Hi, Randy.
It's good to see you today. Thanks for meeting me for coffee
to talk about Chris getting Medicare and becoming dually eligible.
Good to see you too, Karen.
I'm really confused about what all of this means.
You're right.
It's a lot to take in.
Especially since his mom's retirement a couple of years ago
and him becoming Medicare eligible in a couple of months.
I literally don't know anything, including what dually eligible means.
Let's start there.
Being dually eligible means
that Chris will now be getting Medicare in addition to Medicaid.
Medicare will become Chris's primary insurance for many medical services.
Wait, what happens to all the non-medical services that Medicaid covers,
like his employment support and residential services?
Those are long term care services and Medicaid will still cover them,
along with some other services, like transportation
to medical appointments, dental, vision and hearing.
So all of that stays the same.
The part that changes is the medical coverage for hospital
doctor and prescription medication.
That's where Medicare pays first. Got it.
Yes, Medicare will now be Chris's main health insurance.
Medicaid will still cover things that Medicare doesn't
like personal care and some long term services.
Chris will get extra help with prescription drug costs
through Medicare. Basically,
Medicare has different parts.
Part A covers
hospital stays, nursing care, and some home care.
Part B covers doctor's visits,
lab tests, checkups, and medical equipment.
Part D helps pay for prescription medicines.
There's also Medicare Part C, which gives you a choice
to receive services through a managed care plan,
through a contract with the federal government
to make sure the benefits and care are better coordinated.
These are called Medicare Advantage plans.
That seems pretty straightforward.
Why is Chris getting all this information about different plans?
That's because Chris has two choices to make about a plan.
He can either choose
to go through traditional Medicare or through a Medicare Advantage plan.
Yeah, I think I've seen those commercials.
There is a special Medicare
Advantage Plan specifically designed for those who are dually eligible.
These are called Dual Eligible Special Needs Plans, or “DSNPs”
DSNPs specialize in supporting the unique needs
of people who are dually eligible for both Medicare and Medicaid.
In some states, the same DSNP for Chris's Medicare benefits may also be
the same managed care program that helps Chris with some Medicaid services.
This is so benefits are better coordinated, and sometimes
there are additional benefits beyond what traditional Medicare and Medicaid cover.
I think I'm getting lost again.
Is there any support that will help Chris choose a plan?
Yes, there is.
The State Health Insurance Assistance Program, or “SHIP”, is a program
that helps people learn
more about their Medicare choices and to pick what works best for them.
Our state's SHIP program has someone who's available
to meet with Chris in person, and help Chris make this decision at no cost.
It's really important that Chris doesn't lose
his health care providers by choosing the wrong plan.
How do we avoid that?
The SHIP counselor can make sure that the chosen Medicare managed
care plan includes Chris's current doctors and health care providers.
Whew! Okay, new question.
When I go with Chris to doctors appointments and pick up medications
at the pharmacy, do we use the Medicaid or the Medicare card?
It's best to take all benefit cards just to be safe.
We'll also need to make sure that Chris's current doctors accept the Medicare plan
that Chris chose, and that the pharmacy is updated with all new Medicare ID cards.
Just to make sure,
will there be any changes to Chris's Medicaid services with this new plan?
No, the long term services and supports that Chris gets through Medicaid,
like personal care and employment,
those will remain the same.
The reason I wanted to get together is
so that we make sure we stay ahead of the process
and make sure there are no interruptions in Chris's care and services.
This sounds like a good thing for Chris.
Are there places I can learn more in case I missed something?
Yes, you can use some of the resources I shared with Chris to learn on your own.
You can call Medicare or visit their website.
You can also go to the State Health Insurance Assistance Program’s (SHIP) website.
Our state Medicaid agency is also a great resource.
And if you're assisting Chris to get information,
you can always drop by the local Social Security office to get help.
This has been very helpful.
Thank you.
You know, I'll call you if I have more questions.
Chris’s mom told me they're starting the application process next week,
so I'll be on the lookout for the Medicare card.
That's perfect!
And of course, you can always give me a call,
you know where to find me. I think we make a great team.