Speaker 1: Welcome to Medicare and Medicaid 101. Medicare and Medicaid are two separate government-operated programs that provide medical and other health-related services to specific groups of people in the United States. Both are managed by the Centers for Medicare and Medicaid Services, CMS, which is a division of the U.S. Department of Health and Human Services, HHS. Wait, what's the difference? Medicare covers hospital and medical care for elderly and certain disabled Americans. Medicaid covers health and medical services for certain individuals with limited resources and low-income families. Individuals that qualify for support from both programs are considered dual-eligible. Medicare is a federally-operated social health insurance program for certain people, including people 65 or older, certain younger people with disabilities, people with permanent kidney failure requiring dialysis or transplant. Payroll taxes are the primary source of Medicare funding. A 2.9% tax on wages is typically split between the employee and employer. This money is put in a trust fund used to reimburse health care providers and private insurance companies. Additional funding comes from beneficiary premiums and cost-sharing mechanisms, including deductibles, coinsurance and copays. Medicaid is a jointly-operated government health insurance program for certain people, including individuals with limited resources and low-income families. Medicaid can be either full coverage or supplemental, in which case it pays after Medicare, employer health plans and or Medicare Supplemental Insurance, Medigap. Medicaid is managed first at the federal level, though each state administers its own Medicaid program. Oversight at the federal level establishes mandatory requirements for each state program in order to receive federal funding. Individual states establish state-specific eligibility standards. They determine duration, amount, type and scope of services and establish reimbursement rates for services. Medicaid sends payment to health care providers for services rendered based on established fee-for-service agreements or prepayment arrangements like health maintenance organizations, HMOs. Each state is reimbursed for a share of their Medicaid expenditures from the federal government. Each state may impose nominal cost-sharing mechanisms, except for certain populations, including pregnant women, children under 18 years of age, and hospital or nursing home patients who use most of their income to the cover. What is dual eligibility? Dual eligibles are people who are eligible for both Medicare and Medicaid coverage. There are a number of ways dual eligibility can combine coverage. Medicare coverage through original Medicare, Part A or Part B, or through a Medicare Advantage Plan, Part C. Full or supplemental Medicaid coverage. People with Medicare and full Medicaid coverage will have Part D prescription drugs covered through Medicare. Thank you for taking the time to learn about Medicare and Medicaid. For more info about infusion and advocacy efforts on behalf of patients and providers, we encourage you to further explore at infusioncenter.org.