[Applause] Medicare and Medicaid are two different health care programs that were both established by the Social Security amendments of 1965 they are operated by different parts of government and they are designed to serve different groups of people in this video I'll give you my visual mnemonic so you can easily remember the differences come test day let's take a look at the side in front of this hospital here yep we're at a center of care which is obvious by taking a look at that sign that reads we care seems like I've seen signs like this a
million times now anyway the word care here should help anchor you to Medicare because caring happens here right next notice the flag decorating the care centers entrance yep there's always an American flag in front of these places this American flag should help you remember that Medicare is a federal program funded and operated by the federal government Medicare is an insurance program that provides coverage to certain groups of people let me repeat this because it's important Medicare is a federally funded and operated insurance program let's discuss who's covered first take a look inside the care center
to see who's receiving well care yep it's our favorite elderly patient who appears to be hooked up to a dialysis machine I wonder what he's laughing at we'll get to that later but for now just know that this elderly man is here to represent well the elderly that's right elderly patients over 65 years old are covered through Medicare initially designed to provide coverage to older Americans Medicare acts as a social safety net to reward a lifetime of contribution the program has expanded sense but the elderly over 65 still comprised the majority of Medicare patients but
wait we said no the guy was on dialysis right yeah those tubes definitely make that machine look like a dialysis machine and you know what dialysis makes me think of your right kidney failure yep this dialysis machine is here to symbolize in stage renal disease or ESRD because ESRD patients have to receive dialysis right but also because having ESRD is another way you can become eligible for coverage under Medicare next take a look at the parking lot in front of the care center in particular I want you to notice how the space has been marked
with a handicap symbol you know how the parking closest to the door are always reserved for people with disabilities right well this handicap symbol should help you remember disabilities as disabled patients under 65 are generally eligible for coverage under Medicare before we move on I also want to note the patients with ALS also known as Lou Gehrig's disease are also eligible for Medicare we didn't make a symbol for this though as it's an exceedingly rare disease you're much more likely to come across a patient over 65 a patient with end-stage renal disease or a younger
patient with disabilities all right now that we've talked about who receives coverage under Medicare let's talk more about the different parts of Medicare yeah you might have heard about how Medicare is composed of four parts namely Parts A B C and D well now take a moment to discuss the most important parts and what they each cover first notice the birds nests sitting on top of the hospital yep Hospital awnings make great spots for nests oh hey yeah hey at Pixar eyes hey is our recurring symbol for the letter A because hey your Iams with
a done and this hey here should remind you of Medicare Part A moreover these hey nests are sitting on top of the hospital which helps me remember that Medicare Part A covers inpatient hospital stays yeah when you think of Medicare Part A I want you to think about inpatient care inside a hospital just remember Part A as inpatient slash Hospital insurance and you should be good to go next take a look outside at the physician getting off work ah now it makes sense why our elderly gentleman was laughing it looks like our doc here has
gotten into some trouble notice how he's being chased by a swarm of bees wait a minute bees yeah that's right these bees are here to help you remember Medicare Part B bees for bee get it the Part B bees are chasing the doc here which should help you remember that Medicare Part B primarily helps pay for seeing physicians this is why Part II is also known as medical insurance generally speaking Part B helps pay for bills incurred will seem doctors on an outpatient basis I'm talking about doctors fees diagnostic testing like x-rays and any medications
administered while inside your doctor's office again the main distinction between Part A and Part B is that part primarily covers outpatient care to strengthen this association notice how our doctor is running around outside the hospital he's really putting the outside and outpatient huh anyway just remember our bees chasing our doc here and you'll have Medicare Part B down all right now for a quick low yield part that will hopefully give you some context before we discuss Part C Medicare Parts A and B are both fee-for-service programs this means that when medicare covers a patient's expenses
the provider will be reimbursed for each individual service the patient receives this means that if you are admitted to the hospital and receive a chest x-ray antibiotics and a bed for three nights the provider will be reimbursed for a chest x-ray antibiotics in a bed for three nights see each separate service gets added up and reimbursed this is how health care has traditionally been paid for but the big argument against fee for service is that it incentivizes health care providers to provide as many services as possible the more services they do the more they get
paid right in contrast a non fee-for-service program may bundle certain items together and then just reimburse for the bundle for example maybe you'll just get charged a flat amount for the entire hospital stay irrespective of the number of chest x-rays you receive there's a lot of different ways things can be bundled so don't worry about the specifics for now anyway this brings us to our discussion of Medicare Part C which is basically just a different way for patients to get Part A and B coverage Medicare Part C plans also known as Medicare Advantage plans are
all-in-one alternatives to Original Medicare instead of being fee-for-service Part C takes a different approach specifically the government let's private companies offer these all-in-one Part C plans the government then pays them a certain amount monthly for each person they insure this type of payment arrangement is known as capitation capa means head and latin so capitation means that the program has paid a certain amount per head aka per person this is an example of the bundling I was talking about earlier since the provider will only be getting a fixed amount per patient they are no longer incentivized
to give the patient as many services as possible in fact they are incentivized to do fewer services which will hopefully save healthcare dollars as a sidenote bundled payments are technically different than capitation but I think the idea is really some so I'll just leave it at that all right to summarize Medicare Part C is just a different spin on providing Medicare coverage it's offered by private companies and these plans offer at least everything that Parts A and B do is it better you decide okay so that's it for the low yield part now for the
high yield stuff we didn't make a symbol for Medicare Part C because quite frankly it's lower yield importance a and B we also have a good text mnemonic for this based on the letter C ready here it is C stands for combination companies and capitation combination because it's a combination of Parts A and B remember Part C plans are all in one Medicare plans next companies because Part C plans are offered by private companies that are of course approved by Medicare and lastly capitation because the plans are paid a certain amount per person or per
head finally let's discuss Medicare Part D again we don't have a symbol for Part D because I have a better mnemonic the d stands for drugs more specifically prescription drugs meaning inpatient drugs wouldn't be covered nor would drugs administered in the doctor's office remember those are Part A and B respectively anyway Medicare Part D is not standardized so it's up to each individual plan as to which drugs are covered as with Medicare Part C it's also offered by private companies also as with Part C it's not as high yield so just remember D for drugs
all right now that's all for the different medicare parts let's do a quick recap Part A provides inpatient / hospital coverage Part B provides outpatient / medical coverage Part C offers combination plans from private companies Part D provides drug coverage specifically prescription drug coverage alright now we're going to shift gears and talk about the other program Medicaid let's switch to the other side of the image and look at this first-aid kit here the aid and first aid should remind you of Medicaid first aid for Medicaid right there's a lot of complexity here that isn't really
that important instead let's talk about what Medicaid mainly does first notice who's holding the aid kit - state trooper like most state troopers this guy is pretty patriotic his car also sports the American flag by the way the presence of the state trooper and the American flag helps me remember the Medicaid is jointly operated by the federal and state governments this is in contrast to Medicare which is a purely federal program in Medicaid the states draw up their own plans which they then submit to the federal government for additional assistance the federal government sets standards
for and approves the state plans after which it provides additional funding since the states had a lot of control with Medicaid Medicaid eligibility and benefits can differ from state to state this has only gotten more relevant with the passage of the Affordable Care Act after which some states have supported different Medicaid expansions than others but that's a topic for another time just remember our state trooper here to remember that Medicaid is a joint state and federal program now let's talk about why our state trooper has the first aid kit out anyway you see he was
helping out this poor family who just got mugged see the father there he's got quite the black eye and it looks like the attacker even emptied his wallet anyway the empty wallet in the destitute family here should remind you of who Medicaid is designed to benefit people with limited income and resources especially poorer families as children Medicaid is primarily targeted at helping poorer families pay for medical bills just remember our first aid kit helping out the less fortunate family and you'll have Medicaid under wraps all right now that's it for our quick summary of Medicare
and Medicaid there's obviously a lot more to each program but hopefully this mnemonic gives you a good foundation you can start attaching additional complexity to now let's do a quick recap before we close out Medicare and Medicaid are two separate programs with different functions and beneficiaries Medicare is a purely federal program so it's not run by the states it provides coverage to the elderly over age 65 patients with Instinct renal disease and younger patients with disabilities Medicare also has four parts termed a B C and D Part A covers inpatient / hospital care Part B
covers outpatient / medical care Part C is a combination of Parts A and B that is offered by private companies in Part D covers prescription drugs in contrast Medicaid is jointly operated by state and federal government it helps with medical costs for people with limited finances especially poorer families with children all right now we're actually done give yourself a pat on the back you can now tell Medicare and Medicaid apart maybe you can whip out this knowledge at dinner parties to impress your friends and family or maybe it'll help you get a question right on
test day either way I hope you enjoyed it see you next time thanks for watching for more videos like this one click here to subscribe to our YouTube channel you can also support our team by visiting pics arise comm where you'll find exclusive videos and interactive review images if you like what we're doing share with your friends on social media and we'll keep making great content like this we'll see you next time
