1 99:59:59,999 --> 99:59:59,999 I'm here with Dr. Lawrence Baker from Stanford Medical School, and we are going to talk about what? 2 99:59:59,999 --> 99:59:59,999 How about Medicare? 3 99:59:59,999 --> 99:59:59,999 I thikn we knew what was going to happen since we have a picture here already. So what is this a picture 4 99:59:59,999 --> 99:59:59,999 of? 5 99:59:59,999 --> 99:59:59,999 i think this is a picture of LBJ signing the medicare act in 1965. This is the time that we passed medicare. 6 99:59:59,999 --> 99:59:59,999 Lindon Banes Johnson, LBJ. This looks like Truman over here. I think he was there maybe because he was 7 99:59:59,999 --> 99:59:59,999 probably old enough by that time to be a recipient. Yeah, 65 and over. 8 99:59:59,999 --> 99:59:59,999 I think we all have a general idea of what Medicare is. It is kind of a healthcare program or an insurance 9 99:59:59,999 --> 99:59:59,999 program, for people who are retired. But then it starts to get fuzzy after that. There are all these 10 99:59:59,999 --> 99:59:59,999 details that confuse most of us. 11 99:59:59,999 --> 99:59:59,999 Yeah so we talk about Medicare in a bunch of different ways. Medicare is a program, it's a US governmnet 12 99:59:59,999 --> 99:59:59,999 program. It is run by the federal government. 13 99:59:59,999 --> 99:59:59,999 Yup 14 99:59:59,999 --> 99:59:59,999 And sometimes it's thrown in with Medicaid. What is the difference, just at a high level? 15 99:59:59,999 --> 99:59:59,999 So Medicaid is a different program, run by the federal government in coordination wit te state governments. 16 99:59:59,999 --> 99:59:59,999 Medicaid is a federal and state program. 17 99:59:59,999 --> 99:59:59,999 Medicare is a federal program. Medicare is for folks who are 65 or older, and people with disabilities. 18 99:59:59,999 --> 99:59:59,999 Medicaid is the program that is aimed at lower income population. 19 99:59:59,999 --> 99:59:59,999 So this is older people and disabilities and this is lower income and poverty issue. 20 99:59:59,999 --> 99:59:59,999 yes 21 99:59:59,999 --> 99:59:59,999 let me write it down: lower income, primarily retirees. Yeah, the vast majority of people in there are 22 99:59:59,999 --> 99:59:59,999 people who are in there because they are over 65. 23 99:59:59,999 --> 99:59:59,999 And we are just going to focus on Medicare. Medicare is federal government and Medicaid is federal and 24 99:59:59,999 --> 99:59:59,999 state governments. 25 99:59:59,999 --> 99:59:59,999 They obviously sound similar. Yeah they sound very similar. 26 99:59:59,999 --> 99:59:59,999 They are easily confused, especially at the name level. They are really different programs. They operate 27 99:59:59,999 --> 99:59:59,999 completely separately. In a few cases, there are people who get access to both of them. But they pay 28 99:59:59,999 --> 99:59:59,999 differently, they run differently. 29 99:59:59,999 --> 99:59:59,999 So at the federal level, they are still run by the same organization, the centers for Medicaid and Medicare. 30 99:59:59,999 --> 99:59:59,999 Yeah the department of health and human services has a subpart called the centers of medicaid and medicare 31 99:59:59,999 --> 99:59:59,999 services (CMS), the executive branch. So the executive branch of government and there is the secretary 32 99:59:59,999 --> 99:59:59,999 of health and human services, and then within that we have CMS which is Centers for Medicare and Medicai 33 99:59:59,999 --> 99:59:59,999 d services. It really should have 2 Ms in it, but it's shorter to just have one. 34 99:59:59,999 --> 99:59:59,999 They administer at the federal level, both medicare and medicaid. Just to reiterate, medicare is really 35 99:59:59,999 --> 99:59:59,999 mainly a federal thing, while medicaid is both. And they are run separately. So you have medicare is 36 99:59:59,999 --> 99:59:59,999 and you have medicaid here. 37 99:59:59,999 --> 99:59:59,999 I see. 38 99:59:59,999 --> 99:59:59,999 Let's dive deep into medicare. So what is it? 39 99:59:59,999 --> 99:59:59,999 So Medicare is an insurance program. It provides insurance for people who are eligible for it. So if 40 99:59:59,999 --> 99:59:59,999 you're age 65 or over, or if you have a disability, a couple of small groups if you have lugarics or 41 99:59:59,999 --> 99:59:59,999 if you have n stage renal diseases, a kidney failure, then you can get access Medicare too. But those 42 99:59:59,999 --> 99:59:59,999 are small populations. But if you are in those groups, you are eligible for Medicare. Medicare will provide 43 99:59:59,999 --> 99:59:59,999 you with insurance that will cover hospital bills, doctor bills, and some presciption drugs, it'll cover 44 99:59:59,999 --> 99:59:59,999 a lot of the medical care. So here's the thing, I hear all these things, but this is the part that gets 45 99:59:59,999 --> 99:59:59,999 confusing for everyone that you have part a, part b, part c and those are all parts 46 99:59:59,999 --> 99:59:59,999 what are they referring to? Are they exactly insurance or they different? 47 99:59:59,999 --> 99:59:59,999 So Medicare has these 4 parts. Part A, B, C and D and it can get a little confusing but we could break 48 99:59:59,999 --> 99:59:59,999 it up into pieces, but the biggest one in terms of the number of people in it, is what sometimes we call t 49 99:59:59,999 --> 99:59:59,999 traditional medicare, and that's what Part A and B is historically and you can take as a package. Sometimes 50 99:59:59,999 --> 99:59:59,999 people call it standard medicare or original medicare. But you know when they passed the program, when 51 99:59:59,999 --> 99:59:59,999 they first did it, part a was meant to cover hospital expenditure and part b was aimed at doctor cost, 52 99:59:59,999 --> 99:59:59,999 cost for seeing physicians. Of course those 2 go so close together that now they are sort of a pair 53 99:59:59,999 --> 99:59:59,999 so you'd only rarely find someone who only wants part A. Sometimes you hear that the doctor cost are 54 99:59:59,999 --> 99:59:59,999 out patient. Hospital costs are in-patient, because in some sense you're living there while they are 55 99:59:59,999 --> 99:59:59,999 treating you, while out-patient you go visit them for an hour and leave. 56 99:59:59,999 --> 99:59:59,999 Yeah so that's a way of breaking up services medicine provides. Medicare actually gets a little bit, 57 99:59:59,999 --> 99:59:59,999 it's mix-and-match, and so really medicare part A expenditure is when a hospital bills medicare for hospitale, 58 99:59:59,999 --> 99:59:59,999 , for use of the room, use of the hospital 59 99:59:59,999 --> 99:59:59,999 anytime a doctor bills medicare, even when they saw the patient in a hospital they are going to be a 60 99:59:59,999 --> 99:59:59,999 part b expenditure. 61 99:59:59,999 --> 99:59:59,999 I see. So it isn't a strictly an in-patient and out-patient difference. It really is along the lines 62 99:59:59,999 --> 99:59:59,999 of hospital and doctor. It is useful to think about that, the out-patient and in-patient. 63 99:59:59,999 --> 99:59:59,999 So we'll cover everything that happens? 64 99:59:59,999 --> 99:59:59,999 Are we including drugs? 65 99:59:59,999 --> 99:59:59,999 So drugs is one key issue, the first thing is i'd say that traditional medicare is pretty comprehensive, 66 99:59:59,999 --> 99:59:59,999 It covers most of the things people would normally encounter. 67 99:59:59,999 --> 99:59:59,999 So part A and part B do not cover drugs. So when Lindon Johnson was signing this, if Truman had to get 68 99:59:59,999 --> 99:59:59,999 prescription drugs, and if he was a medicare recipient in 1965, he would have had to pay that out of 69 99:59:59,999 --> 99:59:59,999 pocket 70 99:59:59,999 --> 99:59:59,999 Yes. So one caveat I'll note is that if you get prescription drugs while you're in the hospital, you're 71 99:59:59,999 --> 99:59:59,999 staying in the hospital and they are giving you drugs. That's going to be covered. It's when you're outpatient, 72 99:59:59,999 --> 99:59:59,999 and you're going home and someone sends you to the pharmacy to pick up the drugs.. 73 99:59:59,999 --> 99:59:59,999 I see, so Medicare in its original would not cover that. The out-patient cost. So that became a problem 74 99:59:59,999 --> 99:59:59,999 for some folks and that has generated changes in the medicare 75 99:59:59,999 --> 99:59:59,999 There is a part now that covers that. So that is the Part D, an extension of the medicare program that 76 99:59:59,999 --> 99:59:59,999 covers that 77 99:59:59,999 --> 99:59:59,999 I don't know how far we want to get into that 78 99:59:59,999 --> 99:59:59,999 I'll write it here, D for Drugs. 79 99:59:59,999 --> 99:59:59,999 The whole story of Drugs in medicare has a lot to it, people would buy additional policies if they had 80 99:59:59,999 --> 99:59:59,999 A and B and they'd buy a private supplement that might cover the drug itself 81 99:59:59,999 --> 99:59:59,999 but now with the part D program and maybe people will buy that instead 82 99:59:59,999 --> 99:59:59,999 and then there is other stuff going on there 83 99:59:59,999 --> 99:59:59,999 And there's also a C right here. 84 99:59:59,999 --> 99:59:59,999 So A and B, traditional, A hospitals and B doctors and what percent my health insurance copay. How does 85 99:59:59,999 --> 99:59:59,999 it work with traditional health insurance? 86 99:59:59,999 --> 99:59:59,999 So if yo ujust have Part A and Part B, on Part B side doctors are covered 80% of the medicare allowable 87 99:59:59,999 --> 99:59:59,999 charges so medicare has a fee schedule that governs what the doctors can be paid for services and medicare 88 99:59:59,999 --> 99:59:59,999 will cover 80% of the cost and the patient pays remaining 20 89 99:59:59,999 --> 99:59:59,999 For part A, it gets a little more complicated but there is a copayment that you have to make if you go 90 99:59:59,999 --> 99:59:59,999 to the hospital. Medicare will have a co-payment of a fixed amount - several hundred dollars coming u 91 99:59:59,999 --> 99:59:59,999 p 92 99:59:59,999 --> 99:59:59,999 it's just not as simple as 80-20. You're going to pay a co-payment there too. 93 99:59:59,999 --> 99:59:59,999 So they are not bad coverage, but there are some costs you can run up and if you're pretty sick you might 94 99:59:59,999 --> 99:59:59,999 have a bill that left over 95 99:59:59,999 --> 99:59:59,999 And there is extreme flexibility here. So you can see any doctor you want, and go to any hospital you 96 99:59:59,999 --> 99:59:59,999 want 97 99:59:59,999 --> 99:59:59,999 yeah medicare part a and part b is, in a way of thinking, one of the last bastions as it existed 98 99:59:59,999 --> 99:59:59,999 in 1965-70-75, when there were really minimal restrictions on what doctors you can see, doctors get a 99 99:59:59,999 --> 99:59:59,999 lot of discretion in the kind of services they are going to provide 100 99:59:59,999 --> 99:59:59,999 and there's not a lot of oversight that you might see in today's HMOs 101 99:59:59,999 --> 99:59:59,999 But there are still, and maybe I'm wrong here, there still are doctors that wont take medicare patients? 102 99:59:59,999 --> 99:59:59,999 So doctors can elect to be medicare doctors or not and some doctors decide 103 99:59:59,999 --> 99:59:59,999 that they have enough patients from other places then medicare is a plan, 104 99:59:59,999 --> 99:59:59,999 and you have to follow the rules and some people think that medicare doesn't 105 99:59:59,999 --> 99:59:59,999 pay as well, as other options they have. Most of the doctors, the vast majority of doctors in the country 106 99:59:59,999 --> 99:59:59,999 will work with medicare.