.

Good evening and welcome welcome to PBS Fort Wayne.

>> I'm Sandy Thomson.

I'm the host of this show here tonight called LIFE Ahead.

But it's really your show and let me tell you why I have guests every week and different topics every Wednesday night.

>> But this is a live Call-In show.

That's why it's your show because you're going to call with questions tonight.

We have legal issues to talk about if you will.

I have an attorney with me this evening and an insurance agent.

So if you have questions about Medicare and Medicaid, this is your opportunity to have those questions verified.

>> Now if you stay on the phone with us and talk live to us here on the air, that's the bounce that way if they have any questions back to you, you're still right there on the phone.

But don't worry if you're not comfortable doing that.

We do have somebody at the switchboard in the control room that will talk to you and take your question and send it right out here to the studio to me on the teleprompter and I'll read it to them.

OK, these are the guys that I'll be talking you this evening and that you can call and talk to as well.

>> First of all, we'll Stockton you've met him before here on LIFE Ahead an attorney.

>> William, welcome back.

Thank you so much for having me, Sandy .

I'm really excited to get into the issues Medicare and Medicaid, how they can work together, how they're similar, how they're different.

>> Right.

Looking forward to a great show.

Good.

And I'm sure it will be because it's a complicated topic but they're going to simplify it for you and you have invited with you this evening Benjamin Benjamin Snider Benjamin I'll call you Ben, right?

>> Yeah, that's fine.

So you can take any questions we might have on the insurance side because that's part of what we're going to be talking about.

OK, well let's start out with the big question definitions of Medicare and Medicaid and the differences between two because they sound so much alike people confuse them.

>> Absolutely, Sandy .

So obviously with having similar sounding names like that, you run into issues with people thinking Medicare and Medicaid are the same thing or confusing one for the other.

So Medicare just to be clear is a insurance program for seniors over the age of sixty five.

Also some qualified disabled individuals will qualify for Medicare but it is an insurance program for people of a certain age or disability.

Now Medicaid on the other hand is an insurance benefit program for people who have limited income limited assets.

>> It's a needs based government program.

Another big difference is that Medicare is a federal program managed exclusively by the federal government.

Medicaid is a state and federal partnership program where the federal government sets up certain provisions that will apply across all 50 states.

But every state is different in the sense of how what specific numbers, what kind of asset limits, what kind of resources that you're allowed to have and qualify for Medicaid assistance through the state.

>> I did not realize that.pSo en parameters.

So there are certain rules in Medicaid, the Medicaid world that apply regardless of the state you're in.

So like that five year look back rule.

Forty nine states have a five year lookback rule for transfers for Medicaid.

California has a two and a half year lookback rule.

They're the only state it's different but there are a variety of rules.

Everything is kind of similar but the specific amounts are going to vary state by state.

>> Now my understanding is that Medicaid is basically an income based so your income would have to be at a certain level to qualify or below that that number.

>> Who sets that or is that the same in every state?

So in Medicaid that would be a state by state determination as to what the income level limits are, what the asset limits are.

>> They're going to be a variety of programs in Medicaid.

So just kind of hit that big three.

The biggest one is your traditional Medicaid for the aged blind and disabled people in nursing homes.

Institutions have disabilities very strict resource and income tests on those programs something like twelve hundred and fifty dollars a month in income is the maximum two thousand dollars worth of countable resources is the maximum you can have to be on traditional Medicaid.

A lot of those are people who are in long term care in the nursing.

There are also programs like the Healthy Indiana Plan which is not a resource testedpprogra.

It is an income tested program.

It's income limits are a little bit or something in the neighborhood of sixteen hundred dollars a month for a single individual this is an insurance for people aged nineteen to sixty four who don't qualify for Medicare yet.

And then there's also Hoosier health wise which is another program, another big bucket of Medicaid programs for pregnant women and children under age or up to the age COVID 19 some foster children up to the age of twenty five or twenty six.

So those are kind of the three main programs.

They're all going to have different income limits.

They're all going to have different asset tests.

Some things are going to count, some things are not certain programs are going to have resource tests.

Others are going to be solely based on your income but it's so dependent on your age and what your situation is the size of your household medically, what your needs are.

>> So you're navigating that is incredibly complicated.

I know and the fact that you keep adding or well you don't the state or federal does keeps adding new programs makes it more complicated but it makes it more convenient for you as as a viewer, as a person or a resident here.

So it's a good idea to make sure that if you have any insurance needs or you have any situation that you might need some help.

It's good to get some advice on what's available out there again because it's so complicated.

>> Is it possible being to have to be on both Medicare and Medicaid at the same time that perhaps absolutely.

>> And thank you for having me.

It's a pleasure to be here.

>> Thank you for coming out.

One of the things I do and in my role is help people that have both Medicare and Medicaid.

Yeah, we were just talking on the way over here.

There's actually a lot of people that are eligible for Medicaid assistance on Medicare and they don't even know it.

And one of the things I do with my clients is be sure to cover those income limits suggest if you know you're belw this, you know I can help you apply for that and do that application with the state and and then they flag the Medicare coverage flagged them for what's called a Medicare savings program.

And when I think of Medicare and Medicaid, I think of health care as medical insurance and then aid as assistance and people to work together.

>> That's what I do too to help me remember which ones which can't be Medicare like the government is going to help care for us.

An aide is give you some aid or assistance.

>> Well, you're both working on, right?

That is correct.

OK, OK works so I know works I used to live in Columbia City and that's right on the way to work so I still get out that direction a lot but a little crooked like do you know that like oh OK all right beautiful beautiful Indiana lake well thank you for driving to Fort Wayne for our feeling OK, let's go back to Medicare and Medicaid here.

We've talked about what the difference is talk about I've heard of this program Pathways for Aging Pathways for Aging.

>> What is that?

Yeah.

So Pathways is a new Medicaid& program that actually just rolled out two days ago July 1st of twenty twenty for the implementation of this Pathways program.

So in order to understand what that is, we kind of need to take a step back and look at what is traditional Medicaid versus what is managed Medicaid and traditional Medicaid is a fee for service type agreement where you qualify and the providers bill whatever medical expenses that you have directly to the state of Indiana and those things get paid for whereas on the other hand managed care is more like you have an insurance company or a health plan in between you and the state and they're talking about, you know, managing the care, providing those resources assets, all that kind of stuff.

But they are not certainly the same thing now Pathways is a program where you're transitioning Medicaid from something that was mostly handled by the FSA, a state agency and putting sort of in the middle as care coordinators and service coordinators insurance companies.

So United Health Care Anthem and Humana are going to be responsible for helping people coordinate that care starting at age 60.

So if you're on full Medicaid coverage and your age 60 or you get close to age 60, they're going to send you a letter and say there are these three insurance companies you get to choose.

There are some slight differences between them.

They all cover everything that Medicaid covers.

>> There are certain advantages between the plans.

So what do you do then?

Do you choose for your own specific situations or your own health ?

Does that help you choose which of the companies in which plan?

>> Yeah, so currently it doesn't really matter which one you choose does they have open network billing so as long as they accept Medicaid doesn't matter which managed care entity you have providing your care management services they are not allowed to have networks where they have exclusivity with doctors at least for the first couple of years as pathway's gets to be a more well established program they're going to start having contracts with certain hospitals, certain providers, that kind of stuff.

>> So you state that so there are currently twenty five other states that have a managed care system for their Medicaid.

So we are state number twenty six.

>> So it is now more common than not that you have this sort of managed care arrangement for Medicaid.

>> I could add on the Medicare and Medicaid relationship there if you're 60 and older, you know and you're on Medicaid you'll qualify for the pathways the aging program.

Yeah, some folks that are under 65 maybe on Social Security disability insurance and be on Medicare under age sixty five and what gets confusing with this new pathways program as they may or you may you may the viewer already have a Humana policy United health care policy and anthem policy and when you get this pathway's the aging insurance letter it's going to tell you to pick a health care plan and you might be confused about that because I already have one and so Medicaid is turning to these three insurance companies to manage those benefits and you're going to have one of those companies cards and then your Medicare coverage you're going to have a second card by that same company.

>> OK, so it won't be like two different insurance companies end well ideally you can do the same in most cases you would want to pick whatever insurance you already have because it's going to be the same doctors, the same networks, that kind of stuff.

Sure.

But they're going to have different benefits so you know what?

>> We have some questions coming in.

I knew you viewers had some things on your mind you want to know about.

Let's talk this evening with bars.

He's called in and ask this question if you don't sign up for Medicare when you're sixty five, why would an individual individual be penalized?

>> OK, Ben, there you go.

That's for you.

That's an excellent question.

One that boils down to those are the Medicare regulations.

One of the ideas of insurance is you know, insurance is based on the unknown future.

So Medicare is the same thing with Part D. I sometimes have clients that say well I don't take medications.

I don't need a Part D plan.

In fact you do.

And the reason they they have that system set up that way is to prevent what's called negative selection.

So if say I took out a dental policy only when I needed a crown, I'm going to charge my insurance company a lot of money and then I cancel my plan and all of a sudden, you know, the insurance company closes business because they're not making money so so Medicare is looking at people that are turning sixty five needing A and B and then that Part D plan so that everyone's paying into that pot now there are a few circumstances where you can delay say Medicare and not be penalized in those cases would be if you had what's called creditable coverage.

A lot of people will have that through their spouse who's continuing to work or maybe they themselves are continuing to work.

So there are some cases where you can be outside of a zone where you're going to be penalized when and where do you sign up for had a Carabine so you will do that through the Social Security office.

>> They are really pushing people to do that online.

So if you're tech savvy and comfortable with that, they do try to make it easy so you will want to try to get online and do that.

You can also call Social Security the there able to help you sign up that way as well.

If you do do it online, they're going to ask you to create a missile security account again there's multifactor authentication and you know, fortunately the new generations are a little more tech savvy but it is complicated and that's why it's important to work with a local agent.

>> Yeah, I'm sure my kids and my grandkids could do the whole thing in five minutes and I'll be there for an hour trying to figure and I forgot to mention if you are already drawing Social Security benefits before you turn sixty five at least four months before you will automatically be enrolled in Medicare and B so OK so you wouldn't have to crawl and sign up for that.

>> Yeah OK. All right can you contribute to this at all Will in terms of legal so certainly I would want to back up a step and just say hey there are different parts of Medicare Part A is hospital insurance Part B is your doctor's office and medical insurance.

Part D is your prescription drugs.

But as to why you know if you would be penalized for not applying for Medicare, the idea behind insurance in general is that the more people that you can get that are healthy paying into the system, the more it spreads those costs over the rest of society.

So I think that's the federal government weighing in and saying listen, when you turn 65 we're going to presume that you're going to need more care.

So we want everybody on board with signing up.

If you don't sign up and you are otherwise qualified to sign up, we're going to hit you with that penalty.

>> So is a big penalty.

It's 10 percent per 12 month period that you could have had coverage and didn't have it.

OK, it's 10 percent of the part B premium and that's currently one seventy four seventy a month for most people there are a few cases where if you're a high income earner you will pay more.

It's called an Urma and you pay more for your Part B and your part D in most situations that's just deducted from your Social Security payment, correct?

Yeah.

If you're delaying your Social Security benefits you will want to work out with Social Security how you plan to pay for your premium and then after three months if you're not paying your premium they will-do lose that.

Exactly.

Exactly what would you say?

Well, are some of the I don't want to say mistakes that such a negative word but I say it anyway.

What are some of the biggest mistakes or most common situations people do or don't do that get them in trouble here with Medicare or Medicaid.

>> I don't know about getting you in trouble but I mean the biggest mistake I see people make is you have no idea that you qualify for these benefits.

Yeah, I mean it's it's a very complicated system.

Medicaid currently has thirty five different categories that they provide coverage for .

Medicare is complicated enough because you have your traditional Medicare and then you have your supplements and your advantage plan and nobody knows what the difference is between all of those things unless you work in that industry and even when you do it's still incredibly complicated.

>> So getting back to Medicaid, just sitting down with somebody who knows what those limits are, how you can qualify for those benefits and then making sure as you age that you're not doing things like making gifts that impoverish yourself for Medicaid because like we talked about earlier, there is that five year lookback rule.

So that's the biggest problem I see is that people have no idea because the IRS will tell you that you can give away millions of dollars without paying any federal gift or estate tax.

But Medicaid is not so generous.

They say if you give way more than twelve hundred dollars a year to your family members in total not to each family member in total.

Twelve hundred dollars they will come back and say hey, we're going to penalize you with a period of ineligibility because you've made transfers that we presume are to become eligible financially for Medicaid because that's not that much if you're talking about it's not getting to several different families if you've got 12 grandkids you can throw twelve one hundred dollar bills on the floor at Christmas time.

Let them all scramble, get what they get.

>> Oh then you're done for the year.

No more Christmas birthdays nothing so wow.

>> OK, all right.

We do have another phone call coming in here and again we still have several more minutes of the show.

We don't have any commercials so you need to watch this right straight through but you still have some time to dial that number (969) 27 twenty and if you're out of our two six zero area code that's no problem.

You just put the one is that one eight six in front of it and that'll take care of it and you won't won't cost you any long distance.

All right.

So here's a question what happens to my Social Security disability if I go to a nursing home under the age of sixty five?

>> Good question.

And I imagine there are a lot of people that have that situation.

>> OK, Ben, you want to start with an answer on that?

Yeah, I'll I'll let we'll take some legal part of that question but it's largely going to depend on what your coverage currently is.

So if you're on Social Security disability insurance and you're eligible for Medicare, it's going to depend on what other coverage do you have?

Do you have like Quamby with Medicaid?

Do you have a Medicare Advantage plan?

Do you have a supplement long term care insurance long?

Yep, exactly.

So as far as coverage goes, Medicare caps the skilled nursing care to one hundred days if we're talking rehab kind of care the coverage you know will be paid for by Medicare and a supplement.

>> It has to be 100 100 days.

>> That's the maximum for for like a rehab kind of care no matter what the health problem or situation.

>> Yeah.

There there are some Medicare criteria to be admitted to skilled nursing they admitted.

So you do have to meet those criteria.

You can't just pull up to a skilled nursing facility and say I want a bed, I want a good meal and watch some TV.

Same thing with the hospital you got to have certain criteria you meet most whether you're on original Medicare or you're on an insurance plan, there will be checks to make sure that you're meeting those criteria and as soon as you're past those criteria criteria they will discharge you.

>> Does it have to include some sort of therapy physical?

>> Yeah, you've got to you've got to be showing improvement participating in your rehab again.

Obviously if you're in rehab you've gone through a procedure, probably had a hospitalization, a surgery, probably in some pain.

You're probably not excited about rehab but that is one of the criteria you can't just refuse to participate and then it may be well you can take if you're as long I have living there.

>> Yeah.

So as Ben said, Medicare is going to cover up to one hundred days of rehab coverage but if you're still in long term care after that then you're going to be looking at qualifying for Medicaid and the rule on Medicaid is that all of your income goes to the nursing home and you get to keep fifty two bucks a month in the state of Indiana.

We'll pick up the rest of your bill at the nursing home now for Social Security disability.

>> So Medicaid has a variety of program they call one M A D so you D and you make a Medicaid for the age you have and may be Medicaid for the blind.

Oh you have made Medicaid for the disabled and if you have Social Security disability and you're under the age of sixty five you can qualify for Medicaid with before the age of sixty five if you're disabled and you're in the nursing home before the age of sixty five and you have not yet been determined disabled by the Social Security Administration there's a special process called a medical review board that you have to go through to show that you have a qualifying disability and the state would also require that you do apply for those Social Security disability benefits so the long story short is in 90 percent of cases or more probably ninety nine percent of cases if you've got Social Security disability and you go into long term care in the nursing home, your Social Security disability is going to be part of the liability that you pay to the nursing home for your care.

>> Got it.

OK. All right.

Been another insurance question for you.

>> Will?

>> Well, we'll just talk about Medicare in general every year at the end of year you get a booklet from Medicare that has like all the rules and regulations and what they cover and what they don't.

And at the beginning there's always a page or two that will say upcoming changes for next year.

Do you have any indication yet of what that changes might be >> Yes, there are some very significant changes ahead.

I'm glad you asked that question because it's a very important so when it comes to insurance carriers that information's not going to be publicly available so October 1st but there's a couple huge changes that Medicare has made for the twenty twenty five plan for a couple of those relate to Part D which is prescription drug coverage.

So one change that's coming is the coverage gap is going to be done away with taking it away.p.

Oh really?

Yeah.

So that's going away.

Another benefit is the max out-of-pocket limit for prescription drugs is dropping from eight thousand dollars total risk down to two thousand dollars.

>> So that's huge.

So that's really good news for people that are on expensive medications.

Yeah.

And then Medicare is also allowing for members to pay their Part D costs over the course of a payment plan for the year.

So it's going to help people spread out their their income loss towards their Part D expenses.

The bad news is there's good and bad.

The bad news is they don't advertise widely that you know who's going to pay for those changes and ultimate that's going to fall on the shoulders.

So if you're watching right now and you have Medicare, you will be impacted by these changes so both the good and the bad will be notified at hand.

>> These changes are already public and look where you're going to be notified is when you get your what's called an annual notice to change your Social Security.

Well, it's actually from your insurance carrier.

Oh.

So you're you're going to get an annual it's a change.

It's a document that explains what your current benefits are, what they're going to be next year and where you're going to see changes as your premiums are going to go up significantly.

>> I'm hearing rumors that they may even double so to to drop from eight thousand I want to write if you have like an advantage plan and not a standalone prescription drug plan, you're probably going to see some benefit reductions.

There may be some deductibles, there may be some change, maybe some premiums on small premiums.

So we just don't know until we see released in October what those new changes are and you know, being at the toward the end of the year we always have a couple of shows where we do talk specifically about changes and the enrollment period.

So that'll be something you can look forward to as well.

And I looked forward to and will certainly enjoying our company this evening here the legal aspects and the insurance aspects of Medicare and Medicaid.

>> So Will and and thank you so much for being with us here.

Yes, Thank you so much for having us.

>> All right.

Well for the rest of you, we'll be back here next Wednesday night at seven thirty.

We'll see you then.

>> And meanwhile stay safe and stay healthy