

eligible I don't think there's any weak

getting around that yeah and the

unfortunate fact is that too many of

these persons are not only underserved

but they're also under informed

yes and to the degree that we are

assisting that through your podcasting

and having me as your guest Josh what

we've done our part well hopefully

hopefully and hopefully other people get

the word and be Paul Revere I hate to

say it but going down the street saying

look there are options just pull your

head out of the sand and look around you

and seek help it's okay to seek help

there are people like Jay would be more

than willing again Jay's a busy man

right now it's tax time for insurance

guys and I say Jay disparage oozes

insurance guy like the guy from

Groundhog Day remember that movie with a

bilberry grounded the guy who's the

sureties Jay is a certified financial

planner my friend so he's not just

whatever that guy's a Meyerson or

something like that but Jay is always on

this is a fantastic and we'll put this

on the the podcast the YouTube channel

and folks don't forget Jay has his own

YouTube channel which I'll put on the

show notes here what's the name of

YouTube challenge a here's maximize your

Medicare okay there you go on there I'm

not who knew it's the same title as the

book maximize your Medicare and the

website for the book maximize your

Medicare calm good stuff hey as always

Jay thanks we'll see you next time

and folks thanks for Ken for coming on

the podcast and don't forget to

subscribe and we'll see you next time as

well thanks