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

Episode Transcript

Unknown (00:01):
Music Playing

Speaker 00 (00:55):
I'm your host, Jerry Williams, and we talk about all
things related to money from agay perspective.
And today I wanted to talkabout some commercials that I've
been seeing about dual eligibleMedicare supplement plans and
They're running these likenonstop.
And I think the main reason is,of course, we are now in the
open enrollment period, whichmeans that you can make changes

(01:17):
to your Medicare Advantage planor even make changes to switch
back to original Medicare if youwant it.
And that's the reason that Ithink they're doing so much
advertising.
But it seems like theyadvertise this all year long.
But I think for the averageperson, just a little bit of
information sometimes, again,like always goes a long way.
And it's always a good idea totalk with somebody about your

(01:40):
unique and particular situationespecially as it relates to a
medicare advantage plan ormedicare in general or going to
a medicare supplement plan etcbecause there are some moving
parts in it it can be kind ofconfusing if you've never done
this before or if you're notfamiliar with all the terms and
i get that and really you wantto make the best decision for

(02:01):
yourself you know from theget-go and so when you get to
the 65 you You know, age of 65and all these things are going
to come at you fast and furious.
You really, like I said, wantto make the decision, you know,
from the get-go the right way soyou don't have to fool with it
later on or be disappointed withwhat you have and then wonder
why I can't switch or what is itgoing to take to switch or am I

(02:23):
stuck with this and for howlong.
And all that just, you know,can be a little alarming and
unsettling when you get intothat situation.
But from the very beginning,let me just clarify that.
Medicare and Medicaid are twodifferent things.
I think I've mentioned thisbefore, but it's worth
reiterating.
So Medicare is health care forwhen you reach 65.

(02:47):
It's more or lessgovernment-provided.
It's what they call anentitlement program.
And you hear a lot of timesabout, you know, we're going to
cut back entitlements likeSocial Security and Medicare.
But here nor there, and I'm notgoing to talk about all that
because that's another story foranother day.
But these...
plans are essentially whatyou're able to sign up for when

(03:09):
you need health care and you'reessentially retired okay whether
or not you're 100% retired at65 or not kind of doesn't matter
what really matters is do youneed health care or not and the
reason that you would not needit is because essentially you're
either working right and you'recovered by an
employer-sponsored health careplan so you don't necessarily

(03:31):
per se have to sign up formedicare or you are indigent or
you have some other reasons thatyou can qualify for Medicaid,
again, a government-sponsoredplan that, again, provides you
health care.
So when they're talking about adual-eligible Medicaid plan or
Medicare plan, what they're justtalking about is you're

(03:52):
eligible for both Medicaid andMedicare.
If you are not in the indigentworld, then Medicaid really
isn't going to apply to you.
Hence, a dual-need plan is notgoing to apply to you either.
The way that they advertisethese though makes it seems like
everybody's eligible for it andyou should you're missing out
if you don't call well that'sjust a call to action out of

(04:14):
fear trying to get you to dialthem right away and talk to them
again not a bad thing but ifyou don't need it no reason to
call and you can talk to amillion different companies
because there's a bunch outthere and we're talking about
insurance companies that providehealth insurance plans like
Medicare supplements andMedicare Advantage plans.

(04:35):
Some offer both.
Some offer just one or theother.
It really just depends.
But if you speak to a licensedinsurance agent who's healthcare
licensed, then they should beable to guide you through both.
And usually these people justtalk about this all day long,
every day, and so they're prettywell versed in the ins and outs
of it.
And in a nutshell, what itreally boils down to is signing

(04:59):
up when you are eligible and notsigning up after the fact when
you will be penalized and have amonetary penalty that will be
attached to your premiumsforever.
And so you don't want to missyour open enrollment.
Now, if you're covered by anemployer-sponsored plan and

(05:19):
you're still working and let'ssay you're 65, oftentimes they
will require, your health careplan will require that you sign
up for Medicare.
The reason why is because whenyou are not on Medicare, then
that health care plan is theprimary payer.
They pay for everything.
So if they can shift some ofthat cost burden to you and to

(05:42):
the government, then that's whatthey're going to require you to
do.
So signing up for Medicare isoften what happens in that
Medicare then pays first, andyour health care plan becomes
the secondary payer, thesupplement, if you will.
Now, let's say you're stillworking, but you don't have
health care, or they dropped youat 65.
Who knows, right?

(06:02):
All kinds of things can happen.
Okay, so if you do sign up forMedicare itself, then you will
sign up during the...
initial enrollment period.
That's three months before your65th birthday, the month of
your birthday, and three monthsafter your birthday.
That's how long you have tosign up.

(06:23):
And they will start pepperingyou with all sorts of things,
reminding you that you shouldsign up because, again, if you
skip that and you miss it, thenyou're going to incur a forever
penalty.
So when you initially sign upfor Medicare, it has...
four parts, essentially, A, B,C, D.
A is hospitalization.

(06:44):
That covers 80% of yourhealthcare costs in terms of
health when you go to thehospital.
Part B, again, covers 80% ofthe costs when you go to see the
doctor, and that's how he orshe gets paid.
And then there's Medicare PartC, which is Medicare Advantage,
which, for all intents andpurposes, let's just call that

(07:04):
an HMO plan.
And then you have Medicare PartD, which is how your
prescription drug plan arepriced separately outside of A
and B.
You have Part D, and you signup, and you buy a Medicare
prescription drug plan that youpay for separately.
So if you've worked 40 quartersor your spouse has worked 40

(07:26):
quarters, then most people getMedicare Part A free, so to
speak.
And I say that in terms of, isit really free?
because yes and no, right?
You've been paying into thisall along, and so you do get it
free in the sense that you don'thave to...

(07:46):
you're not going to be sent abill, right?
However, if you've never worked40 quarters or you're shy of 40
quarters, then you are going tobe paying monthly.
So let's just say that you onlyworked 30 quarters, okay?
So you didn't have 10 years ofworking time, which is 40
quarters.
So in that case, you could payup to $506 a month in 2024 if

(08:11):
you worked fewer than 30quarters.
If you worked between 30 and 39quarters, Then the premium is
$278 a month.
But again, as long as you workthe 40 quarters, then you're not
going to see a bill.
But then that again just pays80%.
And then we go into part B andthe part B again is essentially

(08:33):
how your doctors get paid.
And that is a monthly premiumor a bill that you're going to
see.
And for 2024, you're going topay $174.70.
All that generally just comesdirectly out of your Social
Security check.
And so you're not going to,again, essentially see it.
Now, again, most likely you'regoing to have to have Part A and

(08:54):
B because why would you havePart 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 forA and B.
Now, you're not required to getwhat's called a Medicare
Supplement Plan, and that coversthe 20% that Part A and B do
not cover.
But it only makes sense thatyou should get it, right?
Because who knows how expensivethat could be.

(09:15):
Let's say you're hospitalizedfor an extended period of time,
then those bills can be justenormous So getting a Medicare
supplement plan is certainly theway to go.
Now, there are a bunch of plansthat exist out there, and they
go from A, B, C, D, all the waydown to Plan K, I believe.
But for the most part, yearsago, people got Plan F, like

(09:40):
Frank.
But the main reason why theygot Plan F is because it pretty
much covered everything, and italso covered the Medicare Part B
premium.
A couple of years ago, Medicarechanged the rules and they
said, no, Medicare supplementplans cannot pay for the
Medicare part, be deductible anylonger.

(10:00):
I guess the idea was that ifpeople have more skin in the
game, then they're going to usetheir health care more
judiciously, and then ratherthey get everything for
quote-unquote free.
And again, I don't really likethat 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

(10:21):
say, again, Part A, which ispaid for.
because you earned it.
And then you're going to havethat $174 that you're going to
be paying out of your SocialSecurity check monthly.
And then you're going to haveto pay for your prescription
drug plan, so whatever thatmight be.
And that just really depends onwhich plan you want to get,
etc.
And that depends on all themedications you're going to

(10:45):
possibly need.
You may not need any right now,right?
So you might not want to takeone, but there could come the
time that all of a sudden youneed a bunch of drugs all of a
sudden and now you're left withno prescription drug plan you
got to pay for all that out ofpocket so yeah it's a necessary
expense if you just want to berather safe than sorry but again

(11:07):
that's kind of up to you so ifyou take you know the current
most popular medicare supplementsupplement plan that would be
plan g like golf and that reallydepends on The cost of it
depends on where you live, yourgender, whether you smoke or
not, and what your age is, ifit's community rated or issue

(11:31):
rated or attained age rated.
All those factors go into howmuch the plan is.
And it can range anywhere fromsomewhere between $100 to $300 a
month.
And this is per individual.
So if you and your husband aremarried, 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 planper se.

(11:52):
There's nothing like that.
So each of you is going to haveto shoulder your own Medicare
costs and come out of your ownSocial Security check.
And then, like I said, you haveyour Medicare Advantage plan,
which you can take that as well.
Now...
Sometimes people will go downthe path of the Medicare

(12:15):
Advantage plan because, as Idescribed, you have the cost
for, you know, the Medicare PartB, which again is the $174, and
then you have the prescriptiondrug plan, and then you have to
pay for the Medicare supplementplan on top of that.
So let's just say you'repaying, I don't know.
$250 a month for the Medicaresupplement plan, and let's say

(12:35):
you pay another, you know, $150for your prescription drug plan,
right?
So right there, boom, you gotalmost $400 a month that you're
paying, you know, just for theplans alone.
And then you have the $174 ontop of that.
So, you know, again, this canadd up, and it can be kind of

(12:55):
pricey in a lot of ways.
You know, so if you're paying,you know, close to...
$575, $600 a month, it's notnecessarily free, right, in that
sense.
So sometimes people look atthat 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'twant to pay that.

(13:18):
Okay, that's okay, right?
That's certainly fine.
So you could take part A and Band just go on about your merry
way and not take a prescriptiondrug plan and not take a
Medicare supplement plan andjust wing it.
Probably not the wisest thingto do, but you could, right?
Or maybe an alternative is totake the Medicare Advantage
plan, which is Medicare Part C.

(13:38):
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, andit's a managed health care plan,
which means that you have aprimary care physician, and then
you have generally to get areferral if you want to go see a
specialist.
And so the costs are managed.
That can be beneficial to youin a lot of ways because these

(14:00):
plans are also a heck of a lotless expensive than if you buy
the Medicare supplement planroute and go with a separate
prescription drug plan.
So sometimes you can find thesefor as little as zero bucks a
month, which sounds, what,crazy?
Yeah, because people are like,how's that possible?
Well, because the governmentpays these companies to sell

(14:22):
these plans, and it's justanother ability for them to, to
provide healthcare to you in adifferent way.
So they're not directlyassociated with the government,
right?
These are not government plans,but they have to follow
government rules.
So Medicare rules are followedby doctors, hospitals that
provide these services and agreeto a Medicare assignment,

(14:47):
meaning they're going to acceptthe costs that Medicare is
providing for these services.
And same thing with theMedicare Advantage plans, that
they have to follow Medicarerules.
So you're not going to getsubstandard care in the sense
that, you know, this is someflunky, funky, you know, off the
shelf kind of fly by nightorganization.
No, I mean, this is alegitimate doctors, hospitals,

(15:10):
et cetera.
But again, in the Medicaresystem, like when you have
regular healthcare, you have PPOplans, right?
Where you can go to any doctoryou want at any time.
And, you know, you don't need areferral and people just like
that freedom of choice, whetheryou go down the path of the HMO
plan, then again, you have themanaged healthcare system and
all the associated parts that gowith that.

(15:31):
So again, It just depends onwhere you want to go.
Now, some of the MedicareAdvantage plans do have a zero.
Some of them have a monthlycost.
Some of them don't haveprescription drug plans.
Most of them do.
So again, it would probablybehoove you to get one that has
it included or has one includedat a very small cost.

(15:51):
Now, if you go to the MedicareAdvantage plans, oftentimes they
do also have some cost sharing.
So meaning you go to the doctorand there's maybe, I don't
know, a $20, $30 cost out ofpocket 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 mindthat, fine.

(16:13):
You know, then that's just anoption for you.
And, again, whether you decidethat it's well worth your time
or not is strictly up to you.
Again, the dual eligible doesnot really apply to anybody
unless you are in that situationwhere you qualify for Medicaid.
and you also qualify forMedicare.
So you're 65, and let's justsay, for all intents and

(16:36):
purposes, you're indigent, okay?
Or you have some healthcarereasons that maybe you qualify
for Medicaid, like you're ondialysis or something, okay?
So those are things that youcan look at if you want to, but
again, all these commercials,you can just pretty much ignore

(16:56):
them.
But one thing that you can'tignore is...
when you fall into these openenrollments, the annual
enrollments, and your initialenrollment period.
Like I explained, the initialenrollment period is pretty cut
and dried, right?
Three months before your 65thbirthday, the month of your
birthday, three months afteryour birthday, okay?

(17:17):
So that's prettystraightforward.
And that can happen at any timeof 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 makechanges.
Now, that's not 100% foreign toa lot of people, right?

(17:39):
Because often when you haveyour regular health care and
you're under 65, you cannotgenerally make changes until the
annual enrollment period, whichis usually October.
So now that we're hittingOctober 1, then most healthcare
companies now are opening thegates, if you will, and allowing
you to make changes.

(18:00):
So does this last forever?
Of course not, right?
It's only going to run fromOctober until December, I think.
Let's see.
October 15th through December7th.
That's the annual enrollmentperiod.
So you have a small window oftime to make these changes.

(18:20):
You can switch from MedicareParts A and B to the Medicare
Advantage Plan, the Part C.
You can switch from oneMedicare 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 timeduring the annual enrollment
period, okay?

(18:40):
So there are some times thatyou can switch from certain
plans if you have some specialcircumstance, like if you quit
your company, you retire, andyou're no longer going to have
health care that'semployer-sponsored, then it
opens a special enrollmentwindow, and generally then you
can join one of these plans.
But it's pretty strict, again,when you're going from one

(19:01):
Medicare Advantage plan,especially back to original
Medicare, because sometimes...
It definitely happens whenpeople are like, I don't like
the gatekeeper concept.
I don't like the fact that Ihave to get a referral whenever
I want to go see someone.
And I don't like everybodywho's on this network.
And I just want to have myfreedom of choice.
And I want to switch back.
Well, again, you can't justswitch whenever you feel like

(19:24):
it.
You have to wait for theseannual enrollment periods or the
open enrollment period.
And then you can make thosechanges.
So it's just...
It's just one of those things.
It's just one of those things.
So those are the times that youreally want to be aware of what
you're doing.
If you're in a MedicareAdvantage open enrollment

(19:45):
period, those dates are fromJanuary 1 to March 31 every
year.
And that's just a specific timethat if you're enrolled in a
Medicare Advantage plan and youwant to make some changes, then
you can switch.
You can switch from oneMedicare Advantage plan with or
without a drug coverage to onethat has one or, you know, vice
versa.
You can drop the originalMedicare Advantage plan or drop

(20:08):
your Medicare Advantage plan andreturn to original Medicare
with the option, again, ofhaving a standalone Medicare
Part D plan, the standaloneprescription drug plan.
So it sounds kind of confusingbecause you have all these
letters, et cetera, et cetera.
But again, it's really prettycut and dry.
It's A and B.
A covers your hospitalization.

(20:28):
B covers your doctor visits.
A and B together only pays 80%of your costs.
There's no prescription drugplan.
If you choose to have yourprescriptions covered through
any kind of a plan, you have tosign 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

(20:50):
original Medicare, then you buya Medicare supplement plan.
And there's, again, any numberof companies that can provide
you one.
And similarly, if you don'twant to pay those costs for the
Medicare supplement plan and theseparate costs for the
prescription drug plan, thenlook for a Medicare Advantage
plan.
So that may be, you know,again, a route that is appealing

(21:14):
to you and it just all depends.
But again, you want to be awareof those timeframes when you
can switch if the time comes orthe situation arises that you
want to make some changes andyou want to go to something
that's either more costeffective or one that just
provides you with a broaderrange of coverage.

(21:34):
So I hope that makes sense.
Again, these, um, All these adsthat are always flying around
just make me think about, youknow, all the confusing parts
that I think a lot of peopledon't really understand.
And this isn't meant to be allencompassing, of course not.
It's just to give you a littlebit more information so that you
have a little bit moreinformation to work with, or

(21:55):
especially if you're helpingsomeone else, you know, you can
make them aware of some of theserules and some of these terms
so that they can be a little bitbetter versed in them, and you
as well, because at some point,you know, this is going to
affect you as well and the moreyou know the better off you're
going to be and we're all goingto hit it someday unless
something else occurs where youdon't need to have health care

(22:17):
at all or you can pay for itbecause you got a lot of money
and you just can pay for it allout of pocket hey more power to
you I hope that is yoursituation anyway I hope that
helps and as always just seeksome competent advice you know
when you need some money in yourcorner okay have a great day
and I will talk to you next time

Unknown (22:38):
Bye.