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Hey Medicare Nation!

www.TheMedicareNation.com

Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020!

THREE more plan sponsors to discuss!

CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00!

HUGE Penalty people!

According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees.

HCSC has the right to Appeal CMS Decision.

NEXT Up..... is Triple-S Management Corporation!

CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020.

CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00!

CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration.

Triple-S has the right to Appeal CMS decision.

Last up..... is Tufts Health Plan, Inc.

CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00.

CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations.

Tufts has the right to Appeal CMS' decision.

If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call.

You can request a "Special Election Period," based on your experience with any of these companies.

Call Medicare at 800 - 633 - 4227 24hrs a day, 7 days a week.

www.TheMedicareNation.com

Thank you for listening to Medicare Nation!

If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

Medicare Nation

CMS Imposes a Civil Money Penalty against HUMANA!

CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019.

Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M.

Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees.

CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........

$257, 262!

Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug.

This allows you time to speak with your doctor to see if there is an alternative prescription drug on the new plan ...... or......

you can request a "Formulary Exception."

This means your doctor is requiring you to take this medication, because it is the one that is stablizing or correcting your condition, and that you need to continue to take it.

If the drug is NOT on the new plan's formulary and they Approve the formulary exception, you WILL be charged a higher amount for taking a drug that is not on their formulary.

Humana has the right to appeal the decision by requesting a hearing.

The notice is signed by John Scott, Acting Director of the Medicare Parts C and D Oversight and Enforcement Group.

Medicare Nation

NEXT CMS Penalty is given notice to.........

SOLIS Health Plans out of Miami, Florida

On December 4, 2019, CMS gave notice to Mr. Daniel Hernandez - CEO of Solis Health Plans.

CMS imposed a CIVIL MONEY PENALTY of

$41,552.00!

CMS stated in their summary that Agents employed by SOLIS engaged in an aggressive marketing campaign that was conducted by a contractor provider clinic.

Solis Agents conducted a marketing presentation in a secluded area and enroll patients upon conclusion of the presentation.

CMS determined that Solis violated the communication and marketing requirements, which had the substantial likelihood of adversely affecting its enrollees.

Solis Failed to oversee and manage the marketing process to ensure its agents and brokers did not engage in inappropriate marketing practices including "misleading" beneficiaries.

Solis may request a hearing to appeal CMS's determination.

Both notices are signed by John Scott, acting director of the Medicare parts C and D Oversight and Enforcement Group.

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

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Hey Medicare Nation!

Medicare Nation

Today, I'm informing you about The Centers For Medicare & Medicaid Services Notice, given to Mr. Art Carlos, CEO of Delaware Life Insurance Company.

In a notice dated January 31, 2020, CMS notified Mr. Carlos that they were immediately imposing Intermediate "Sanctions" against Delaware Life Insurance Company.

CMS determined that Delaware Life Insurance Company is "in substantial violation of Medicare Advantage and Prescription Drug Plan requirements."

SIX specific violations were listed in the notice to Carlos.

LISTEN to the episode to learn about the violations and what you can do if YOU are a beneficiary under one of Delaware Life Insurance Company's Medicare Advantage Plan or Prescription Drug Plan.

www.TheMedicareNation.com

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

Medicare Consultant

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Hey Medicare Nation!

www.TheMedicareNation.com

Medicare has taken many steps to assist you during the COVID-19 crisis.

Coronavirus tests

Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called COVID-19). This test is covered when your doctor or other health care provider orders the test.

I spoke about testing for COVID-19 in the previous episode, dated April 1, 2020. Listen to episode 101 to learn more about COVID-19 Testing.

Your costs in Original Medicare for COVID-19 Testing.

You pay nothing for this test. NADA!

This includes the newly available COVID-19 “Antibody” test, which determines if you have antibodies in your blood, that were created to recognize the COVID-19 Virus in your body.

Hospitalization

Medicare covers All medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might have been discharged from the hospital after an inpatient stay, but……. instead you need to stay in the hospital under quarantine.

Your costs in Original Medicare

ZERO!

3 VACCINE FOR COVID-19

At this time, there's no vaccine for COVID-19.

However, If and when one becomes available, it will be covered by all MEDICARE Prescription Drug plans - Which is Part D of Medicare.

TELEHEALTH SERVICES

During the National Emergency for COVID-19, you will be able to receive a specific set of services through telehealth

These services include:

Evaluation and management visits (common office visits),
mental health counseling and
preventive health screenings
without a copayment if you have Original Medicare.

Your costs in Original Medicare

$0 Co-Pay if you have Original Medicare.

You can use your smart phone or computer to access Telehealth services.

Virtual check-ins virtual check-ins (also called “brief communication technology-based services”) with your doctors and certain other practitioners.

What is it ? Virtual check-ins allow you to talk to your doctor or certain other practitioners, like nurse practitioners or physician assistants, using a device like your phone, integrated audio/video system on your laptop or computer, or captured video image without going to the doctor’s office.

Your doctor or other practitioner can respond to you using:

Phone
Audio/visit
Secure text messages
Email
Use of a patient portal

Virtual Check-Ins can be used for treatment for the Coronavirus from ANYWHERE……including places of residences….HOMES. Nursing Homes, AND Assisted Living Facilities.

Things to know * You must talk to your doctor or other practitioner to start these types of visits. * The communication must not be related to a medical visit within the past 7 days and must not lead to the medical visit within the next 24 hours (or the soonest appointment available). * You must verbally consent to the virtual check-in, and your consent must be documented in your medical record. * Since January 1, 2020 your doctor may obtain a single consent for a year’s worth of these services.

Your costs in Original Medicare Normally, you would pay for “Virtual Visits” under Part B of Medicare.

During the National Emergency, your co-insurance and deductible will be waived, and you will have “No Co-insurance, or deductible” for Virtual Visits for COVID-19 services.

Certain Skilled Nursing Facility Care requirements have been waived during the National Emergency for COVID-19.

During the COVID-19 Pandemic, some people may be able to get renewed SNF coverage without first having to start a new benefit period.
Original Medicare covers up to “100 consecutive days” in a Skilled Nursing Facility.”

For each benefit stay. During the National Emergency for COVID-19, your Doctor may request an extension of days for your benefit period.

If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get SNF care without a qualifying hospital stay.
if you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described above and many plans have waived Hospital co-pays during the pandemic.
Check with your plan about your coverage and costs for ALL services covered for COVID-19.
Review your Summary of Benefit Booklet for 2020 from your Medicare Advantage Plan Carrier.
Don’t have one……… Go to the plan’s website to download a digital copy. OR…… Call the Customer Service number on the back of your Identification card and ask them to mail you a “Formulary” for your Specific plan.

Preparing for healthcare needs * Be sure you have over-the-counter medicines and medical supplies like tissues….cough drops…. Tylenol…etc. to treat fever and other symptoms.

Most people will be able to recover from COVID-19 at home.
Have enough household items and groceries on hand…..Soup, Macaroni and Cheese, Bread for Toast…. Whatever it is you will eat & drink when you’re sick….so that you'll be prepared to stay at home for a period of time.

Check out the following websites for updates on COVID-19

Centers for Disease and Control - CDC.gov ….. has the latest public health and safety information from the CDC and for the medical and health provider community on COVID-19.
USA.gov - has the latest information about what the U.S. Government is doing in response to COVID-19.

CoronaVirus.gov - is the source for the latest information about COVID-19 prevention, symptoms, and answers to frequent questions.

Visit your State Department of Health for local COVID-19 Information about YOUR State.

You can search on Google for your State’s Health Dept. by typing in ……… NY State Health Depart……… CA State Health Dept……..Florida State Health Depart……

Visit my website for a LIST of EVERY State Health Department’s Phone Number……

By going to www.TheMedicareNation.com/COVID19

Many of you are turning 65 and have no idea what to do to enroll in Medicare or what Plan to enroll in.

I invite you to contact me….. so that I can assist you with all this.

Send me your question to Support@TheMedicareNation.com

I answer ALL emails myself! No Assistants, NO Virtual Assistants….. I do!

I will answer your question in one paragraph. If I cannot, I will let you know how to contact me if you wish to reach out to me for a consultation.

Until next time……. Practice Social Distancing…..Do things to Make you Happy……. AND Stay Healthy!!

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

The information on this podcast and/or website is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional, which neither I nor anyone else associated with Medicare Nation LLC is not! Please consult with your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. If you think you may have a medical emergency, call your physician and/or 911 immediately.

Medicare Nation LLC reserves the right to add, remove or edit content on this page at its’ sole discretion.

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Hey Medicare Nation!

www.TheMedicareNation.com

It’s April 1st and over One Million People have been diagnosed with the COVID-19 Virus Worldwide!

On this week’s episode….. I provide a time-line of the events of the Pandemic as well as updates on COVID-19 testing and Important phone numbers should you have symptoms or questions about COVID-19.

I also have a “list” of phone numbers, for EACH Health Department in All 50 States!

You can email me at Support@TheMedicareNation.com for the list or check the show notes for an attachment.

Here is an important phone number for the CDC HOTLINE on COVID-19

800 -232- 4636 - CDC Hotline

Advent Health 24hr Hotline - 877 – 847 – 8747

You can also download the Advent Health App on iTunes or Google Play in order to have a “Virtual” visit with an Advent Health Doctor.

Bay Care Virtual Doctor Hotline - 800 – 229 – 2273

You can also go to this website for a “virtual” visit with a Bay Care Doctor –

www.BayCareAnywhere.org

The Florida Department of Health Hotline is

866 – 779 – 6121

State Health Department List of Phone Numbers

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Contact Me!

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

We're smack in the middle of a Corona Virus Pandemic!

The Medicare Nation

I wanted to give you an episode that is full of USEFULL information. I know you've been hammered by the news, internet and newspapers about the Corona Virus.

Let's start with a very important fact:

Human coronaviruses were first identified in the mid-1960s.

The 1960's people!

the coronavirus gets its name from a distinctive corona or in a scientists world…a “Crown of Sugary Proteins,” that projects from the surface of the virus.

There are four main types of Human Corona Viruses

Alphacoronavirus,
Betacoronavirus,
Gammacoronavirus, and
Deltacoronavirus.

The first two only infect mammals, including bats, pigs, cats, and humans.

Gammacoronavirus mostly infects birds such as poultry (chickens) and Deltacoronavirus can infect both birds and mammals.

Do you recognize the Virus named SARS?

Severe acute respiratory syndrome abbreviated as …. (SARS-CoV) SARS-CoV (the beta coronavirus. Guess what it causes? It causes severe… acute…..respiratory syndrome,

SARS was first recognized as a distinct strain of coronavirus in 2002. The source of the virus has never been clear, though the first human infections can be traced back to the Chinese province of Guangdong in November of 2002.

The virus then became a pandemic, causing more than 8,000 infections of an influenza-like disease in 26 countries with close to 800 deaths.

In the United States, only eight persons were laboratory-confirmed as SARS cases. There were NO SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.

By July of 2003….. the World Health Organization declared the outbreak over.

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is….SARS-COV-2 aka coronavirus disease 2019, abbreviated as COVID-19. ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease.

The Medicare Nation

COVID-19 is a new disease, caused by a novel (or new) “coronavirus” or strain of “Corona Virus” that has not previously been seen in humans.

What are the Symptoms of COVID-19?

The CDC (Centers of Disease Control) have listed these as the most common symptoms of COVID-19:

Fever
Cough
Shortness of breath

Symptoms may appear 2-14 days after exposure.

Reported illnesses have ranged from mild symptoms….like a dry cough….

to severe illness, with high fever and shortness of breath, requiring hospitalization and there have been deaths reported for confirmed coronavirus disease 2019 (COVID-19) cases.

Currently……according to the WHO… as of March 13th….there are over 132, 758 reported cases of COVID-19 …. Worldwide.

Of those cases….. there are 4,955 Deaths worldwide.

Over 80% of the reported cases are recovering.

In the U.S…… there are currently 1,629 reported cases…… in 47 of the 50 States.

No reported cases yet….in Idaho, Alabama and West Virginia.

There have been 41 Deaths reported in the U.S. ….. with 37 Deaths coming from the State of Washington. The deaths mainly being reported from a nursing facility, with those being elderly and having underlying medical conditions prior to contracting the CoronaVirus.

What do we mean by Underlying medical conditions????

If you have a blood disorder.... like sickle cell disease... or ... you have chronic kidney disease.... you're currently receiving chemotherapy or radiation. You may have congestive heart failure or coronary artery disease.

You may have chronic asthma or chronic obstructive pulmonary disease or you may need oxygen at home.

All of these conditions..... as well as many more..... may raise your risk of contracting COVID-19. You may NOT contract the virus. Just be more cognizant of your surroundings and who you are in contact with.

What do you do if you believe you have symptoms of the COVID-19?

NUMBER 1…. Call your Primary Doctor. Speak with the Nurse or Physician’s Assistant. Tell them your symptoms and they will advise you of what to do.

IF You CANT get Through to your Doctor…….

If you have a Medicare Advantage Plan…… the Plan most likely has a 24 hr. Nurse’s Line. CALL THEM!! Tell the nurse your symptoms. They will advise you.
Call your STATE Health Department for Advise. Each State has an information line dedicated to the COVID-19 Crisis and will be able to assist you with answering question.
If you have any severe symptoms….. as in Difficulty Breathing, fluid in your lungs, High fever of over 104 degrees…. CALL 911!

If you do have symptoms, and your doctor wants you to have the test to confirm COVID-19…. Where do you go??

According to the FDA….. here is the current list of laboratories across the U.S. that will be offering testing for the COVID-19 very soon

Advent Health Laboratories

Lab Corp

Quest Laboratories

As well as many other public health, university and private labs will be available on the FDA list of laboratories to test for the COVID-19.

Medicare IS Covering the Test for COVID-19 as a Preventative Diagnostic Test….and therefore ….. you will have NO COPAY when you take the test.

There are currently TWO Testing Codes for the COVID-19 Test

Is for having the Test at a Public Health Lab ( your local community Health Department) which is U0001
The 2nd is for having the test at a commercial or private lab (like Lab Corp) which is U0002.

If you are diagnosed with COVID-19, self-quarantine yourself in your home, away from your family members and pets, until you have tested negative.

We ALL need to SELF-Police ourselves and HELP STOP the Spread of COVID-19….. so we can curtail the spread and help stop the pandemic.

Remember to Drink lots of fluids….. eat plenty of chicken soup and crackers ….. and get lots of REST!!

The Medicare Nation

You can go to the Center for Disease Control website for daily updates on the Corona Virus 19 situation ….. go to….. www.CDC.gov

You can also go to the World Health Organization website…. Go to …. www.who.int

AND…. PLEASE go to your STATE”S Health Department website for local information by “Googling” your State.

That’s all for today Nation. Call your Parents….. Make sure they’re ok and help them subscribe to Medicare Nation…. So they can hear this episode as well as over 100 other episodes about Medicare and it’s Resources.

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

www.TheMedicareNation.com

It's still January...but February is right around the corner. Spring WILL come. I promise!

Let me give you some good news!

Medicare is now covering Acupuncture!

As of January 21, 2020, The Center for Medicare & Medicaid Services (CMS), will cover acupuncture for "Chronic Low Back Pain."

Let's look at the coverage in the Medicare National Coverage Determination Manual.

Section 1862(a)(1)(A) of the Social Security Act

Up to "12" visits in 90 days are covered for Medicare Beneficiaries under the following circumstances:

a. Chronic Low Back Pain which lasts "12 weeks or longer,"

b. the Chronic Low Back Pain is "non-specific," in that it has NO identifiable systemic cause (NOT associated with metastatic, inflammatory, infectious, disease).

c. the Chronic Low Back Pain is NOT associated with surgery

d. the Chronic Low Back Pain is NOT associated with pregnancy.

An ADDITIONAL "Eight" (8) sessions WILL be covered for those patients demonstrating an improvement.

No more than "20" acupuncture treatments may be administered annually.

Treatment MUST be discontinued if the patient is NOT improving or is regressing.

The Acupuncture must be Administered under the supervision of a doctor of medicine or osteopathy.

Need more information? Check out our website www.TheMedicareNation.com

What plans cover Acupuncture?

Acupuncture for Chronic Low Back Pain, will be covered under ORIGINAL Medicare.

If you present your Medicare ID Card to providers as your Health Insurance..... You may start utilizing this treatment now.

If you present your Medicare ID Card, as well as a Medi-Gap (Medicare Supplement) Plan..... You may start utilizing this treatment now.

If you have a Medicare Advantage Plan, you need to check your Summary of Benefits Book under your plan, to see if they cover Acupuncture. If you can't find it.... call the customer service number on the back of your ID Card and ask the representative.

Acupuncture is NOT covered under Medicare Part D. Part D is ONLY for Prescription Drug Coverage.

If you have any questions.... send them to Support@TheMedicareNation.com

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels Medicare Consultant

Support@TheMedicareNation.com

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Hey Medicare Nation!

www.TheMedicareNation.com

It's 2020! Love the sound of that!

Right now...... the Medicare Advantage Open Enrollment Period is in full swing.

If you are on a "Medicare Advantage Plan," you have the opportunity to make a ONE TIME change, between January 1st through March 31st.

You can change from one Medicare Advantage Plan to another Medicare Advantage Plan.

You can "disenroll" from the Medicare Advantage Plan you're on and go back onto "Original Medicare." With Original Medicare, you can add a stand-alone-prescription drug plan and ..... you can enroll into a Medicare Supplement Plan (aka Medi-gap) to help defray the costs of Original Medicare.

Here are options you can do during the Medicare Advantage Open Enrollment Period:

Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
Join a Medicare Prescription Drug Plan.
Switch from one Medicare drug plan to another Medicare drug plan.
Drop your Medicare prescription drug coverage completely

I'm adding the EXACT language from the Medicare Managed Manual, regarding the Medicare Advantage Open Enrollment Period.

***30.5 – Medicare Advantage Open Enrollment Period (MA OEP) 42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019)

During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

This chart outlines who can use the MA OEP and when: Who can use the MA OEP: MA OEP occurs:***

***Individuals enrolled in MA plans as of January 1 – March 31 New Medicare beneficiaries who are enrolled in an MA plan during their ICEP The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to: • MA-PD • MA-only • Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).***

You may also go onto Medicare.gov to view information on the Medicare Advantage Open Enrollment Period.

If you decide to make a change during the MA OEP, you will be "locked-in" to the new plan, until the next enrollment period.... which is....the Annual Enrollment Period, from October 15th through December 7th.

You may also make a change to your plan if you have a "special circumstance."

These are listed under the "Special Election Periods" for Medicare on Medicare.gov

You can also LISTEN to my previous show on Special Election Periods..... Episode 051, which was published on July 29, 2016. The episode is titled..... "Special Election Period Q & A"

I go into detail about the Special Elections available.

www.TheMedicareNation.com

Remember Medicare Nation listeners........ an "Insurance Agent," is NOT allowed to "solicit" you during the Medicare Advantage Open Enrollment Period.

There are strict Medicare regulations regarding this.

YOU must make the first move in contacting or telling your "Agent" or Medicare Specialist, that you are unhappy with your current plan.

No one should be calling you, texting you, emailing you ..... or worse...... knocking on your door, telling you about the Open Enrollment Period. If someone does...... tell them to "Take a Hike!" You don't need a dishonest person like that helping you with your Medicare needs!

If you need help finding a new plan during the OEP, contact you're Medicare Advisor.

If you are all set with your Medicare Advantage Plan for 2020, You don't need to do anything! Just enjoy your family, friends and activities!

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Contact me on my website - www.TheMedicareNation.com

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels Medicare Consultant Medicare Nation LLC.

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Hey Medicare Nation!

CMS just announced the 2020 Medicare Part B Premium increase!

CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible.

Here's a look at what's changing in 2020:

| Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act. SOCIAL SECURITY Increase: 1.6% (Avg $24 more a month) Average Monthly SS Check $1,503.00 2020 - PART A DEDUCTIBLE AND COINSURANCE Inpatient Hospital Deductible: $1408.00 Daily Coinsurance Days 61-90: $ 352.00 Daily Coinsurance-Lifetime Reserve: $ 704.00 Skilled Nursing Facility-Days 21-100: $ 176.00 2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE Standard Monthly Premium: $ 144.60 ($9.00 More) Annual Deductible: $ 198.00 It's a great time to review your plan for 2020. Is it the right plan to fit your unique needs? If so........ keep it! If not....... change it! I am available to assist you with your Medicare Plan choices for 2020. If I can answer your email in one paragraph or less, I WILL answer your question for you! If the answer to your question requires any research or my response is longer than one paragraph..... I will let you know that you will need to hire me to answer that question. If you live outside of Florida, you can hire me as your consultant at a rate of $200.00 an hour ( The hourly rate is going up to $250.00 an hour, starting January 1 2020). If you are a Florida resident, I can assist you in enrolling into the plan that fit's your unique needs at no additional charge. I will receive a commission from the insurance carrier once you are enrolled. The commission is regulated by Medicare. The Annual Enrollment Period ends December 7th, so make sure you do your "due dilligence" and find the plan that works for you! Until next time..... Have a Happy, peaceful & prosperous week! Diane Daniels Medicare Consultant 855-855-7266 |

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Hey Medicare Nation!

www.TheMedicareNation.com

It's October! That means it's Medicare Time!

The Annual Enrollment Period is just around the corner. Did you receive your "Annual Notice of Changes (ANOC)" for your Medicare Advantage Plan or Prescription Drug Plan?

If not....contact your plan and request the ANOC.

Today......I want to talk with you about Part D Prescription Drug Coverage for 2020!

Medicare has set the maximum Part D Deductible for 2020 at $435.00.

Medicare Advantage Plans and Stand-Alone Prescription Drug Plans have the option to charge the maximum deductible amount of $435.00......

or.......

They can eliminate the Deductible altogether....

or......

They can charge an amount in between.

You MUST do your "Due Dilligence" in determining which Prescription Drug Plan will fit your unique needs for 2020.

Contact your Medicare Specialist and request their assistance in finding a Prescription Drug Plan for 2020.

If you have a question about Medicare or your Prescription Drug Plan....

You can send me an email to Support@TheMedicareNation.com

If I can answer your question in ONE Paragraph, I will answer your question!

If I cannot ...... I will request you hire me as your consultant.

I currently charge $199.00 an hour for my consultation services.

I always do my best to answer your questions in ONE paragraph.

The "initial coverage period (ICP)" for Part D, has a threshold of $4,020.00

When you hand in a prescription, the total amount of the prescription is applied towards the ICP.

If you have a Deductible, that is applied towards the ICP too.

When the total amount of your prescriptions reaches $4,020.00..... you will now enter a new phase called the "coverage gap."

In this stage.... you will now pay 25% of generic drugs....

and you will pay 25% of brand name drugs.

If you reach $5,018.75 you will enter the next stage, which is called....

The "Catastrophic Stage."

In the Catastrophic Stage, you will now pay a 5% co-insurance or $3.60 for Generic Drugs..... or....

$8.95 for Brand or non-preferred Drugs....

which ever is a greater amount.

You will remain in the Catastrophic Stage until your out-of-pocket spending reaches $6,350 or.....

when the ball drops on New Year's Eve!

I know prescription drugs can be very expensive!

There are programs available for those of you with lower incomes.

The program is called "Extra Help," or "Low Income Subsidy."

To apply for Extra Help, go to the social security website -

www.socialsecurity.gov/extrahelp

If your individual income is less than $1,562 a month, you would qualify for the LIS program.

If your income is more than $1,562 a month, but is less than $1,900 a month....APPLY!

You have nothing to lose! All they can say is No!

You can also appy for the "Medicare Savings Program" If you qualify, CMS will pay for your Medicare Part B Premium. Depending on your qualifications, CMS may pay your premium, deductible and co-insurance.

Apply for the Medicare Savings Program here:

https://www.medicare.gov/Contacts/#resources/msps

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

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Hey Medicare Nation!

www.TheMedicareNation.com

How Do I get treatment & prescriptions during a weather emergency?

Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety.

What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency?

Or….

What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency?

Let’s take a look at these questions for you.

After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States. Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian.

What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration.

For example…….

You evacuated your home in Savannah Georgia, to go stay with your relatives in Michigan. Prior to evacuating your home, you were receiving home health care for physical therapy…due to a sprained ankle.

If you are on Original Medicare, you can contact “Any” home health agency that accepts Medicare to re-start your physical therapy at your relative’s home. They should be able to contact Medicare to get copies of the orders you had for the Physical Therapy.

If you’re on a Medicare Advantage Plan, you will need to contact your Plan carrier…… advise them you evacuated from a Public Health Emergency area and that you need to “Resume” physical therapy at home ASAP. The plan should contact a home health care vendor in the area you’re temporarily staying in, to resume your physical therapy.

If you have a Medicare Specialist, call them! You WILL need their help in expediting the process. Remember…… MILLIONS of people have evacuated coastal areas! Don’t Delay!!! If you need to use your Medicare benefits…. CALL as soon as possible.

For Prescription Medications……let’s say in the stress of having to “evacuate,” you forgot all your prescriptions at home.

under a Medicare Advantage Plan, call your carrier & tell them what happened. You should be able to get a “Refill” under the “Emergency Waiver,” for most prescriptions. If you need an Extension for 60 – 90 days for your prescription, due to being out of the area, call your plan and ask them if they “offer” extended day prescriptions.

If you’re on an “opioid” prescription……… call your plan & advise them of your situation. Hopefully, you can get a refill…. for at least a day…. or two…… under the waiver, until you can be seen by a doctor in the area you’re temporarily staying at.

Your carrier will tell you which Pharmacy is “IN” network…. Where you’re staying. If there is NO pharmacy “In” Network where you’re staying, ask the carrier if they will “reimburse” you for the cost of the prescriptions.

You will need a receipt with the Pharmacy name, prescription name, and the price you paid for the prescription on the receipt to submit to your Medicare Advantage Carrier for reimbursement.

If you had Durable Medical Equipment …… Orthotics, Prosthetics, or Oxygen Supplies for example….. that was lost, destroyed, “irreparably damaged” ….. or otherwise rendered unusable…… you should be able to replace it from a vendor in the area you’re staying….. with the “flexibility” to WAIVE the replacement requirements that are normally in place.

If you are on a Medicare Advantage Plan, contact your carrier for assistance in getting a replacement…. And advise them the “Blanket Waiver” is in place.

They will assist you in finding a local vendor to “Replace” your equipment.

For those of you needing to stay at a “Skilled Nursing Facility,”Under “Normal” Circumstances…… if you or a loved one needed to enter a “Skilled Nursing Facility,” you would be required to have a “ 3 Day Prior Hospitalization” … prior to entering the Skilled Nursing Facility.

Under the “Blanket Waiver,” the 3 Day prior hospitalization is “waived,” so that you can enter the Skilled Nursing Facility without further delay.

This rule would be in effect “temporarily,” for those who are …… “ evacuated, transferred, or otherwise…. “dislocated” as a result of the emergency.

So….. if you “evacuated” your home in Puerto Rico, Florida, Georgia or South Carolina, due to Hurricane Dorian….. and let’s say you’re temporarily staying with relatives in Pennsylvania………and you need to enter a Skilled Nursing Facility……you would be able to enter the facility without the 3 day prior hospitalization.

If you are on a Medicare Advantage Plan, you must contact your carrier to assist you in determining which “Skilled Nursing Facilities” has room for you to be admitted into.

These are examples of how Medicare “requirements” are more flexible during a Public Health Emergency WITH a “Blanket Waiver.”

How long does the Blanket Waiver Last? Until Secretary AZAR signs an order stating the Public Health Emergency is over.

NOW….. let’s take a look at how FEMA affects enrollment into Medicare.

FEMA… which stands for the Federal Emergency Management Agency, also declared emergencies in Puerto Rico, Florida, Georgia, South Carolina AND the Virgin Islands (which are St. Croix, St. John, St. Thomas AND Water Island) ….., which creates a “Special Election Period” for Medicare Beneficiaries, who needed to enroll in a Medicare Plan during that time, but were unable to ….. due to the effects of Hurricane Dorian.

This means if you needed to enroll in Medicare, or into a Medicare Advantage Plan for September 1st…….. you will be given a Special Election Period to do so….

Under the Emergency “Weather Event.”

So….if you need to enroll into a Medicare Advantage Plan…..OR…. a Stand-Alone Prescription Drug Plan…. you can do so, most likely through the end of October…… or even November in South Carolina & Georgia, under the FEMA Emergency.

You can call Medicare at 800 – 633 – 4227 or your Medicare Specialist for more information.

If you feel you are overly “stressed” with all the information on TV & social media, about Hurricane Dorian…… #1 ….. STOP watching the news continuously! Listen to some music…. Read a book….. play a board game. Go out for a walk.

Continuously Watching the news about the weather is the worst thing you could do!

If you need to speak with someone, you can call the “Disaster Distress Helpline.”

Call 800 – 985 - 5990 to connect with a trained counselor, who can assist you with your distress.

You can even “TEXT” ….. TALKWITHUS type the letters all together and send it to…. 66746.

You can also go online to get more Public Health & Safety info by going to

https://www.phe.gov/Dorian

Finally….. if you would like to help those affected by Hurricane Dorian in the Bahamas….OR ….any of the other impacted States…..

Call your local TV Station or go onto their websites to find information on how to volunteer or donate supplies.

If you’d like to “donate” money to a cause…..

For Animals. Go to the Humane Society of the United States website…

HumaneSociety.org/Disaster-Relief

The Humane Society is evacuating animals form Animal Shelters across Florida and the other States. They have already helped transport almost 100 animals here in Florida, that they will place in “safe shelters,” with the hope of being put up for adoption.

If you’d like to contribute to a Humanitarian Charity….. or one that is specifically helping those in the Bahamas…… go to the Charity Navigator website & they have a list of highly ranked charities that are providing relief.

Go to http://charities.foundation/dorian

To donate to one of these funds.

That’s all for this special show and I wish everyone out there, in the path of Dorian…… that you & your loved ones are safe.

Till next time....

Have a Safe & Peaceful week!

Diane

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Hey Medicare Nation!

www.TheMedicareNation.com

If you are turning 65 or still working on an employer group insurance plan, you may need assistance in finding the Medicare plan that fits YOUR unique needs.

You may have a loved one in a nursing home or in an assisted living facility, who is not receiving proper care.

Call me! You can hire me as a consultant to assist you with Medicare issues!

Call 855-855-7266

or eMail me at Support@TheMedicareNation.com

Tell me the situation and I'll personally get back to you!

Today, I am speaking to you about Shingles Vaccines!

There are two Shingles vaccines licensed in the United States available.

The first one is the "Zoster Vaccine Live," also known as "Zostavax." Many of you probably have received this vaccine, which is a "Live" vaccine and the CDC reports it as being 51% effective against Shingles.

The second vaccine is the "Recombinant Zoster Vaccine," also known as "Shingrix" has been used since October of 2017.

The CDC reports the Shingrix vaccine is about 91% effective against Shingles.

The cost of the Shingles vaccine is covered under Medicare "Part D."

You can look up the Zostavax vaccine or Shingrix vaccine in your plan's formulary, or you can call the customer service number on the back of your identification card.

Every plan can have a different cost for either vaccine, so it is important you check with your plan, prior to getting the vaccine.

There are side effects that can be associated with either vaccine.

Go to the CDC website to learn more about Shingles and the vaccines

www.cdc.gov/vaccinesafety

Learn more about how Shingles is transmitted, the sign & symptons and treatment for Shingles here:

www.cdc.gov/shingles

I'm not a doctor!

If you have any health related questions regarding shingles and/or vaccines, due your own due diligence or contact your health care provider for more information.

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

www.TheMedicareNation.com

Help your PARENTS, Spouses and Friends "SUBSCRIBE" to Medicare Nation!

With almost 100 episodes on Medicare and Medicare Resources available, your loved-one will be able to find answers to their Medicare questions!

Use the "Purple" colored icon on an Apple phone or ....

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Search for "Medicare" and "click" on the Medicare Nation logo.

You'll see the "subscribe" button on the page. "Click" subscribe and they'll get the NEWEST Medicare Nation episodes delievered to their phone.

TODAY.... I'm discussing NEW information released from CMS.

CMS Decision Summary Ambulatory Blood Pressure Monitoring Devices

July 2, 2019…..The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries.

What is hypertension (high blood pressure)?

The American Heart Association (AHA) defines blood pressure as…. a force that pushes blood through a network of arteries, veins and capillaries.

The blood pressure reading is the result of two forces:

the systolic pressure occurs as blood pumps out of the heart and into the arteries;
diastolic pressure is created as the heart rests between heart beats (American Heart Association, 2018).

Elevated blood pressure, or hypertension, leads to harm by causing tiny tears in the interior lining of the arteries and coronary vessels…..stimulating a local immune response in the endothelial cells within the atrial walls.

In these regions, the arterial intima retains apolipoprotein B, which attracts lipid-rich macrophages (foam cells).

These preatherotic lesions develop into atherosclerotic plaques which become increasingly fibrotic and can form fissures, hematomas, thrombi, and calcifications (Swirski and Nahrendorf, 2013). The end result is stiff, thickened arteries that narrow the flow of blood to organs and limbs….which both increases pressure on target organs and limits oxygenation of them.

There is also the risk of atherosclerotic plaque rupture, resulting in distal vascular obstruction and ischemia and infarction of end organs, such as stroke in the brain (U.S. Department of Health & Human Services, 2018).

CMS is lowering the blood pressure threshold for hypertension… from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria.

This will allow more patients to use ABPM and receive appropriate treatment if needed.

General

Ambulatory blood pressure monitoring (ABPM) is a diagnostic test… that allows for the identification of various types of high blood pressure.

ABPM devises are small… portable machines that are connected to a blood pressure cuff worn by patients…. that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities..including sleep.

The recording is interpreted by a physician or non-physician practitioner….and appropriate action is taken based on the findings.

Diagnosis and treatment of high blood pressure is important for the management of various conditions…. including cardiovascular disease and kidney disease.

Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries is covered under the following circumstances:

For beneficiaries with suspected “white coat hypertension,” which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm … but less than 160 mm … or diastolic blood pressure greater than 80… but less than 100… on two separate clinic/office visits …..with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are <130/80 mm Hg.
For beneficiaries with suspected “masked hypertension,” which is defined as average office blood pressure between 120 and 129 for systolic blood pressure or between 75 and 79 for diastolic blood pressure on two separate clinic/office visits…. with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥ 130/80

ABPM devices must be:

capable of producing standardized plots of blood pressure measurements for 24 hours with daytime and night-time windows and normal blood pressure bands demarcated;
provided to patients with oral and written instructions and a test run in the physician’s office must be performed; and
interpreted by the treating physician or treating non-physician practitioner.
For eligible patients, ABPM is covered once per year.

CMS has covered ABPM since 2001 only for those patients with documented suspected white coat hypertension. On January 16, 2003, a technical correction for this National Coverage Determination was issued…. to clarify that a physician is required to perform the interpretation of the data obtained through ABPM…. but that there are no requirements regarding the setting in which the interpretation is performed.

CMS received a complete, formal request for a reconsideration of the national coverage determination from the American Heart Association and American Medical Association.

You can view the formal request letter on the tracking sheet on the CMS website.

Benefit Category

Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.

ABPM may be considered to be within the benefits described under sections:

other diagnostic tests (§1861(s)(3).

Medicare regulations state in part, that "…diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem." (42 CFR 410.32(a))

UNDER APPENDIX C

(Current Section 20.19 of the National Coverage Determination Manual)

Item/Service Description

Ambulatory blood pressure monitoring (ABPM) involves the use of a non-invasive device which is used to measure blood pressure in 24-hour cycles. These 24-hour measurements are stored in the device and are later interpreted by the physician.

Indications and Limitations of Coverage

ABPM must be performed for at least 24 hours to meet coverage criteria.

ABPM is only covered for those patients with suspected white coat hypertension.

Suspected white coat hypertension is defined as:

Office blood pressure >140/90 on at least three separate clinic/office visits with two separate measurements made at each visit;

At least two documented blood pressure measurements taken outside the office which are <140/90 and
No evidence of end-organ damage.
The information obtained by ABPM is necessary in order to determine the appropriate management of the patient. ABPM is not covered for any other uses.

In the rare circumstance that ABPM needs to be performed more than once

in a patient, the qualifying criteria described above must be met for each subsequent ABPM test.

For those patients that undergo ABPM and have an ambulatory blood pressure of <135/85 with no evidence of end-organ damage, it is likely that their cardiovascular risk is similar to that of normotensives. Patients should be followed over time.

Patients for which ABPM demonstrates a blood pressure of >135/85 may be at increased cardiovascular risk, and a physician may wish to consider antihypertensive therapy

Resources: Medicare.gov Website

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

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Hey Medicare Nation!

www.TheMedicareNation.com

Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200!

CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.

From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information.

In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing.

Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services.

Enrollees were affected in the following area:

Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY.

Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs.

CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage.

Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost.

In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0, you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.

Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you.

If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation.

If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240.

You can also make a complaint to Medicare directly by calling 800-633-4227.

If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240.

If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can :

contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan

contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/

when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads -

Find Your Local SHIP

"Click" on that ORANGE buton and a list will come up of all 50 States.

"Click" on the State where you reside, to contact your local SHIP center.

If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either:

Support@TheMedicareNation.com

call me at 855-855-7266

If I can answer your question in ONE paragraph in an email, I will directly answer your question!

If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.

I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country!

Please SUBSCRIBE to Medicare Nation so that you will receive EVERY NEW episode that is published!

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Thanks so much for listening!

If you'd like to hear about a specific topic on the show or you'd like a specific guest on the show...... send me an email to Support@TheMedicareNation.com

I appreciate your Support!

Diane Daniels

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Multi Target Stool DNA Test vs. Fecal Occult Blood Test

Hey Medicare Nation!

www.TheMedicareNation.com

Have you subscribed to Medicare Nation? Don’t know how?

If you have an Apple iPhone……. Click on the “Purple” icon…. With the white microphone. When the page opens….Click on SEARCH. Type in Medicare. Medicare Nation comes right up… WHY……BECAUSE….. it’s a TOP 100 APPLE PODCAST Nation!

Click on that Beautiful Flag “Medicare Nation” Logo. When the page opens….Click on the SUBSCRIBE button! That’s it. You’ll get the latest information on Medicare and you can search through the almost 100 episodes on Medicare Information!

Are Your Parents subscribed to Medicare Nation? Come On “Sandwich Generation” Show your parents HOW to Subscribe to Medicare Nation! Once they subscribe…. They will STOP asking you questions about Medicare, because they WILL Find the answer by listening to Medicare Nation episodes!

Let’s give YOU back some time…. So that YOU can have more time for yourself

Today…..I’m going to be talking to you about the Differences Between Multi Target Stool DNA Test vs. Fecal Occult Blood Test

Medicare offers these Preventative Tests to determine if you have blood in your stool and/or suspected cancerous characteristics.

ColoRectal cancer (CRC) is the second most frequent cause of cancer DEATH in the United States. The Most Frequent Cause of Cancer Death is…… Lung Cancer.

This year, an estimated 145,600 adults in the United States will be diagnosed with colorectal cancer.

According to Cancer.net…… an estimated 51,020 of the 145,600 adults will die this year…..due to ColoRectal Cancer.

When colorectal cancer is found early, it can often be cured. CURED Nation!

This is due to improvements in treatment and increased screening….. which finds colorectal changes before they turn cancerous and cancer at earlier stages.

Medicare Part B offers TWO Preventative Screening Tests

The First…. Is a Fecal Occult Blood Test

“Fecal Occult” Blood Test is just a scary way of saying….. “ Looking for Blood in your Poop.” The test ONLY detects the “presence” or “absence” of blood in your stool. The test does not indicate potential sources of bleeding and it does not “Diagnos” disease.

“Fecal” means……“Stool” or “Poop”….and…. “Occult Blood” means you can’t see the blood in your stool with the “naked eye,” so….. the specimen is sent to the lab for a closer look.

Blood in the stool may indicate polyps…. or it may indicate cancer in the intestine or rectum….though not all cancers or polyps bleed.

If blood is detected through the “Fecal Occult Blood Test,” additional tests may be needed to determine the source of bleeding as well as “diagnosing” an ailment or disease.

Blood in the stool could also mean Hemorrhoids….which are swollen veins in the lowest part of your rectum and anus.

Sometimes the walls of these blood vessels stretch so thin….. that the veins bulge and get irritated, especially when you poop! Straining while pooping is a major factor in Hemorrhoids. EAT more Fiber Nation! Eat More Vegetables….try Metamucil or Miralax. Straining to poop is not good. Drink more water! You should try to drink at least 96 oz. a day. I use a 24oz bottle I fill 4 x a day….. to get my 96 oz of water. You can do it. It’s important.

Hemorrhoids can cause itching & pain. Hemorrhoids can also bleed.

There are several types of Fecal Occult Blood Tests,

I’m going to discuss the “newer version,” which is called a “ Immunochemical Fecal Occult Blood Test,” (aka iFOBT or FIT)

The IFOBT or FIT test is less of a mess and easy to administer.

Typically, you have a “spoon-like” device to collect the sample of stool and you place the device into a collection container then seal it.

You either return the collection container to your doctor’s office, or you mail it.

There are no dietary restriction with the iFOB-IT and the test can be performed on any random sample of your stool.

Your Doctor will review the results and there are just two options:

Negative Result, which means no blood was detected in the stool sample you provided.

OR……..

Positive Result, which means blood WAS detected in the stool sample you provided.

This type of test ISN’T ALWAYS accurate.

Your fecal occult blood test could show a negative test result when cancer is present (false-negative result) if your cancer or polyps don't bleed.

If you had the test to screen for colon cancer and you're at average risk — you have no colon cancer risk factors other than age — your doctor may recommend waiting one year and then repeating the test.

If you have a “positive result,” You may need additional testing — such as a colonoscopy — to locate the source of the bleeding.

Under Medicare…… The Fecal Occult Blood Test…. can be given ONCE every 12 months if you’re 50 or older, at ZERO Cost to you.

Now….. let’s take a look at Mult-Target Stool DNA Tests.

You will know the “Multi-Target Stool DNA Test” more commonly known as “ColoGuard.”

ColoGuard ……. addresses several barriers to colorectal screening.

Patient concerns with colonoscopy. Include…having to schedule a separate and lengthy appointment at the testing facility.
The need to undergo a “Stay Close to my Bathroom” bowel preparation
the exposure to sedation or anesthesia……and
the discomfort associated with an invasive imaging process…. Of sticking either the “colono-scope” during a colonoscopy or a flexible sigmoud device up your butt.

By comparison, the “Multi Target Stool DNA” screening test is a noninvasive, “multi-marker”, stool-based ColoRectal Cancer screening test…..

that detects altered De-oxyribo-nucleic Acid (DNA), , as well as a fecal immunochemical test (FIT)… for blood released from cancer and precancerous lesions of the colon.

The presence of fecal hemoglobin….. even in the absence of elevated DNA markers…..can lead to a positive result given the weighted nature of the Multi Target Stool DNA algorithm.

Patients may collect and mail stool specimens from their homes with no bowel preparations and no dietary or medication restrictions.

Medicare covers this at-home multi-target stool DNA lab test…. once every 3 years…if you meet ALL of these conditions:

You’re between the age of 50-85.
You show NO CURRENT symptoms of colorectal disease including, but not limited to one of these:
Lower gastrointestinal pain
Blood in stool
Positive Guaiac fecal occult blood test….which is an older version of the Immunochemical Test… where you “smear” stool onto a TEST Card with a wooden applicator or brush. The Guaiac test has dietary restrictions and you are required to collect “TWO” or more samples from the same Stool Sample for the test. Much Messier than the Immunochemical Fecal Blood Occult Test.
OR……
A Positive Result from a Fecal Blood Occult Test

ALSO YOU NEED TO BE…..

at average risk for developing colorectal cancer, meaning:
- You have no personal history of (adenomateous ) polyps” which are ….. a common type of polyp. They are gland-like growths that develop on the mucous membrane that lines the large intestine. They are also called adenomas:

You have no personal history of … colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.

OR……

You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

If you meet the above criteria….. You pay nothing for this test if your doctor…. or other qualified health care provider accepts Medicare.

So that’s the difference between Multi Target Stool DNA Tests vs. Fecal Occult Blood Test.

If you haven’t had one of these preventative tests, speak to your primary doctor and get one. It could very well SAVE YOUR LIFE!

If you have any questions about Medicare…. Send me an email to –

Support@TheMedicareNation.com

I answer ALL my emails. As long as I can answer your question in a paragraph, I’ll answer your question.

If my response involves any research or it will take more than one paragraph to answer you….. I’ll send you a suggestion to hire me as your Medicare Consultant.

I charge $199.00 an hour. I’m one of the TOP Medicare Experts in the Country Nation…… I could easily command $400 or $500 an hour, but I CARE about each and every one of you! My time is extremely valuable and I want to help as many of you as I can with your Medicare problems and Medicare Plan Comparisons.

Also…..if you’d like to have me speak about Medicare … go to the website… www.TheMedicareNation.com and click on the Contact tab and send me your information.

I’ve already started booking speaking engagements for the Annual Enrollment Period…. Starting in October…so contact me now to schedule me for your corporation or event.

Thanks for listening to Medicare Nation! I appreciate your loyalty and referrals.

Until next time…. I want YOU to have a Peaceful, Happy & Prosperous Week!

Diane

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Hey Medicare Nation!

www.TheMedicareNation.com

I'm not an expert on Reverse Mortgages......in fact, I don't know much about them.

I have heard about Reverse Mortgages on commercials, in newspapers and on FaceBook feeds. I never had the need to learn about Reverse Mortgages, so...... I never did......until...... a client asked me about them.

When a client asks me a question about Medicare..... I know the answer. I'm a Medicare Expert....I'm in the business of knowing as much as I can about Medicare.

Because my clients trust me with their Medicare needs and concerns, they ask me all kinds of questions. When I know the answer.... I tell them. When I don't know the answer..... I get the answer for them!

So....when my client asked me about Reverse Mortgages.... I started reading about them.

When I was introduced to Michael Banner, President of Professional Mortgage Alliance, LLC, I had many, many questions.

Michael Banner was very patient and answered every question I had..... truthfully.

An hour and a half later..... I had a much better idea about reverse mortgages, and I invited Michael Banner to come onto The Medicare Nation Podcast to share his knowledge with our Medicare Beneficiaries and Sandwich Generation!

Here are the highlights of my interview with Michael Banner:

* What is a Reverse Mortgage?

* Do I pay a higher intersest rate with a Reverse Mortgage?

* If I "Will" my home to my children.... what happens to the Reverse Mortgage?

* What is a Non-Recourse Loan?

* What does it mean if the value of my house is "upside down?"

* What is No-Debt Service?

* Is a Reverse Mortgage Safe?

* If a person leaves the home to live in an assisted living facility, what happens to the Reverse Mortgage?

* Can a person "out live" a Reverse Mortgage?

* What are the "5 Ways" payments are made with a Reverse Mortgage?

Want to learn more about Reverse Mortgages?

Reach out to Michael Banner at :

MBanner@PMAnow.com

Website for Professional Mortgage Alliance, LLC

Professional Mortgage Alliance

Michael Banner's Phone Number - (727) 224 - 3859

Where to purchase Michael Banner's Book -

MBanner@PMAnow.com

The 62 Who Knew Show

www.WeBeamTV.com

Have Questions About Medicare?

Send me an email to - Support@TheMedicareNation.com

If you'd like to hire me as a Medicare Consultant, starting

June 1, 2019.... my rate is $199.00 an hour. Contact me by either email at .... Support@TheMedicareNation.com

or ... call me ..... 855 - 855 - 7266.

Thanks for listening to Medicare Nation!

SUBSCRIBE to Medicare Nation and get the latest episodes delivered to you!

Give us a Rating & Review on iTunes!

This helps others find Medicare Nation so that they can have their Medicare questions answered too!

www.TheMedicareNation.com

Until next time.... have a happy, peaceful & prosperous week!

Diane Daniels

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Hey Medicare Nation!

www.TheMedicareNation.com

On the Last episode.....I spoke to you about Medicare Supplement Plan "F" and High Deductible Plan F.

Today....I'm going to talk about Medicare Supplement Plan "G" and Plan "N"

Plan "G" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier......

in return...... Medicare Supplement Plan G, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for ..... The Annual Part B Deductible. YOU will be responsible for the Annual Part B deductible each year.

Currently.... in 2019, the Annual Part B Deductible is $185.00.

So..... when you seek medical care in the beginning of the year.... you will pay out-of-pocket until you hit the $185.00 Part B Deductible.

After you pay the $185.00 Part B Deductible....you will NOT be responsible for ANY other deductibles, co-pays or co-insurance under Medicare Supplement Plan G, that are medically necessary under Medicare.

Plan "N" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier......

in return...... Medicare Supplement Plan N, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for .....

1. The Annual Part B Deductible ($185.00 in 2019)

2. A co-pay of up to $20.00 for each doctor visit.

3. A co-pay of $50.00 if you go to the Emergency Room and you are "Discharged" from the Emergency Room.

If you are "admitted" to the hospital from the ER... you will NOT incur a $50.00 co-pay.

If you have paid all of your Part B Deductible, you will have NO other out-of-pocket costs while you are an inpatient in the hospital.

4. If you seek treatment, testing or diagnostic testing from a physician or facility that does NOT accept Medicare, you WILL be responsible for 100% of the cost of that service.

The provider or facility can legally charge you 15% above and beyond the Medicare Allowable charge.

It is vital that you always ask prior to receiving care, a test or doctor visit....if the physician or facility "accepts Medicare."

If they do.....your charges are outlined above.

If they do not accept Medicare..... you may be responsible for ALL of the charges, up to 15% of the Medicare Allowable charge.

ASK BEFORE YOU SEE A DR or RECEIVE TREATMENT!

Prices for Medicare Supplements VARY by zipcode!

Get quotes from MANY different insurance carriers prior to enrolling in a plan. You could save hundreds....sometimes over a thousand dollars a year!

HAVE a Question for ME?

Send it to me at Support@TheMedicareNation.com

I will answer ALL emails I receive.... personally!

If the answer to your question will take me more than 1 paragraph to answer... or .... it is necessary to do some research for you in order to answer the question.... I will respond and advise you to hire me as your consultant.

Many of your questions may be answered on the official Medicare website - www.Medicare.gov

Always do YOUR Due Dilligence before you enroll in a Medicare Plan!

Consider leaving a review & rating on the Medicare Nation Podcast page in iTunes.

http://nation.reviews/medicare8

Thanks for listening to Medicare Nation!

Show your Parents how to "Subscribe" to Medicare Nation. With over 100 episodes... most of their questions will be answered by listening to my episodes.

This way... your parents are NOT bothering YOU for information about Medicare! Enjoy time for yourself and your family!

Teach people how to "subscribe" to Medicare Nation!

YOU will be responsible for the Annual Part B deductible each year.

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Hey Medicare Nation!

www.TheMedicareNation.com

More than 10,000 people a day are turning 65!

While qualifying for Medicare Part A and Part B, Medicare Beneficiaries are VERY confused as to what type of plan to enroll in, to "supplement" Original Medicare.

By zipcode, a Medicare Beneficiary may have over "100 Plans" to choose from to help supplement their Original Medicare.

That's an ENORMOUS amount of research to do! If you have the time and enjoy doing all that research.......go for it!

If you're like most Medicare Beneficiaries, you are retiring and you want to ENJOY LIFE! You don't want to "waste" time researching Medicare Plans.

Call a "Medicare Consultant" or "Medicare Specialist" to assist you in finding the plan that will fit YOUR unique needs.

How do you do that?

"Google" "Medicare Consultant" or "Medicare Specialist" and add your city or zipcode to that search.

As an example, you would search....Medicare Consultant Tampa FL......or........Medicare Specialist Dallas TX.......

Google will then populate the "Ads" first. Businesses PAY to be on the top of the 1st page of Google.

SCROLL down past the "ADS." Just because a business "Pays" for an ad DOES NOT mean they are the best option for you.

You will start seeing local businesses and names of Medicare Specilaists.

You should be checking out these "Brokers" and "Medicare Specialists" or "Medicare Consultants."

I'm speaking specifically about Medi-Gap Plan F and the High Deductible F Plan.

The Supplement F Plan to Medicare, is an Insurance Policy you take out on yourself.

Medi-gap Plans are NOT part of Medicare. Medi-Gap Plans are an insurance policy that an Insurance Carrier sells to you.

You are "purchasing" a policy, where you pay a monthly premium to the Insurance Carrier to protect some or all of your out-of-pocket costs associated with Medicare.

Medi-Gap "F" Plan pays the out-of-pocket costs YOU are responsible for. The "F" Plan will pay your "medically necessary" out-of-pocket costs.

Plan F pays for your Part A In-Patient Hospital Deductible. Plan F pays your co-pay for being in a Skilled Nursing Facility.

Plan F pays your Annual Part B deductible and Plan F pays your 20% co-insurance under Part B.

Plan F pays for all of this, for one monthly premium.

ALL Medicare Plan F Plans have EXACTLY the same benefits. It doesn't matter if you live in Tampa, FL......San Francisco, CA.....or Salt Lake City, Utah.....The BENEFITS under Plan F are the SAME!

What IS different..is the MONTHLY PREMIUM!

In YOUR ZipCode.......there may be up to 50 DIFFERENT Insurance Carriers that offer Plan F....EACH one of those Insurance Carriers offer a DIFFERENT Premium for the SAME Plan F Plan.

You should find the LOWEST Monthly Premium from the Insurance Carrier that has an "A" Financial Rating.

An "A" financial rating means the company WILL pay your claims. That's the Insurance Carrier your looking for.

Plan F is the "Peace of Mind" Medi-Gap Plan. There is NO Network of Doctors and Facilities....because......Plan F is NOT part of Medicare.

Original Medicare has NO Network.....Original Medicare allows you to see ANY Doctor....or go to ANY Medical Facility in the U.S. that ACCEPTS Medicare!

YOUR Health Insurance IS......Original Medicare.....NOT your Plan F!

So.....if you're looking for a Medicare Supplement Plan that will cover ALL your Medicare Necessary out-of-pocket costs...Then Plan F is for you.

Now.....let's take a look at the High Deductile F Plan.

The High Deductible F Plan.....has a DEDUCTIBLE!

For 2019.....the annual deductible is $2,300.00

That means......you WILL pay-out-of-pocket until......you reach the $2,300 DEDUCTIBLE. When you reach the $2,300 deductible, the plan will then pay all your "medically necessary" out-of-pocket costs that you are responsible for under Medicare, for the remainder of the calendar year.

You will NOT pay the "Cash" price......you will be paying the Medicare Allowable price....BIG difference.

If you go to a cardiologist, and the visit under Medicare, costs a total of $150, Medicare will pay 80% of that amount.... which is $120. you would pay the remaining 20%, which $30.

You would continue to pay out-of-pocket until you reach $2,300.

If you don't see many doctors or have any diagnostic tests, you will ONLY pay for the services you use.

For a healthy person, this could be a very viable option.

If you are a person with a chronic illness, let's say for example...Diabetes......Asthma.....or high cholesterol with high blood pressure.....this plan may NOT be a good choice for you.

It's important for you to take into consideration your own health history, what medications you take, your financial status and what doctors you see, before enrolling in a Medicare Plan.

Next time, I will go over the differences between Plan G and PLan N.

If you are turning 65....or.....you are getting ready to come off of your employer plan and you need to figure out what Medicare Plan will suit your needs best.....

Contact Me!

Reach out to me by email -

Support@TheMedicareNation.com

or.....

by phone....... (855) 855 - 7266.

I will help you find the plan that fits YOUR unique needs.

Go to my website..... www.TheMedicareNation.com

for more information.

Until next time.....have a very happy, a very healthy and Prosperous week!

Diane Daniels

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Hey Medicare Nation!

www.TheMedicareNation.com

It's almost Spring time! For many people, this has been a terrible winter. Many Medicare Nation listeners have been emailing me to find out if Medicare covers "Emergencies" while traveling across the U.S. or abroad.

That's a great question!

Original Medicare and Medicare Advantage Plans Do cover "Emergency Care" AND Urgent Care ANYWHERE in the United States and it's Territories.

An "Emergency" is Life-Threatening. An example would be if you were having chest pain and you believed you were having a heart attack. In this situation.....you would go to the nearest hospital to seek emergency care.

Even if it turns out you were diagnosed with "heart burn," Original Medicare AND Medicare Advantage plans will cover the medically necessary treatment for this situation because you believed you were in a "life-threatening" situation.

"Urgent Care" is defined by Medicare as:

Care that you get outside of your Medicare health plan's service area for a sudden illness or injury that needs medical care right away but isn’t life threatening. If it’s not safe to wait until you get home to get care from a plan doctor, the health plan must pay for the care.

An "Urgent Care" example would be if you were walking in St. Peter's Square at the Vatican, and you slipped on a banana peel and fell onto the ground, breaking your ankle. That's an injury that isn't life threatening, but requires immediate medical care.

So......if you are traveling ANYWHERE in the U.S. or it's Territories, AND you have an Urgent Care or Emergency situation.....you can go to the nearest hospital or Urgent Care Center to receive care AND it will be covered by Original Medicare and Medicare Advantage Plans.

If you are traveling outside of the U.S. Medicare generally DOES NOT cover emergencies or urgent care needs.

There are a few circumstances where Original Medicare WILL cover Emergency Care AND Urgent Care.

www.TheMedicareNation.com

If you are on a CRUISE and you require EMERGENCY care from a doctor who is stationed on the ship while the ship is in a U.S. port.....Your Emergency Care WILL be covered by Original Medicare.
If the ship is Departing or Arriving to/from a U.S. port within 6 hours and you have a medical emergency and require to be treated by the ship's doctor......Your Emergency Care will be covered by Original Medicare.
If you are in Alaska and you are traveling directly to another State without unreasonable delay, and you require Emergency Care at a hospital in Canada, because it was the closest hospital at the time of the emergency......Your Emergency Care will be covered by Original Medicare.

If you have a "Medicare Advantage Plan," you may have coverage for Emergency and/or Urgent Care Coverage on your plan.

You must do your own due dilligence to understand the benefits of your plan while you are traveling abroad.

Some Medicare Advantage Plans have a deductible for emergency care outside the U.S.

Some Medicare Advantage Plans have a deductible and a co-pay for emergency care outside the U.S.

There is an annual maximum out-of-pocket amount for your plan. Some are around $1,500.00 all the way up to $6,700.00

READ Your Plan's EVIDENCE OF COVERAGE Booklet.

Some of you have "Medi-Gap" or Supplement to Original Medicare Plans.

Plans "C" through "G" and also plan "M" and "N" have coverage for Emergency Care while traveling abroad.

Some Medi-Gap plans have a deductible. Some plans have "Maximum Lifetime Amounts." It is important to READ your Medi-Gap Policy to determine coverage while traveling abroad.

Travel Insurance

www.TheMedicareNation.com

I always recommend purchasing "Travel Insurance," while traveling abroad.

I use these different websites to look for policies:

www.TravelGuard.com
www.AllianzTravelInsurance.com
www.TravelInsurance.com

Cost will depend on -

a. Total Cost of the Trip

b. Your Age

c. What country you're visiting

d. Types of coverage you're adding (ex: Air evacuation, cancel for any reason etc.)

If you have ANY questions, and I can answer your question in ONE paragrapn, send them to me by email.

Support@TheMedicareNation.com

If I need to do research or write more than one paragraph, I will let you know that I am available for a consultation to solve your problem at $150.00 an hour.

Reach out to me.....I answer all emails personally!

Thanks soo much for listening to Medicare Nation!

I appreciate your time and I love to educate you on all things Medicare!

Diane Daniels

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Hey Medicare Nation!

htpps://www.TheMedicareNation.com

Today, I'm going to speak with you about the Medicare Advantage Open Enrollment Period.

CMS...Centers For Medicare & Medicaid Services has issued a new regulation that began January 1, 2019.

Under 42 CFR 422.62(a)(3)....CMS published the following:

During the MA OEP, MA plan enrolles may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

Who can use the Medicare Advantage Open Enrollment Period?

1. Individuals enrolled in Medicare Advantage plans as of January 1.

2. New Medicare beneficiaries who are enrolled in an Medicare Advantage plan during their Initial enrollment into Medicare

a. The month of entitlement to Part A and Part B up until the last day of the 3rd month...after the month of their entitlement to Part A and Part B.

Can Medicare Advantage beneficiaries add or drop their Part D coverage during the Medicare Advantage Open Enrollment Period?

Yes. Individuals who are already enrolled in a Medicare Advantage Plan with Prescription Drug Coverage can switch to:

a. Another Medicare Advantage Prescription Drug Plan

b. A Medicare Advantage Plan ONLY (with NO prescription drug coverage)

c. Go back to "Original Medicare" and add a stand-alone prescription drug plan or don't add one.

d. Go back to "Original Medicare" and add a Supplement to Original Medicare Plan.

How long is the Medicare Advantage Open Enrollment Period?

It runs from January 1st through March 31st each year.

How many times may a Medicare Beneficiary change Medicare Advantage Plans during the MA OEP?

A Medicare Beneficiary may make only ONE change during the MA OEP.

If you have ANY questions regarding the MA OEP....

and you would like me to answer it in ONE paragraph, send me an email to

Support@TheMedicareNation.com

I ALWAYS answer emails if I can answer them in ONE paragraph.

If I can not answer your question in one paragraph, you may hire me and I charge $150.00 hr.

I can answer ANY question about Medicare and I can solve ANY problem you have with Medicare.

Looking for more information on Medicare?

Go to www.TheMedicareNation.com website.

Looking for a SPEAKER at your conference or event?

Just click on the "Contact" tab on the website.

Thank you so much for listening to Medicare Nation. I appreciate it very much!

If you feel I'm delivering important content, I would love it if you would leave a rating & review on the Apple Podcasts review page (formerly iTunes).

Until next time Nation.....I want each of you to have a Happy, Peaceful and Prosperous week!

Diane Daniels

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Hey Medicare Nation!

You are getting ready for Thanksgiving and you haven't even looked at Prescription Drug Plans for 2019.

Don't panic!

I have your back :)

There are Prescription Drug Plan changes for 2019.

Listen to this episode to learn about the NEW changes and make a confident decision to enroll in the Medicare Prescription Drug Plan that fits your unique needs.

Here is the link to the Medicare.gov website as an additional resoure:

www.medicare.gov

Have a question about Prescription Drug Plans for 2019?

Ask me!

If I can answer your question in ONE PARAGRAPH, I will!

If I need to do "any" type of research or the answer to your question is longer than ONE paragraph, you may have to hire me as a consultant.

I answer ALL emails personally. I'm the expert and I make sure you receive my expertise in answering your questions.

Send your questions to -

Support@TheMedicareNation.com

I look forward to hearing from you!

Happy Thanksgiving everyone!

Diane

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Hey Medicare Nation!

It's October! Lots of changes going on in the Medicare landscape.

Social Security recently announced the 2019 COLA, and for those of you on Social Security and Social Security Disability, you will be receiving a 2.8% raise in your monthly check.

Social Security raise goes into effect January 1, 2019.

Social Securtiy Disbility goies into effect December 31, 2018.

Some more good news is.....the payroll taxes for Medicare & Social Security are staying the same in 2019. Yeah!!

The combined tax rate for Social Security & Medicare will remain at 7.65% in 2019 for employees.

The combined tax rate for Self Employed will also remain the same in 2019 at 15.30%

When Social Security authorizes a COLA raise, that is the signal that Medicare Part B Premiums may also rise.

For 2019, that's exactly what happened.

Let's take a look at the 2019 Medicare Premiums & Deductibles.

Medicare Part A

In 2019, the Medicare Part A Deductible for being an inpatient in the hospital is going up to $1,364.00 in 2019.

This means, you will have an out-of-pocket deductible when you are admitted to the hospital as an inpatient, whether you stay for one night or sixty consequative nights.

You will have to pay the $1,364.00 each time you are admitted to the hospital, unless you are readmitted to the hospital less than 60 days after you are discharged from the hospital and you are admitted for the exact same reason.

SNF

A Skilled Nursing Facility (SNF) has 24hr Medical care and specializes in rehabilliation.

A person who had a stroke may be transferred to a SNF, to rehab the loss of sensation in a limb or to improve speech.

A person who recently had hip replacement surgery may be transferred to a SNF to strengthen their leg(s) and learn to walk with a proper gait.

Under Medicare, the first twenty days in a SNF is a benefit with no co-pay. If a person is required to stay day 21 and up to 100 consequative days, the co-pay will be $170.50 per day in 2019, under Medicare Part A.

Medicare Part B

Every person, who is a member of Medicare Part B has a monthly premium.

For those with an income below the Federal threshold, the Medicare Part B Premium is paid by that individual's State Medicaid Program.

For individuals on Medicare Part B, whose annual adjusted gross income is $85,000.00 or less, filing as a single taxpayer, the 2019 Medicare Part B monthly premium will be $135.50

Here is the chart for Medicare beneficiaries with a higher income, who will pay a higher Part B Premium Monthly.

Beneficiaries who file individual tax returns with income:
who make Less than or equal to $85,000 $135.50

Married, filing joint returns & make less than or equal to $170,000 $135.50

Beneficiaries who file individual tax returns with income:
who make Greater than $85,000 and less than or equal to $107,000 $189.60

Married, filing joint returns & make Greater than $170,000 and less than or equal to $214,000 $189.60

Beneficiaries who file individual tax returns with income:
who make Greater than $107,000 and less than or equal to $133,500 $270.90

Married, filing joint returns & make Greater than $214,000 and less than or equal to $267,000 $270.90

Beneficiaries who file individual tax returns with income:
who make Greater than $133,500 and less than or equal to $160,000 $352.20

Married, filing joint returns & make Greater than $267,000 and less than or equal to $320,000 $352.20

Beneficiaries who file individual tax returns with income:
who make Greater than $160,000 and less than or equal to $500,000 $433.40

Married, filing joint returns & make Greater than $320,000 and less than or equal to $750,000 $433.40

Beneficiaries who file individual tax returns with income:
who make Greater than or equal to $500,000 $460.50

Married, filing joint returns & make Greater than $750,000
$460.50

Medicare Part B Deductible

Medicare has an Annual Part B Deductible.

In 2019, the Part B deductible is going up to $185.00.

After you pay your Part B deductible, you will then have to pay 20% of the Medicare Allowable for Part B services.

If you are on a Medicare Advantage Plan, you probably didn't even know you had a Part B Deductible. The majority of Medicare Advantage plans absorb the Part B Deductible into their plan. The Majority of Medicare beneficiaries on a Medicare Advantage Plan do not have a Medical deducatible on their plan. I always say......"You Pay as you go."

If you currently have a Medi-Gap Plan "F" or Plan "C", you also don't pay out of pocket for the Annual Part B Deductible.

Things will change in 2020, for now.....everyone is good to go.

The Medicare Annual Enrollment Period is here!

If you have a question......Email it to me!

If I can answer it in one paragraph....I will!

If I have to do ANY kind of research, or my answer requires more than one paragraph....then you may need to hire me to consult with you.

I presently charge $150.00 an hour for consulting on Medicare issues and comparisons.

I can help you with just about anything to do with Medicare.

I have vast knowledge in Medicare and I am very fair.

Need help with Medicare? I can help you.

Send me an email to Support@TheMedicareNation.com

Things are getting busy with Medicare.

More updates will be coming soon!

Until then.....I want each of you to have a Happy, peaceful and prosperous week!

Diane Daniels

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Hey Medicare Nation!

I have a special show for you today.

The FDA has issued a "Voluntary Recall" on Westminster Pharmaceuticals of all lots of their Levothyroxine and Liothyronine (Thyroid Tablets).

Westminster Pharmaceuticals, LLC, which has its Corporate HQ in Tampa, Florida, is voluntarily recalling all lots, within the expiration date, of Levo-thyroxine and Lio-thyronine (Thyroid Tablets) dosages of 15 mg, 30 mg, 60 mg, 90 mg, & 120 mg up to the wholesale level.

These products are being recalled by Westminster Pharmaceuticals as a precaution, because they were manufactured using active pharmaceutical ingredients that were sourced, prior to the FDA’s “Import Alert” of Sichuan Friendly Pharmaceutical Co., Ltd., which is out of China.

The Recall comes as a result of a 2017 inspection where deficiencies were found with “Current Good Manufacturing Practices” (cGMP). Substandard cGMP practices…..could represent……the possibility of risk….. being introduced into the manufacturing process.

To date, Westminster Pharmaceuticals has not received any reports of adverse events related to this product.

Levothyroxine and Liothyronine (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands. Thyroid tablets contain both tetra-io-do-thyronine sodium (T4 levothyroxine) and lio-thy-ronine sodium (T3 liothyronine).

Levothyroxine and Liothyronine tablets (thyroid tablets, USP) are indicated as replacement or supplemental therapy in patients with hypothyroidism.

Because these products may be used in the treatment of serious medical conditions, patients taking the recalled medicines should continue taking their medicine until they have a replacement product.

According to the U.S. Food & Drug Administration Report.....

[8/17/2018] FDA is alerting active pharmaceutical ingredient (API) repackagers and distributors, finished drug manufacturers, and compounders that Sichuan Friendly Pharmaceutical Co. Limited, China, is recalling certain lots of porcine thyroid API due to inconsistent quality of the API. FDA recommends that manufacturers and compounders not use Sichuan Friendly’s porcine thyroid API received since August 2015. This thyroid API comes from porcine (pig) thyroid glands and is used to make a non-FDA approved drug product, composed of levothyroxine and liothyronine, to treat hypothyroidism (underactive thyroid).

FDA laboratory testing confirmed the Sichuan Friendly API has inconsistent levels of the active ingredients – levothyroxine and liothyronine – and should not be used to manufacture or compound drugs for patient use. Risks associated with over or under treatment of hypothyroidism could result in permanent or life-threatening adverse health consequences.

These lots were distributed nationwide in the USA to Westminster’s direct accounts.

These lots were distributed nationwide in the USA

| NDC | Product | Lot | Expiration | | --- | --- | --- | --- | | 69367-159-04 | Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15mg X 100ct | 15918VP03 | 2/29/2020 | | 15918VP02 | 2/29/2020 | | 15918VP01 | 2/29/2020 | | 15918007 | 3/31/2020 | | 15918006 | 3/31/2020 | | 15918005 | 2/29/2020 | | 15918004 | 12/31/2019 | | 15918003 | 12/31/2019 | | 15918002 | 12/31/2019 | | 15918001 | 12/31/2019 | | 15917VP03 | 10/31/2019 | | 15917VP02 | 10/31/2019 | | 15917VP01 | 10/31/2019 | | 69367-155-04 | Levothyroxine and Liothyronine (Thyroid Tablets, USP) 30mg X 100ct | 15517VP01 | 8/31/2019 | | 15517VP02 | 8/31/2019 | | 15517VP03 | 8/31/2019 | | 15518001 | 12/31/2019 | | 15518002 | 3/31/2020 | | 69367-156-04 | Levothyroxine and Liothyronine (Thyroid Tablets, USP) 60mg X 100ct | 15618011 | 3/31/2020 | | 15618009 | 2/29/2020 | | 15618008 | 2/29/2020 | | 15618004 | 12/31/2019 | | 15618002 | 12/31/2019 | | 15617VP06 | 11/30/2019 | | 15617VP05 | 11/30/2019 | | 15617VP04 | 12/31/2019 | | 15617VP03 | 7/31/2019 | | 15617VP01 | 7/31/2019 | | 15617VP-02 | 7/31/2019 | | 69367-157-04 | Levothyroxine and Liothyronine (Thyroid Tablets, USP) 90mg X 100ct | 15717VP-01 | 7/31/2019 | | 15717VP-02 | 7/31/2019 | | 15717VP-03 | 7/31/2019 | | 15718004 | 3/31/2020 | | 15717002 | 12/31/2019 | | 69367-158-04 | Levothyroxine and Liothyronine (Thyroid Tablets, USP) 120mg X 100ct | 15817VP-01 | 9/30/2019 | | 15817VP-02 | 9/30/2019 | | 15817VP-03 | 9/30/2019 | | 15818001 | 3/31/2020 |

Westminster is notifying its direct accounts by email and by phone to immediately discontinue distribution of the product being recalled.

The FDA Advises Consumers who have the recalled products, should not discontinue use before contacting their physician for further guidance.

There are several manufacturers who make “generic” Levothyroxine and Liothyronine (thyroid tablets) that your doctor can give you a new prescription for. Call the Pharmacy where you receive your Levothyroxine or Liothyronine, and ask the pharmacist who the manufacturer of their supply is. They should be able to easily tell you that.

Customers and patients with medical-related questions, information about an adverse event or other questions about the Westminster’s product’s being recalled……. should contact Westminster’s Regulatory Affairs department by phone at: 888-354-9939 ….. Live calls are received Monday-Friday, 9:00AM - 5:00PM EST with voicemail available 24 hours/day, 7 days/week

or you can send an email to recalls@wprx.com.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online…..by regular mail……or by fax.

To Complete and submit the report Online…....just “click” on the link & it will take you directly to the FDA MedWatch Page.

FDA Med Watch Page

If you’d like to report Adverse Reactions or quality problems by Mail or Fax: Download form

www.fda.gov/MedWatch/getforms.htm

Med Watch Reporting Form

or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form……or…….submit by

Fax to 1-800-FDA- 0178

It’s almost the Annual Enrollment Period!

Beginning Monday, October 15th through Friday, December 7th, many of you will be able to switch Medicare Advantage Plans, Switch Medicare Prescription Drug Plans or return to Original Medicare, with the majority of you having NEW effective dates of January 1, 2019.

There are MANY Changes coming to Medicare for 2019, so I will be busy Posting Changes for you Starting the Week of October 1st.

Medicare Nation, will be going back to a “weekly” episode during the Annual Enrollment Period, so that I can bring to you the most up-to-date information I can.

Remember, I am here to answer ANY Medicare question you have, as long as I can answer your question in ONE paragraph.

If I need to “research” anything or…..if it takes me more than one paragraph to answer your question, I will advise you that you can contact me to help you with your Medicare needs by hiring me to “consult” with you about your Medicare needs.

Many of you contacted me last Medicare Annual Enrollment Period for consultations and I am here again to assist you or your parent’s Medicare Questions or concerns.

Need help choosing a Medicare Advantage Plan or Prescription Drug Plan where you live? I can help you with that.

Need help comparing your employer insurance plan benefits to a Medicare plan?

I can help you with that too.

Contact me by email at Support@TheMedicareNation.com or call the toll free number 855-855-7266 and tell me how I can help you with your Medicare Needs.

If you like Medicare Nation, I’d love for you to give Medicare Nation an honest Rating and Review on Apple Podcasts.

How to leave an iTunes rating or review for a podcast from your iPhone or iPad 1. Launch Apple's Podcast 2. Tap the Search 3. Enter Medicare Nation in the search field. 4. Tap the blue Searchkey at the bottom right. 5. Tap the album art for Medicare Nation. 6. Tap the Reviews 7. Tap Write a Reviewat the bottom. 8. Enter your iTunes passwordto login. 9. Tap the Starsto leave a rating. 10. Enter title text and content to leave a review. 11. Tap Send.

If you have an ANDROID phone…..open up your “Stitcher” App or Download the Stitcher App from your Google Play App.

OR……just go to ……. subscribe on Android.com

When the page opens, just type in Medicare Nation into the field. Hit enter and voila!

Click on the Medicare Nation Full LOGO and “click” Subscribe on Android.

That’s it! Folks You now will receive my up to date Medicare Weekly episode to get you through the AEP

Thanks for listening to Medicare Nation! I appreciate it.

Until next time….I want each of you to have a …..Happy, Healthy and Prosperous Week!

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Hey Medicare Nation!

Medicare Nation

The topic of Medical Marijuana is BOOMING!

I had to bring back Dr. Rachna Patel to update us on what's going on in the Medical Marijuana Community.

Currently, there are 9 States, plus the District of Columbia (DC), that have "Legalized" the "Recreational" use of Marijuana.

The 9 States are:

1. Alaska

2. California

3. Colorado

4. D.C.

5. Massachusetts

6. Nevada

7. Oregon

8. Vermont

9. Washington

Twenty-Nine (29) States, have Legalized Medical Marijuana usage.

The 29 States are:

1. Alaska

2. Arizona

3. Arkansas

4. California

5. Colorado

6. Connecticut

7. Delaware

8. Florida

9. Hawaii

10. Illinois

11. Maine

12. Maryland

13. Massachusetts

14. Michigan

15. Minnesota

16. Montana

17. Nevada

18. New Hampshire

19. New Jersey

20. New Mexico

21. New York

22. North Dakota

23. Ohio

24. Oregon

25. Pennsylvania

26. Rhode Island

27. Vermont

28. Washington

29. Washington D.C.

30. West Virginia

Dr. Patel commonly treats patient with the following conditions for Medical Marijuana:

1. Chronic Pain - especially patients with Fibromyalgia, Arthrittis, Back Pain, Migraines, Neuropothy

2. Anxiety

3. Insomnia

Dr. Patel is consulting with patients across the U.S. to help guide patients step-by-step on the usage of Medical Marijuana.

You can reach Dr. Patel by going to her website,

www.drrachnapatel.com

You can also go to her Facebook page,

Facebook.com/DoctorRachnaPatel

Here's her YouTube Channel with GREAT videos!

The Medical Marijuana Expert - Dr. Rachna Patel

Thanks for listening to Medicare Nation!

If you find my content interesting, please give us a Review on Apple Podcasts!

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Hey Medicare Nation!

Millions of people are diagnosed with "Foot Drop."

Some people also call it......"Drop Foot."

Help A Child or Adult Walk Again!

Either way, Foot Drop is a serious matter!

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot, necessary for walking. Foot Drop causes a person to drag the foot and toes, or engage in a high-stepping walk called a steppage gait.

Foot Drop Increases the risk of falling.

Who Can Be Diagnosed With Foot Drop?

Men or Women, at any age.

What are some causes of Foot Drop?

Multiple Sclerosis, Cerebral Paulsy, Stroke, Traumatic Brain Injurey, Spinal Cord Injuries, and other injuries to the Peroneal Nerve in the leg.

Viruses can cause Foot Drop as well as other infections.

Injuries to the leg and/or the lower back can also cause Foot Drop.

What is a WalkAide?

A WalkAide is a Functional Electrical Stimulation Device, when wore on the calf, sends electric impulses to the affected foot causing the foot and leg to lift.

Where Can I get information on WalkAides?

Go to the Hanger Clinic website:

https://goo.gl/9UuX7Y

Are Other Types of FES Devices Available?

Yes. The Bioness L300 is also available. Go to the Bioness Website for more information.

https://goo.gl/FMXr5i

Who are the Freedom to Walk Foundation?

The Freedom to Walk Foundation is a 5019c)3 non-profit, dedicated to assisting with funds for the purchases of WalkAides for children AND Adults diagnosed with Foot Drop due to:

Multiple Sclerosis

*Cerebral Palsy

Stroke
Incomplete Spinal Cord Injury
Traumatic Brain Injury

If you want more information about the Freedom to Walk Foundation, go to their website:

FreedomToWalkFoundation.org

Go To 6th Annual Freedom to Walk Foundation GALA

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Hey Medicare Nation!

Do you know what "Drop Foot" is?

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot necessary for walking.

It causes a person to drag the foot and toes, or engage in a high-stepping walk called a "steppage gait."

This increases the risk of falling for individuals.

There are about 70,000 people diagnosed with Food Drop in the State of Florida alone!

I have teamed up with the Freedom to Walk Foundation, to assist them in raising funds for the purchase of WalkAides.

WalkAides are electronic stimulating devices when worn on the calf, sends electric impulses to the affected foot, causing the muscles to contract and lift the foot and leg.

Children and adults are WALKING agian with the help of WalkAides!

The one major problem, is that most medical insurance companies don't cover WalkAides.

Medicare will only cover WalkAides for those diagnosed with "Incomplete Spinal Cord Injury."

Those diagnosed with Multiple Sclerosis, Cerebal Palsy, stroke, traumatic brain injuries and complete spinal cord injuries, are not covered by most insurance companies.

How can you help?

A WalkAide costs $5,000 to purchase.

A $5.00 or more donation to the Freedom to Walk Foundation will help children and adults purchase WalkAides.

Please be considerate and donate with your heart!

www.FreedomtoWalkFoundation.org/donate

Thank You!

NEW MEDICARE CARDS are being mailed now. Your New Medicare Cards…….which are now called “Medicare Beneficiary Identifier” or MBI……have started mailing! 1. People who are enrolling in Medicare for the first time will be among the first in the country to receive the new cards. 2. Your new card will automatically come to you. You don't need to do anything as long as your address is up to date. If you need to update your address, visit ssa.gov and sign up for MySocialSecurity Account. 3. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.

Current States Receiving New Medicare Cards Delaware Pennsylvania Virginia Washington D.C. AND….. West Virginia Want to know when YOUR card has been mailed? Go to Medicare.gov/NewCard Enter your email to receive an email when your new Medicare Card is mailed to you. What do the New Medicare Cards Look Like? Across the top of the New Medicare Card will read…..Medicare Health Insurance….in “white” letters inside a blue border. There is also an image of an Eagle in white outline. Your Name will appear on the next line. The next line will be the NEW set of Characters. The New Card will have “11 Characters – both numbers and letters of the alphabet. All Letters will be Capitalized and spot # 2, 5, 8 & 9 on your card, will ALWAYS be a Letter of the alphabet. Finally, you’ll see Your effective date of your Part A of Medicare…….. And you’ll see Your effective date of Part B if you enrolled in Medicare Part B. Here are things to know about your new Medicare card 1. Your new card will automatically be mailed to you. You don’t have to do anything as long as your address is up to date.

If you need to update your address, go to www.ssa.org and enroll in a My Social Security Account.

Your Medicare coverage and benefits will stay the same.
Your card may arrive at a different time than your friend’s or neighbor’s. Medicare is mailing over 60 million New Cards. CMS says they will have completed the mailing by April of 2019. We’ll see if that’s true!
Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare—Use your Medicare Advantage Plan ID Card whenever you need care.

And, if you have a separate Medicare precrption drug plan, be sure to keep that ID card as well.

Doctors, other health care providers and facilities know it’s coming and will ask for your new Medicare card when you need care, so carry it with you.
Only give your new Medicare Number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare
If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online.

And….until January 2020, health care providers may use your New Medicare Card or your Social Security number to process claims.

FINALLY…..

Be Careful!

Scammers are out there trying to steal your identity!

Medicare will NEVER call you and ask for Personal Information!

The Government can’t even process Medicare Advantage Plan Changes timely…….they certainly don’t have the staff or the time to call Medicare Beneficiaries. So DON”T trust ANYONE who calls and says they are calling you from Medicare.

Your Insurance Agent, Medicare Advisor or a representative from your Medicare Advantage Plan or Medicare Prescription Drug Plan will call you …..WITH YOUR PERMISSION!

If someone calls and says they are calling about your New Medicare card…..

HANG UP THE PHONE ON THEM!

If someone calls and says they are from your Medicare Advantage Plan….

Ask them a few questions to make sure they are legit.

Ask them these questions:

How much is my current premium for my Medicare Plan?

If they are from your Medicare Insurance Plan….they should know the answer!

Ask them who your Primary Doctor is.

Again……they should have that information documented.

Finally……if you are still unsure of who you are talking to…..HANG UP!

Call the customer service number on the back of your Medicare Insurance Plan card and when a representative answers……ask them if they just contacted you.

RESOURCES:

ssa.org

www.medicare.gov/newcard

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Hey Medicare Nation!

www.TheMedicareNation.com

Special Election Period Extended through March 31, 2018 for Medicare Beneficiaries Affected by California Wildfires.

The Centers for Medicare & Medicaid Services (CMS) has extended the Special Election Period (SEP) for Medicare Beneficiaries affected by the California Wildfires to March 31, 2018.

Any Medicaer Beneficiary who resides in, or resided in an area for which the Federal Emergency Management Agency (FEMA) declared a disaster area is eligible for the SEP......if......the beneficiary was unable to enroll in a Medicare Advantage Plan or stand-alone-prescription drug plan, during the annual enrollment period (AEP) or other qualifying election period.

Also....if you don't live in the affected counties of California, but you receive assistance from someone living in one of the affected areas that was declared a disaster area, you are eligible for the SEP.

You can call Medicare at 800-633-4227, or you can contact a Medicare Advisor or Medicare Consultant to assist you in finding a plan that will suit your unique needs.

How do you find a Medicare Advisor or Medicare Consultant like me?

Google it!

Type in ......Medicare Consultant Los Angeles California....or Medicare Advisor San Francisco California.

After you get beyond the "ADS" by all the paid advertisers.....you will start seeing results for what you asked for.

So here are the COUNTIES in California affected by the WildFires, which have a SEP:

Butte

Lake

Los Angeles

Mendocino

Napa

Nevada

Orange

Riverside

San Diego

Santa Barbara

Solano

Sonoma

Ventura

and Yuba.

You can also go to the FEMA website and read more infomation at:

www.fema.gov/disasters

Any questions? Have a special guest you'd like to hear on Medicare Nation?

Send Diane an email to -

Support@TheMedicareNation.com

Need help with Medicare......Contact Diane and she will schedule a call with you to determine your needs.

Send your request to Support@TheMedicareNation.com

Have a Happy, Peaceful and Prosperous Week!

www.TheMedicareNation.com

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Hey Medicare Nation!

It's January 2018!

I hope everyone made informed decisions regarding your Medicare Advantage Plans for 2018.

If you missed the last episode, go back and listen to it!

I discussed the Medicare Premiums, co-pays and co-insurance for 2018.

Many of you have sent me emails "asking me" if you can change your Medicare Advantage Plan in January.

The answer is......yes....with specific guidelines.

Currently, it is the Medicare Advantage Plan "Disenrollment Period."

The current Disenrollment Period runs from January 1st through February 14th each year.

During this time, you can "drop" your Medicare Advantage Plan and go back onto Original Medicare.

You do this by contacting MEDICARE by phone 800-633-4227.....and telling the Medicare representative that you would like to "Disenroll from your Medicare Advantage Plan" to go back onto Original Medicare. Medicare may also help you with a Part D prescription Drug Plan if you'd like.

On Original Medicare, you are covered under Part A and Part B of Medicare.

Under Part A....you are covered for Medicare benefits where you would stay at a location as an "inpatient."

The most common location is .....The Hospital. Another location where you stay overnight as an inpatient is....a Skilled Nursing Facility (SNF).

A SNF is NOT a Nursing Home. An SNF is a location where you are admitted as an inpatient to receive medical care and rehab 24hrs a day.

Also..... if you are diagnosed with a terminal illness, your doctor may suggest you enter Hospice as an inpatient.

All the services covered in the Hospital, SNF and Hospice are covered under Part A of Medicare.

There is a "Deductible" each time you are admitted to the Hospital. The Deductible cost for being admitted as an inpatient in the hospital is $1,340.00 in 2018. The Deductible is due EACH benefit period you are admitted.

Part B of Medicare is for "Outpatient Services."

Benefits under Medicare for Outpatient Services covered under Part B include, but not limited to:

* Doctor Vists

* MRI's

* Laboratory Blood Draws

* Outpatient Same Day Surgery

* Oxygen in your home

There is an "Annual Deductible" for Part B of $183.00.

After you pay your $183.00 annual deductible, you will be responsible for the remaining 20% Medicare Allowable Charges for services under Part B.

What does that mean?

Let's say you already visited your Cardiologist and had bloodwork drawn at Quest or Labcorp.

We'll say your out-of-pocket costs for both cost a total of $183.00.

That takes care of your annual Part B deductible for 2018.

Now....let's say three months later.....you need to have an MRI. We'll say the Medicare allowable cost is $1,500.00.

Medicare Part B covers 80% of the $1,500.00, which is $1,200.00.

You will be responsible for the remaining 20%, which is $300.00.

You will pay 20% of ALL Part B Medicare Allowable Charges. There is NO Cap!

You may also need Prescription Drug Coverage.

Prescription Drugs are NOT covered under Part A or Part B in general. Prescription Drugs will be covered while you are admitted to one of the facilities under Part A.

If you want Prescription Drug coverage, you WILL need to enroll in a stand-alone-prescription-drug-plan.

You can find which Prescription Drug Plan (PDP) is available in your area, by going onto the Medicare.gov website and "hover" over the FIRST Blue Box named "Sign Up/Change Plans."

A column will appear and go down to where it reads..."Find Health & Drug Plans."

"Click" on that box and it will bring you to the Medicare Plan Finder site.

Type in your zipcode and follow the instructions.

If you are comfortable with the costs associated with Original Medicare Parts A & Part B.....then that's all you need to do.

If you'd like to add additional coverage to protect you against the on-going out-of-pocket costs associated with Original Medicare, you can purchase a Medicare Supplement (a.k.a. Medi-Gap) Plan.

A Medicare Supplement Plan is an Insurance Policy, where you pay the insurance carrier a monthly premium and the plan will pay Medicare out-of-pocket costs that you have pre-determined.

Medicare Supplement Plans "VARY" in coverage and in premiums.

The "Medicare Benefits" they pay for you, are the SAME, no matter where you live in the U.S.

So.....if you chose a Supplement Plan "F," which is the policy which pays ALL your out-of-pocket costs for Medically Necessary services under Medicare, and you live in Seattle, WA.......you will be covered for the EXACT SAME Medicare benefits as a person living in Tampa, FL.

What is different you ask?

The difference is in the PREMIUM you pay.

Insurance Carriers that offer Medicare Supplement Policies charge DIFFERENT Premiums!

You NEED to know what the difference in Premiums are by EACH Insurance Carrier for the SAME TYPE OF PLAN.

Here's an example:

Mary is turning 65 in March of 2018. Mary has a history of heart problems and would like to remain on Original Medicare and purchase a Medicare Supplement Plan "F" so that she can see ANY Cardiologist that is contracted with Medicare.... in ANY State.

Mary also wants to have a budget for her out-of-pocket health costs and having a Medicare Supplement "F" plan will allow her to do that.

Mary lives in Miami, FL and calls her Medicare Specialist Diane.

Mary discusses purchasing a Medicare Supplement with Diane and asks for her expertise and guidance.

Diane tells Mary that the 3 lowest premiums in her zipcode have the following montly premiums:

1. $239.00 From Acme Insurance Co.

2. $250.00 From Beta Insurance Co.

and

3. $275.00 From Delta Insurance Co.

These premiums are for the EXACT same Plan with the SAME benefits!

Why would you pay Delta insurance company $275.00 a month, when you can pay Acme Insurance Company $36.00 a month less....for the SAME benefits!

That's why it's soooo important to speak with a Medicare Specialist or Medicare Consultant like myself.

I speak MEDICARE! I care about YOUR best interests! I have NO loyalties to ANY Insurance Company!

You can also STAY on the Medicare Advantage Plan you are enrolled in.

Do your Due Dilligenct to ensure you are doing what's best for your health and out of pocket costs for 2018.

I'm hear to help you if you need me!

You can contact me by email at Support@TheMedicareNation.com

You can contact me by phone: 855-855-7266.

I will even answer your question by email if I can answer it in ONE paragraph!

If I have to do any kind of research, you need to hire me as your consultant.

My time is valuable and I want to do what's best for you!

Thanks for listening Nation!

Would love a Review if you would take a minute to do it for me!

Leave me a "Voice" review at www.TheMedicareNation.com

or ...... an iTunes review.

Go to iTunes or Stitcher and in the SEARCH bar type in MEDICARE NATION

MY show comes right up. "Click" on Subscribe and then click on Rating or Review.

Leave me your feedback and if you can.....give us 5 stars!

Thank you and have a Happy, Peaceful & Prosperous Week!

Diane

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Hey Medicare Nation!

The Center For Medicare & Medicaid Services has finally announced 2018 Premiums and deductibles for Part A & Part B of Medicare.

Just as I had anticipated...... CMS has increased the Part B premium in 2018. A hefty amount....I might add.

The 2018 Part B Premium for 2018 will be $134.00.

Over 50 Million Medicare beneficiaries were protected by the "held harmless" regulation in 2017.

Those Medicare beneficiaries did not see an increase in their Part B Premium for 2017, since the Part B Premium increase of $134.00 was higher than the Social Security COLA (Cost of Living Adjustment) of .3%.

When Social Security approved a 2% COLA (Cost of Living Adjustment) for 2018, that gave Medicare the "go ahead" to increase the Part B premium.

As long as the Medicare Part B Premium is equal to or less than the Social Security COLA adjustment, the Part B Premium increase will go into effect.

Such is the case for 2018.

With a 2% COLA increase in Social Security benefits, the majority of Social Security beneficiaries will see an increase of about $24-$25 in their Social Security benefit checks.

Those same Social Security beneficiaries, make up about 70% of the Medicare population.

CMS planned this out perfectly!

The majority of Medicare beneficiaries that make up the same 70%, currently pay about $109.00 for their Medicare Part B Premium.

If you add $25 to $109.00, you get........

$134.00!

CMS adjusted the amount to become $134.00, to be aligned with the remaining 30% of Medicare beneficiaries, who currently already pay $134.00 for their Part B Premium.

Now the majority of Medicare beneficiaries will be paying $134.00 a month for their Part B Premium in 2018.

It's not rocket science people. Medicare needs more money to stay solvent.

When you take over 50 million people and add $25 a month in premiums.....that equates to BILLIONS of dollars A MONTH!

Let's look at the remaining 2018 Deductibles:

Part A Hospital Deductible - $1,340.00 per benefit period.

In English.....that means you pay $1,340.00 each time you are admitted to the hospital as an inpatient. Whether you are an inpatient for one day or sixty days, you will pay a $1,340.00 deductible.

That's an increase of $24.00 from 2017.

If you need to remain in the hospital for over 60 consecutive days, you will pay $335.00 per day from days 61-90 of a hospitalization.

If you require more than 90 consecutive days in a hospital, you can use your "lifetime reserve" days.

You are given 60 lifetime reserve days.

When you use a lifetime reserve day....it's gone....forever.

Let's say you have a piggy bank that has 60 pennies in it. If you break open the piggy bank and take 1 penny out to use....you have 59 left in the bank.

Works the same way for lifetime reserve days.

Each lifetime reserve day you use, will cost you $670 per lifetime reserve day in 2018. An increase of $12. from 2017.

Skilled Nursing Facility

Medicare allows up to 100 consecutive days in a Skilled Nursing Facility.

Days 1-20 as a inpatient in a Skilled Nursing Facility will cost you $0.

Days 21-100 of extended care services in a Skilled Nursing Facility in the same benefit period will have a co-pay of $167.50 per day. If you require more than 100 consecutive days in a Skilled Nursing Facility, you are responsible for 100% of the charges.

Part B of Medicare

Aside from paying $134.00 a month for being a "member" of Medicare Part B, you will also have out-of-pocket costs when you use outpatient services.

The annual deductible for Part B in 2018 will be $183.00.

That is the same amount as 2017. There will be on increase in the Part B deductible.

Once you pay your Part B deductible, you will be responsible for 20% of the remaining Medicare allowable charge....under Original Medicare.

Let's say you had to visit a Cardiologist and the Medicare allowable charge was $100.00

Medicare would pay 80% of the $100.00 and you would pay the remaining 20%.

So....Medicare pays $80 and you would pay $20.

You will continue to pay 20% of all Medicare allowable charges under Part B.

Advocacy Groups For Medicare

Here are some national advocacy groups, fighting for your rights under Medicare, Medicaid and Social Security.

Help the cause by volunteering or donating a few bucks to ensure the fight for your rights continue.

National Committee to Preserve Social Security & Medicare The National Committee is dedicated to protecting Social Security and Medicare benefits for all communities and generations. Center For Medicare Advocacy The Center for Medicare Advocacy’s mission is to advance access to comprehensive Medicare coverage and quality health care for older people and people with disabilities by providing exceptional legal analysis, education, and advocacy. State Health Insurance Program provide free, in depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands, and are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL). Consulting During Medicare Annual Enrollment If you would like to hire me as a consultant to assist you in comparing Medicare Plans or employer coverage, I am available to assist you. Send me an email to Support@TheMedicareNation.com and send me your information and how I can assist you. You can also go to the website - www.TheMedicareNation.com and "click" on the contact tab. I am also available as a professional speaker or emcee for your event. Thank you for listening to Medicare Nation! I appreciate your support! Diane Daniels

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Hey Medicare Nation!

It's Medicare Annual Enrollment Time! The Medicare Annual Enrollment Period runs from October 15th through December 7th, each year.

Many of you are looking at different Medicare Advantage Plans and Prescription Drug Plans for 2018.

Some of you are staying with the Medicare Advantage Plan you're already on.

What many of you don't know.......is that the Center for Medicare & Medicaid Services (CMS) has added a Special Election Period for individuals affected by weather related disaster's since September.

Anyone that resides in Alabama, Florida, Georgia, Puerto Rico, South Carolina or the U.S. Virgin Islands, may qualify for this special election period, due to hurricane Irma.

Anyone residing in Louisiana and Mississippi may qualify for the Special Election Period, due to Tropical Storm Nate.

Residents of Texas may qualify due to Hurricane Harvey.

To determine if you qualify for this special election period, CMS has deferred the locations affected by Weather Disaster's to FEMA.

Go to the FEMA website - www.fema.gov/disasters

and click on the weather related emergency, to see if your location was declared an emergency by FEMA.

If your county or State has been declared an emergency due to the unique weather event, you will be granted an SEP by CMS, to change your Medicare Advantage Plan or stand alone Prescription Drug Plan.

In addition, the weather related special election period is available to..... those individuals who don't live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas.

Go to www.fema.gov and click on the link for the weather related disaster in your State, to see if you qualify for this special election period.

You can call Medicare if you have questions regarding the "weather event" special election period.

Call 800-633-4227.

The "weather event" special election period runs till December 31, 2017.

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Hey Medicare Nation!

It's October, and that means it's Medicare season!

If you need help navigating the 2018 Medicare Advantage Plans or Medicare Prescription Drug Plans, I'm available to help!

Go to my website...... www.TheMedicareNation.com and click on the "contact" button. Send me a short email of how I can assist you and I'll get back to you with details.

How many of you receive excess letters, brochures and booklets from Medicare insurance companies? I'm sure most of you do.

How many of you, in the past, have received an "official looking" postcard or letter, that you believed came from Medicare or the Social Security Administration...... only to find out it's a "scam?" Again.....I'm certain many of you did.

Right now, many of you or your parents, have or will be receiving an actual letter from the social security administration, that is real! I'm serious.....it's not a scam!

That's right...... in a joint venture to promote the Medicare Savings Program and the Extra Help Program, the federal government has been sending letters to Medicare beneficiaries, who may qualify for one or both programs.

The letter details the criteria to qualify for the programs, as well as how to apply for each program.

So..... what is the Medicare Savings Program?

The Medicare Savings Program is run by your State's Medicaid Program. The program assists those who can't afford Medicare premiums or Medicare deductibles, co-insurance and/or co-payments.

To qualify for a Medicare Savings Program, your "monthly" income and total "resources" (like money in the bank, stocks, annuities etc.) must be at or below the amounts the program has set as "The Threshold."

The house you live in, as well as one car you own, does not count towards the "resource" level.

Let's take a look at those "thresholds" now.

Medicare Savings Program

2017 Monthly Income Limit:

Single Person

$1,377.00

Married (living together)

$1,847.00

2017 Total "Resource" Limit:

Single Person

$7,390

Married (living together)

$11,090

To apply for the Medicare Savings Program, go to the official Medicare website www.Medicare.gov/contacts

or.... call Medicare and ask them for your State's Medicaid office telephone number (800-633-4227).

Now....let's take a look at the "Extra Help" program.

The "Extra Help" program is run by the Social Security Administration.

Extra Help is a Medicare program that may help you or your parents pay Medicare prescription drug (Part D) deductibles, premiums, co-insurance and/or co-payments.

You must be enrolled in Medicare Part D to be considered for the Extra Help program.

You don't have to file two separate applications to apply for the Extra Help and the Medicare Savings Program.

When you apply for the Extra Help program, Social Security will send your information to your State Medicaid office, to see if you also qualify for the Medicare Savings Program.

If you don't want to apply for the Medicare Savings Program, you will need to indicate that on the application or advise the State Medicaid representative that you do not want to apply for the Medicare Savings Program.

Let's take a look at the criteria for the Extra Help program.

Extra Help Program

2017 Monthly Income Limit:

Single Person

$1,507.50

Married (living together)

$2,030.00

2017 Total "Resource" Limit:

Single Person

$13,820.00

Married (living together)

$27,600.00

To Apply for the Extra Help program, go to the official social security website - www.socialsecurityl.gov/extrahelp

or call Medicaid......800-772-1212 to ask for an application.

You can also go to your local Social Security office and wait in line if you'd like...... go here to find your local office -

www.socialsecurity.gov/locator

That's it for today Nation!

I"ll see you next week with more Medicare information and resources!

Diane

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2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

As of October 1st, licensed health insurance agents may begin speaking about 2018 Medicare Advantage Plans and stand-alone prescription drug plans.

If you have a relationship with a licensed health insurance agent, Medicare Specialist or Medicare Consultant, they will more than likely start contacting you about your current plan.

This is the time to discuss your concerns with your Medicare Specialist. You need to determine if all your prescription drugs are listed in the plan's 2018 formulary.

You also need to determine what your 2018 monthly costs will be for all your prescription medications.

Ask yourself......."Have my out-of-pocket prescription drugs costs remained feasible on my current plan for 2018?"

If so..... that's great! If not, it may be time to take a look at a new stand-alone-prescription drug plan.

If you're on a Medicare Advantage Drug Plan, you will need to determine if your physicians are still in your plan's network and if your medical out-of-pocket costs are reasonable before you make any decisions.

It is important to remember........

Medicare Specialists cannot take an enrollment application from you .......BEFORE October 15th!

That is a Medicare Regulation!

If a Medicare licensed agent tries to take a signed application from you PRIOR to October 15th.......

FIND A NEW AGENT!

As a reminder........ NO ONE from Medicare will be knocking on your door or CALL you on the phone.

Medicare will send you mail from the Social Security Administration ONLY!

Any post cards or any letters with a return address from anywhere else on this Earth other than the Social Security Administration........ is not from MEDICARE!

It is most likely a solicitation from an Insurance Agent trying to get your business. Throw it out!

Ok......let's take a look at the 2018 changes to Part D Prescription Drug Plans.

Annual Deductible

The 2018 Maximum PDP Annual Deductible is $405.00.

That's an increase of $5.00 from $400.00 in 2017.

Starting January 1st of 2018....... if you are on a Medicare Advantage Prescription Drug Plan or Stand-Alone-Prescription Drug Plan...... that has a annual deductible, you will fit in one of two categories:

You will need to pay your annual deductible right away prior to your plan's benefits kicking-in.

As of January 1, 2018, when you hand in a prescription for a listed drug on your plan's formulary, you will be expected to pay the full cost of that drug or the listed annual prescription deductible, whichever is less.

For example, your stand-alone prescription drug plan has an annual prescription deductible of $405 on all tiers.

You hand in your first prescription for lisinopril, which is listed as a Tier 1 on your plan's formulary. The listed co-pay for a Tier 1 drug on your plan is $2.00.

The total cost for a 30 day supply of lisinopril at your preferred pharmacy is $100.00. Since you have a $405.00 deductible, the cost for the 30 day supply of lisinopril at $100.00 would be a lower out-of-pocket cost than the full $405.00 deductible. Therefore, you pay the $100.00 and deduct that amount from the $405.00 annual deductible, leaving you with a balance of $305.00.

You will pay $100.00 for February, March and April for your lisinopril and in May you will pay the remaining balance of your deductible, which is $5.00. Then, your prescription drug benefits will kick in and you will also pay your $2.00 co-pay.

Beginning in June, you will pay a $2.00 co-pay for your lisinopril for the remainder of the year.

You will pay the annual deductible if and when you "trigger" the deductible.

As an example, You would trigger the annual deductible if you requested a prescription for a drug that was a Tier 3, Tier 4 or Tier 5 on your Medicare Advantage Drug Plan or Stand-Alone Prescription Drug Plan.

If you requested a drug that was a Tier 1 or Tier 2 on that same plan, you would NOT "trigger" the annual deductible. Therefore, you would just pay the listed co-pay or co-insurance for that Tier 1 or Tier 2 prescription drug on your plan.

So.....as we used lisinopril in the above example, in this case you would just pay your $2.00 co-pay for the 30 day supply of lisinopril starting right away in January.

This is because lisinopril is listed as a Tier 1 drug on your plan's formulary. You wouldn't pay an annual deductible, since you haven't requested a prescription that was a Tier 3, Tier 4 or Tier 5 drug.

You will continue to pay a $2.00 co-pay for your lisinopril for the remainder of 2018.

The next portion of cost-sharing under prescription drug plans is called the Initial Coverage Period (ICP)

During this portion of cost-sharing, the total amount spent during the Initial Coverage Period (ICP) is $3,750.00.

The costs of covered drugs are shared - 25% by the beneficiary and 75% by the plan.

If you do not have an annual deductible for prescription coverage, the maximum a beneficiary would spend out of pocket during the ICP is $937.50. The plan would pay the remaining balance, which is $2,812.50 ($3,750.00 - $2,812.50 = $937.50)

You pay your co-pays and/or co-insurance, which is placed towards the $937.50. The plan pays the remaining balance of the Medicare negotiated price for the prescription, which is applied towards the $2,812.50.

Once the total amount of your prescription drug costs (from your out of pocket costs and the plan's contributions) reach $3,750.00, you move into the next phase of cost-sharing.

The next phase of Part D cost-sharing is called, The Coverage Gap, or commonly known as the "Donut Hole."

During this phase, you will pay more for your prescription drugs.

You will pay 35% for Brand name drugs and 44% for Generic drugs.

Let's use Lisinopril again to look at the costs during the Donut Hole.

We stated a 30 day supply of Lisinopril from a preferred pharmacy is $100.00. Lisinopril is a generic drug, listed as a Tier 1 on your plan. In the Donut Hole, you are required to pay 44% of the Medicare negotiated price for Generics. In this example, you would pay $44.00 for a 30 day supply of Lisinopril in the Donut Hole.

You are also paying a "Dispensing Fee," (about $1-$3 per drug) while in the Donut Hole.

If you have a Brand prescription drug that is listed on a Tier 3, Tier 4 or Tier 5 on your plan, you will pay 35% of the Medicare negotiated price, while in the Donut Hole.

Only True out-of-pocket (TrOOP) costs are counted toward the cost-sharing amount in the Donut Hole.

TrOOP costs are -

1. The drug costs paid by the beneficiary

2. A 50% discount on Brand-Name drugs that is provided by the drug manufacturer.

Payments made by the "plan" during the Donut Hole on Brand Name drugs DO NOT count toward TrOOP.

If you DO have an annual deductible for your prescription drug coverage, the amount you pay out-of-pocket for your deductible is applied towards the ICP of $3,750.00.

The maximum amount you would pay out-of-pocket during the Donut Hole portion of cost-sharing is $3,758.75

If the total cost-sharing amount reaches $3,758.75 in the Donut Hole phase, you will then move into the final phase of cost-sharing for 2018, which is called the "Catastrophic Stage."

In the Catastrophic Stage, you will pay reduced co-pays and or co-insurance.

You will pay either:

A 5% co-insurance or a $3.35 co-pay for Generic drugs or a $8.35 co-pay for Brand drugs.

You will pay whichever amount is greater.

Let's use our example of Lisinopril one more time. With a total cost of Lisinopril being $100.00, a 5% co-insurance would be $5.00.

With $5.00 being greater than $3.35 for Generic drugs, you would pay $5.00 for the 30 day supply of Lisinopril.

You will remain in the "Catastrophic Phase" until January 1, 2019, when the slate is wiped clean and we start all over again.

I hope that answers your questions regarding changes to Prescription Drug Costs for 2018.

If you have a question, and I can answer it in ONE paragraph or less, send me an email to -

Support@TheMedicareNation.com

I'll be happy to answer your question.

If my answer requires more than one paragraph, or I need to research an answer....... you will need to hire me as a consultant to assist you.

Go to this link and request a consultation from the "contact" tab.

www.TheMedicareNation.com

That's it for this week's show!

I would love for you to rate & review Medicare Nation!

Go to this link and tell me what you think!

https://goo.gl/sb3JXo

Have a happy, peaceful and prosperous week everyone!

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Hey Medicare Nation!

Here I am bringing you yet another Medicare Advantage Plan Sponsor, being slapped by CMS, for failing to comply with Medicare requirements related to Part C (Medicare Choice) and Part D (Medicare Prescription Drug Plans).

Today, I will be discussing the CMS Civil Money Penalty (CMP) that was imposed on Fallon Community Health Plan.

On June 29, 2017, a letter was issued to Mr. Richard Burke, the President and CEO of Fallon Community Health Plan, from Vikki Ahern, Director of the Medicare Parts C and D Oversight and Enforcement Group.

The letter was written relating to a "Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Numbers: H2411, H2470 and H9001.

Summary of Noncomplliance

CMS conducted an audit of Fallon's Medicare operations from February 16, 2016 through February 26, 2016.

In the audit report issued on July 20, 2016, CMS auditors reported that Fallon failed to comply with Medicare requirements related to...."Part C and Part D organization/coverage determinations, appeals and grievances in violation of 42 CFR" (Code of Federal Regulations).

The audit report lists the exact subsections of 42 CFR that were violated

The letter goes on to state....Fallon's failures in these areas were systemic and resulted in enrollees inappropriately experiencing delayed or denied access to benefits and/or increased out-of-pocket costs.

CMS made a determination to impose a civil money penalty (CMP) for Fallon's failure to comply, in the amount of $344,100.00.

That's a BIG fine!

Fallon Comunity Health Plan was founded in 1977. They have a product portfolio of group and individual health plan options.

Fallon also has a Senior Care Services Division, oversees all products, programs and solutions which focus on the senior population.

If you are a member of a Fallon Medicare Advantage Plan and you have questions regarding your plan, I would call the Senior Care Services Division.

The number is - 800-868-5200.

If you are a current member of a Fallon Medicare Advantage Prescription Drug Plan, your benefits are intact and working for you.

The $300,100 CMP was issued due to the incorrect classifications of "grievances", "organization determinations" for Part C complaints or "coverage determinations" for Part D complaints by members.

These incorrect classifications resulted in members not receiving the required level of review, and/or experiencing delayed access to medically necessary or life-sustaining treatments.

How does something like this happen, you may ask?

Insufficient training of Fallon customer representatives and agents.

Employers like Fallon, need to ensure their employees are properly trained in CMS Medicare Advantage Plan and Medicare Part D regulations as well as Fallon's Medicare Health Plans and benefits.

Train your employees Fallon!

Fallon needs to ensure their employees are competent and complying with Medicare rules & regulations relating to Medicare Advantage Part C and Medicare Part D.

What Should You Do if You or Your Parent(s) are on a Fallon Medicare Advantage Prescription Drug Plan?

Pay attention to your MONTHLY Explanation of Benefits (EOB) letter.

Look the document over and ensure all the prescriptions you filled that month are correct!

Look and make sure the provider(s) listed on your EOB are doctors or facilities you visited. Ensure any treatments or diagnostic tests were ones you actually did!

If you find a discrepancy, call Fallon customer service to notify them of it.

A Fallon customer service rep should be able to assist you with this issue.

If Fallon customer service is unable to assist you or if they refuse to assist you, you have two good options:

1. Call your Medicare Agent or Medicare Advisor. They enrolled you in the Fallon Medicare plan and should be a liaison between you and Fallon.

2. Call Senior Medicare Patrol.

Senior Medicare Patrol (SMP) is an awesome resource that is available to you for free!

SMP Volunteer's are seniors and understand what you're going through. They are trained to investigate or notify the agency who can investigate, suspicious or fraudulent charges on your EOB statement.

Go to the SMP website to find an SMP location near you:

www.SMPresource.org

If you believe you were denied coverage or delayed in receiving your benefits, you have a right to appea

Ask your Medicare Agent or Medicare Advisor to assist you and explain your options.

Your coverage and benefits are intact and not in danger at Fallon Health Plan.

Fallon has the right to appeal the CMS CMP by August 29, 2017.

We'll see what happens.

In the meantime, due your due-dilligence and monitor your EOB statements no matter which Medicare Advantage or Medicare Prescription Drug Plan you are on.

Report any discrepancies or suspicions right away.

I am available for consultations if you feel you have been denied a claim or your benefits were delayed due to an incorrect classification.

I also can initiate a reconsideration appeal for Part C claims or a redetermination appeal for Part D claims.

Contact me at Support@TheMedicareNation if you'd like me to consult with you.

Thank you for listening to Medicare Nation!

I appreciate you taking the time to learn more about Medicare and Medicare Plans.

Help your parents and grandparents learn about Medicare, by showing them how to gain access to the Medicare Nation Podcast!

Questions about Medicare or your Medicare Plan you need answered?

Send me an email to Support@TheMedicareNation.com or go to my website www.callsamm.com

Have a very happy, peaceful and prosperous week everyone!

Diane Daniels

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Hey Medicare Nation!

I'm so happy to be here and tell you the latest, regarding Cigna-HealthSpring (Cigna) Medicare Advantage Prescription Drug Plans (MAPD) and Prescription Drug Plans (PDP).

In January of 2016, CMS suspended Cigna from enrolling NEW Medicare Beneficiaries into their Medicare Advantage and stand-alone Prescription Drug Plans.

The following States were affected by the suspension:

Alabama, Arizona, Florida, Georgia, North Carolina, Pennsylvania, South Carolina and Tennesse.

ON June 16, 2017, CMS released the suspension of marketing and enrollment sanctions on Cigna.....with a big BUT.

On March 17, 2017, CMS received an attestation from Cigna, stating Cigna had corrected all the violations that were listed in the CMS sanction notice.

Quoted from the letter CMS sent to Cigna interim CEO & COO Mr. Shawn Moore -

"CMS required Cigna to hire an independent auditor to conduct a validation audit provide CMS with the results of the audit.

CMS used the information in the audit report to determine whether Cigna corrected the deficiencies that formed the basis for the sanction."

Based on the results of the audit report, CMS determined that......"Cigna's deficiencies have been sufficiently corrected." Therefore, effective June 16, 2017, CMS is lifting the intermediate sanctions for Cigna's contracts and Cigna will return to normal marketing and enrollment status."

Further down in the CMS document, on page 2, paragraph 1, line 3, it states...."In addition, during the independent validation audit, several findings were indentified, none of which prevent CMS from releasing Cigna from sanctions, but some of which merit additional monitoring and reporting.

.......For up to one year, CMS will also conduct targeted monitoring in certain areas to ensure that Cigna continues to improve its operations.

What does that mean if you are currently a Medicare beneficiary on a Cigna-HealthSpring MAPD or PDP Plan?

First of all, you are completely** covered. Your benefits are intact and current.

What you need to do now is become more "diligent" in reviewing your "explanation of benefits" (EOB) statement.

Your EOB statement will contain information regarding prescription drugs, medical visits, diagnostics etc.

You should be ensuring the prescriptions listed on your EOB are the ones you received and that each doctor, diagnostic tests & procedures, hospitalizations etc. were actually done!

Mistakes happen more than you know. Human errors and computer errors happen frequently. When you look at your EOB Statement every month you help eliminate these errors.

It is soooo important to review your EOB statement each month.

If you find an error on your EOB statement, you have several options to rectify it.

#1. Call Cigna Customer Support (800-668-3813)

Explain to customer support the "discrepency" you found on your EOB statement. That may easily correct the issue you found.

#2. Call your Medicare Consultant, Medicare Advisor or Agent.

Your Medicare Agent, who "sold" you this policy, should be available to assist you with questions or issues with your Cigna plan.

#3. Contact Senior Medicare Patrol

Go to the Senior Medicare Patrol website to look up resources in your area.

Senior Medicare Patrol

#4. Contact your State Dept. of Aging

Every State has a Department of Aging or Department of Elder Affairs, which will assist you with many types of issues.

The "Healthy Aging" website has a list of each State's contact information for their Department of Aging or Elder Affairs.

Here's the link:

Healthy Aging List of State Agencies

#5. Contact Medicare

As a last resort, call Medicare directly. Government "downsizing" has caused delays in telephone correspondence, but it is still a reliable source.

Expect to be on hold from ten minutes to an hour, depending on the day and season.

Expect to see Cigna hit the airwaves and your mailboxes with advertisements regarding their Medicare Advantage and Prescription Drug plans.

If you are not sure if you should remain on a Cigna Medicare Advantage Plan for 2018 and you have no one to speak to for assistance, call me!

I am available for consulting and I do so on an hourly basis. I charge $150.00 an hour and I assure you, I am very honest in my time.

If you have an interest in contacting me for consulting, send me an email to:

Support@TheMedicareNation.com

You can also visit my website for more information.

www.CallSamm.com

I thank each of you for listening to Medicare Nation and I look forward to hearing from you with any questions you have regarding Medicare.

Until next time, have a happy, peaceful and prosperous week!

Diane

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Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare.

A question that is quite common is:

"What vaccinations are covered under Medicare?"

That's what this week's episode is all about.... vaccinations!

There are currently three vaccinations that are covered under preventative and screening services under Medicare:

Flu Shot
Hepatitis Shot
Pneumococcal Vaccine

Flu Shot

If you are enrolled in Medicare Part B, you can receive a Flu Shot from your doctor or other qualified health provider, who accepts Medicare assignment for administering the flu shot.

The cost for the Flu Shot under this scenario is $0 out-of-pocket for you.

If your doctor or other healthcare provider does not accept Medicare assignment, your out-of-pocket cost be up to 100% of the cost of the Flu shot.

Ensure your doctor or healthcare physician is contracted with Medicare before receiving treatment.

For more information on the Flu, I'm sending you to this website:

www.Flu.gov

Hepatitis B

The Hepatitis B shot is available to individuals who are enrolled in Medicare Part B, have a doctor or other qualified health provider, who accepts Medicare assignment and you are at a "Medium" or "High" Risk to contract Hepatitis B.

What indicates a Medium or High Risk?

Well....there are many answers, but if you have certain diseases like hemophilia, ESRD (End Stage Renal Failure), Diabetes or other conditions that lower your resistance to infection are some good examples.

If you have any questions regarding your eligibility for the Hepatitis B shot, ask your doctor.

Since the Hepatitis B shot is covered under the Preventative and Screening Services of Medicare, there is $0 out-of-pocket cost to you.

To learn more about Hepatitis B, I'm giving you the link to the Center for Disease Control and Prevention (CDC).

Learn More About Hepatitis B

Pneumococcal Shot

You are entitled to a Pneumococcal Shot if your doctor believes you need one, he or she is a qualified health provider, who accepts Medicare assignment and you are enrolled in Medicare Part B.****

**There is also a second, different Pneumococcal shot that is administered one year after the first shot is given. Medicare Part B will cover this additional shot if your doctor says you need the two shots.****

**You should always discuss your options and your concerns with your primary doctor.****

Here is the link to the CDC website on additional information about pneumococcal vaccinations:

Learn More About Pneumococcal Vaccinations

Additional Vaccinations and Shots Available

Other commercially administered vaccinations are available under Medicare Part "D"

Tetanus, Diptheria and Pertussis (Whooping Cough) are examples of Part D coverage. A "Booster" shot, given to adults, adolescents and children is available as Tdap.

Depending on what type of Prescription Drug Plan you are on, will depend on your out-of-pocket cost.

You should contact your Medicare Insurance Carrier customer service department to request such information.

Shingles

The Shingles Vaccine (Herpes Zoster) is also available under Part "D" of Medicare.

The Shingles Vaccine out-of-pocket costs will vary by plan. You must contact your Medicare Plan Carrier's customer service department to determine your out-of-pocket cost for the Shingles Vaccine.

If you are not enrolled in Medicare Part D, you may have to pay up to 100% of the cost for the Shingles Vaccine.

Here is the link to the CDC website for information on Shingles.

Learn More about Shingles

I also did an ENTIRE EPISODE ON SHINGLES!

Go to Apple Podcasts and search in the Medicare Nation "Feed" directory.

You'll see the episode is number 46, and was published on June 17, 2016.

Listen to that episode! It is EXTREMELY educational.

As the Medicare season has slowed down, I will be taking a break from the weekly publishing for the next few months.

I'll post a new episode about every 3-4 weeks until September, when I'll pick right up and publish weekly shows again.

Thank you soooo much for being a loyal Medicare Nation listener!

If you are enjoying Medicare Nation, give us a 5 Star Review on Apple Podcasts!

The more people we can reach, the more people will learn more about Medicare. It' as simple as that!

Thank you for listening to Medicare Nation!

I'm so happy you are here! Share Medicare Nation with your family and friends, so they can learn more about Medicare and their benefits.

Have a peaceful and prosperous week!

Diane

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Hey Medicare Nation!

Over 17.5 Million of you are on a Medicare Advantage plan. And many of you have been, or know of a situation where your doctor has left the “network” and you are told by your Medicare Advantage Plan Carrier that you must find a new doctor. You tell your Medicare Advantage Plan carrier that you would like to change plans to keep your doctor, and they will tell you something that goes like this….”I’m sorry, you are unable to change plans mid-year. You will have to wait until the Annual Enrollment Period occurs to change plans, unless you have a special election. So….you’ll need to change doctors at this time.”

Sound familiar?

Well…..on today’s show, I’m going to discuss a “special election (SEP),” called – “Significant Network Change,” that many, many Insurance Agents don’t even know about.

Revisions were made to the Medicare Managed Care Manual, which went into effect on April 22, 2016.

The Significant Network Change Special Election Period, as written in the Medicare Managed Care Manual is listed as:

“Pursuant to 42 CFR § 422.62(b)(4), enrollees who meet the exceptional conditions of being substantially affected by a significant no-cause provider network termination may be afforded a special election period (SEP). If CMS determines that an MAO’s network change is significant with substantial enrollee impact, then a “significant network change SEP” may be warranted. CMS will use a variety of criteria for making this determination, such as:

(1) the number of enrollees affected;

(2) the size of the service area affected;

(3) the timing of the termination;

(4) whether adequate and timely notice is provided to enrollees,

(5) and any other information that may be relevant to the particular circumstance(s).

The Medicare Advantage Organization will be required to notify eligible enrollees of the significant network change SEP if the SEP is granted by CMS. SEPs will not be granted when MAOs make changes to their network that are effective on January 1 of the following contract year, as long as affected enrollees are notified of the changes prior to the AEP.

According to the rules, if a Medicare Insurance Carrier makes a “significant change” to one of their Medicare Advantage plan’s networks, that plan’s beneficiaries could possibly be granted a Special Election Period. This provider network change SEP allows beneficiaries “three months” to switch to traditional Medicare, with or without a stand-alone Prescription Drug Plan, or switch to a different Medicare Advantage plan, with or without Part D coverage. Whether or not beneficiaries qualify for this SEP is entirely up to CMS.

CMS states in the Medicare Managed Care Manual that they may grant a provider network change SEP to beneficiaries based on some of the following factors:

The amount of beneficiaries affected
Whether or not beneficiaries received adequate and timely advance notice of the provider terminations
The size of the plan’s service area
The time of the year that the plan made changes to its provider network

So…..if you have lost your primary care doctor, due to a non-cause termination in your Medicare Advantage Network, and it has caused you a “significant change” to your healthcare due to your doctor’s termination from the network, call Medicare and fight for this SEP!

If Medicare denies your request for a SEP and you honestly feel you qualify under one or more of the criteria stated……. Call me and hire me to contact Medicare on your behalf!

I have listed other Special Enrollment instances when you can make changes to your Medicare Advantage Plan outside of the Annual Enrollment Period.

For a complete list, go to www.Medicare.gov

TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD

Here’s quick guide to when you can make changes to your Medicare Advantage Plan:

You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65.

During the Annual Enrollment Period which is between October 15th through Dec 7th every year.
You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
You may have a “Special Election” that qualifies you to change your plan.

The Special Election Period that qualifies you to change your Medicare Advantage Plan, is what we want to focus on today. There are certain circumstances which allow you to qualify for this option.

If You Move

If you move and your new residence is not in your plan service area. You would need to notify Medicare as soon as possible, because you have the rest of the current month you are moving and the following 2 full months as the Special Election Period.
If you move to a new address and your plan is still in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of the new option plans.
Snowbirds that live in 2 locations, have to determine which of those residences is your primary residence. Where you vote and where you pay taxes are going to determine which is your primary residence.
If you move out of the country for a period of time and now you are coming back to live in the US, that will trigger a Special Election Period.
If you are moving into a long term care facility or a Skilled Nursing Facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are residing in the facility and when you move out of the facility.

Losing Coverage:

If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc.
If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage(credible coverage), that triggers a SEP. Or if you have had drug coverage through a Medicare Cost Plan and you leave the Cost Plan.
If you leave a PACE (Program All-Inclusive Care for the Elderly) Program.
If you had Medicaid and lost eligibility because of income requirements.

When there are plan changes with Medicare Contracts:

If your Medicare Advantage Plan was sanctioned by CMS, then you would be able to contact Medicare directly to request a Special Election Period to choose another Medicare Advantage Plan.
If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.

Special Circumstances

You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like!
If you qualify for LIS (Limited Income Sources) you may get extra help with prescription drug coverage and a Special Election Period to enroll in a different Medicare Advantage Plan.
During your Initial Enrollment Period for Medicare, you may have enrolled in a Medigap plan, and decided to change to a Medicare Advantage Plan during your first enrollment year. If you decide you want to change back to a Medicare Supplement Plan during your first year of coverage, you qualify.
SNP Plan - for chronic conditions (Diabetes, Heart Disease, COP) - may change your current Medicare Advantage Plan to enroll in a SNP plan, or you may no longer qualify for a SNP, so you can choose another Medicare Advantage Plan.
f an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.
If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP for Medicare Supplement Plans.

Precautions:

If you have a chronic illness, cancer, cardiovascular disease or other medical conditions, a Medicare Supplement (MediGap) plan does not have to enroll you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The Medicare Supplement carrier may not take you due to pre-existing conditions and once you drop your Medicare Advantage Plan, you may be "locked out" and not able to re-enroll until the next open enrollment period..Medicare Supplement Carriers can discriminate due to pre-existing conditions!

The price of Medicare Supplement plans do change as you age, and where you live. Keep that in mind.

Need more information on "Special Enrollment Periods?"

See the entire list at www.Medicare.gov

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Hey Medicare Nation!

March is colon cancer awareness month!

Medicare offers different types of "preventative" tests and exams, which aid in diagnosing illnesses and diseases, such as colon cancer.

Always speak with your primary care physician or specialist doctor, to discuss your medical history, family history regarding illness and diseases, as well as any signs & symptoms you may have.

This will assist your physician in determining which type of "preventative" test or exam,is best for you.

A special "Thank You," goes out to Phillip, from Kenosha, Wisconsin, who asks the question:

"I don't like going through a colonoscopy. Are other options available and how often do I need one?"

Let's look at Medicare's* official website, to find out more about "preventative" Colo rectal cancer screenings.***

www.medicare.gov

How often is it covered?

Medicare Part B covers several types of colo rectal cancer screening tests to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

Screening barium enema:When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it once every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer.
Screening colonoscopy: Medicare covers this test once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, Medicare covers this test once every 120 months (ten years), or… 48 months after a previous flexible sigmoidoscopy.
Screening fecal occult blood test: Medicare covers this lab test once every 12 months if you're 50 or older.
Multi-target stool DNA test: Medicare covers this at-home test once every 3 years for people who meet allof these conditions:
- The Medicare Beneficiary is between 50–85.
- show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
- They’re at average risk for developing colorectal cancer, meaning:
  - They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
  - They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
- Screening flexible sigmoidoscopy: Medicare covers this test once every 48 months for most people 50 or older. If you aren't at high risk, Medicare covers this test 120 months (ten years) after a previous screening colonoscopy.

Who's eligible?

All people age 50 or older with Part B are covered.

People of any age are eligible for a colonoscopy.

Your costs in Original Medicare

For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. In a hospital outpatient setting, you also pay a co-payment or co-insurance
You pay nothing for a multi-target stool DNA test.
You pay nothing for the screening colonoscopy or screening flexible sigmoidoscopy, if your doctor accepts assignment (contracted with Medicare or is an out-of-network physician who accepts assignment).
If a screening colonoscopy or screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you may have to pay co-insurance and/or a co-payment, but the Part B deductible doesn't apply.
You pay nothing for the screening fecal occult blood test. This screening test is covered if you get a referral from your doctor, physician assistant, nurse practitioner, or clinical nurse specialist.

Early detection of cancer is critical to successful treatment and may prove to be life-saving!

Get your preventative colorectal screening done as soon as your physician recommends it!

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them toSupport@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

I receive many phone calls from clients, who say they were unable to schedule an appointment with a new doctor; even though they are on a Medicare Supplement Plan.

I made many phone calls, with my clients to physician offices, in order to fix these issues.

What I found out didn't surprise me.

Many of the staff at physician office's across the country are inadequately trained in the different types of Medicare Plans.

I decided to educate you on how to make an appointment with a physician, lab, hospital, SNF or radiology center, if you have a Medicare Supplement Plan.

Having a Medicare Supplement Plan allows you the freedom to see any physician or provider you want.....,as long as the provider "accepts assignment" with Medicare.

Let's take an example.

If you wanted to make an appointment with a new Cardiologist,

call the office you want to be seen in.
Tell the person, who is scheduling your appointment, that Medicare is your Primary Insurance.
You may be asked if you have a "secondary insurance." If you are enrolled in a Medicare Supplement Plan, the answer is .... "Yes, I have a Medicare Supplement Plan."

If you are enrolled in a Medicare Advantage Plan, the Medicare Advantage Plan is your "Primary Insurance."

Most likely, you don't have another plan.

When you visit the physician's office for the first time, show the receptionist your Medicare Supplement ID Card. You may be asked if you have your Medicare ID Card. Hopefully, you've made a copy of your Medicare ID Card and have left your original Medicare ID Card at home in a safe place. You shouldn't be carrying your Original Medicare ID Card!

The staff will bill Medicare and the Medicare Supplement Plan for the amount you would have owed, if on Original Medicare.

You should not receive any paperwork to submit to Medicare or a Medicare Insurance Carrier.

Prior to any physician visits or procedures, call and ask if you have any co-pay, co-insurance or deductible if you are enrolled in a Medicare Supplement Plan that is not designated by the letter "F."

Medicare Supplement Plans are designated by Letters of the Alphabet and those "letter" plans can be offered by many different Insurance Companies.

Each "lettered" plan pays co-pays, co-insurance or deductibles, on your behalf, based on the plan you select.

After the physician's staff has your Medicare Supplement Plan info on file, they shouldn't require you to show them your card the next time you come in for an appointment.

Hopefully, this has helped you understand what is going on in the real world, and it will make it a less frustrating place for you!

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them to Support@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

Many of you carry your Medicare ID card in your wallet or purse. If you are a Medicare Advantage beneficiary, you have a “separate” medical ID card from the insurance carrier. It is not necessary to carry your Medicare ID card, If you have a Medicare Advantage ID card.

Who should carry their Medicare ID Card?

If the official Medicare program is your “primary” insurance, you should be carrying your Medicare ID card.

Now….. let me discuss with you how you can carry your Medicare ID card in a safer way.

Currently, your Medicare ID Card has your Social Security number on it, with a letter at the end of your Social Security number. If you have your social security number memorized, take these steps to help prevent “identity theft.”

Make a copy of your Medicare ID Card
Place your original Medicare ID Card in a safe place.
Take a Black Permanent Marker and “black out” all of the numbers of your social security number( except the last four numbers and the letter), on the copy.
Laminate the copy
Put this copy of your Medicare ID card in your wallet or purse.

If you are on a Medicare Advantage Plan or a Supplement to Medicare Plan, you should be carrying the Medical ID card the insurance carrier provided you.

If you have a stand-alone prescription drug plan, you will also have a separate card for your prescriptions. You will need to carry this card in your wallet or purse also.

How Do I Replace My Medicare ID Card if I Lost it or it Was Stolen?

If you made a copy of your Medicare ID Card like I described above, you won’t have a problem.

You can retrieve your Medicare ID Card from it’s safe place and make a new copy of the card.

If you didn’t make a copy of your Medicare ID Card, you will need to ask the Social Security Administration for a replacement card.

Follow these steps:

You can ask for a Medicare Replacement Card :

Online
By phone
At a local Social Security office location A.Online
1. Go to ssa.gov
2. You’ll see pretty pictures on the home page. On the left side is a picture, with the caption… “Learn What You Can Do Online.”
3. “Click” on the that photo.
4. When the next page opens, look down to about the 7th
5. It will read….”If you get Social Security benefits or have Medicare you can….”
6. “Click” on that line.
7. Sign in or Register for a “My Social Security Account.”
8. 5th line down should read….. “Get a Replacement Medicare Card”
9. Select – “Replacement Documents” tab.
10. Fill out the required information.
11. If the site “accepts” your information, you are all set! You should receive your replacement Medicare Card in 30 – 60 days.
12. If the site shows any kind of “error” or “red flags,” you will need to physically go down to a local Social Security location. B. By Phone

1. Call 800 - 633 - 4227

C. Social Security Office

1. Click on the "Social Security Location" tab and put in your zip code to find the nearest location to you.

Thanks so much for listening to Medicare Nation!

I appreciate the time you took to listen. If you have a parent or grandparent, who is approaching Medicare age (65) or is already receiving Medicare benefits, help them “Subscribe” to Medicare Nation.

Buy them a Smartphone!

If you buy them an Apple phone…show them the “purple” podcast icon on the phone and how they access Medicare Nation. Once the Medicare Nation page loads….. click on “subscribe.” All current shows will load automatically once a week for them!

If you buy them an Android phone, just go to Google Play and “Search” for the app – “Stitcher.”

Download the Stitcher App.

When you open Stitcher, they will need to sign up with an email address and password.

Once the home page opens, show them how to “swipe” to the left, until they reach the “last page.” This is the “Search” page.

In the “search” bar…. Type in “Medicare Nation.”

Medicare Nation comes right up!

“Click” on the Subscribe button…… they are set!

Help your parents “search” for other types of podcasts they would have an interest in. You will be opening up a brand new world for them and they WILL thank you for it!

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Hey Medicare Nation!

I hope everyone is having an awesome week!

Say goodbye to February! I know all of you Northerners are thrilled to see it go! Bring it on March!

You know, I see many, many clients and one of the top questions I am asked is, "What does the letter on my Medicare ID card mean?"

It happens so often, I figured I better dedicate an episode to just that!

The Social Security Administration (SSA) assigns a letter and a number, (if you fit into a sub-group) when you apply for Social Security Benefits and/or Medicare.

The letter (and number if it applies) is found on your Medicare ID Card, right after your social security number.

As an example, if you have worked and contributed to FICA (Federal Insurance Contribution Act), and started receiving your Social Security benefits at age 64, and you enrolled in Medicare at age 65, the letter "A" will be designated to you.

The "claim" number would look like this on your Medicare ID Card:

123-45-6789A

Just as "Different Strokes for different Folks," the Social Security Administration assigns "claim" numbers for different situations.

"Where Do I find the full list of Social Security claim letters?"

You can go to the following locations to see a full list of claim letters:

1. www.ssa.gov

2. Title XVIII of the Social Security Act

3. For a Free List of the Codes Listed by the Social Security Administration on their website, go to

my website -

www.callsamm.com

Thanks for listening to Medicare Nation!

Please SHOW someone how to "subscribe" to Medicare Nation, so they can learn about their Medicare benefits and what type of Medicare Plan they should be on!

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What is the Difference Between a Welcome to Medicare Visit vs. an Annual Wellness Visit?

A "Welcome to Medicare" preventive visit: Is an introductory visit only within the first 12 months you have Medicare Part B. This visit includes a review of your medical and social history with your Primary Physician, as well as possibly including preventive services, including:

Certain screenings, shots, and referrals for other care, if needed
Height, weight, and blood pressure measurements
A calculation of your body mass index
A simple vision test
A review of your potential risk for depression and your level of safety
An offer to talk with you about creating "Advanced Directives"
A written plan letting you know which screenings, shots, and other preventive services you need.

This visit is covered one time. You don’t need to have this visit as a "prerequisite," to be covered for yearly "Wellness" visits.

Annual "Wellness" visits: If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan. This plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:

A review of your medical and family history
Developing or updating a list of current providers and prescriptions
Height, weight, blood pressure, and other routine measurements
Detection of any cognitive impairment
Personalized health advice
A list of risk factors and treatment options for you
A screening schedule (like a checklist) for appropriate preventive services.

This visit is covered once every 12 months (11 full months must have passed since the last visit).

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment with Medicare The Part B deductible doesn’t apply for annual wellness visits.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

Your doctor or other health care provider performs additional tests or services during the same visit (ex: an EKG or draws blood).
The additional tests or services aren't covered under the preventive benefits.

An "Annual Exam" is where your Primary Care Physician will provide a "hands on" examination of you and you may have tests like an EKG or have blood drawn.

Co-pays, coinsurance and deductibles will apply for Annual Exams.

Share Medicare Nation with someone!

Teach your parents, your grandparents how to access this podcast! Buy them a smartphone. Show them how to access iTunes & Stitcher.

The more they know, the less they will ask you for help.

It's not easy being the "Sandwich Generation."

So...... do yourself and your parents a favor and help them listen to Medicare Nation!

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Hey There Medicare Nation!

Today, I'm speaking with a special guest.

I'm speaking with my good friend James Van Prooyen. James recently retired from the military, where he spent twenty years in the Air Force.

James didn't always want to serve in the Military. At first, James wanted to follow in his grandfather's footsteps and become an electrician.

While James was a senior in High School, in Northern Michigan, he was introduced to a recruiting officer. James learned a great deal about being in the Military, and James wanted to serve - for four years!

Shortly approaching his fourth year in the Air Force, James thought about his future. He had a wonderful wife and a new baby. James loved working with his Air Force family, and he decided to enlist again for four more years. Those four years soon turned into twenty, and James found himself retiring and not knowing what to do next.

James kept very busy after retiring from the Air Force by helping his wife with her nutritional business and helping to take care of his daughter.

James soon began networking and found himself part of the Tampa Bay Business Owners Association, and he soon learned he wanted to be an entrepreneur.

James learned about Podcasting and new he wanted to have a Military Show.

The Veteran's in Business Show was born!

James wants the Veteran's in Business Show to be a conduit for veterans who already own a business, to guide and teach veterans who will be leaving the military in the coming year. Veteran's who want to start their own business, will learn from other veterans, who have done it before them.

Resources for veteran's. James wants to make the transition easier for his brother and sister veterans.

If you are a veteran business owner and would like to be interviewed on Jame's podcast..... send him an email to

TheMilitaryPodcastNetwork@gmail.com

If you know of a veteran who would love to learn how to start their own business, tell them to listen to the Veteran's in Business Show with James Van Prooyen.

Find the podcast here:

veterans-in-business-show

Contact James Van Prooyen:

@JamesVanProoyen

on Snap Chat - JamesVanProoyen

LinkedIn - James Van Prooyen

James - Thank You for your Service!

Tell a family or friend about Medicare Nation!

Help someone get on Medicare Nation with a Smart Phone!

The resources for people 64 and older is so valuable!

I'm counting on my "Sandwich Generation" to help out and get their parents on the show!

Help me to help you!

Thanks for listenening!

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Hey Medicare Nation!

This week I’m discussing Medical Marijuana!

2017 has issued in with additional States Legalizing Marijuana for Medicinal purposes. I am speaking with Dr. Rachna Patel, The Medical Marijuana Expert this week on Medicare Nation.

Dr. Rachna Patel completed her undergraduate studies at Northwestern University in Illinois and her Medical studies at Touro University in Vallejo, CA.

Dr. Patel is a licensed practitioner in the State of California and is in impeccable standing with the State of California Medical Board. She has been practicing in the area of Medical Marijuana (cannabis) since 2012, and she has treated countless patients!

Dr. Patel is known for her “bedside manner” with her patients and does things differently than other Medical Marijuana doctors. Dr. Patel sees her patients “in person” and not by phone or virtually. Dr. Patel spends a thorough amount of time with patients to ensure she is guiding them step-by-step through the Medical Marijuana process.

Dr. Patel may “recommend” medical marijuana for conditions and diagnoses such as, but not limited to:

Chronic Pain (nerve, muscular)
Auto-Immune Conditions
Anxiety
Insomnia
Cancer

Dr. Patel may “not” recommend medical marijuana for conditions and diagnoses such as, but not limited to:

Spinal Stenosis
Severe “Shingles” Case
Bi-Polar Disorder
History of Heart Attack/Stroke

Medical Marijuana is “Googled” daily by tens-of-thousands of people.

According to ProCon.org , Colorado residents show the most interest in “searching” information on Medical Marijuana. This may be due to the fact that Colorado was the first State to legalize “recreational use” of marijuana, and has set a "standard" for other States to follow.

According to the website ProCon.org, as of March of 2016, there are over 1,250,000.00 people using marijuana medicinally. As more States legalize the use of Medical Marijuana, those numbers will steadily rise.

The following 21 States have passed legislation for the use of Medicinal Marijuana:

Montana, North Dakota, Minnesota, Michigan, Ohio, Pennsylvania, New York, Vermont, New Hampshire, Rhode Island, Connecticut, New Jersey, Delaware, Hawaii.

The following Nine States have passed legislation for the recreational use of marijuana:

Washington, Oregon, California, Nevada, Alaska, Colorado, Maine, Massachusetts, D.C.

That’s 30 States Total that have legalized Medicinal Marijuana.

Here are a few links to learn more about Medical Marijuana:

www.weedmaps.com

http://medicalmarijuana.procon.org/

Would you like to contact Dr. Rachna Patel to learn more about Medical Marijuana and/or her practice?

Here are links for Dr. Patel.

Website – www.Dr.RachnaPatel.com

Facebook page: www.facebook.com/DoctorRachnaPatel

YouTube https://www.youtube.com/channel/UCNtN7JXpNKHAYA7ZdWzpi1A

How to Choose a Medical Marijuana Doctor that You Can Trust

28 Legal Medical Marijuana States and DC: Laws, Fees, and Possession Limits

Thank you for listening to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!

If you have any questions, send them to Support@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

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Hey Medicare Nation!

How many of you have just found out your Doctor is leaving the Medicare Advantage Network you're in?

I'm certain there are "Thousands of you."

That is the #1 complaint I receive from clients, is that their "Doctor" is leaving or has left their Medicare Advantage Plan (MAPD) Network.

Medicare has regulations about how a Medicare Advantage Organization (MAO) can "terminate" a Doctor contracted in their network and in reverse, there are regulations on how a Doctor can leave a MAO.

There are also regulations on how a MAO publishes it's "Provider Directory" for their network.

Chapter 4, Section 110.1.1 of the Medicare Managed Care Manual, titled, Provider Network Standards, lists in part....

"MAO's are required to establish and maintain provider networks that:

...... Are accurately reflected in up-to-date directories. Plans are responsible for verifying and regularly updating their network directories to ensure that providers included in the directories are available to their enrollees (ie, listed providers accept new patients who are enrolled in the plan).

In section 110.2.2 labeled Provider Directory Updates, it states in part:

....MAO's must include information regarding all contracted network providers in directories at the time of enrollment. Directories must include information about the number, mix, and distribution of all network providers. MAO's may have separate directories for each geographic area they serve (e.g. metropolitan areas, surrounding county areas), provided that all directories together cover the entire service area.

Provider Directories must be updated anytime the MAO becomes aware of changes. They have 30 days to update the changes or be non-compliant.

When there is a change to the provider network (a provider is terminated or the provider is leaving the network), The MAO "must make a good faith effort to provide a written notice of a termination of a contracted provider at least 30 calendar days before the termination effective date to all enrollees who are patients seen on a regular basis by the provider whose contract is terminating."

In regards to termination of "Primary Care Physicians," all enrollees who are patients of that primary care professional must be notified."

So.....what's being done about all the inaccuracies to provider directories?

CMS conducted it's first review of 54 Medicare Advantage Organizations (MAO's) online provider directories, between February and August of 2016.

The finding......45% of provider directory locations listed in these online directories were inaccurate!

About one-third of all MAO's with 5,832 providers were reviewed in total.

Twenty-One MAO's received warning letters from CMS around January 6th, and they have 30 days to fix the errors or face possible fines or sanctions, which could include suspending marketing and enrollment of medicare beneficiaries.

Here are the Medicare Advantage Plans that received warning letters from CMS to immediately fix the errors in their provider directories.

Blue Cross & Blue Shield of Rhode Island - RI

Rhode IslandBlue Cross Blue Shield of Michigan - FL MI, MO WI

Catholic Health Partners - IA,KY, MI, OH

CIGNA - IL, IA

Community Health Plan of Washington - WA

Emblem Health Inc. - CT, NY, RI

Fallon Community Health - MA

Gateway Health Plan, LP - OH, PA, WV

Health Partners Plans, Inc. - PA

Highmark Health - PA

Humana Inc. - WI

Indiana University Health - IA

Magellan Health Inc. - NY

Moda, Inc. AK, ID, MT, NM, OR, WA

Molina Healthcare, Inc. - UT

Piedmont Community Health Plan - VA

Premera - WA

Samaritan Health Services - OR

SCAN Health Plan - CA

UnitedHealth Group, Inc. - CO

Wellcare Health Plans - IL

Now.... if you are a member of one of these MAO plans that received a "warning letter," you mayqualify for a "Special Enrollment Period," from Medicare.

What should you do?........

Call Medicare - 800-633-4227
Tell the Medicare employee that you are a member of the ________ Medicare Advantage Plan, that received a "Warning Letter" from CMS for non-compliance of their provider directory.
State (if it's true!) that you were not notified by your physician or the MAO of the termination of your doctor, and your directory wasn't updated.
VERY IMPORTANT TO STATE.....

Tell the Medicare employee you RELY on the directory to locate an in-network provider, and by the Medicare Advantage Plan & the Doctor NOT informing you that he/she was LEAVING the network, it caused a SIGNIFICANT access to care barrier for you!

Because now...... You can't see your doctor who has taken such good care of you..... due to the error.

Ask for a Special Election Period, so that you can choose a Medicare Advantage Plan where your Doctor is in-network.
If they grant you the Special Election Period, tell the Medicare employee which Medicare Advantage Plan you want to be on.
If they say "NO," Thank the Medicare Representative for their help and say goodbye.

What do you do now????

See if you qualify for a different Special Election Period. Listen to my earlier episode on SEP's.

Listen to Last Friday's episode on 5 STAR Plans.

Listen to the episode on the Medicare Advantage Disenrollment Period. It also includes information on Special Need Plans.

If NONE of these ideas offer you the opportunity to change your Medicare Advantage Plan to a better option, than you will have to remain on the Medicare Advantage Plan you are on until the Annual Enrollment Period to change plans.

Do your Due Dilligence Nation!

Don't enroll in another Medicare Advantage Plan.... just because the doctor who is leaving the network is on that one!

Make sure the plan will fit your Medical, financial and prescription needs for 2017!

Share Medicare Nation with someone!

Teach your parents, your grandparents how to access this podcast! Buy them a smartphone.

The more they know, the less they will ask you for help.

It's not easy being the "Sandwich Generation."

So...... do yourself and your parents a favor and help them listen to Medicare Nation!

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Hey Medicare Nation!

Medicare has announced the 2017 "5 Star Plans."

What are 5 Star Plans?

Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing.

There are 2 main types of Star Ratings:

Overall Star Rating that combines all of the plan's scores.
A Summary Star Rating that focuses on a plan's medical or prescription drug services.

A few areas Medicare reviews for these Star Ratings include:

How plan members rate their plan's services and care.
How well a plan's network of doctors detect illnesses and keep members healthy.
How well a plan helps it's members use recommended and safe prescription medications.

A plan can receive a 1 to 5 Star Rating.

5 Stars is Excellent

4 Stars is above average

3 Stars is average

Stars is below average

and 1 Star is poor.

You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is available in your area.

You can only switch to a 5 Star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once from December 8th to November 30th of the next year.

Once you use your election to enroll in a 5 Star Plan, you cannot use it again.

If a Medicare Advantage Plan or a Stand-Alone Prescription Drug Plan has received a 5 Star Rating from Medicare, it doesnot mean you automatically go out and enroll in the 5 Star Plan.

That 5 Star Plan may not fit your unique needs!

The option is available..... if you need it!

Some people enroll in a Medicare Advantage Plan during the Annual Enrollment Period, and only switched plans because they received an incentive from the new plan.

Ex: Your neighbor "Phil" tells you he is on the greatest Medicare Advantage Plan. He receives $30 in "Bandaids" from his plan every month. He tells you to "switch" plans so you can get $30 worth of over-the-counter supplies every month. Phil hands you his "Agent's" card.

You call Phil's "Agent," who gladly comes out and enrolls you into the same exact plan that Phil has. The plan goes into effect January 1st. You call your Primary Doctor on February 6th for an appointment because you think you have the flu.

The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network?

Sorry......you should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th.

Maybe you were better off on the plan you originally were on.

In this example, you may have another option!

You find out in January, that XYZ Medicare Advantage Plan has a 5 Star Rating in your area. You can look up the XYZ Plans and determine if one of their plans accepts your Primary Doctor in their network. Check the co-pays, co-insurance and deductibles on the new plan. Check that all your prescription drugs are in the new 5 Star Plan's formulary.

If you like what you found out about the 5 Star Rating Plan that is available in your area, you are allowed to "switch" one time from the Medicare Advantage Plan you are stuck on, to the 5 Star Rating Plan available in your area.

Once you make the election to switch to the 5 Star Plan, you cannot enroll into another plan - whether it has 5 Stars or not.

Only a criteria that fits a Special Election Period will be allowed.

Look on the www.Medicare.gov website for the list of Special Election Period examples.

The 14 Medicare advantage Plans that received "5 Star Ratings" for 2017 are:

Company Name Service Area

1. KS Plan Administrators, LLC - 4 Counties TX

2. Kaiser Found. HP, INC 31 Counties CA

3. Kaiser Found. HP of CO 17 Counties CO

4. Kaiser Found. of the Mid- D.C. & Atlantic States 11 Counties MD 9 Counties VA

5. Tufts Assoc. HMO 10 Counties MA

6. BCBS of MA HMO Blue 11 Counties MA

7. Group Health Plan (MN) 87 Counties MN 8 Counties WI

8. Aultcare Health Ins. Corp 12 Counties OH

9. Physicians Health Choice TX 19 Counties TX

10. Gundersen Health Plan 1 County IA, 8 Counties WI

11. Optimum Healthcare Inc. 25 Counties FL

12. Kaiser Found. HP of NW 9 Counties OR 4 Counties WA

13. Sierra Health & Life Ins. 1 County CO, 1 County KS, 2 Counties MA, 3 Counties MD. 1 County MI, 2 Counties NJ, 2 Counties PA, 2 Counties TX, 1 County in VA

If you live in the service area of the above 5 Star Rated Plans, you should go onto the Medicare.gov website and compare the 5 Star Plan to the Plan you are currently on. Make sure your doctors are in the network. Make sure ALL your prescription drugs are covered in the formulary. Look at the co-pays, co-insurance and any deductibles.

Make sure the "5 Star Plan," is worth "switching" too!

Just because it was given a 5 Star Rating from Medicare, doesn't mean the plan will automatically be the best choice for your unique needs.

Do your Due Diligence!

You can check the Medicare.gov site for any 5 Star Prescription Drug Plans in your service area and Medicare Advantage Plans that are health plans only and do not offer prescription drug coverage on that particular plan.

You can also listen to episode MN061. I give you information on the Medicare Advantage Disenrollment period and information on Special Need Plans.

You don't have to be "stuck" on a Medicare Advantage Plan that doesnot suit your needs.

This is the time of year to make changes. Make sure you switch to a better plan this time!

Questions??

Send them to Support@TheMedicareNation.com

Thanks for listening to Medicare Nation.

If you like the information that is provided, give us a 5 Star Review on iTunes!

The more reviews we get, the more exposure iTunes will give Medicare Nation, and that means more people will be able to find the show.

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Have a happy, peaceful & prosperous week!

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Hello Medicare Nation! Happy New Year to everyone.

I hope everyone had a wonderful holiday season.

The Annual Enrollment Period is over. I hope each of you did your due diligence in deciding which plan will fit you best for 2017.

I have many episodes available for you to learn all about Medicare Advantage Plans, Original Medicare and Part D of Medicare.

If you determine the Medicare Advantage Plan you are on is not suitable for you or a loved one in 2017, you may have other options available to you.

Right now, you are in the Medicare Advantage Disenrollment Period. It started on December 8th and will end on February 14th of 2017.

Here is how you "dis-enroll" from a Medicare Advantage Plan during this time period.

Call Medicare 800-633-4227
Advise the Medicare Representative that you would like to "dis-enroll" from your current Medicare Advantage Plan and go back onto Original Medicare.
You can enroll in a stand-alone Part D prescription drug plan.
You can also enroll in a Supplement to Original Medicare plan, that will assist you in paying your out of pocket costs for Part A & Part B.

Each Supplement to Original Medicare Plan (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan J, Plan K, Plan L and Plan N.) cover different out of pocket Medicare costs. Research each one prior to enrolling in the Supplement plan to determine the plan that will fit your health & financial needs for 2017.

If you find it difficult to figure out if Original Medicare and enrolling in a Part D and/or a Supplement to Original Medicare Plan is right for you, contact me at either -

Support@TheMedicareNation.com

Go to my website..... www.CallSamm.com and tell me in the "Contact Me" how I can assist you.

SPECIAL NEED PLANS

Are you a Diabetic? Do you have COPD? Do you have Cardiovascular Disease?

If you answered "yes" to any of these questions, you may be eligible to enroll in a special needs plan.

A special needs plan is a Medicare Advantage Plan. If you are diagnosed with any of the conditions I listed above, you may use a special election to change to a special needs plan one time during the year.

How do you determine if you have Special Need Plans in your area?

Go to www.medicare.gov and click on the "find health and drug plans." The database will take you through several screens and you should select "special needs plan," when you advise Medicare what type of plan you are on.

The database will provide you with the special need plans in your area.

You can also look under special election periods, to determine if you have a qualified reason to change.

If you like Medicare Nation, please give us a 5 Star Review on iTunes!

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When you leave us a great review, iTunes gives Medicare Nation more exposure. More exposure means individuals who need advise about Medicare will find the show!

I appreciate you listening to Medicare Nation!

Have a happy, healthy & prosperous week!

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10 Days left in the Annual Enrollment Period. That's plenty of time to find the plan that fits your needs for 2017,

The one change that everyone is talking about is the increase to the Medicare Part B Premium.

Last month, Social Security announced a .03% COLA for Social Security beneficiaries in 2017.

With the COLA announcement, the hold harmless rule is in effect. This means if the social security COLA doesn’t cover the increase to the Medicare Part B base premium, those individuals who already have their Medicare Part B premium taken out of their Social Security benefit check will not see that deduction in their benefit check.

The hold harmless individuals, who make up about 70% of all Medicare beneficiaries, won’t even come close to covering the $134.00 base Part B premium in 2017. The hold harmless protection will squeak out a Medicare Part B premium increase of about $109.00.

The hold harmless rule does not protect individuals who:

Are enrolling in Medicare Part B for the first time.
Haven’t started receiving their Social Security Benefits and are enrolled in Medicare Part B.
Are directly billed for their Medicare Part B premium
Make an annual income of $85,000.00 or more
Are enrolled in the Medicare Savings Program (States pay the new Medicare Premium increase).
Are enrolled in Medicare and Medicaid, the State pays for the individual’s Medicare premiums.

Individuals who are not protected by the hold harmless rule, and have an annual income of less than $85,000.00, will be paying a base Part B premium of a whopping $134.00 a month in 2017.

Individuals with an annual income of more than $85,000.00, but less than $107,000.00, will pay a Part B premium of $107.50 a month.

Individuals who earn an annual income between $107,000.00 and $160,000.00, will pay a monthly Part B premium of $243.60.

Those who earn an annual income between $160,000.00 up to $214,000.00, will pay $316.70 a month premium for Medicare Part B.

Finally, those individuals who earn an annual income of more than $214,000.00, will pay $389.80 a month.

The Medicare Annual Enrollment Period is in full swing and allows Medicare Advantage enrollees the opportunity to voluntarily make plan changes, which are effective January 1, 2017.

Individuals can make the following changes during the Annual Enrollment Period:

Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Drop their Medicare Advantage Plan and go back to Original Medicare.
Switch from a Stand-alone Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan and vice versa.
Go from Original Medicare onto a Medicare Advantage Plan.
Stay with the Medicare Advantage Plan they currently have.
Switch from a Medicare Supplement Plan to a Medicare Advantage Plan.
Drop a Medicare Advantage Plan and enroll in a Medicare Supplement Plan (underwriting may apply).

But according to a brief published by The Kaiser Family Foundation in September of 2016, from 2007 – 2014, only an average of 10% of Medicare Advantage enrollees voluntarily switched plans each year. (https://goo.gl/KqmCXL)

In my experience, Medicare enrollees do not have enough resources to make informed decisions in selecting a Medicare plan for themselves. During the Annual Enrollment Period, people are bombarded with TV infomercials, newspaper ads, direct mail offerings and inaccurate advice from friends and family. Overwhelming information!

So what is the answer for over 31% of Medicare beneficiaries on Medicare Advantage Plans during the Annual Enrollment Period?

There are several options available.

If you have a Medicare Advisor or Insurance Agent, who can offer you several different Medicare Advantage carriers in their portfolio – call them.

It wouldn’t be in your best interest to contact an insurance agent, who works for only one Medicare insurance carrier. These agents are only able to offer you Medicare Advantage Plans from their one carrier. They will not have your best interest in mind. If they don’t enroll you in one of their plans, they won’t get paid.

Using a Medicare Advisor or insurance agent, who has different Medicare carriers available to you, will have your best interest. They will help find you a Medicare plan that fits your unique needs.

If you don’t personally know a Medicare Advisor or insurance agent, you can Google “Medicare Advisor + your town.” An example would be – Medicare Advisor Tampa, FL.

Each State has a Department of Aging, with volunteers to assist you with your Medicare questions.

Advise the representative that you’d like to speak with someone who is knowledgeable with the different Medicare Advantage Plans in your area and they will connect you with a person who is unbiased.

Many States have educational seminars on Medicare at community Senior Centers. Ask if any will be in your area.

Individuals can go onto the www.Medicare.gov website and use the plan finder database, but understand the information is not 100% complete.

When you are deciding between two plans, go onto the insurance plan's website to look at the plan details to compare out of pocket costs for each plan.

The Medicare Part B premium increase for 2017, is going to make many people anxious and frustrated. It is in your best interest to plan ahead and research your Medicare plan options at least three to four months prior to turning 65.

If you are still employed and on an employer’s health insurance plan, compare your cost for your employer’s plan against Medicare plans.

Don’t forget to calculate the Medicare Part B premium into your comparison.

You can participate in a credible employer health plan and not have to enroll in Medicare Part B when you turn 65.

In my experience, I have found over 80% of the time, a Medicare Supplement plan is more cost effective than the employer’s plan. The Medicare Supplement plan also provides the freedom to choose any physician in the United States, who is contracted with Medicare. Take your time and do your due diligence.

“A stitch in time saves nine.” Properly preparing for your initial enrollment in Medicare and choosing a Medicare plan that fits your unique needs, will save you the aggravation and possibly making a poor financial and health coverage decision.

Diane Daniels

Medicare Advisor Senior Advocates For Medicare & Medicaid, LLC 855-855-7266

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The Center for Medicare & Medicaid Services, has recently announced the costs for Medicare in 2017.

The one change that everyone is talking about is the increase to the Medicare Part B Premium.

Last month, Social Security announced a .03% COLA for Social Security beneficiaries in 2017.

The hold harmless rule does not protect individuals who:

Are enrolling in Medicare Part B for the first time.
Haven’t started receiving their Social Security Benefits and are enrolled in Medicare Part B.
Are directly billed for their Medicare Part B premium
Make an annual income of $85,000.00 or more
Are enrolled in the Medicare Savings Program (States pay the new Medicare Premium increase).
Are enrolled in Medicare and Medicaid, the State pays for the individual’s Medicare premiums.

Individuals who are not protected by the hold harmless rule, and have an annual income of less than $85,000.00, will be paying a base Part B premium of a whopping $134.00 a month in 2017.

Individuals with an annual income of more than $85,000.00, but less than $107,000.00, will pay a Part B premium of $107.50 a month.

Individuals who earn an annual income between $107,000.00 and $160,000.00 will pay a monthly Part B premium of $243.60.

Those who earn an annual income between $160,000.00 up to $214,000.00 will pay $316.70 a month premium for Medicare Part B.

Finally, those individuals who earn an annual income of more than $214,000.00 will pay $389.80 a month.

The Medicare Annual Enrollment Period is in full swing and allows Medicare Advantage enrollees the opportunity to voluntarily make plan changes, which are effective January 1, 2017.

Individuals can make the following changes during the Annual Enrollment Period:

Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Drop their Medicare Advantage Plan and go back to Original Medicare.
Switch from a Stand-alone Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan and vice versa.
Go from Original Medicare onto a Medicare Advantage Plan.
Stay with the Medicare Advantage Plan they currently have.
Switch from a Medicare Supplement Plan to a Medicare Advantage Plan.
Drop a Medicare Advantage Plan and enroll in a Medicare Supplement Plan (underwriting may apply).

So what is the answer for over 31% of Medicare beneficiaries on Medicare Advantage Plans during the Annual Enrollment Period?

There are several options available.

If you have a Medicare Advisor or Insurance Agent, who can offer you several different Medicare Advantage carriers in their portfolio – call them.

Using a Medicare Advisor or insurance agent, who has different Medicare carriers available to you, will have your best interest. They will help find you a Medicare plan that fits your unique needs.

If you don’t personally know a Medicare Advisor or insurance agent, you can Google “Medicare Advisor + your town.” An example would be – Medicare Advisor Tampa, FL.

Each State has a Department of Aging, with volunteers to assist you with your Medicare questions.

Many States have educational seminars on Medicare at community Senior Centers. Ask if any will be in your area.

Individuals can go onto the www.Medicare.gov website and use the plan finder database, but understand the information is not 100% complete.

The Medicare Part B premium increase for 2017 is going to make many people anxious and frustrated. It is in your best interest to plan ahead and research your Medicare plan options at least three to four months prior to turning 65.

If you are still employed and on an employer’s health insurance plan, compare your cost for your employer’s plan against Medicare plans.

Don’t forget to calculate the Medicare Part B premium into your comparison.

You can participate in a credible employer health plan and not have to enroll in Medicare Part B when you turn 65.

Need help with understanding Medicare?

Call SAMM is available throughout the Annual Enrollment Period to help educate you about Medicare plans.

Call 855-855-7266 for more information.

You can also send an email to Support@TheMedicareNation.com

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Welcome, Medicare Nation!

I’m excited about our guest and our important topic today. We’re discussing the confusion surrounding advanced directives. Have you ever thought about what would happen if you can’t speak for yourself and are in an emergency health situation? Who will express your wishes, and will the health care professionals understand? Dr. Ferdinando (Fred) Mirarchi is the ER Director of University of Pittsburgh Medical Center-Hamot. He has a solution!

Tell us about health care directives and the issues that commonly arise when people come to the ER.
- There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise the safety concerns.
What happens when someone comes to the ER with no accompanying family and no papers?
- It’s not just an ER situation, but anywhere in the hospital, for any medical procedure. “You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means.” About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you’re an end of life care patient and don’t want care. Many don’t understand the difference between being critically ill and being in an “end of life” situation.
If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
- Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn’t compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
Can you explain the difference in a Living Will and a DNR?
- A Living Will is a legal document, not a medical document. It is for use in situations when someone can’t speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it’s a DNR, then it can affect care and treatment of any medical emergency. “It’s a coin toss with a 50% chance of being treated or not being treated.”
You’ve developed a solution to help people explain their wishes about receiving treatment. Can you explain?
- At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
Will this ID card work in any medical office, hospital, or ER?
- Yes, and it’s in clear and understandable medical language so that any professional will know what to do.
Can you explain how to find out more and what the service includes?
- Visit our website: www.institutehcd.com or email us: info@institutehcd.com. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you’re at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry.
- Here is the news story video of the 57y.o. man who was mistakenly noted as "DNR" in his hospital file
whistle blower 9 Investigative news
- http://www.wsoctv.com/news/9-investigates/whistleblower-9/whistleblower-9-do-not-resuscitate-bracelet-mistakenly-put-on-hospitalized-mans-wrist/446014450
Here is a Parody Video on "Advanced Directives"

https://youtu.be/S6XKv7MOuts

Good Practice (A parody of Green Day's " Good Riddance")

By Michael Barton + Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Hello Medicare Nation listeners!

Today, I’ve put together a few questions from our audience that I’d like to read on the air. Many of you ask the same questions, so I’d like to help out as many of you as I can.

Wendy from King of Prussia, Pennsylvania asks???

HOW DO I GET A REPLACEMENT MEDICARE CARD?

If you are on Original Medicare, your Medicare ID card is proof of your Medicare insurance. , If your Medicare card was lost, stolen, destroyed or illegible, you can ask for a replacement card by going online and logging in to your Social Security account at www.ssa.gov

If you don’t have an online social security account, you can register one on the www.ssa.gov website.

Once you’ve logged into your account, select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.” Your replacement Medicare card will arrive in the mail in about 30 days, at the address on file with Social Security.

If you moved and you did not update Social Security with your new address, you must update your new address into the database, or Social Security will be sending your replacement Medicare card to your old address!

If you don’t have the internet, a computer or you just want to call Social Security, here’s the number to call:

800-772-1213

You can also go to your nearest Social Security office to get a Medicare card replacement. To find the nearest social security office, get on the home page of www.ssa.gov “click” on the social security office location tab and type in your zip code for the nearest social security office.

Kenny from Rio Rancho, New Mexico asks??????

WHAT INTERNET BROWSER CAN I USE TO VIEW THE MEDICARE.GOV WEBSITE?

The official Medicare.gov website states –

For optimal results, use Internet Explorer 8.0 or 9.0. You can also view in Firefox, Chrome and Opera.

June from San Diego – California asks????

WHAT DOES MEDICALLY NECESSARY MEAN?

Medicare will only pay for services that are considered to be medically necessary. According to Medicare.gov, services or supplies are considered medically necessary if they:

Are needed for the diagnosis, or treatment of your medical condition.
Are provided for the diagnosis, direct care, and treatment of your medical condition.
Meet the standards of good medical practice in the medical community of your local area.
Are not mainly for the convenience of you or your doctor. AN EXAMPLE of NOT “Medically Necessary,” is cosmetic surgery. Maybe you don’t like your nose because it’s too big for your face. Medicare will not pay for cosmetic surgery to make you look pretty. It must be “Medically Necessary.” A better example would be if your face was disfigured due to a car accident, a fire or a severe dog bite. You will need treatment to stop the bleeding and to prevent infection, so Medicare will pay for the treatment of those types of injuries.

Thanks for listening!

Send your questions to Support@TheMedicareNation.com

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How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary.

MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary.

Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions.

If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period.

You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016.

Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016.

Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area.

How do you compare plans to find the right one for you or your loved one?

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

You’ll see a Dark Blue Bar under Medicare.gov
Hover your cursor over the tab that reads “Drug Coverage.”
Click on the last item in the column labeled “Find Health & Drug Plans.”
Add your zip code & click on “Find Plans.”
Check the box that pertains to you.

Original Medicare?

Health Plan (MAPD)?

Check the box that pertains to you in regards to assistance.

Do you receive extra help?

I Don’t Know?

Click “Continue.”
Now enter your drugs. All of them.

When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.”

If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later.

Select “My Drug List is Complete.”
You’ll see on the right side a grayish box that has a Prescription ID#

Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver!

Now select a pharmacy you use.
Then select “Continue to plan results”
On this page, you’ll see a summary of your search.
Select the box that pertains to your plan.

Either Prescription Drug Plan with Original Medicare or

Health Plan with Prescription Drug Plan (MAPD).

All the drug plans in your geographical area available to you will be displayed.

Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.

You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.

You have several options.

With your Prescription ID# and the Password Date, you will be able to come back at a later date and edit your list.

Start getting your list together, so it will be easier for you to check out 2017 plans!

Here's the link to read the guidelines your Primary Doctor uses in prescribing you scheduled drugs.

www.cdc.gov/drugoverdose/prescribing/guideline

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me!

No other equipment is needed!

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary.

You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016.

Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016.

Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area.

How do you compare plans to find the right one for you or your loved one?

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

You’ll see a Dark Blue Bar under Medicare.gov
Hover your cursor over the tab that reads “Drug Coverage.”
Click on the last item in the column labeled “Find Health & Drug Plans.”
Add your zip code & click on “Find Plans.”
Check the box that pertains to you. Original Medicare? Health Plan (MAPD)?
Check the box that pertains to you in regards to assistance. Do you receive extra help? I Don’t Know?
Click “Continue.”
Now enter your drugs. All of them.

When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.”

If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later.

Select “My Drug List is Complete.”
You’ll see on the right side a grayish box that has a Prescription ID# Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver!
Now select a pharmacy you use.
Then select “Continue to plan results”
On this page, you’ll see a summary of your search.
Select the box that pertains to your plan. Either Prescription Drug Plan with Original Medicare or Health Plan with Prescription Drug Plan (MAPD).

All the drug plans in your geographical area available to you will be displayed.

Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.

You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.

You have several options.

With your Prescription ID# and the Password Date, you will be able to come back at a later date and edit your list.

Start getting your list together, so it will be easier for you to check out 2017 plans!

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me!

No other equipment is needed!

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome Medicare Nation!

I just had my annual eye exam and what a surprise I got!

I was diagnosed with Narrow Angle Glaucoma!

How could I be diagnosed with Glaucoma being just 54 years old? Not only was I diagnosed, but I had to have immediate laser surgery to correct it. I don't want any of you to be diagnosed with Narrow Angle Glaucoma, so I'm going to discuss glaucoma with you to help you understand this disease.

There are several types of glaucoma. The two main types I will be discussing today are open-angle and narrow angle glaucoma. These types of glaucoma are marked by an increase of pressure inside the eye.

Open-Angle Glaucoma Open-angle glaucoma, (also called Chronic Glaucoma), is the most common form of glaucoma, accounting for at least 90% of all glaucoma cases:

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve can occur. It is a lifelong condition and needs to be monitored.

It is the most common type of glaucoma, affecting about 3 million Americans, many of whom do not know they have the disease, because you will not have signs or symptoms until it is too late.

You are at increased risk of glaucoma if your parents or siblings have the disease, if you are African-American or Latino, and possibly if you are diabetic or have cardiovascular disease. The risk of glaucoma also increases with age.

The 2nd type of Glaucoma is called - Narrow Angle Glaucoma Narrow Angle Glaucoma, also called acute glaucoma, is a less common form of glaucoma – less than 5% of the general population develops Narrow Angle Glaucoma.

Far sighted people are more common to have narrow angle glaucoma, since their Front Chamber of their eye is smaller than normal.

The Iris can “bow” forward, thinning the angle that drains fluid from the eye. Fluid builds up and so does the pressure inside the eye.

This happens when the drainage canals get blocked. Such as When you put a drainage stopper in the sink or something clogs the drain.

With angle-closure glaucoma, the iris (which is the colored portion of your eye – your brown eyes, your blue eyes etc.) is not as wide and open as it should be. The outer edge of the iris can bunch up over the drainage canals, when the pupil enlarges too much or too quickly. This can happen when entering a dark room.

Unlike open-angle glaucoma, narrow angle glaucoma is a result of the angle between the iris and cornea closing quickly.

What are some Symptoms of Angle-Closure Glaucoma?

Hazy or blurred vision
The appearance of rainbow-colored circles around bright lights
Severe eye and head pain
Nausea or vomiting (accompanying severe eye pain)
Sudden sight loss

Treatment

Treatment for Glaucoma an involve eye drops, laser or conventional surgery. Everyone is unique and may require different treatment.

Eye drops

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. The medications are intended to reduce elevated pressure in your eye and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye. Combination drugs are available for patients who require more than one type of medication.

2 Types of Laser Surgeries Are:

Micropulse Laser Trabeculoplasty (MLT) is a common procedure for the treatment of primary open-angle glaucoma MLT provides pressure-lowering effects. It is unique in that it uses a specific diode laser to deliver laser energy in short microbursts. MLT is a relatively new laser procedure.

Laser Peripheral Iridotomy (LPI) For the treatment of narrow angles and narrow-angle glaucoma.

Narrow-angle glaucoma (also known as acute angle glaucoma). LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain. In general, surgery for narrow angle glaucoma is successful and long lasting. Regular checkups are still important though, because a chronic form of glaucoma could still occur.

Conventional Surgery MIGS stands for minimally invasive glaucoma surgery. The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve.

Standard glaucoma surgeries are major surgeries. While they are very often effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications. The MIGS group of operations have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries.

MIGS procedures work by using microscopic-sized equipment (tiny, tiny tubes & shunts) and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety.

Get Your Annual Exam so your Optometrist can detect any issues with your eyes early! A Comprehensive Glaucoma Exam Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy. Tonometry measures the pressure within your eye. During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device called a tonometer to measure the inner pressure of the eye.

Eye pressure is unique to each person.

Ophthalmoscopy This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil, so that the doctor can see through your eye to examine the shape and color of the optic nerve.

If the pressure within your eye is not within the normal range or if the optic nerve looks unusual, your doctor may ask you to have one or two more glaucoma exams: perimetry and gonioscopy.

Perimetry Perimetry is a visual field test that produces a map of your complete field of vision. This test will help a doctor determine whether your vision has been affected by glaucoma. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a "map" of your vision.

Gonioscopy This diagnostic exam helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye. A hand-held contact lens is gently placed on the eye. This contact lens has a mirror that shows the doctor if the angle between the iris and cornea is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).

Pachymetry Pachymetry is a simple, painless test to measure the thickness of your cornea – (the clear window at the front of the eye over the pupil).

Diagnosing glaucoma is not always easy, and careful evaluation of the optic nerve is needed for diagnosis and treatment. Always get a second opinion of any diagnosis of open angle or narrow angle glaucoma.

Resources:

http://www.glaucoma.org/glaucoma/video-narrow-angle-glaucoma.php

www.glaucoma.org

www.worldglaucoma.org

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Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

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The NOTICE ACT

On August 6, 2016, The Notice of Observation Treatment and Implication for Care Eligibility Act, went into effect.

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services(Medicre) to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive (Observation Services) which:

explains the individual's status as an outpatient and not as an inpatient and the reasons why;
explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility;
includes appropriate additional information;
is written and formatted using plain language and made available in appropriate languages; and
is signed by the individual or a person acting on the individual's behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.

Here is the link to the Federal Register, which explains in more detail Procedures Applicable to Beneficiaries Receiving Observation Services:

https://www.gpo.gov/fdsys/pkg/FR-2016-04-27/pdf/2016-09120.pdf

Medicare Advantage Plans

“A beneficiary enrolled in a Medicare Advantage or other Medicare health plan would receive the required notice under the existing rules that apply to hospitals and CAHs under a provider agreement governed by the provisions of section 1866(a)(1)(Y) of the Act.”

If you are enrolled in a Medicare Advantage Plan, you are covered under the provisions of your plan. READ your plan’s Evidence of Coverage (EOC) to determine what your out-of-pocket expenses will be in this situation.

I am urging each of you to be Pro Active with your own Health Care!

If you or a loved one goes to the Emergency Room or a Critical Access Hospital, be prepared to speak up!

Speak to the Physician in the ER who is treating you. Ask the physician specifically…..”Am I being ADMITTED to the hospital as an INPATIENT?”

If the answer is “Yes,” you will be covered under Medicare Part A benefits.

If the answer is…. “No…..you are UNDER OBSERVATION. OR……”No……you are receiving OUTPATIENT SERVICES.” You WILL more than likely be responsible for co-payments, co-insurance or maybe ALL charges!

Call your Primary Physician or Specialist. Tell the office or Answering Service that you or your Family member is in so and so Emergency Room, so and so hospital and you want your Doctor to either:

Come to the hospital and examine you to determine if you should be admitted to the hospital as an inpatient

Have your doctor speak to the Emergency Room physician who is treating you, in order to determine if you will be admitted or able to be discharged from the Emergency Room.

You Should NOT have to be in an Emergency Room for up to 23 and a quarter hours UNDER OBSERVATION!

Your Primary Doctor is the “Quarterback of your health team!”

Your Primary Doctor is in charge of your health care! That is what they get paid to do all that extra paperwork for! Put them to work for you!

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Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation.

Go to my website www.callsamm.com

And “Click” on the contact tab.

You’ll see a button that says “ Record Your Message Here.” Click on it and start talking! No equipment required!

You’ll be able to leave a short message of what you’ve enjoyed over the past year on Medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me

“I want to be ON Medicare Nation.”

Thank you for being part of Medicare Nation’s Anniversary!

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Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

An Advance Beneficiary Notice (ABN), also known as a waiver of liability is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover.

ABNs only apply if you have Original Medicare, are on a Medicare Supplement Plan. ABNs do not apply if you are in a Medicare Advantage private health plan. If you receive an ABN and you're on a Medicare Advantage Plan, ask to speak to the office manager.

Providers must give you an ABN when the service or item could be covered by Medicare, but the provider expects that Medicare will not find the care to be medically necessary and will, therefore, deny coverage.

The ABN must list the reason why the provider doubts Medicare will cover care. For example, an ABN might say, “Medicare only pays for this test once every ten years.” That would be the case for a colonoscopy, since Medicare pays for a low-risk colonoscopy once every ten years.

You should not be receiving an ABN for services or items that are never covered by Medicare, such as hearing aids.

In order to receive an official decision from Medicare, you must:

First receive the care or receive the item 2. You must sign the ABN form, agreeing to pay for it yourself if Medicare rejects coverage.

Also, you must select Option 1 on the ABN form in order for the doctor or supplier to bill Medicare! Selecting this option requires your provider to bill Medicare after providing you with the service or item.

If you don't select Option 1 on the ABN, you have no chance, nada, zilch chance of Medicare coverage because your doctor is not required to submit the claim.

You will receive a Medicare Summary Notice (MSN) from Medicare. The Medicare Summary Notice will show if Medicare has denied payment for a service or item. If Medicare denies your claim, you should file an appeal.

Just because you filled out an ABN does not prevent you from filing an appeal.

Medicare has specific rules about an ABN and how it should look. If these rules are not followed, there is a good chance you may not be responsible for the cost of the care. Remember, first you will have to file an appeal to prove your case.

Here are a few reasons you would not be responsible for the charges on an ABN

Is difficult to read or hard to understand.
Is given by the provider (except a lab) to every single patient with no reason to believe the claims may be denied by Medicare.
The ABN does not list the actual service provided
The ABN is signed after the date the service was provided.
The ABN is handed to you during an emergency or is handed to you just prior to receiving a service (ex:You're on the xray table & they hand you an ABN)
An ABN was not given to you when it should have.

You can file an appeal by going to your Medicare Supplement website and search for Appeal Form, call your Medicare Supplement Health Insurance Carrier or you can call Medicare at 800-633-4227 and ask them to mail you an appeal form.

Thanks for listening to Medicare Nation!

I appreciate you taking your time to listen to the show!

Send me your questions to Support@TheMedicareNation.com

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Welcome Medicare Nation! We have a question today and I know many of you need this information!

MEDICARE SPECIAL ENROLLMENT PERIOD SHOW NOTES

Here’s quick guide to when you can make changes to your Medicare Advantage Plan:

You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65.
During the Annual Enrollment Period which is between October 15th through Dec 7th every year.
You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
You may have a “Special Election” that qualifies you to change your plan.

If You Move

If you move and your new residence is not in your plan service area. You would need to notify Medicare as soon as possible, because you have the rest of the current month you are moving and the following 2 full months as the Special Election Period.
If you move to a new address and your plan is still in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of the new option plans.
Snowbirds that live in 2 locations, have to determine which of those residences is your primary residence. Where you vote and where you pay taxes are going to determine which is your primary residence.
If you move out of the country for a period of time and now you are coming back to live in the US, that will trigger a Special Election Period.
If you are moving into a long term care facility or a Skilled Nursing Facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are residing in the facility and when you move out of the facility.

Losing Coverage:

If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc.
If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage(credible coverage), that triggers a SEP. Or if you have had drug coverage through a Medicare Cost Plan and you leave the Cost Plan.
If you leave a PACE (Program All-Inclusive Care for the Elderly) Program.
If you had Medicaid and lost eligibility because of income requirements.

When there are plan changes with Medicare Contracts:

If your Medicare Advantage Plan was sanctioned by CMS, then you would be able to contact Medicare directly to request a Special Election Period to choose another Medicare Advantage Plan.
If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.

Special Circumstances

You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like!
If you qualify for LIS (Limited Income Sources) you may get extra help with prescription drug coverage and a Special Election Period to enroll in a different Medicare Advantage Plan.
During your Initial Enrollment Period for Medicare, you may have enrolled in a Medigap plan, and decided to change to a Medicare Advantage Plan during your first enrollment year. If you decide you want to change back to a Medicare Supplement Plan during your first year of coverage, you qualify.
SNP Plan - for chronic conditions (Diabetes, Heart Disease, COP) - may change your current Medicare Advantage Plan to enroll in a SNP plan, or you may no longer qualify for a SNP, so you can choose another Medicare Advantage Plan.
f an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.

*You cannot get an SEP because your Doctor left the network****

If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP for Medicare Supplement Plans.

Precautions:

The price of Medicare Supplement plans do change as you age, and where you live. Keep that in mind.

Need more information on "Special Enrollment Periods?"

www.callsamm.com - has all of this information available for you. Download the Quick PDF List for Special Election Periods.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Welcome, Medicare Nation! Today I want to explain a brand new bill being introduced in the US House and Senate. It’s the BENES Act (Beneficiary Enrollment Notification and Eligibility Simplification Act). This bill impacts people eligible for Medicare, specifically those who are nearing the age 65 enrollment period for Part B. The bill was introduced by Rep. Raul Ruiz (Dem.-CA) and Rep. Patrick Mann (Rep.-PA) in the House and by Sen. Bob Casey (Dem.-PA) and Sen. Chuck Schumer (Dem.-NY) in the Senate. I hope I can clear up any confusion for you!

Let’s look at the current PROBLEM, which boils down to a LACK OF INFORMATION:

The current system lets CERTAIN people know when to enroll in Medicare. If you are receiving SSI(disability) or SS benefits, then you will receive a letter as your 65th birthday approaches, advising you of your enrollment period and Medicare effective date. What about those NOT receiving those benefits? THAT is the problem!
If you don’t receive current SSI or SS benefits, then the government has no “trigger” to alert you that it’s time to enroll as you approach age 65. If you don’t enroll during your initial enrollment period (three months prior to, including, and following your BIRTHDAY MONTH—for a total of seven months), then significant late penalties can apply. These can raise the premium you pay by as much as 30%! In 2014, ONE MILLION people paid a late penalty. The average monthly premium is $105 and the average late penalty adds an average of 30% to your monthly premium—EVERY MONTH!
Remember the following:
- If you have worked for 10 years (40 quarters paid into FICA), then you have paid the minimum to qualify for Medicare Part A, premium-free. Part A is the “accommodations” part of Medicare, meaning it covers overnight stays in medical care facilities.
- Part B covers outpatient services, which includes everything you might need in health care, excluding overnight stays.
- Under current law, the government will NOT send you any notification of your approaching enrollment period, and then they will assess you a substantial late penalty if you don’t enroll when you should. “It’s all about the mighty dollar, folks!”

Let’s look at what the BENES Act will do to correct the PROBLEM:

The Act will make it possible for those turning 65 (10,000 Americans EVERY DAY!) to avoid mistakes and will give uniform information about the Part B enrollment process. Each individual will receive a “clear and detailed” notice of Part B enrollment rules that will help them make informed decisions. The government will send a notification when you are 64, letting you know that your initial enrollment period (that 7-month window around your birthday) is approaching. I’m excited about the possibilities of this new law, but it has to get passed first. Congress will reconvene on September 6 after their summer break, and if you want to stay informed about the progress of the BENES Act, then see our resources section.

Here’s a listener question from Teresa in Philadelphia:

How do I enroll in Medicare?

Well, Teresa, there are some options. If you are turning 65 and not currently receiving SSI or SS benefits, then you need to visit www.ssa.gov, go under Menu—Benefits—Medicare, and then scroll down to “Apply for Medicare only.” Click on “Start a New Application” and follow the directions. It should take about 10 minutes! Do it prior to your 65th birthday. My caution is that your personal information must have been updated with the Social Security Administration or there will be delays. If you have moved to a new address, changed your marital status or name, then you will have to go to the local SS office to enroll. You can call 800-772-1213 to enroll over the phone, but it is a LONG process.

If you are over 65 and still working and are covered by your employer’s credible insurance plan, and NOT under Part B---then you will have to go to the local office and have two forms with you: the Employer Attestation Form (to prove there have been no gaps in insurance coverage since your 65th birthday) and the Application to enroll in Part B. Find these forms at www.ssa.gov or email me at support@the medicarenation.com and request copies. Thanks for the question, Teresa, and I hope this helps you!

Resources:

www.medicare.gov and www.callsamm.gov can give you information NOW about Medicare enrollment.

www.congress.gov (Keep up with the BENES Act progress—reference House Bill 5772.)

www.medicarerights.org (For great information and resources!)

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome, Medicare Nation! Today’s topic is Diabetes Prevention, based on the expansion of a pilot program instituted by the CMS (Centers for Medicare/ Medicaid Services). I’ll be explaining the program’s components and the results. Join me!

What you’ll hear in this episode:

Statistics about diabetes:
- There are currently more than 30 million Americans with Type 2 diabetes.
- There are TWO deaths every FIVE minutes from diabetes!
- There are 86 million Americans at a high risk of developing diabetes.
- One out of three adults have “pre-diabetes,” which means they have higher than normal (normal is <100) blood glucose levels and are at an increased risk to develop diabetes within the next ten years.
- The sad fact is that most diabetes cases ARE preventable!
Basics of the Diabetes Prevention Program:
- The DPP began in 2011, when the US Department of Health and Human Services provided, through the Affordable Care Act, $11.8 million for the pilot program to be administered by the YMCA.
- The program included weekly meetings with lifestyle coaches for dietary and behavioral changes, and monthly follow-up meetings.
- The target was for each participant to achieve 5% weight loss, which was accomplished. That is enough to substantially reduce the diabetes risk!
- About 80% of the program participants attended at least 4 weekly meetings.
Results of the Diabetes Prevention Program:
- The 5% weight loss goal was reached.
- The estimated healthcare cost savings per participant, when compared to those NOT enrolled in the program, was $2650.
- The Dept. of Health and Human Services wants to invest in programs like this, because of the cost savings and the improved health.
- The program’s success is relevant to Medicare, employers, and insurers.
- The pilot program will now be expanded to benefit more people, and be put in place by January, 2018.
- The expansion program will include 16 intensive core group sessions, focusing on nutrition, physical activity, and behavior changes (with follow-up sessions also).
Ideal eligibility factors for participants:
- A BMI (body mass index) of 25 or higher (23 for Asians)
- Hemoglobin ANC-1 level of 5.7-6.4%
- Fasting glucose level of 110-125
- Glucose tolerance test level of 140-199
Visit www.callsamm.com to take the quiz to assess YOUR diabetes risk. Remember, PREVENTION is always the best medicine! If you have questions about Medicare, email me: support@themedicarenation.com. Hey-our ONE YEAR anniversary is coming up next week! Visit our website to help us celebrate and record your message about how the show has helped you. I would love to play those on the show as we celebrate together!

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome, Medicare Nation!

Today’s episode is a Q & A in which I answer questions from two listeners. If you have a question for me about Medicare, then email me: support@themedicarenation.com. Let’s jump right in!

From Mike, in Pleasanton, CA: If my doctor drops out of my HMO network, can I change to a Medicare Advantage plan that the doctor currently takes?
- Here’s the thing, Mike: when you enroll in Medicare Advantage, you are in a “locked-in” period unless you have a “special election.” A special election can occur for a number of reasons: if you moved to a different county with new plans, or if CMS (Center for Medicare Services) decided to terminate a Medicare Advantage policy and you need to find a new one. Another situation for special election would be if you are still working, at age 65 or over, and are covered under your employer’s plan and aren’t on Part B. If you need to drop your employer’s coverage and enroll in Part B, then a special election would exist. Unfortunately, doctors can drop out of an HMO or PPO anytime, although they do have to give 60 days’ notice.

Mike, you will have to change doctors unless this occurs between October 15 and December 7, which is the open enrollment period, or unless you have a special election period. Your situation would not be considered for special election. It’s unfortunate, but it is very common and happens to many people each year. The doctors do this because of money, but keep in mind that if you follow a doctor to another plan, then the same thing can occur again. I hope this helps. Visit www.callsamm.com or www.medicare.gov for more information.

From Sharon, in Austin, TX: How much will I have to pay to be in the hospital for 7 days?
- Well, Sharon, the answer depends upon your plan. If you have original Medicare, Part A, then you have what I like to call “accommodations insurance.” This means overnight stays are covered, with a deductible of $1288 for any stay of 1-60 days. All services and procedures in the hospital would then be covered for you. From days 61-90, you would pay $322/day for the same coverage. Of any stay of more than 90 consecutive days, you can draw on your lifetime reserve of 60 days at a cost of $644/day. Keep in mind, though, that those extra 60 days are a “lifetime piggy bank” of days, and you can’t get them back once you use them. The old adage, "You use them - You lose them," applies here.

If you have a Medicare Advantage plan, then they are all different. An HMO will have a smaller network, and your co-pay will range from $0-$250/day. A PPO network is larger, therefore, your co-pay for an inpatient hospital stay will range from $0-$425/day. You would need to contact your Medicare Advantage Carrier to determine the exact amount of what your inpatient hospital co-pay will be. There are also Medicare Supplements (MediGap) plans, such as the F plan, G plan, and N plan. For these plans, you pay your monthly premium, but then have $0 out-of-pocket "medically necessary" inpatient hospital stays. Other Medicare Supplement (MediGap) Plans have a Part A deductible. Again, you need to contact your Medicare Plan customer service representative to determine your exact cost.

Sorry, I can’t be more specific since I don’t know your plan, Sharon, but I hope this information is helpful for you. Thanks for the question!

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome, Medicare Nation! I’m excited about our guest and our important topic today. We’re discussing the confusion surrounding advanced directives. Have you ever thought about what would happen if you can’t speak for yourself and are in an emergency health situation? Who will express your wishes, and will the health care professionals understand? Dr. Ferdinando (Fred) Mirarchi is the ER Director of University of Pittsburgh Medical Center-Hamot. He has a solution! Join us to learn more!

Tell us about health care directives and the issues that commonly arise when people come to the ER.
- There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise the safety concerns.
What happens when someone comes to the ER with no accompanying family and no papers?
- It’s not just an ER situation, but anywhere in the hospital, for any medical procedure. “You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means.” About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you’re an end of life care patient and don’t want care. Many don’t understand the difference between being critically ill and being in an “end of life” situation.
If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
- Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn’t compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
Can you explain the difference in a Living Will and a DNR?
- A Living Will is a legal document, not a medical document. It is for use in situations when someone can’t speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it’s a DNR, then it can affect care and treatment of any medical emergency. “It’s a coin toss with a 50% chance of being treated or not being treated.”
You’ve developed a solution to help people explain their wishes about receiving treatment. Can you explain?
- At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
Will this ID card work in any medical office, hospital, or ER?
- Yes, and it’s in clear and understandable medical language so that any professional will know what to do.
Can you explain how to find out more and what the service includes?
- Visit our website: www.institutehcd.com or email us: info@institutehcd.com. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you’re at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry. Do you have questions or feedback? I’d love to hear it!
I may answer one of your questions on the air!

email me:

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Welcome, Medicare Nation! My guest today is Dr. Steven Loomis, an optometrist in Littleton, CO. Dr. Loomis is also the president of the American Optometric Association. Did you know that June is Cataract Awareness Month? It’s important to know what cataracts are, how they develop, and how to treat them. Dr. Loomis is here to discuss those topics and others related to general eye health. Join us!

Many people don’t understand the difference between an optometrist and ophthalmologist. Can you explain?
- Think of an optometrist “like a family doctor for your eyes.” These are medical doctors with four years of undergraduate education and four years of specialization. They deal with eye issues such as blurred vision, diabetes, and glaucoma. Optometrists actually diagnosed 240,000 cases of diabetes in 2014! An ophthalmologist is an eye surgeon who works in conjunction with a patient’s optometrist.
We know we need comprehensive eye exams, but how often should we get them, and what is included in that exam?
- An annual exam is recommended unless there is a condition that warrants more frequent care. Specific tests are included, such as visual acuity, auto refraction, an image of the inside of the eye, visual field, blood pressure, and a check of the pupils. The doctor will also ask questions about medical family history.
What exactly does “20/20 vision” mean?
- Vision is based on the Snellen Acuity Chart, which was invented by Dr. Snellen over 100 years ago. It is the basic eye chart we are all familiar with that has a series of letters or shapes of certain sizes. The “20 foot” standard has been established, meaning that you see what you should see at a distance of 20 feet. A vision of 20/30 or 20/40 means that you see at 20 ft. what the normal eye sees at 30 or 40 ft. Some people see better than normal, like 20/15. It’s interesting how they measure the 20 feet distance, when most exam rooms are not 20 ft. long. The chart might be 12 ft. away from the patient on the wall, and a mirror is placed 8 ft. behind the patient, to make up the 20 ft. distance.
As we age, does 20/20 vision decrease?
- Yes, unfortunately. It’s completely normal because our eyes age as do other parts of our bodies. As your lens ages, cataracts may form and the retina and cornea lose some functionality.
What are “floaters,” and can they clear up?
- Floaters are very common. They can be seen during an eye exam with dilated eyes. What happens is that the vitreous fluid in the eye, which should be firm, solid, and gelatinous, begins to liquefy as we age. This more liquid substance has fibers in it that appear in our vision as floaters. The good news is that they can clear up; they can shrink, sink, and then we THINK they are gone. If floaters increase or change, then see your optometrist to be checked.
What is glaucoma?
- In short, it occurs when the pressure inside the eye damages the optic nerve. Risk factors include family history, racial characteristics, age, and medications. The first symptom is often vision loss.
If glaucoma is indicated, what is the treatment?
- Medications can control the pressure. Usually eye drops are prescribed once daily and can safely manage the disease.
What are cataracts and how are they treated?
- Cataracts are very, very common and usually show up around age 60. The lens becomes not as clear as it used to be as it loses its clarity and transparency. Exposure to UV rays can cause them, as well as steroids, diabetes, radiation treatments, eye trauma, and eye surgery. The #1 cause? Too many birthdays! There is no treatment needed for early cataracts, but they can worsen to cause hazy vision and nighttime glare. Surgery is the only cure, where the natural lens is removed and an artificial lens is implanted. The good news is that your lens prescription can be incorporated into the artificial lens so your vision is improved on multiple layers. (Tune in to hear a fascinating account of cataract surgery details! Did you know it only takes 5-8 minutes to complete?)
How do Medicare benefits factor into cataract surgery?
- Medicare will pay for a monofocal artificial lens, but the patient can pay for an upgraded lens if desired. Medicare, depending on your plan, will pay a portion of glasses or contacts needed for after surgery.
Final words from Dr. Loomis: Keep up with your annual eye exams and discuss options with your doctor when issues arise. Visit www.aoa.org for more information and for their “doctor locator” tool.
Question from Eileen in PA: Does Medicare cover eyeglasses? The answer is no, except for what is needed after cataract surgery, and then a portion may be covered under your plan.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Welcome Medicare Nation! Today we’re talking about Shingles. I recently had shingles and my eyes were opened to how painful it is. It’s really a terribly painful illness, so I wanted to give you some facts and tips to help you diagnose your symptoms early.

What is Shingles?

A virus that is a type of herpes zoster virus. You can only get shingles if you’ve had chicken pox. The virus stays dormant in your spine and attach itself to some of the nerves in your spine. Then something comes along and activates it when you have a lower immune system. If you are on auto-immune suppressing drugs, you are more susceptible to the virus.

Increased stress can also trigger an outbreak of shingles.

What are the symptoms?

A blistery rash that generally starts around your back and wraps around your side. I got a blister on the palm of my hand. About a week before the outbreak, you can begin having pain from the nerve endings being affected.

Patches of blisters will grow and then they are painful. You can have headaches and other pain that goes along with it.

The virus starts coming down your nerve path and it becomes extremely painful. The pain is similar to neuropathy pain.

Treatment?

Because I sought treatment within 48 hours of the onset of symptoms, I was able to take an anti-viral medication. This caused the pain to being to lessen over the next few days.

Anti-Viral medications

Acyclavir
Valacyclavir

Lidocaine can be given to block the pain.

Advil.,Motrin will also be given to lessen pain.

Anybody can get shingles. More likely to occur in older folks because the immune system is naturally weaker.

50% of people over the age of 60 to get shingles.

Shingles is contagious. It is contagious when the blisters are broken open and oozing. Direct contact with open blisters should be avoided.

Shingles Vaccine - given to people 60 and over - Zostavax. There is a 51% chance of not getting the virus when you get the vaccine.

Who should NOT get the vaccine?

-People with allergies to gelatin

If you are allergies to neomycin
If you have a weekend immune system from AIDS or other illness
If you have leukemia or lymphoma
If you are pregnant

Info about Shingles Vaccine:

Medicare Advantage plans will require a co-pay. Find out what it costs with your plan by calling customer service with you plan.

Original Medicare - you will pay 20%

Medigap - you won’t pay anything

There is no season for shingles. Anyone can get it at any time.

You can find out more about shingles here.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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Welcome, Medicare Nation! I’ve had a busy two weeks and have just returned from a conference in Miami for the National Osteoporosis Foundation. I have been flooded with emails, so today’s episode will be a Q&A session in which I address as many of those questions as possible. Join me!

From Steve in Texas: “I’m turning 65 in July and your program has been helpful to me. Can I change Part D prescription options over time without having to pass insurability determinations?”
- The options can be confusing. You can change Part D plans during the annual enrollment period, from October 15-December 7. You can change plans every year, if needed. You should review your plans yearly, based on your prescription needs and usage.
From Dottie: “I have a Medicare Advantage Plan with Blue Cross. When I get the benefits summary, do the fees reflect those set by Medicare or do the doctors make these up?”
- Every Medicare insurance carrier negotiates with each doctor and facility so they have a contract for how much the doctor gets paid for services. The summary shows what the doctor usually charges, what your plan covers, and what your co-pay amount is. What you see is what the doctor normally charges, but NOT what you will pay. The negotiated rate will be applied by your plan and you pay your co-pay or co-insurance.
From Dottie, the 2nd part of her question: “If I want to change to another Medicare Advantage Plan, can I keep my same doctor even if he isn’t in the network?”
- Remember, Medicare Advantage is all about being in a network. It’s a “pay as you go” plan because you only pay for what you need. If your doctor is not in network, you have to decide what’s more important. Do you have to stay with that doctor or do you value the plan’s benefits more? You may need to change plans or pay out of pocket. This depends upon if your plan is an HMO or a PPO. A PPO has an out of network option but you will pay a higher co-pay. An HMO in Medicare Advantage doesn’t allow any out of network options.

I hope these questions and answers have been helpful to you. If need be, we’ll add another show each week just to cover your questions. So, keep those coming! Email me: support@themedicarenation.com. Remember, you can visit www.medicare.gov for more information.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Welcome, Medicare Nation! Can you believe the month of June is here? The year is rolling right along, and you may not be aware that June is Aphasia Awareness Month. If you’re not familiar with aphasia, you should know that it’s an acquired disorder that affects a person’s ability to speak and to process language, but it does not affect intelligence. Let’s learn more about this disorder.

Here are a few basic facts about aphasia:

Often, aphasia is the result of brain injury, brain tumor, neurological disease, or stroke. (25-40% of stroke survivors will have aphasia.)
About 2 million Americans are affected by aphasia, with 180,000 acquiring it yearly.
Aphasia can affect any age, race, ethnicity, and gender. Those over age 60 have the highest aphasia rates, with those over age 40 being the second highest. The rate of occurrence is the same for all other age groups.
Aphasia can’t be cured but can be treated and improved with speech and occupational therapy, and these are covered by Medicare, depending on the plan.
Some helpful therapies can be done via an app or on a computer. Many of these costs can be reimbursed, depending on your Medicare plan.
Aphasia is self-diagnosable because the signs are noticeable, and may include social isolation, repeated actions/words, and jumbled/slurred speech.

There are several types of aphasia:

Global aphasia is the most severe form. It leaves the person unable to speak more than a few words and they can’t understand spoken words or read.
Broca’s aphasia has characteristics of reduced speech output, limited vocabulary, but the person can understand language and read.
Mixed Non-fluent aphasia makes it hard to speak and limits comprehension. The person cannot read or write beyond the elementary school level.
Wernicke’s aphasia leaves the person fluent, where they can grasp the overall meaning of a sentence, but may not comprehend individual word meanings.
Primary progressive aphasia is a rare neurological syndrome in which brain tissue degenerates.

To find out more about aphasia, visit the website for the National Aphasia Association: www.aphasia.org. You may contact them via email: naa@aphasia.org or find them on Facebook: Aphasia Recovery Connect.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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Welcome Medicare Nation! Today’s episode is Part 2 of our interview series live from the Interdisciplinary Symposium on Osteoporosis held by the National Osteoporosis Foundation in Miami, FL. Today’s episode features some of the leading Osteoporosis practitioners in the country, as well as an important summary of Medicare Benefits that relate to the treatment of Osteoporosis.

Today’s episode features:

Medicare Benefits for Bone Mass Measurement (Bone Density) Testing

How often is it covered?

Medicare Part B (Medical Insurance) covers this test, which helps to see if you're at risk to broken bones, once every 24 months (more often if medically necessary) for people who meet the criteria below. Medicare only covers this test when it's ordered by a doctor or other qualified provider.

Who's eligible?

All qualified people with Part B who are at risk for osteoporosis and meet one or more of these conditions:

•A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings

•A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures

•A person taking prednisone or steroid-type drugs or is planning to begin this treatment

•A person who has been diagnosed with primary hyperparathyroidism

•A person who is being monitored to see if their osteoporosis drug therapy is working

Your costs in Original Medicare

You pay nothing for this test if the doctor or other qualified health care provider accepts assignment.

Some good times to talk to your Physician about this testing:

During your “new to Medicare” visit to Dr. visit, discuss preventative exams with Dr, they can suggest bone density.
Annual wellness visit to Dr - talk about bone density exam

Listen to this episode to hear interviews from the following professionals:

Dr. Thomas Olinginski - Tom Olenginski, MD, FACP is an associate in Rheumatology at Geisinger Medical Center. A graduate of the Pennsylvania State University and Penn State College of Medicine, he completed both his General Internal Medicine Residency and Rheumatology Fellowship at Geisinger Medical Center. Since 2008, he has been Co-Director of Geisinger’s High-Risk Osteoporosis Clinic. He is Chair of Geisinger’s Bone Density Committee and is responsible for Geisinger’s Osteoporosis Curriculum within its Rheumatology Fellowship. He has also served as a member of the NBHA Secondary Fracture Prevention Committee. His major interests are daily clinical care as a rheumatologist, teaching within Geisinger’s Rheumatology Fellowship and Internal Medicine Residency, as well as metabolic bone disease and system-based osteoporosis care, clinically-oriented bone density interpretation, and Geisinger’s Fracture Liaison Service.
Sherri Betz - SHERRI BETZ, PT, GCS, CEEAA, PMA®-CPT is a 1991 graduate of the Louisiana State University Medical Center's School of Physical Therapy. Sherri actually began her career as a national gymnastics competitor and as a group fitness instructor and personal trainer for Nautilus Fitness Centers in the 1980's. Inspired by the work of a physical therapist in one of the clubs where she trained, Sherri pursued a degree in physical therapy. Selected to serve on the Foundation for Osteoporosis Research and Education (FORE) Professional Education Committee and the NOF Exercise and Rehabilitation Advisory Council, Sherri is involved in improving awareness about bone health for the lay public, exercise teachers and for healthcare professionals. These committees review the latest updates in research, develop guidelines and design educational programs for physicians and allied health professionals. She has developed the "Do It Right and Prevent Fractures Booklet" for FORE/American Bone Health.
Dr. Steven Harris - Steven Harris, MD is a board-certified internist and endocrinologist with a subspecialty focus on osteoporosis, metabolic bone disease and disorders of mineral metabolism. He received his medical degree from the University of California, San Francisco, and completed a residency and chief residency in Internal Medicine at the same institution. He completed a clinical and research fellowship in Endocrinology and Metabolism at Massachusetts General Hospital in Boston. In 1983, he returned to the University of California, San Francisco, where he is a Clinical Professor of Medicine. Dr. Harris has spent many years working on a variety of clinical research projects to examine the effects of nutrition, calcium supplements, vitamin D, hormone therapy, bisphosphonates, calcitonin, PTH and SERMs upon the prevention and treatment of osteoporosis. Dr. Harris maintains an active consultative practice in metabolic bone disease, but is also engaged in a wide variety of educational initiatives related to osteoporosis.
Dr. Sandesh Nagamani - graduated from the J S S MED COLL, MYSORE UNIV, MYSORE, KARNATAKA, INDIA in 2000. He works in Houston, TX and specializes in Genetics, Medical. Dr. Sreenath Nagamani is affiliated with Methodist Hospital and St Lukes Hospital At The Vintage. He speaks English and Spanish. As an adult clinical geneticist, he provides clinical care for adult patients with a wide variety of heritable conditions. Dr. Nagamani serves as the Director of the Clinic for Metabolic and Genetic disorders of bone that caters to adult subjects with OI, heritable disorders of bone, early-onset osteoporosis, and other common forms of metabolic bone diseases.

Check out the Food4Bones app for iPhone and Android

www.nof.org

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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Welcome Medicare Nation! I interviewed clinicians and global experts in the bone health field gathered during the Interdisciplinary Symposium on Osteoporosis held in Miami, Florida from May 12 to 15, 2016. May is the National Osteoporosis Awareness Month. Clinicians and Academicians Joined the National Osteoporosis Foundation to Identify Solutions for Reducing the Two Million Broken Bones Caused by Osteoporosis Each Year.

This conference was sponsored by the National Osteoporosis Foundation (NOF), the organization dedicated to preventing osteoporosis, promoting strong bones, and reducing human suffering through education, advocacy, and research. NOF is committed to promoting bone health among the elderly through healthy diet and safe exercise. Both can help stop the loss of bone mass and help prevent fractures.

Leading medical and scientific experts in the bone health field discussed the latest information on preventing broken bones and lead in-depth educational sessions on the prevention, diagnosis and treatment of osteoporosis.

I met brilliant doctors, nurses, and therapists from all over the world and learned about:

Prevention and treatment of osteoporosis
Education for prevention of people at risk
There are 54 million Americans who suffer from osteoporosis
To address this significant care gap, the ISO 2016 included training on preventive care model that operates under the supervision of a bone health specialist and seeks to prevent repeat fractures.
The Fracture Liaison Service (FLS) Model of Care Training Course is designed to help doctors, nurse practitioners, physician assistants, registered nurses and other healthcare professionals improve the care management of post-fracture patients and navigate the complicated coordination of care process across hospitals, medical offices and multiple medical specialties through the application of best practices.
The FLS model of care is the key to sparing millions of American from breaking bones due to osteoporosis.
This 2016 ISO includes updated FLS training, and the introduction of Bone Health ECHO (Extension for Community Healthcare Outcomes), a strategy of telementoring FLS coordinators and healthcare professionals of all levels, with the aim of reducing the osteoporosis treatment gap said E. Michael Lewiecki, MD, FACP, FACE, New Mexico Clinical Research & Osteoporosis Center, Co-Chair ISO Planning Committee 2016.
If you are over 50 and have hip or back fracture, then you have osteoporosis.
Secondary fractures can occur, too.
Every year, osteoporosis is responsible for two million broken bones, yet fewer than 25 percent of older women and men who suffer from a fracture are tested or treated for osteoporosis.

So many things can happen, secondary fracture, pneumonia,

You can find the best information about osteoporosis from www.nof.org National Osteoporosis Foundation.

Listen to the first part of a 2-part interview. Learn about food for the bones, calcium-enriched diet, safe exercises for the elderly. We are on iTunes, and Google Play. Please tell your friends about medicare nation, and the 3 other shows I have. You shouldn’t be breaking your hip or back. If you get fractured, you have osteoporosis.

Susan Randall
Osteoporosis is the condition where the bone is weakened and impaired and more prone to rapture.
Causes of osteoporosis include: aging and decline in estrogen and testosterone
Women and men both have the same hormones. Both lose these key hormones as we age
These hormones influence other bodily functions. As the hormones decline, bone strength and quality are affected
Treatment for breast cancer put on a class of medications that are aromataste inhibitor
Primary and secondary causes of osteoporosis. It’s multifactorial
Dr. Sanjeev Arora
Dr. Arora, MD, is the Keynote speaker , head of Project ECHO and Improving Health in Underserved Populations through Technology;
He is from the University of New Mexico;
Project ECHO, Extension for Community Health Outcome use the FLS model to improve efficiencies and democratize medical knowledge.
Project ECHO uses video conferencing technology where conference participants can talk via skype about the best treatment in underserved nations. It’s a new platform for medicine
Project ECHO is based on the idea that a multidisciplinary team of providers can attract outcome in the internet
The project targets meeting the medical needs of a billion people by 2020. It currently connects 13 countries and hundreds of universities and clinics.
Additional ISO16 Highlights include:
Sessions exploring the controversies in osteoporosis treatment and care;
New tools for assessing fracture risk;
Interactive sessions on safe exercises for people with osteoporosis;
Evidence-based answers to the most common patient questions on osteoporosis and fracture prevention;
Professional development workshops on patient education and new coding and reimbursement for osteoporosis;
Karen Kemmis
Karen is a Physical Therapist specializing in safe exercises and movements.
Silver sneakers – use gyms medicare vantage plan
Some exercise and moves could be dangerous for the elderly
Many fitness instructors are not well versed with chronic conditions we have to be careful what is safe for their particular condition
Anything in the upright position is safe for the low-density bone mass
Dangerous moves include forward bending such as toe touches, twisting hard, full rotation, sit-ups
Safe exercise moves include lying on the back; lay grazing, isometric exercise,
To work safely with a fitness instructor tell them about your bone concern, go to www. nof.org, search positive exercises, print those materials and bring to instructor
Dr Maria Pesquera
Is a primary physician in Albany, New York and has a lot of patients who have osteoporosis.
Her medical team is having issues with medication used for treating osteoporosis
She favors exercise alternatives such as yoga and pilates.
She promotes a Holistic method of treatment that includes healthy diet

Resources:

National Osteoporosis website: www.nof.org
The best way to contact ECHO and Dr. Arora is via the website: echo.unm.edu

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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May 10th was World Lupus Day. So today, we wanted to highlight the disease so that we can get the word out.

Linda Ruescher, author, public speaker and Lupus advocate is our guest today. Linda actually has Lupus as well.

How many people in the US have Lupus?

1.5 Million people in the US.

What is LUPUS?

An auto-immune disease in which your body mistakes other body parts are toxins and invaders and tries to kill them. Lupus doesn’t have one particular body part that it targets. It can go after any part of your body.

Lupus can be difficult to diagnose because:

It flares instead of being chronic
The symptoms are the same as other diseases
There is no definitive test for Lupus
Generally they try to diagnose other things first
A rheumatologist can be necessary to get a diagnosis

Lupus is like having a never-ending flu. The symptoms are the same, and the body reacts in the same way.

After 38 years undiagnosed, Linda was diagnosed in 2003. She is treated today with immune-suppressing drugs. She also takes a chemotherapy drug. It is important to know that Lupus is not cancer. The reason chemo drugs are used is because the side effect of weakening your immune system is desirable for Lupus patients.

Lupus primarily affects women in their child-bearing years.

UVA/UVB light can cause flares, so Lupus patients should stay out of the sun.

If you are on Medicare, and IV infusion would be covered under Medicare Part A.

Linda’s book, The 100 Questions and Answers About Chronic Illness. was written after she exhausted the reading of all the other books and getting peeved that she couldn’t find the information she needed.

You can find her book on amazon.com, and in the paperback and Kindle versions.

Lupus Symptoms:

•Fatigue and fever

•Joint pain, stiffness and swelling

•Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose

•Skin lesions that appear or worsen with sun exposure (photosensitivity)

•Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)

•Shortness of breath

•Chest pain

•Dry eyes

•Headaches, confusion and memory loss

If you have 3 or more symptoms, see your Dr. If you aren’t getting anywhere with your Dr, then go see a Rheumatologist (or get a referral to one).

Resources:

www.rheumatology.org - find a Dr. by zip code

Lupus Foundation of America - www.lupus.org

Lupus Florida - www.lupusflorida.com

Contact Linda Ruescher:

On Twitter: www.twitter.com/chronicillness

On Facebook: www.facebook.com/Linda Ruescher

Email: linda.ruescher@gmail.com

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Today’s topic is the Medicare Savings Program. It can help you pay part of your Medicare premiums. It’s based on certain criteria of your income and resources.

2016 Medicare Savings Programs:

Resources include stock, bonds, 401K, IRA.

It does not include your home, 1 vehicle and other personal items.

4 Levels of Coverage:

QDWI Plan: (Qualified, Disabled, and Working Individual)

Monthly income limit - $4045 (Married $5425)

Resource limit - $4000 (Married $6000)

QI Plan: (Qualifying Individual)

Monthly income limit: $1357 (Married $1823)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

Specified Low Income Medicare Beneficiary Program (SLIM-B)

Monthly income limit: $1208 (Married $1622)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

Qualified Medicare beneficiary (QMB)

Pays Part A, Part B Premium, Deductibles, Co-pays

Monthly income limit: $1010 (Married $1355)

Resources limit: $7280 (Married $10,930)

How to Apply:

Go online to www.ssa.gov. Click “Benefits”, then “Extra Help for RX Drugs”, look on right side for “Application”.
Go to the Social Security office (find locations on ssa.gov) to apply
Go through your state Medicaid Program - Google “medicare” and your state

It may take 4-6 weeks for them to send you an acceptance/rejection letter.

You have to re-qualify annually.

Questions?

Call SSA at 800-772-1212

Email me: support@themedicarenation.com

Call me: 855-855-7266

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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Welcome Medicare Nation!

Today, I want to tell you about the federal government program called The Extra Help program, also called Limited Income Subsidy (LIS). If you never heard of this program, you may be missing out on some additional subsidies for your prescription drug purchases. So let’s walk through the program to see if you qualify.

Qualifications for the Program:

Must be a resident of one of the 50 states in America
Your resources (savings, stocks, bonds, 401k etc.) cannot exceed $13,640 (married $27,250)
Your annual income cannot be more than $17,820/yr (married $24,030)
If you support someone else who resides with you (not your spouse), you may qualify for a higher threshold

How to Apply for Extra Help:

The easiest route is to apply through Social Security

Apply online: www.ssa.gov - click benefits and then apply for extra help
Call Social Security directly at 800-772-1213
Go to your local Social Security office - find locations at www.ssa.gov
Make sure you keep a paper trail of your application.
If you go in person, get them to stamp your application to prove they received it

Automatic qualifications:

On Medicare and Medicaid you are a dual enrollee
If you receive SSI income
If you receive Medicaid

You have to re-qualify every year. Social Security will send you a letter and determine your eligibility for the next year around August.

You can get an overview of the Extra Help program by emailing support@themedicarenation.com and ask for the Extra Help pamphlet.

You can call me with questions at 855-855-7266.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome Medicare Nation!

Hot Topic – The Comprehensive Care For Joint Replacement Model (CJR Model)

Hip Replacements & Knee Replacements are the MOST COMMON Inpatient Surgery for Medicare Beneficiaries.
In 2014 over 400K procedures were done, which cost Medicare over 7 Billion $ for the Hospitalization for these procedures ALONE.
Hip & Knee Replacement Surgeries can require long recovery time & long Rehab periods.

I KNOW! I’m not even on Medicare yet, and I’ve had TWO Arthroscopic Knee Surgeries, and each surgery took me about a good 6 MONTHS to recover.

This is the SCARY PART!

The Quality & Care you receive VARIES from one Hospital to the next!

Complications like –

Infections received at the hospital …….OR
Implant Failures

Can be 3X Higher Performed at Some Hospitals More Than Other Hospitals.

To me……that is just NEGLIGENCE!

When you go into a hospital……you expect to receive the best care, a clean environment and YOU SHOULD NOT CONTRACT ANY INFECTION OR DISEASE from the Hospital you’re being treated at! That’s what you Expect from a Hospital…..NOTHING LESS. But……it is apparently going on RIGHT NOW Nation!

And it takes a CMS LAW or MODEL PROGAM to prevent it from happening in EVERY Hospital? Aye,,yi,,,yi.

WHY IS THIS HAPPENING TO YOU?

In episode 34 on Medicare Nation, you listened to Melissa’s Story.

Melissa’s story is about the struggles she had with her mother, who suffered a broken hip and the FRAGMENTED care her mom received while in the hospital and the struggles she had in moving her mom to a skilled care facility and then setting up home care physical therapy for her mom.

That is why all this is happening Nation!

There is a LACK OF COMMUNICATION, between Hospital Staff, other Doctor’s, Skilled Nursing Facilities and Home Care Physical Therapy.

NO ONE is talking to anyone else! The LINKS in the CHAIN of Patient Care is BROKEN, and YOU are paying for it!

This FRAGMENTATION of Care is causing LONGER RECOVERY TIMES, HIGHER HOSPITAL RE-ADMISSIONS & HIGHER OUT OF POCKET COSTS FOR YOU & FOR MEDICARE.

The Comp Care Joint Replace Model Addresses the LOW QUaLITY CARE & Higher Costs that come from this FRAGMENTED CARE, by –

PROMOTING CO-ORDINATED PATIENT CENTERED CARE!

Imagine that Nation! Putting the Patient 1st! What a New Concept!

HOW WILL THE CJR MODEL WORK?

Started April 1, 2016

The hospital in which the hip or knee replacement and/or other major

leg procedure takes place, will be accountable for the costs and quality of related care from the time of the surgery through 90 days after hospital discharge—what is called an “episode” of care.

Depending on the hospital’s quality and cost performance during the

episode, the hospital will either

Earn a financial reward OR,
beginning with the second performance year, be required to repay Medicare for a portion of the spending.
This payment structure gives hospitals an incentive to work with
physicians,
home health agencies,
skilled nursing facilities,
and other providers to make sure beneficiaries receive the coordinated care they need

The goal is reducing avoidable hospitalizations and complications.

Hospitals in the model will be provided access to additional tools – such as spending and utilization data and sharing of best practices -- to improve the effectiveness of care coordination. The model also gives providers additional flexibilities that are not otherwise available under Medicare so they can better manage the care of patients, including patients who are at home.

By “bundling” payments for an episode of care, hospitals, physicians, and other providers have an incentive to work together to deliver more effective and efficient care.

The CJR model is being tested in 67 geographic areas throughout the country, and nearly ALL hospitals in those geographic areas are required to participate.

The CJR model supports Health & Human Service’s efforts to transform the health care system towards one focused on better quality care, smarter spending, and healthier people through care transformation and payment reform.

WHAT AREAS ARE PARTICIPATING IN THE CCJR MODEL

Over 800 Hospitals across the US are participating, in 67 Geographical Locations.

Areas were determined based on statistical population data, with populations of over 50K residents.

Here are a Few selected Areas:

Florida – Broward, Collier County, Gainsville, Hernando, Hillsborough, Indian River County, Lake County, Martin, Miami-Dade, Orange County, Osceola, Palm County, Pensicola area, Pinellas, Pasco, Santa Rosa County, Seminole County and St. Lucia County
California – Alemeda County, Contra Costa County, Los Angeles County, Marin County, Orange County, San Francisco County, San Mateo, Stanislaus County,

The rest are on the CMS.gov site. Search “CJR Model Geographical Areas,” To find out if a Hospital or County where you reside is participating.

You can go to my website, www.callsamm.com and I’ll put up a PDF of the Counties participating in the CJR Model program for you to request.

You can also download a copy of the Federal Register, which is a daily journal of the US Government. The FINAL Rule for the CCJR Model is there in LONG Form

https://goo.gl/hN44cm

Federal Register/ Vol. 80, No. 226 / Tuesday, November 24, 2015 / Rules and Regulations

www.callsamm.com - has all of this information available for you.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome Medicare Nation! It’s tax season! Today is April 15th and it’s the dreaded tax deadline day! It’s this time of year that people realize they need to make some changes to their Medicare plan. However, many people don’t realize that you can’t just make changes anytime you want to a Medicare Advantage Plan. There are specific times that you can make changes, and then you have to live with them until the opportunity arises to make changes again.

Here’s quick guide to making changes to your Medicare Advantage Plan:

You make your initial selection of your Medicare Advantage Plan when you enroll at 65.
During annual enrollment from October 15 to Dec 7th.
You can dis-enroll from January 1- Feb 14th, but you would have to go on to original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
You may have a “Special Election” that allows you to change your plan.

That Special Election for Medicare Advantage is what we want to focus on today. There are certain circumstances that can qualify you to have this option.

Moving Your Residence:

If you move your home and your new location is not in your plan service area. You would need to notify Medicare as soon as possible, because you only have the rest of the current month and the following 2 full months from your move as the Special Election Period.
If you move to a new address and your plan still is in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of those previously unavailable plans.
Snowbirds that live in 2 areas have to determine which of those places is your primary residence. Where you vote and where you pay taxes are going to determine your primary residence.
If you are out of the country for a period of time and now you are coming back to the US, then that could trigger a Special Election Period.
If you are moving into a longer term care facility or rehab facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are at the facility and when you move out of the facility.

Losing Coverage:

If you leave a job, or the union through retirement, etc.
If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage, that triggers an SEP. Or if you have had drug coverage through Medicare Cost Plan and left that job.
If you lost coverage through the PACE Plan.
If you had Medicaid and lost eligibility because of the income requirements.

You have a chance to get other coverage:

If you had coverage from an employer and it was better than Medicare, you could go on it.
If your employer had better plan coverage and you wanted to get on that plan.
If you wanted to get into a PACE Plan

When there are plan changes with Medicare Contracts:

If a provider was sanctioned by CMS, then you would be able to choose another plan.
If Medicare terminated a contract

Dual Member (Medicare and Medicaid)

You may get extra help with drug coverage
May have been on a Medigap plan, changed to a Medicare Advantage Plan and then wanted to change back, you can change to a Medicare Supplement plan during your first year of coverage.
SNIP Plan - for chronic conditions - may leave Medicare Advantage to go on the SNIP, or yu no longer qualify for a SNIP, so you can choose another plan.

If an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.

*You cannot get an SEP because your Doctor left the network****

If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP.

Precautions:

If you have a chronic illness, cancer, cardiovascular disease, a plan does not have to take you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The other company might not take you due to pre-existing conditions and your old plan may not take you back. They can discriminate due to pre-existing conditions.

The price of these plans do change as you age, so keep that in mind.

Original Medicare:

Part A, B and D - you are on all the time, so you don’t make changes unless it is open enrollment or an SEP.

www.callsamm.com - has all of this information available for you.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome Medicare Nation! Today we wrap up our “trilogy” about Care Coordination by talking to Patient Advocate Karyn Rizzo!

Karyn wrote the book - Aging in America - What you need to know about Navigating our Healthcare System

Karyn’s book is available on Amazon. It covers everything from finding a primary care physician, choosing Medicare programs, and also some information for LGBT friendly providers, and safety tips, fall prevention etc. It just covers lots of real life issues that you face, including respite and how to take a break from care giving!

The book came out of the needs Karyn saw in her work everyday! She knew there was so much information she needed to cover, so she created a powerful resource in the book!

Fall prevention tips that Karyn provides in the book:

Eliminate rugs in the bathroom and other rooms of the house
Check the types of shoes to make sure they don’t contribute to a fall
Falls happen in the middle of the night going to bathroom, so install rails
Is walker or cane easily accessible from the bed?
Do you have motion sensor lighting?
Medications can contribute to falls

Another great resource on fall prevention is mayoclinic,org

Advocacy for Patients is important today because of the following factors:

Healthcare providers don’t have the time to spend with you explaining things
Insurance companies have complex coverage rules
Healthcare treatment options are more complicated than ever

What a Patient Advocate Does:

Individuals that directly advocate for the patient
Neutral parties hired by the family - not employed by hospital or insurance company
Evaluate the care plan for the patient
Advocate will put together a care plan that meets the patient's needs
Works through the process of appealing insurance and hospital decisions
They know the system, the lingo, and the rules, so they can use them to the patient’s advantage
Knows what programs the patient is eligible for and how to get you on the right program for them
Advocate can also help involve other specialty Physicians to evaluate the best treatment plan for the patient
Advocates can also help navigate care options for Hospice and understand when it is appropriate and when other options are better for the patient.
Hospice does have a Home Health division and it can be confusing between that and end of life Hospice care, so the patient advocate can make sure you are on the appropriate service.
Healthcare regulations vary from state to state, so it’s important to get accurate help navigating the system.

Where do you find a Patient Advocate?

Sometimes called a Geriatric Care Manager, Social Service Agencies - There is a national website that provides a directory of caregivers:

CareManager.org

CareGiver.org

AgingGuidebook1.com - Karyn’s website has TONS of resources

What type of Licensing does a Patient Care Advocate have?

Every state calls the role something different, but there are programs that certify in each state.

Generally, they are nurses or social workers, or have equivalent experience.

Licensing or certification is required for this role.

A Geriatric Care Manager is a position that you will have to pay for. Case managers that are paid by Medicare, the hospital or the insurance company will always represent those organization’s interest first, and yours afterward.

It is worth every penny to have someone in the trenches that is representing your best interests!

Online Tools when you are out of state from the patient:

ecarediary.com

reunioncare.com

These websites create a circle of care that allows everyone in that circle to have access to all the information and take action on different aspects of the care for the patient from where ever they are in the world.

Got questions about Patient Advocacy?

Karyn could assist in a consultative role if you are not located in FL. She can direct you to resources in your area.

Karyn can be reached:

By Phone: 727-452-1300

By Email: info@agingguidebook1.com

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

AGING in AMERICA: What you NEED TO KNOW about Navigating our Healthcare System

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Welcome Medicare Nation!

After last week’s show with Dr. Jeffrey Burns, I wanted to bring a guest on the show that could talk to us about her experience with the lack of care coordination with Medicare.

Melissa’s Mother fell and broke her hip before Christmas. At only 67, ended up having surgery and being in the hospital and then in a skilled nursing facility. At home she had outpatient therapy.

Melissa shares the following about her Mother’s experience:

She went to stay with her Mother during this time - she lived 4 hours away
She felt like she would just provide companionship and help her Mom get back on her feet
She quickly realized she would have to be a patient advocate for her Mother
She found out that the care for her Mom was good, but communication was terrible
She tried to follow up on her Mom's care on a daily basis, but it was overwhelming
Melissa wasn’t exactly sure of the medicine her Mother took on a daily basis
Melissa didn’t have all the information available about the Doctors that her Mom sees
Mom had an app on her cellphone that had all her medical info and also allowed her to call 911
Mom lived alone and fell late at night when she was in her garage
1 in 3 people 65 and over will fall and a hip fracture is the #1 injury from that fall
She and her Mom text every night and every morning since her Mom lives alone
Surgery on the hip was successful, but there were some blood clots to deal with
Mom has a high tolerance for pain, but yet still seemed to be in a great deal of pain
Melissa found out that there was some miscommunication between the nurses and her Mom regarding pain meds
The hospital staff thought that Melissa's Mom had refused one of her pain medications
Actually Mom only questioned it because she thought she couldn’t have the 2 meds together
It wasn’t a refusal of medication, but her Mom just didn’t understand the issues and was confused
Constantly ask questions. Write them down as you remember them. Ask the questions to every staff member at every shift.
Her Mom spent a week in the hospital before she went to rehab. It felt like they wanted to release her too soon.
The clinical coordinator for the hospital didn’t have a lot of information on placement options in a city 45 minutes away
They used the online site ratings through Medicare to find a skilled nursing facility
Minimum requirement is 3 overnight stays in the hospital to qualify to go to skilled nursing facility
medicare.gov has the resources to check ratings of skilled nursing facilities.
Private Institution ratings are not available on www.medicare.gov
Transportation to the skilled nursing facility, 45 minutes away, wasn’t handled by the hospital because the facility she was moving to was out of their "network."
The family had to arrange transportation through a private medical transportation service, where Mom could transported in her wheelchair.
In the skilled nursing facility, her Mom was there for 5 days before she even saw the nurse practitioner.
The physical therapist never actually showed up due to scheduling conflicts.
It’s important to find out the schedule that the Doctors will be keeping and seeing your family member and make sure you are there when they make the rounds.
Melissa found out that her Mom got confused about what meds she was taking for what ailments, so she wasn’t a help to sort things out.
Medicare allows Physicians to write prescriptions for home care therapy and it is provided at no cost to you. As long as a Dr. writes a prescription and the Physical Therapist is an approved Medicare provider and the patient can’t make it out to traditional therapy, it will be provided on most Medicare plans free of charge.
Melissa was shocked at how important it was for her to be involved in her Mother’s care and recovery.
The outcome for Melissa’s Mom was good, but there were so many times along the way that could have gone terribly wrong, if Melissa wasn’t there to advocate for her Mom.
If you are not physically able to be with a family member during a crisis, you may need to inquire about hiring a Patient Advocate.

The Official Medicare website is a starting place for finding skilled nursing facility ratings.

Getting a patient advocate is a good idea if you aren’t prepared or able to assist your loved ones during a medical crisis.

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome, Medicare Nation!

March is National Kidney Disease Awareness Month, so I’ve invited Dr. Jeffrey Berns on Medicare Nation. Dr. Berns is the president of the National Kidney Foundation and a professor of medicine and pediatrics at the Perelman School of Medicine at the University of Pennsylvania and the Associate Chief of the Renal Electrolyte and Hypertension Division. He is also the director of the Nephrology Fellowship Training Program and the Associate Dean for Graduate Medical Education. Dr. Berns is a busy and dedicated physician, and I’m grateful he is taking the time to inform us about kidney disease today!

Give the listeners an idea of the prevalence of kidney disease in the US.

One in three people are at risk for kidney disease, while one in nine already has some level of kidney disease. Chronic kidney disease is measured in stage 3, 4, and 5. Stage 5 is the level at which dialysis or a transplant is required. Throughout your lifetime, it’s important to avoid exposure to things that can damage the kidneys, and that includes many prescription medications.

Is it correct to say that kidney disease if most often a “silent” disease?

It is similar to high blood pressure, which is also an important risk factor for kidney disease. Kidney disease is asymptomatic until permanent damage is done. Some tests can reveal the disease to a doctor, but patients don’t often have symptoms until it’s late in the game.

What is the difference between a nephrologist and an urologist?

A nephrologist is a physician with specialized training in medical diseases of the kidney, while a urologist is trained in surgical diseases of the kidney and urinary tract.

What are signs and symptoms that would indicate late stage kidney disease?
Protein in the urine in large amounts
Swelling of the feet, hands, legs, and face
High blood pressure
Fatigue
Difficulty concentrating
Sexual dysfunction
Loss of appetite
Metallic taste in the mouth
When should people see their doctor about kidney disease?

We all have to be aware of the risk. Most older people are at increased risk, and minorities are at a higher risk. If kidney disease is in the family history, then the risk is higher. Diabetes increases the risk, but many cases of mild kidney disease can be managed quite well by a primary care physician.

Wouldn’t it be a good idea to check blood levels for patients at yearly checkups?

That would be the perfect time and opportunity for routinely-done tests. Your doctor can monitor you for any change over time, and you can ask your doctor if you have signs of chronic kidney disease.

The National Kidney Foundation has partnered with MACC (Medicare Advantage Care Coordination) Task Force, aligned with 35 leading patient-care providers for patients with multiple disorders. Tell us more about MACC.

Many patients with kidney disease also have other issues. MACC allows for their care to be more cohesive and patient-centered instead of fragmented care coordination.

What can listeners do to improve care coordination?

Make sure each of your doctors are communicating with each other. Most providers have electronic patient records that every doctor can see. Patients should remind each of their physicians to send their medical records to their primary physician. Your Primary physician is in charge of coordinating your care. Provide your Primary physician with a list of your other providers names and phone numbers. Carry a list of up-to-date medications to every doctor.

How is Care Coordination utilized with different types of Medicare Plans ?

Original Medicare provides the most freedom in seeking physicians with no referrals. Lack of communication between physicians causes fragmented care, with no care coordination. Medicare Advantage Plans include networks of physicians, with required referrals to see specialists. This allows continuity and greater communication in care coordination. Medicare Advantage Plans are continually trying to improve payment models and care coordination. Here are several steps individuals should follow to improve care coordination:

Know your risk factors.
Talk to your primary care doctor and have screening tests.
Carry a list of medications with you.
Keep a list of numbers and names of care providers.
Make sure your plan has care coordination tools.

Learn more about Kidney Disease, find helpful resources and support on the National Kidney Foundation's website

Visit www.kidney.org for more information.

To learn more about the Medicare Advantage Care Coordination Task Force :

Visit www.medicarechoices.org

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Welcome, Medicare Nation! It’s March, which is a huge month for awareness. Last week’s show highlighted colon cancer awareness, this week we are discussing MS awareness, and next week’s topic is chronic kidney disease.

What is MS?

MS is multiple sclerosis, which is a disabling disease of the central nervous system. It occurs when there is a disruption of the electrical circuit between the brain and the rest of the body. Nerves have a myelin sheath that covers and protects them; when the sheath is damaged and the electrical impulses are disrupted, then multiple sclerosis is the diagnosis.

What are signs and symptoms of MS?

Fatigue that interferes with your ability to function
Numbness/tingling in face and extremities
Muscle weakness
Dizziness/vertigo
Pain, significant and chronic
Vision problems

How is MS diagnosed?

It’s a difficult disorder to diagnose, and can be found using blood tests and MRI’s. Doctors can test the electrical impulses in the brain, and they also pay attention to family history. Medicare covers these diagnostic tests to some degree, so CHECK YOUR PLAN! See your doctor if you experience any symptoms. Over 400,000 people in the US have been diagnosed, with more than 200 newly diagnosed cases each week! Most patients are between 20-50 years old. There is no cure for MS; all doctors can do is to try to slow the progression of the disease.

For more information, visit www.nationalmssociety.org or call 1-800-344-4867 to contact the National MS Society.

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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The Center for Medicare and Medicaid Services has suspended another Insurance Medicare provider's plan.

CMS has suspended and sanctioned Ultimate Health Plan (UHP) Medicare Advantage Plan. Suspended Feb 26 and effective immediately. They are not allowed to market and sign up new enrollments for the UHP. They have determined that the conduct of UHP failed to provide services in compliance with CMS standards. According to the CMS document, "the failures were determined to be widespread and systemic."

If you are on a UHP plan, you still have your benefits at this time. A Special Enrollment Period has not been granted by CMS at this time.You will need to contact Medicare at 800-633-4227 to request permission to select another plan due to the suspension. Document your conversation with the representative - their name, the date and time that you got the approval, etc.

If you used a "captive" insurance agent, they only offer Medicare plans from the company they are contracted with. I do not recommended that you contact a "captive" agent, because they will not advise you about other options with insurance carriers that may provide you with better options.

If your family member is on Ultimate Health Plan and has a serious, chronic disease then you may want to look into other Medicare plans in the area in which they reside, to see if a better plan option is available. If you or a family member has Chronic Kidney Disease which requires dialysis or a kidney transplant, they may not be able to switch plans at this time.

Medicare will look at each individual's situation on a case-by-case basis.

If you have questions regarding the sanctions against Ultimate Health Plan, send me an email at:

support@themedicarenation.com

To speak with a Medicare broker or Medicare advisor in your area, simple Google “Medicare Advisor” - and your county or location. An example would be - Medicare Adviser Tampa, Florida

Politics and Medicare:

This isn’t an endorsement for any candidate. This is just a summary of the candidates platform for Medicare and/or Healthcare

On The Republican Side:

Donald Trump:

Does not want to make cuts to Medicare

Favors health savings account

Does not favor current Obamacare

Favors taking away boundaries on state lines to encourage competition between states

Ted Cruz:

Wants to save Medicare by gradually increasing the eligibility age from 65 to a higher age

Wants to move to a “Premium Support System”, whatever that means

Marco Rubio:

Wants to raise the eligibility age gradually

Supports a voucher type program in Paul Ryan’s budget proposal

John Kasich:

Hasn’t specifically talked about Medicare, only Healthcare

Believes in the “value over volume” system of Medicare reimbursements

Advocates healthcare savings accounts

On The Democratic Side:

Hillary Clinton:

Continue Obamacare and build on it

Protect seniors from rising costs

Bernie Sanders:

Advocates a single payer plan - administered by the government

Comprehensive coverage for all Americans paid for by the government

This will be paid by a 6.2% healthcare premium paid by employers

2.2% income based premium per household

This would be a government run system

No matter who you support, please make sure you exercise your right to vote!

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Kevin Harrington, creator of the infomercial and the chairman of the As Seen On TV brand, is my guess today. Kevin has launched over 500 products to the tune of $4 billion! He is one of the original sharks on ABC’s Shark Tank. Kevin is an author who has helped me greatly with this podcast and my book, The Medicare Survival Guide.

What would you suggest to people in our generation who might be affected if age requirements for Medicare benefits are changed in the near future due to political change in America?

I would advise people to explore second income opportunities. If you’re working, then keep your job, but plant some seeds in case you need to work an extra 2-5 years than you originally planned. I suggest considering internet and mobile marketing opportunities. Anyone can do these jobs from home, connecting with people and selling products. Many entrepreneurs have started these small businesses and have become very successful for part-time or even full-time income.

You have a new book coming out. Would you tell us about it?

My book, Key Person of Influence, was written with Daniel Priestley. It’s an amazing program that takes you step-by-step through establishing yourself as a “guru.” For me, the turning point was becoming a KPI in As Seen On TV products. There are five essential skills, which include raising your profile, developing your pitch, and partnering with people. You can follow the system and become a guru in your industry.

Visit www.keypersonofinfluence.com!

Visit www.kevinharrington.tv for links to my books and KPI information.

Changing gears just a bit, today is March 4th, which is Colon Cancer Awareness Day. Last week’s show was about this topic. Let’s all wear our blue today to promote colon cancer awareness!
Judy, from Tampa, asked a question about the DNA Stool Test, so I want to give some detailed information. This test is relatively new, done at home, and less invasive than some others. It is covered by some Medicare plans, but you need to check on yours specifically. The test assesses your risk but does not replace the colonoscopy. The test is allowed every 3 years for those ages 50-85 who have no symptoms of colorectal disease, no Crohn’s, IBS, colitis, or polyps. Visit www.cca.org for more information.
If you have questions about this show or others, please contact me. I love to hear from you and answer whatever questions you have! Thanks for listening!

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Do you know how your Medicare benefits would be affected by the changes in government that would come from a new President? It's time to think about it and weigh in on what you think is best for you and for the country. Listen as Diane talks to real people who have an opinion.

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes!(Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome, Medicare Nation! Today’s guest is Lee Silverstein, who is a colon cancer survivor. Lee is here to discuss the risks, prevalence, and treatments for this disease. Colorectal cancer is the most commonly diagnosed but also the most preventable through proper screening. The American Cancer Society estimates that 95,000 people will be newly diagnosed with colon cancer in 2016. Over their lifetimes, 1 in 21 men and 1 in 23 women will be diagnosed! Colon cancer is clearly not “the old man’s disease” that many of us have been led to believe. Let’s hear Lee’s amazing story!

Why has colon cancer become so widespread for people under age 40?

“Over the last few years, the rates for diagnosis have remained steady, with a huge increase in the number of cases in people under age 40. It is scary, alarming, and unexplainable by doctors. I recently attended a conference on colon cancer and met a newly diagnosed 23-year-old. The common risk factors are being overweight, a lack of physical activity, a diet rich in red meat, heavy smoking and alcohol use. Keep in mind that you can have NONE of these risk factors and still be diagnosed with the disease, like what happened to me.”

Would you mind telling our Medicare Nation listeners your personal story?

“Not at all—I would love to share my story. I had NO risk factors and had just turned 50, living a very health-conscious life. I exercised regularly and was eating smart. I had a colonoscopy in March 2011, and the doctor couldn’t get the scope where he needed it to go. I wasn’t alarmed, but received a call from the doctor two days later saying I had a tumor in my transverse colon. This colonoscopy saved my life!”

Would you share what your treatment was?

“I had colon cancer and needed to have the tumor removed; the surgeon was confident that he could remove it all. My cancer was classified as Stage 2, which meant it was borderline as to whether there were benefits to undergoing chemotherapy. I got three opinions and determined that the benefits of chemo did NOT outweigh the risk. My follow-up exam included a CT scan and bloodwork, which showed a small spot on my liver. A biopsy was ordered and showed that my colon cancer had spread to my liver, even though it was a small spot and slow-growing. Surgery was recommended and chemotherapy. I went to Sloan-Kettering, which was the hospital I had been treated at as a child when I had a rare kidney cancer. The liver surgeon there was confident that I would be fine. Surgery was scheduled for January 2013 and I finished chemo treatments in August. In 2014, two small spots on my lungs were discovered. The doctor suspected that it was colon cancer that had metastasized to my lungs. He wanted to treat it with SBRT, a cyberknife-type targeted radiation procedure. In normal radiation, low doses are given over a wide area over a long period of time, with damage to the surrounding tissue. In this procedure, pinpointed high doses are given over a short time. I had the treatment with no side effects, and was even able to continue training for a race. The one spot disappeared and the other shrunk significantly. I’m not cancer-free, but I am stable. The goal of colon cancer treatment is to make it a chronic manageable disease.”

Can you tell Medicare Nation listeners about the Colon Cancer Alliance?

“I found this organization when I was first diagnosed. They are the largest patient support non-profit organization for colon cancer, based in Washington, DC. They do research and provide online support.”

Medicare provides several levels of preventive care and testing for colon cancer:
Barium enema is allowed every 24 or 48 months, depending on the risk.
Colonoscopy is allowed every 120 or 48 months, depending on the risk.
Fecal blood tests are allowed every 12 months.
Flexible sigmoidoscopy is allowed every 48 months for people over 50.
Multitargeted DNA test is allowed every 3 years for people aged 50-85. This is a new test with many stipulations.
Plans, coverage, and co-payments differ.
Some procedures are free, but related surgical procedures (like to remove polyps) are NOT free.
Tell our listeners about your podcast.

“I started The Colon Cancer Podcast about a year ago. I interview survivors, caregivers, and medical professionals. We share stories of struggle, hope, and survival in the face of colorectal cancer.”

Tell us about the “Undie Run.”

“These are 5K events sponsored by the Colon Cancer Alliance. We run around in our underwear! Events are held 2-3 times each month, in different cities around the country from February through October. The events are to raise funds and raise awareness of the disease.”

Resources:

www.ccalliance.org

877-422-2030

Find the Facebook group: Blue Hope Nation

Special Bonus! Stay tuned to the entire show where Diane Daniels answers listener questions after the interview!

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Welcome, Medicare Nation! My guest today is Dr. Andrea Singer, who is a professor of Obstetrics and Gynecology at Georgetown University Medical Center. Dr. Singer is the Director of Women’s Primary Care and the Director of the Bone Densitometry program. She is a trustee and clinical director for the National Osteoporosis Foundation and a national lecturer on the subject. Dr. Singer has published extensively on many women’s issues and is active in the education of medical students and residents at Georgetown University Medical Center. Dr. Singer is here to teach us about osteoporosis and how it affects our lives and health.

Can you define osteoporosis for Medicare Nation listeners?

“Yes—I value this opportunity and hope it can be a call to action for your listeners. Osteoporosis is a disease of the bones in which too much bone is lost or the body simply makes too little bone. The bones become weak and can break from minor falls or simple actions, even like bumping into furniture or sneezing!”

How prevalent is osteoporosis in the US?

“It’s a very common disease and I’ll give you some statistics: 50% of people age 50 or older (54 million of the 99 million) have either osteoporosis or low bone mass. The number jumps to 65% of people age 65 or older who are at risk for broken bones.”

Do these numbers apply to both genders, or just to women?

“They apply to both genders, even though it’s commonly thought of as a woman’s disease. Interestingly, men have a harder time recovering after a broken bone incident. Of the population age 50 or older, 1 in 2 women and 1 in 4 men will break a bone due to osteoporosis in their remaining years.”

What are the risk factors for osteoporosis?

“Risk factors can be broken into two categories: non-modifiable and modifiable factors. Non-modifiable risk factors are those that you can’t control, like age, gender, family history, low body weight/frame, and previous bone fractures. Modifiable risk factors include lack of calcium/vitamin D, inactive lifestyle, smoking, and too much alcohol. Regarding previous fractures, those of the spine, hip, wrist, shoulder, and pelvis are classic osteoporosis fractures. Also, certain medications for other disorders can increase bone loss. If you have these risk factors, you should speak to your health care provider and ask about being evaluated for osteoporosis.”

How is osteoporosis diagnosed?

“Doctors will look at risk factors and do physical exams and lab tests, but the only real way to find osteoporosis is to do a bone density test. The lower the bone density, the greater the risk will be. The DXA scan is the bone density test, and is covered under the Welcome to Medicare package for women. Men are not covered for this test unless they fall into one of the following categories: on long-term steroid therapy, diagnosed with hyperparathyroidism, already on osteoporosis therapy, or has a vertebral abnormality or deformity found on an x-ray. The National Osteoporosis Foundation recommends that men be screened at age 70, but the bone density test isn’t covered unless one of the four criteria is met.”

Why are there not many people being screened for osteoporosis?

“Osteoporosis is under diagnosed, under recognized, and under treated. It’s thought of as ‘my grandmother’s disease,’ and many people don’t recognize the risk factors. In addition, there are fewer health providers doing DXA scans. For many, they lack the realization that broken bones over age 50 is a strong indicator of osteoporosis. We need to raise awareness so that people who are candidates for osteoporosis will get tested. I hope that this discussion empowers people to take charge of their bone health, be proactive and advocate for yourself to your doctor.”

How is the medical community treating osteoporosis?

“People need to get adequate calcium and vitamin D, either through diet or supplements. Weight-bearing, muscle-strengthening exercise can help stimulate the bones to remodel themselves and reduces the risk for falls. Fall prevention is a big part of treatment, and there are medications that can slow the bone breakdown or build new bone.”

What are the options for osteoporosis medications?

“Prescription pills can be taken daily, weekly, or monthly. These are covered under Medicare Part D. Injections can be given daily, once yearly, or 4x/year; these are covered under Medicare Part B or Part A, depending on where they are administered. The important point is that there is a medication to fit everyone who is at risk.”

Where can Medicare Nation listeners go for more information and resources?

Visit the website of the National Osteoporosis Foundation: www.nof.org. You can also find the Foundation on Twitter: @osteoporosisnof or on Facebook. There is also a new app available on iTunes or Google Play: Food4Bones. Check out these valuable resources for more information!

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome Medicare Nation! I have some alerts for your today for some important changes to Medicare that are going on right now. I want you to know if you are affected, and what you need to do to make sure you have coverage. There are 2 main topics we need to discuss today:

Dis-Enrolling from Medicare Advantage Plan
Cigna Suspension

Jan 1- Feb 14 - the period in which you can dis-enroll from your Medicare Advantage plan - if you don’t like it.

You cannot then switch to another Medicare Advantage Plan during this period
You would only be able to go back to original Medicare when you disenroll
You would have Part A and Part B
This means you have deductibles and co-insurance
There is no network - any provider contracted with Medicare will work for you
Part B deductibles are either $104.90 or $121.80, depending on your situation
Part A deductibles are $1288 for each new occurrence during the coverage period
First 60 days you are covered by the deductible
Day 61-90 you pay co-insurance of $322/day
Day 91-100 you pay $644/day
After that you have your 60 lifetime reserve days at $644/day also
Part B has annual deductible of $166 for 2016
After the deductible you pay 20% of Medicare allowable cost for every procedure
You can purchase a Medicare Supplement plan for which you would pay a monthly premium

Need Help?

Call 1-800-Medicare if you have questions
support@themedicarenation.com

Cigna Suspension:

The States - AL, AZ, FL, GA, NC, PA, SC, TN - are affected. They cannot enroll any new people for the plan. If you had it, you can stay on it. Or you can leave. This was a sanction from CMS for failing to comply with the Medicare Standards. They found that Cigna has a long standing history of non-compliance with CMS standards. The suspension is indefinite.

This sanction opens a “Special Enrollment Period”. This allows you to enroll in a different Medicare Plan.

Need Help?

Contact Medicare - 1-800-633-4227

Medicare Website - www.medicare.gov/contacts

support@themedicarenation.com

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome, Medicare Nation! My guest today is Dr. Ralph Sacco, who is the Executive Director of the Evelyn F. McKnight Brain Institute at the University of Miami. He is also the Chief of Neurology Services at Jackson Memorial Hospital. Dr. Sacco has published extensively in the areas of stroke prevention, treatment, risk factors, human genetics, and stroke recurrence. He is the recipient of numerous awards and has lectured at national and international meetings and conferences. He was the first neurologist to serve as president of the American Heart Association and serves as the president-elect of the American Academy of Neurology. Dr. Sacco is here to give us valuable information about strokes and stroke prevention. Join us!

Tell us what you do at the University of Miami.

“I’ve been the Chairman of Neurology since 2007. Our department has grown and is ranked 15th in NIH funding. We are leading the way in treating various neurological diseases.”

Tell our listeners what a stroke is and what the signs and symptoms are.

“Stroke is a huge public health issue, especially as our population ages. About 795,000 strokes occur each year, which is one every 40 seconds! A stroke is like a heart attack in the brain. In a stroke, the brain is injured by bleeding or some other problem with blood vessels. The warning signs are often missed, but our current awareness campaign uses the acronym FAST to help people remember:

F-Face-Drooping on one side

A-Arm-Weakness in one arm

S-Speech-Slurred speech

T-Time-Call 911 immediately!

Other common symptoms are numbness and tingling on one side, severe sudden headache, and difficulty walking.”

Are there similarities in treating stroke and treating heart attacks?

“Heart attacks usually allow a little more time for treatment than the brain does. With a stroke, you MUST get to a stroke center immediately. TIME IS BRAIN! A clotbuster drug can be used with success in blood vessel blockages up to 4.5 hours after the stroke begins.”

I’ve heard that people should chew on an aspirin if they feel they are having a heart attack. Is that the same advice for a stroke?

“No, some strokes—about 15%--are bleeding strokes. Aspirin can make it worse. We advise calling 911 and getting to a treatment center. We can use drugs and catheters to remove clots up to six hours after stroke onset. This improves outcomes tremendously.”

What happens if signs and symptoms aren’t recognized and several hours go by? Is there irreversible brain damage?

“Exactly—the longer we wait in opening that artery, the less chance we have of total recovery. Some recovery can happen between 6-18 hours, but it’s more difficult. Too many people ignore symptoms, and then it’s too late.”

One side effect of stroke can be paralysis on one side. What exactly causes that?

“Most symptoms occur on one side of the body since one side of the brain controls the opposite side of the body. Everyone should know FAST and know how to activate the 911 call.”

Are there any foods we can eat to promote good blood vessel health? Is there a type of diet that helps?

“Diet is a big factor of ideal cardiovascular health. The AHA estimates that less than 1% of people have ideal cardiovascular health. There are five key components:

Fruits and Vegetables: 4.5 cups each day

Fish: 2 servings each week

Fiber-rich Whole Grain: 3 servings each day

Lower your sodium intake: Sodium increases blood pressure, and high blood pressure is THE single leading modifiable risk factor for stroke. Most people get 3500 mg/day when the recommended limit is only 1500 mg/day!

Limit sugar-sweetened beverages: This increases the risk for diabetes.”

What tips can you give about stroke prevention?

“Remember, what’s good for heart health is good for brain health, too. The AHA lists seven key factors, called ‘Life’s Simple Seven’:

Never smoking
Body Mass Index
Physical activity
Diet
Total cholesterol less than 200
Blood pressure not higher than 120/80
Fasting blood glucose less than 100”
Doctor, for our seniors—or for anyone—is walking a daily exercise that you recommend?

“Walking is a great exercise. Just 75-100 minutes of walking over a week’s time can really help in the battle for ideal health.”

Resources:

Remember, part of Medicare benefits and preventive care includes nutrition counseling. You can talk to your primary care doctor for more information on how this service can help you. Visit www.medicare.gov for more information.

www.strokeassociation.org

www.heart.org

The FAST app for your smartphone is now available!

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome Medicare Nation! Everyone keeps asking me about the changes to Medicare for 2016. There are quite a few changes, so today I will focus on the biggest ones you want to know about today.

How much will you pay for Medicare Part B (Outpatient Services)?

There is no COLA (Cost of Living Adjustment) for 2016. The Hold Harmless Rule comes into play. If there is no COLA, then there can be no increase in Medicare Part B.

For everyone who is already on Medicare and receiving SS benefits, your Part B stays the same at $104.90. That’s 75% of the people that are on it.

If you are turning 65 in 2016 and you are on Medicare, your premium will increase. If you delayed taking SS benefits because you continued working, your premium will increase. If you are on Medicare and Medicaid, your premium will go up. You may qualify for the state reimbursement for Medicaid costs. New premiums will be $121.80. Recommendations were that Medicare Part B premiums should be up around $159, but Congress limited the increase to $121.80. In actuality, Congress gave you a loan for the difference between $121.80 and $159, and charged you a fee for the loan until it can be repaid.

Over $65 Billion of Medicare dollars is lost to fraud. Instead of worrying about the fraud, your politicians gave you a loan! Oy Vey!

If you make over $85K in income, your premium will increase to a different amount, which you can reference on the website.

Medicare Part D (Drugs) - Medicare Advantage Plan majority will have drug coverage included already.

For 2016, know your deductible situation (max $360). Some have them and you will have to pay out first, and others will only be triggered with a brand name drug.

The Donut Hole - You don’t want to be in this category. $3310 is the maximum expense for this category. When you add up the amount of money you have paid and the plan has paid, and it exceeds $3310 and now you are in the donut hole.

Now the government wants you to start paying more for your coverage. The new threshold is $4850 for this level. You will now pay 45% of the cost of the brand name drug and you will pay 58% for a generic drug. What you pay out of pocket plus a 50% manufacturer discount. Once you meet $4850, you now fall into the catastrophic coverage phase.

Catastrophic Phase - Last through the end of the calendar year. You will pay 5% of the cost of the drug or $7.40, whichever is higher. For generics you pay 5% of the cost of the drug or $2.95, whichever is higher.

The slate gets wiped clean as of Jan. 1 and your classification starts all over again.

Medicare Payout for Providers:

For 2016, payments will be reduced by 30%

They are looking at tying procedures together when there are multiple issues stemming from the procedure. Payment will be reduced when you are re-admitted to the hospital within a certain timeframe.

When a patient contracts an infection during a hospital stay, the payments will also be reduced.

They are looking at “Value over Volume”.

If you have been on Medicare for a year, you can have an annual Wellness medicare checkup. This isn’t your annual physical, but a Wellness Medicare Exam.

From now thru Feb. 14, you can drop your Medicate Advantage Plan and go back to original Medicare and have coverage for Part A and Part B. Then you would need to purchase Part D separately.

No premium for Part A (overnight stays in any type of facility) $1288 is the amount you pay for 60 days. Day 61-90, you pay an additional $322/day and after day 90, you pay $644/day. Every person has 60 lifetime reserve days for one time use only.
In skilled nursing 0-20, 21-100 (max) you pay $161/day.
Part B has a one time deductible of $166, and then 20% of Medicare allowable cost. Find out your co-insurance payment prior to the appointment.

Stand Alone Prescription Drugs Plans:

All have premiums
Check for the deductibles too
You can apply for a supplement for Medicare to help cover the cost of Original Medicare

Do you have questions or feedback? I’d love to hear it!

email me:

support@themedicarenation.com

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome! My guest today is Dr. Vincent Bufalino from Illinois. He is board certified in Internal Medicine and Cardiovascular Disease. He is the Senior Vice President of the Advocate Heart Institute and the Senior Medical Director of Cardiology of Advanced Medical Group (AMG). AMG is ranked as one of the top five health systems in the US and has 140 physicians in cardiology practice! Let’s hear more from Dr. Bufalino!

Tell us what you do at AMG.

“We care for patients in 12 hospitals in the Chicago area. Last year, over 20,000 cardiac procedures were performed at AMG. We provide expert medical care to those with high blood pressure, high cholesterol, and diabetes. Our surgical program provides the latest in technology to provide the highest level of quality health care.”

Do you treat patients from all around the US?

“We service most of northern Illinois and have outreach clinics even in the rural communities. Most of our patients are from this area, but some continue to access our care for follow-ups, even after they’ve moved to other states.”

What is meant by the term “heart disease”?

“We look at risk factors, which are not managed as well as they should be. High cholesterol is very common, and we have many tools to treat it although not everyone needs to be on medications. Some people can be treated with diet and exercise, but those over age 35-40 with family risk factors should be evaluated. Those that are experiencing symptoms should be evaluated. The death rate from heart attacks has decreased from about 20% a few decades ago to just 2% today. Unfortunately, some patients develop heart failure and require advanced care, but there are still many treatment options available.”

What are some common signs and symptoms of heart attacks?

“Exertion-related symptoms are common, like discomfort, pressure, tightness, and burning. The two most common symptoms are chest discomfort and shortness of breath. You should also pay attention to rapid heartbeat and fluttering in the chest. Acid indigestion CAN be a symptom, especially if it doesn’t subside when you take an antacid.”

What is a stroke?

“Essentially, a stroke is damage to the brain, usually from a blood clot or a ruptured blood vessel. Sometimes a “warning” occurs, known as a TIA (transient ischemic attack). It is accompanied by numbness/weakness on one side, vision loss, and slurred speech. Time is critical since permanent damage can be done. Within the first 60-90 minutes, we can intervene and dissolve the clot.”

What are some procedures that Medicare allows to detect heart disease?

“For those over age 65, an ultrasound is allowed to assess the risk of Abdominal Aortic Aneurysm (AAA), which is the ballooning of the main artery going down into the abdomen. The ultrasound detects any enlargement of the aorta. Those with a family history of aneurysm, men with high blood pressure, and smokers have an increased risk.”

Can you explain the Cardiac Disease Screening under Medicare?

“There is a ‘Welcome to Medicare’ physical exam that is allowed during the 12-month period after you turn 65. There are also nutritional therapy services available, and most people don’t even know about them or take advantage of them. The purpose is to try to give people tips that can make a difference and help them live healthier lifestyles.”

How is salt tied to heart disease?

“Salt is tied to high blood pressure, and this isn’t just from the salt shaker! Sodium is packed into processed foods, so it’s important to read labels.”

You were president of the American Heart Association in Illinois. How can the AHA help people?

“The AHA supports the work we do at AMG with patient education and research. Their website offers resources and even cookbooks. Find them at www.heart.org.”

Do you have any tips that people can follow RIGHT NOW to prevent heart disease?

“The two most important things are to eat better and exercise more.”

Resources:

www.heart.org

www.advocatehealthcare.com

www.meetup.com (Find walking groups all around the country.)

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome! Today’s guest is Brad Hubbard of National Flood Experts. He has built a company and a career dedicated to helping people save huge amounts of money! Join us for more!

What is your background that led you to start National Flood Experts?

“I worked for 12 years as a civil engineer, working with FEMA (Federal Emergency Management Agency) on flood zone issues. When I grew tired of working as an engineer, I began working as an insurance agent specializing in flood issues. I noticed how many homeowners were required to carry flood insurance even though there was almost no risk for flood. I found out FEMA has a process to take these homes out of the flood zone and save the homeowner from paying for flood insurance. Before long, I helped 20-30 clients and then created NFE to help millions of Americans who shouldn’t be paying for flood insurance.”

Why would someone be required to have flood insurance?

“There are two requirements to have flood insurance: having a mortgage and living in a flood zone, as determined by FEMA. Being near water doesn’t necessarily mean you MUST have flood insurance, and both residential and commercial properties are subject to these requirements.”

How are flood insurance rates determined?

“There are different factors that vary according to different agents. The rates are not standardized but are affected by how high the home is built and how high the speculated flood may be.”

Is FEMA in charge of determining flood zones?

“Yes. FEMA created the NFIP (National Flood Insurance Program, which oversees all federal flood insurance in conjunction with local municipalities. They categorize flood zones and update maps every 10-15 years. NFE actually benefits FEMA by helping make their maps more accurate.”

So, as homeowners, is it accurate to say that we can actually CHALLENGE FEMA’s flood zone designation?

“Yes. Challenge is exactly the right word for what we can do. Most people don’t even know that this is possible, because we assume when the government says something, then that’s the end of it.”

Can you give us an example of how NFE can help a client?

“Yes. I have a client who lives in a 55+ neighborhood and was paying $1800/year for flood insurance. Our company did an Elevation Certificate and determined that we could help her. We charged her $500 for our services, submitted our report to FEMA, and they took her out of the flood zone within three days. She talked with her mortgage lender and her insurance agent and received a $900 refund from her escrow account and $1800 back from her previous year’s flood insurance. When you are taken out of a flood zone, then you’re entitled to a refund of every penny that you paid in flood insurance from the previous year! In addition to the $2700 refund, her mortgage payment dropped by $200/monthly—all of this was accomplished in just a few days’ time!”

How do homeowners get an Elevation Certificate?

“It’s part of the package with a survey and appraisal when you purchase a home or purchase flood insurance. Only about 20% of people don’t have one. Our crew can complete an Elevation Certificate for $150-500. If your home has been built or improved upon in the last 20-30 years, then an Elevation Certificate probably exists. Every municipality is required to keep these as public record in order to have FEMA participation.”

Does your service fee vary according to whether a home is in a low-value area or a high-dollar area?

“No, our services are based on a flat rate no matter where you live.”

What can NFE do for Medicare recipients?

“In all 50 states, Puerto Rico, and anywhere that FEMA regulates, NFE has a way to make it easy. There is a 24-hour recorded message line: 888-289-3134. You can access our free consumer’s guide to purchasing flood insurance. Our services are 100% guaranteed, with a total refund if we can’t help them, so there is NO RISK! If you mention this podcast when you call, then you will receive a $50 discount.”

Tell us what you can do to help our listeners.

“For some, we can get you out of a flood zone designation and eliminate your need for flood insurance. For others, we can reduce your insurance premium in several different ways in reviewing your property and options.”

Can you give us a summary of what your company does when a client calls?

“When you call and leave a message, all we need is your name and address to begin our research. We will be in touch with you within 24 hours and give our recommendations regarding how we can help. There is no payment required until a determination is made that we can help. The initial review is free and the only charge happens when we KNOW that we can help (and don’t forget the MONEY-BACK GUARANTEE!)”

How does your fee differ from residential and commercial clients?

“The pricing is a little different, based on how much we can save a commercial client in a year, but the process and the guarantee are the same!”

What if a residential homeowner has had flooding? Can they still contact you?

“Yes and no. If you’ve had a flood claim, then FEMA is not going to remove you from the flood zone, but there still are things you can do to reduce your premium. Keep in mind that FEMA defines a “flood” as rising water over more than two acres and where two or more properties are affected. Flooding does NOT include broken pipes or a water main break. Your normal homeowners’ insurance covers those water damage issues.

If you are paying for flood insurance, you should give NFE a call at 888-289-3134 or visit their website: www.nationalfloodexperts.com.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome! My guest today is Peter Fitzgerald, who is the Executive Vice President for Policy and Strategy for the National PACE Association (Program of All-Inclusive Care for the Elderly.) The PACE program helps guide the association policy and advocacy efforts at the federal and state levels. The program is always looking to improve services for those needing long-term care.

What is the PACE program and its history? PACE provides all the programs that the elderly need, from health care services to long-term care, all designed to keep seniors living in a community-based setting at home. It began as a pilot program in Chinatown in San Francisco, because the Chinese culture is based strongly on keeping elders at home with their families and out of nursing homes. Alternatives were explored to keep them living in the community with some assistance. The program began with a Daycenter that provided meals and healthcare and remedied the social isolation that some seniors feel. Over time, more services were added to the model. Now, people enroll in the program, which is sponsored by local healthcare provider organizations. PACE meets all the healthcare needs of the seniors except housing, but provides transportation, day centers, therapy, rehabilitation, meals, doctor visits, and home care services. The overall goal of the program is to keep seniors living in the community rather than in nursing homes.
Is it true that the PACE program is its own network of doctors and facilities combined into one? Yes, it’s designed to be a complete system. PACE programs employ their own doctors, nurses, practitioners, home health aides, home health nurses, and transportation services. The program secures contracts with hospitals for Medicare services and other needs.
Which Medicare coverage will pay for the PACE program? Upon enrollment, the PACE program becomes the source of all Medicare benefits and replaces traditional Medicare or Medicare Advantage Plans. Medicare actually pays the PACE program monthly for patient care, so in reality, it’s like another Medicare Advantage Plan.
Who is eligible for PACE? Enrollees must be 55 or older and live within a PACE service area, which is usually about a 45 minute driving radius. The program becomes all-encompassing health care, so patients must have access to a PACE center within a reasonable distance. The program is designed for those with complex and chronic needs. However, if someone has to enter a nursing home during their care, then the program does continue for them, even though they were not able to remain at home.
Almost one-half of PACE enrollees have some sort of dementia diagnosis, so do you think those numbers will continue to increase? The dementia and Alzheimer’s diagnoses are a potential area of growth for PACE. The president recently signed into law the creation of some new PACE programs that allow enrollment for some people under age 55. Early intervention may help people improve and maintain their quality of life.
What would the average cost be for a private pay patient under the PACE program? It would vary greatly from state to state, but the average would probably be around $3000/month with no co-pay or deductible. The rate is determined by the state, but remember that long-term care is included in the program, AND you get to stay in your home with your loved ones.
Is PACE considered “for profit” or “not for profit”? The program originally began as “not for profit,” but has since allowed “for profit” sponsorships. There is currently only one “for profit” PACE program operating in PA, but these will become more widely available in the future.
How many PACE programs are there? In 32 states, there are 116 PACE organizations currently serving 220 communities. You can find out more about the program and its availability in your local area by visiting www.pace4u.org or www.npaonline.org. You can also call 703-535-1565, find them on Facebook, or on Twitter @TweetNPA.
Can individuals volunteer or donate within the PACE program? YES! There are many ways to volunteer and donations are always accepted. Check with your local organization for further information.

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Welcome! I’m honored to introduce you to my guest today, Dr. Regina Benjamin, who is the former U.S. Surgeon General under President Obama.

There has been some confusion about the position of US Surgeon General, so can you describe the position and tell us what it entails? “Most people associate the US Surgeon General with the warnings on tobacco products about the dangers. That’s not all we do, though. We are responsible to communicate the best health science that we have. The Surgeon General is also the leader of US Public Health Services. We are considered part of the military. I like to say we carry needles, and not guns.”
Are you appointed or elected to the position? “The US Surgeon General is nominated by the president, and then confirmed by the Senate. The Senate also assigns the position for a 1-4 year term. I was fortunate to be confirmed unanimously without a hearing.”
Can you explain the focus of your mission today? “Part of the division of Science and Communication is to get the word out about health information and raise awareness. I’m partnering with Pfizer to get the word out about pneumococcal pneumonia, especially to older Americans, who are at a greater risk.”
Most people probably don’t understand that vaccinations are free under Medicare. Can you explain? “Vaccinations are included in preventive services, and so they are free and without a co-payment, even for those with private insurance. These vaccines are available at doctors’ offices, clinics, health centers, and drugstores. The goal is to make them easy and accessible.”
Is there a season in which pneumococcal pneumonia is more prevalent than others? “Not really—this disease is not weather-related. It is more related to the immune system of the patient. For some reason, African-Americans seem to be at a higher risk.”
Can an older person get more than one vaccination at a time, like a flu shot AND the pneumococcal pneumonia shot? “It varies according to the person, so it’s important to talk to your doctor. In general, the vaccinations probably can be given together if there aren’t other special conditions.”
What are the signs and symptoms of pneumococcal pneumonia? “Anybody can get this disease, even a very healthy person. Those over age 65 are at a greater risk. The symptoms include a sudden onset of high fever, shortness of breath, coughing, and chest pain. The average hospital stay is about five days and it can even cause death. Prevention is the key!”
For pneumococcal pneumonia, is there a live strain of the bacteria in the vaccination, or is it a synthetic form? “Most vaccinations today have an ‘attenuated’ form, which means they are live but not active. The goal is for your immune system to ‘think’ you have had the disease when you haven’t, so the antibodies are produced. There are different types and different brands of the vaccine. Your doctor can help decide which form of the vaccine is best for you.”
What are the best ways to keep from getting this disease? “Handwashing is the best preventive. You should also exercise, eat well, and live a healthy lifestyle. Pneumococcal pneumonia is spread by coughing and sneezing, or by touching surfaces where someone has coughed or sneezed. We can’t avoid people completely, so that is why the vaccine is so important.”
Dr. Benjamin, what was the most wonderful thing about your job as US Surgeon General? “My favorite thing was getting to meet people in their communities and talk about the prevention of disease and the promotion of good health.”

Resources:

www.knowpneumonia.com

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Welcome! My guest today is Jim Jenson, who is the owner of “Fit for Life,” an adaptive fitness business. He is a certified fitness instructor and the host of the podcast, “The Essential Boomer.” Jim is here to talk about the specific fitness needs for baby boomers.

Tell us about “Fit for Life” and what adaptive fitness is. I have been in business for about ten years, located 20 miles south of San Francisco. I work with special fitness issues like MS, wheelchair-bound clients, and balance issues. I usually travel in a 10-15 mile radius to visit clients in their homes to work with them. I love helping people improve their lifestyle and their health!
How are you certified to do what you do? I’m certified through the National Academy of Sports Medicine (NASM), with both basic and advanced certifications. Special training is essential to prevent injuries, so Baby Boomers need to make sure to work with someone trained in disabilities and chronic issues.
At this time of year, there are many offerings of “free memberships” in fitness programs. How can people get the most from this benefit? Always work with a trainer, and be sure they are certified for your needs and goals. You really need one-on-one training for success and injury prevention. Don’t be afraid to ask about their certification, and check with your primary doctor about beginning a fitness program.
What kinds of exercises do you teach those with special challenges? I am a big fan of resistance bands and I take them everywhere! They allow core exercises even while sitting and help with balance and stability. Recumbent bikes are great for cardio workouts. I even use foam swords for “sword fights” with wheelchair-bound clients! Check out my website for Predator Bands and a video about a total body workout with bands!
What are the primary causes of balance problems? De-conditioning is the biggest problem. This is due to the lack of use of the core muscles. Other causes include medication interaction, chronic conditions, and vision/hearing changes. Remember, a previous fall increases your chances for another fall!
What exercises can be done at home to reduce the risk of a fall? Strengthen your core muscles and practice your balance. Don’t be ashamed to use a cane or a walker for extra safety. You can even work with a certified trainer to improve your gait.
What about exercises to strengthen the core? There are many “mat work” exercises, and yoga that is geared toward seniors can increase core strength and flexibility. One of my very favorite resources is The Core Program: 15 Minutes a Day That Can Change Your Life, by Peggy Brill.
What other things can boomers do to maintain active lifestyles? For longevity, cardiovascular exercise is preferred. It’s GOOD to huff and puff and then let your body recover. For quality of life, resistance exercises (like bands) are a great option. Dancing is also wonderful for balance, stability, cardiovascular exercise, and FUN!
Do you take any insurance in your fitness business? No, there is no insurance that pays for personal trainers except on the rare occasion when it may be included in a workman’s comp claim.
Tell us about your podcast, The Essential Boomer. It is the Baby Boomer’s Survival Guide! It’s my passion and what feeds my soul. I started it in May, and it has grown. I interview knowledgeable guests to give information to Baby Boomers. The podcast is connected to a private Facebook group by the same name.

Resources:

The Core Program: 15 Minutes a Day That Can Change Your Life by Peggy Brill

www.essentialboomer.guide (Jim’s website)

jim@essentialboomer.guide (Jim’s email)

650-704-0377 (Jim’s phone number)

www.nasm.org or 800-460-6276 (Contact NASM for certified trainers in your area.)

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It's annual enrollment time and I know that the prescription drug coverage options can be confusing. So, today I wanted to try to clarify what you need to look for in the best drug coverage plan for you.

Original Medicare requires a stand alone plan for prescription drugs.

These plans are a pain, and that’s exactly why this episode exists.

Do not be loyal to any particular drug plan. You want the plan with the least out of pocket expense, and the ones that carry your drugs.
You will pay a monthly premium, either a lower ($16-18 to $30-35) premium and then a higher deductible. Or you can have a high premium (up to $180 monthly) and then almost no deductible.
Make sure your particular drugs are on the plan before you commit to any plan. This list is always changing and you have to double check it from year to year.

If you have several drugs, you could easily meet your deductible in the first month of the new year.

It is important to do the math and see what your overall out of pocket expenses are going to be.

Don’t assume that the generic drugs are always cheaper. Check your plan!

The Donut Hole:

Jan 1 you have $3310 to use towards prescriptions. This is a combination of copays and what the plan pays. Once you reach $3310 total, then everything else is in the donut hole.

So now, your cost of prescriptions will change. Once you reach $4850, you get out of the donut hole. After $4850, then you are now in the catastrophic phase of the plan. So you either pay the higher of 5% of the total price or the designated price for that prescription.

In 2020, the donut hole is eliminated, and then everyone will pay a flat 25% of the cost of the drug.

Silver Scripts - owned by CVS - it has a pretty good premium ($25.60 monthly in FL) and then you have no deductible. You just have to make sure your drugs are on the plane. silverscripts.com will tell you what the tiers are for the drugs and the monthly costs.

Always look at plans year to year and make sure you get the best plan for you.

If you have questions, you can reach out to me:

Call 855-855-7266

Twitter.com/medicarenation

themedicarenation.com

facebook.com/medicarenation

You always have an alternative as well, if none of this fits you. If you decide you made a mistake, you still can drop your plan in January and go back to Original Medicare and a stand alone plan. Listen to the episode and Diane will tell you what your options are.

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It’s that time of year! You have 5 days left to choose your Medicare plan for the coming year.

Did you choose the right plan?

If you are confused, this is the episode for you! I’m going to tell you exactly what you need to know to make the right choice.

3 Choices:

Original Medicare - Part A and Part B

Medicare Advantage

Medigap to Original Medicare

Medicare for 62 and older and it was never designed to be free,

Part A - Stay overnight

Part B - (Outpatient) Everything where you don’t stay overnight

annual deductibles

copayments

Medicare Advantage - networks, HMO and PPO healthcare providers.

HMO is smaller and PPO’s are larger and carry Medicare products in different states.

Supplement is a private insurance (F Plan) and it is expensive, but the coverage is comprehensive.

All will have the same basics of Original Medicare Plan.
Most of them include prescription drug coverage with co-pays
Some have premiums and some do not - you just have to research. I don’t recommend plans with a monthly premium.
Don’t get a plan with a deductible
Max out of pocket is $6400 for the year for Medicare - so look for the lower maximum out of pocket expenses. It is for the same coverage.
Don’t fall for the plans that give you a discount on over the counter items. It isn’t worth it.
No monthly premium
No drug deductible
Lowest maximum out of pocket expenses
Make sure your doctors are on the plan that you are choosing

There is no binding agreement that keeps Doctors in the network, so they may come and go.

If you have the plan with no monthly premium, no drug deductible and a low maximum deductible with $3000 or so, then that is a great plan!

If you are looking for supplemental plans, you need to realize that the benefits are standardized. The F Plan is the most comprehensive and it will go away in 2019. They are also eliminating the C Plan in 2019 as well. The C Plan just doesn’t cover excessive charges. The G Plan means you are responsible for your Part B premium and also for excessive charges.

Compare the prices for the F Plan under each insurance agency, because they will be different and then you need to know what the financial rating of that company is. AAA+ is the best rating and F is the worst.

You can find more information and keep in touch with us in the following places.

855-855-7266 - Call us and we will help you!

www.themedicarenation.com

facebook.com/medicarenation

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Welcome! My guest today is Dr. Jeffrey Berns, who is the president of the National Kidney Foundation. He is a professor of Medicine and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Dr. Burns is the Associate Chief of the Renal, Electrolyte, and Hypertension Division and the Director of the Nephrology Fellowship Training Program and the Associate Dean for Graduate Medical Education.

Dr. Berns addresses the following aspects of kidney disease and its risks:

What is the National Kidney Foundation (NKF), its mission, and your role? The central office is in NY, but there are offices around the country, each manned by a wonderful staff. Dr. Berns’ role is to talk about the NKF, kidney disease and be a spokesperson and advisor to the board. The mission of the NKF is to help those with chronic kidney disease (CKD) identify the diseases. About 80% of kidney function can actually be lost to CKD with no noticeable symptoms! The NKF also focuses on education about CKD, risk factors, and causes, and research to identify treatments and cures.
What are the most common risk factors for CKD? One out of three adults is at risk, and up to 10% may already have CKD but be unaware of it. The most common causes are high blood pressure and diabetes; these diseases cause over 60% of all CKD that requires dialysis or transplant. Family history is a risk factor, as well as minority ethnicity and being over age 60. The ethnicity risk is tied to some socioeconomic factors and some genetic markers that seem to predispose African-Americans to CKD. Kidney disease is an important disease and is under-recognized in the US.
For patients with hypertension or diabetes, what tests can be done to screen for kidney disease? The most common tests are a blood test called a Serum Creatinine Level to test kidney function and a urine test to detect protein in the urine. Simply assessing urine output is not an accurate indicator.
Are urinary tract infections (UTI’s) a determinant in CKD? These infections are not really a risk factor, but recurrent kidney stones and kidney infections may be precursors to CKD.
How would someone know if they have CKD? Blood and urine tests are the only way to detect the disease until symptoms advance to a very serious stage. Discolored urine and swelling of the feet and ankles may be symptoms. The blood and urine tests are most commonly done at the ER and doctors’ offices in conjunction with other exams and other issues.
What kinds of resources are available through the NKF? Visit their website at www.kidney.org. You will find information there about the prevention of kidney disease as well as information about kidney function, tests, organ donation, and transplantation. NKF Cares is the patient information Helpline, available in English and Spanish. The website also includes a Peer Support program for patients, information about insurance, and My Food Coach, which has nutritional guidelines.
How does Medicare coverage factor into CKD? Those over age 65 are already at higher risk for kidney disease, and Medicare is the primary payer for those patients. A co-pay of 20% is required unless you have co-insurance, and most services are covered under Medicare Part B. For people under 65, coverage is a little trickier. After 30 months, Medicare becomes the primary provider for those on dialysis, but the rules vary according to the type of dialysis that people require. Medicare coverage kicks in immediately for transplant patients, but only lasts three years. The NKF is working to change those coverage limits.
For kidney donors, are exact matches required? Kidneys are matched with compatible blood types. An identical sibling is an ideal match, but any living donor is preferred over a deceased donor. Family members, friends and co-workers can be donors.
How good is the function of only one kidney if you’ve become a donor? Potential donors are extensively screened to assure a very low risk for future kidney disease. There are small risks, as with any surgical procedure, but the remaining kidney will adapt and actually increase its function after the removal of one kidney.
What is the name of a kidney specialist? A kidney specialist is called a “nephrologist,” not to be confused with a urologist, who is a surgeon specializing in the urinary tract. A nephrologist has studied internal medicine and chosen to specialize in kidney diseases and treatments.
Visit the NKF website for more information about becoming a donor or a volunteer. You may also call 1-855-NKF-CARES.

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Welcome! My guest today is Rosemary Gibson, who is an author and renowned speaker and presenter on the subject of healthcare. Rosemary is currently the senior advisor at the Hastings Center, and the founding editor of Less is More narratives in JAMA internal medicine. In 2014, she was the recipient of the highest honor from the American Medical Writers Association in the field of medical communication. Her books include Medicare Meltdown: How Wall Street and Washington and Ruining Medicare and How to Fix it, The Battle over Healthcare, The Treatment Trap, and Wall of Silence.

Tell us what the Hastings Center is and what you do there.

The Hastings Center is a healthcare think tank that looks at ethical issues from the perspective of public interest. It’s a non-partisan, non-profit organization with whom I’m proud to be affiliated. We seek to inform the public on critical healthcare issues of the day. I do this work as a public service because we have the right to know!

Where are healthcare costs headed for beneficiaries?

Costs keep going up! The reason is that hospitals, doctors, and medical device companies can keep billing for whatever they want and as often as they want. There is no one to stop it! Their motto is “Bill, Baby, Bill!” Medicare is taking a larger and larger share of social security tax. Millions are facing a 50% increase in their Medicare Part B premium. Your Medicare card is the credit card for those doctors, hospitals, and medical device companies and you can’t do anything about it! When Medicare started, there were no healthcare companies on the Fortune 100 list, but now there are 15! The system is full of corruption that is off the charts!

What is the answer? How can we stop this?

You have to take charge of your health and not trust it to anyone else! Healthcare is something they want to SELL to all of us, and we cannot assume that they want the best for us. Rosemary calls our condition “The Marinated Mind,” because we’ve been marinated to believe that any procedure recommended by a doctor is ok. Baby boomers have been brainwashed to NEVER question what the doctor says. Rosemary teaches you her “exit strategy,” where you can respectfully decline a procedure, ask for more time to think about it, and discuss it with the doctor at a later date. Listen in for details! The truth has been hidden from us, but we need to become empowered to make our own decisions!

Find Rosemary Gibson’s books at www.rosemarygibson.org or www.amazon.com.

Medicare Nation listeners, you know I’m always reminding you that we each play a part in reducing Medicare fraud. We all have to do our part. Always examine your monthly summary statement for anything that looks suspicious. One more tip: It’s Medicare enrollment time, so STAY AWAY from the high-pressure seminars! Read the material and visit www.medicare.gov or www.samm.com for more information. Do your research or find the right advisor who has your best interests in mind. Thanks for listening!

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Welcome! My guests today are Catherine McMahon and Anna Howard. Catherine provides in-depth analysis for legislative and regulatory priorities for all levels of government and develops public policy principles for cancer prevention. Anna helps develop public policy principles in issues related to healthcare coverage for individuals with cancer. She is also the consumer representative for the National Association for Insurance Commissioners.

Catherine and Anna are here to help listeners understand the resources available for those diagnosed with cancer and for those whose loved ones have been diagnosed. People over 65 account for 65% of all new malignancies and about 70% of cancer deaths in the US. Listening to this podcast will help you understand how to use Medicare benefits in the best ways to prevent cancer.

What is the Cancer Action Network, and what does it do? The CAN is the nonprofit, advocacy affiliate of the American Cancer Society that supports legislative solutions to defeat cancer. One purpose is to give patients and their families a voice in government. There is a federal lobbying team in Washington, DC and staff in every state working on the local level. The CAN works to prevent cancer and to help patients find access to care. (The complete abbreviation is ACSCAN.)
Why are preventive services so important? Screening tests, counseling, and preventive medications work together to prevent illness before symptoms occur. 50% of cancers can be prevented with these services, including tobacco cessation screening, obesity screenings, and cancer screenings to detect early stage cancer. The ACS has made cancer prevention a top priority.
What is the function of the US Preventive Services Task Force? The USPSTF is an independent, voluntary panel of national experts in preventive medicine. Their clinical recommendations will become the appropriate insurance coverage for preventive services.
What preventive services does Medicare cover for cancer screenings? The USPSTF updates their recommendations periodically, but currently, an initial physical exam and annual physical exams are covered. Some of the screenings are a colorectal exam, lung cancer screening, breast and cervical cancer screening. To be eligible for the lung cancer screening, a patient must by 55-77 years old and be either currently smoking or have quit smoking in the last 15 years. They must have a “smoking history” such as a pack a day and have a written order from their doctor for the screening. A colonoscopy is another screening that is covered, but the problem occurs if the doctor removes polyps during the exam because that qualifies as surgery and will make the patient subject to out of pocket costs.
What legislation is currently being introduced to Congress? The ACSCAN is pushing for new laws to include removal of polyps in screening exams instead of calling it “surgery.” The bill is called “Removing Barriers to Colorectal Cancer Screening Act and is HR 1220 in the House and S624 in the Senate. Listeners are encouraged to call their members of Congress and urge them to co-sponsor and pass this legislation ASAP!
What choices are available to Medicare beneficiaries? Patients can choose Traditional Medicare, Parts A, B, or D, or they can choose a Private Plan Option called Medicare Advantage. Over 30% of Medicare users choose an Advantage plan.
What should you ask your doctor about screenings? First of all, take advantage of the annual wellness exam, but talk to your doctor about what’s going on with your heath and your medications.
Visit www.acscan.org for information, tips, and fact sheets. You can find volunteer opportunities at www.cancer.org or call 1-800-227-2345 to ask questions of the ACs 24/7. Check out these resources for the maximum use of your Medicare benefits!

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Welcome! My guest today is Dr. Steven Loomis, who is an optometrist in Colorado. He has been a member of the American Optometric Association Board of Trustees since 2007 and is the newly elected president of the AOA since 2015. He has served on numerous other professional boards and received many awards.

During this Medicare enrollment season, there are many questions about eyeglasses, hearing aids, and dental care, which are not part of regular Medicare benefits. You may be wondering what to do. Dr. Loomis is here to answer some relevant questions:

How did you decide to become an optometrist? “I had decided to be a pediatrician when I realized I might not want to be with children ALL DAY LONG. A friend suggested optometry, so I considered it.” Dr. Loomis has found the perfect niche over the past 30 years, and he is confident that he made the right decision.
Can you clarify the difference between optometrist and ophthalmologist? An optometrist treats most eye diseases and injuries to the eye, along with providing exams for glasses and contacts. Optometrists provide 70% of primary eye care to patients. An ophthalmologist is an eye surgeon who works closely with an optometrist to treat patients. They even sub-specialize in specific eye care fields.
Are most optometrists Medicare providers? Yes, all that I know of are. We have been full Medicare participants since 1986.
What will Medicare cover for vision care? Medicare will cover any eye disease or injury, inflammation, glaucoma, but does not cover routine well vision exams. Those diagnosed eye diseases have their regular exams covered to monitor their problems. Medicare Advantage Plans DO cover preventative eye care services, but you MUST know and understand your plan.
Can you explain diabetic retinopathy? The retina is sensory tissue in the back of your eye that transmits pictures to the brain. Diabetes attacks the tiny blood vessels in the eye, but a special photo must be taken to view the vessels. Diabetics and pre-diabetics must have yearly exams to monitor the condition.
Why should a Medicare Nation listener get an annual eye exam if they aren’t having a problem? The two leading causes of blindness are diabetic retinopathy and glaucoma. Glaucoma is a condition in which pressure inside the eye damages nerve fibers. Macular degeneration is another eye disease. These eye diseases are asymptomatic, which means that they can exist without initial symptoms until vision is severely affected.
How would a senior make the most of their Medicare dollars? They must understand their plan; participants in Parts A & B are eligible, but the amounts vary from state to state. Usually, patients have to pay about 20% of approved amounts. If they have met their deductibles, then now is a good time to get it done. For example, the Part B deductible is only $147, so must people have already met that by the time the 4th quarter rolls around.
How else can uncorrected eye problems or undiagnosed eye problems affect seniors’ quality of life? Most seniors want to maintain their vision for reading, watching TV, and other daily activities. Also, falls are a big problem that can devastate a senior, and a significant number of falls occur because of poor vision.

Links and Resources:

www.aoa.org

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Welcome to today’s episode, which covers Medicare fraud. The Medicare Strike Force and the Health Insurance Preventive Enforcement Action Team (HEAT) exist to stop fraud in its tracks. Do you think fraud is a widespread problem? Take a look at the statistics: in 2011, $15-60 billion was lost to Medicare fraud, and the Center for Medicare Services (CMS) predicts that $65 billion yearly is issued in error. Those are huge numbers! My guest today will help explain the ongoing efforts to stop the fraud!

Anne Frederickson works for one of the volunteer programs trying to help in the fight against fraud. Ann is a project manager in Ohio for the Senior Medicare Patrol at Pro-Seniors, which is a non-profit, long-term care and advocacy program in Cincinnati. Ann has been in this position since 2002, and has also worked in geriatrics and hospital administration for 30+ years. Ann hosts a weekly radio program, “Medicare Moment” on WMKV 89.3 FM.

Explain what Senior Medicare Patrol (SMP) is all about.

SMP volunteers help Medicare and Medicaid beneficiaries prevent, detect, and report potential fraud. Across the state of Ohio, there are 3 paid staff members and 50 trained volunteers. The SMP program exists in all 50 states and US territories.

Tell us about the background of the SMP program.

The program began in 1995 as part of Operation Restored Trust (ORT) in partnership with the Department of Health and Human Services and the Center for Medicare Services. The push to institute the program was spearheaded by two senators from Iowa.

What exactly do the volunteers in the SMP do?

Volunteers do outreach and group presentations, manage exhibits at health fairs and events, and help with one-on-one counseling. Their “bible” is a personal health care journal, which is a tool to record information from health care providers. Beneficiaries are encouraged to use the journal to keep track of their information. Nationwide, SMP volunteers have recovered $106 million for Medicare and Medicaid. They also seek to educate people to detect fraud and abuse.

What are some examples of the kinds of fraud SMP volunteers would find?

Billing for services and/or supplies never provided
Luring beneficiaries into providing Medicare numbers for free services, and then billing Medicare
Equipment or insurance plan providers tricking senior center participants into giving up their personal information

What advice can you give about fraudulent calls during this open enrollment time?

NO ONE calls a senior and asks for any information unless they are the agent of record that has already been dealing with the beneficiary. You can put your phone number on the DO NOT CALL list, which subjects callers to severe fines if they violate. Many states also have programs with access to free information. Call the SMP about anything that looks suspicious on your monthly summary notices. DO NOT ever be reluctant to call when you have questions. The Fraud Hotline is 866-357-6677.

How do listeners get involved and learn more about SMP?

The best way is to visit the website at www.smpresource.org. There is a drop-down menu for each state. Online training is available, along with group education training and one-on-one training.

Are people allowed to donate to the SMP?

YES! It’s best to contact your local group. All SMP’s are hosted by local non-profit community groups, a state agency, or local county agency.

Would you like to tell us briefly about your radio show?

The show is “Medicare Moment,” and airs on public radio. It features different guests who talk about health care topics, Medicare, Social Security, and other subjects for seniors and caregivers. The 15-minute show airs weekly on WMKV FM.

Resources:

www.stopmedicarefraud.gov

www.smpresource.org

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Welcome Medicare Nation! Today’s guest from the American Lung Association is Dr. Norman Edelman. Dr. Edelman has an years of experience that includes:

Norman H. Edelman, M.D. is Professor of Preventive Medicine, Internal Medicine, and Physiology and Biophysics at the State University of New York at Stony Brook. From 1996 - 2006, he served in a dual capacity as Vice President for Health Sciences and Dean of the School of Medicine at Stony Brook. A graduate of Brooklyn College, Dr. Edelman received his M.D. degree from New York University, where he was elected to the Alpha Omega Alpha honor medical society. He received postgraduate training at Bellevue Hospital in New York City and went on to be a Research Associate at the National Institutes of Health, National Heart Institute, and then Visiting Fellow in Medicine and Advanced Research Fellow of the American Heart Association, Cardiorespiratory Laboratory, Columbia University, College of Physicians and Surgeons, Presbyterian Hospital.

What is the American Lung Association?

It was founded originally to combat tuberculosis, and was quite successful in helping get it under control. Now it concerns it’s with all lung diseases, an advocate for clean air, and smoking cessation.

What are the benefits of quitting smoking?

Smoking is the leading preventable cause of death in the US, ahead of even obesity. Stopping smoking can improve your healthy at any age. Stopping the progression of the disease is important in order to prolong life.

Does Medicare cover Lung Cancer Screening?

Medicare recipients meeting certain criteria, Medicare will pay for a Lung Cancer Screening at no cost to you. To be eligible, you must meet the following criteria:

If you smoked at least 30 pack years (a pack a day for 30 years)
If you stopped less than 15 yrs ago
55-77 years old

This screening can reduce death from lung cancer by 20%, by detecting nodules in the lungs.

COPD and Emphysema - what’s the difference?

They are both cause primarily by smoking and air pollution. COPD is what used to be called chronic bronchitis. They now are combined under one diagnosis for ease.

How does one get oxygen for home use?

A physician would determine that you don’t have enough oxygen in your blood when at rest, and then prescribe supplemental oxygen. Physician would fill out a form that certifies this meets the Medicare criteria, and once this is done, oxygen would be provided at no charge.

What is Pulmonary Rehab and who needs it?

Teaching people how to breathe properly. Allows people to exercise and condition your heart and muscles so that they require less oxygen to function. This eases shortness of breath. If you have chronic lung disease, you should ask your Doctor if you would benefit from pulmonary rehab.

What types of breathing exercises can improve lung function?

The incentive spirometer can be a great exercise to increase oxygen capacity. Any form of cardio exercises will allow the lungs to improve.

Is there a correlation between early onset asthma and later stage COPD?

Asthma sufferers frequently progress into COPD. Asthma is a broad term and really can mean a lot of different things to a lot of different people. They can be different in biology and in our ability to treat them.

How important is an inhaler with these diseases?

They can be life saving. They are very effective for treating asthma and flare ups. The American Lung Association is concerned about the affordability of inhalers.

Who are the lung disease specialists?

Start with your primary care physician. They can then refer you to a Pulmonologist, who specializes in treating lung diseases.

What diseases does the American Lung Association help with?

Pulmonary fibrosis

Lung cancer

Infectious lung diseases

Allergic lung diseases

They also have a helpline and the number is on the website.

The website is a treasure trove of information - www.lung.org

Freedom from Smoking - Smoking Cessation program. Best treatment combines an accountability program, along with a pharmaceutical.

Got questions about Medicare Services for Lung Disease? Send them to support@medicarenation.com. We will address them in future episodes.

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Welcome Medicare Nation! Today’s discussion spells out the essential elements of Elder Law, and how the specialty is necessary for so many circumstances. That’s why I am talking to an expert in the field today, who can help us clarify some common misconceptions, and also point us to the right resources to make sure you and your family are protected.

My guest today is Andrew Brusky, who is an attorney who specializes in elder law, offering services designed to provide greater options and security for the elderly and disabled. Mr. Brusky regularly handles cases and is a frequent speaker on issues involving Medicaid eligibility, health care and financial powers of attorney, trust documents, as well as long-term care options for the elderly. Andrew has worked for Legal Assistance to the Elderly in San Francisco, California and as an intern with the Center for Public Representation in Madison, Wisconsin. Mr. Brusky received his Undergraduate degree in psychology and gerontology from Santa Clara University and his law degree from the University of Wisconsin Law School. He is a member of the Milwaukee and Wisconsin Bar Associations (State Bar Elder Law Section Board Member and Past Chair, founding member of the Milwaukee Bar Elder Law Section serving as its Past Chair), the National Academy of Elder Law Attorneys, past chair and board member for the Greater Milwaukee Interfaith Older Adult Program, and is currently a member of the Life Navigators trust committee in Wauwatosa. Andrew has been listed in The Best Lawyers in America in the specialty area of Elder Law and Wisconsin Super Lawyer.

What is Elder Law and the difference between estate planners, etc?

Elder law attorneys are looking at your estate, looking at what counts and what doesn’t. They determine what needs to be spent down, and what steps you need to take for estate recovery. There are also considerations for post-eligibility estate planning as well. There are so many nuances to the law for each specific situation, such as considering what happens if the healthy spouse passes prior to the nursing home spouse, so it really is imperative to have a specialist to make sure there are no surprises down the road. You want to leave yourself and your estate in the best situation possible in regards to taxation, etc.

What is Divestment and how is that associated with Elder Law?

It helps to think of it in terms of gifting, because you are not getting anything in return for the asset you transfer. It’s problematic because it can be a barrier to qualifying for Medicaid. Currently there is a 5 year period prior to eligibility that you cannot conduct these transactions. An elder law attorney will be able to do things on the front end to make sure you aren’t losing your option for Medicaid. There are many mitigating actions if this isn’t done correctly from the start, but it takes more time and money than if you did it the right way from the beginning.

Can Financial Powers of Attorney be helpful in the context of Elder Law?

Yes, many times the spouse who has all or part of ownership, isn’t able to administer it themselves, so someone else will need to do it for them. Many of the pitfalls can be alleviated with a well drafted Financial Power of Attorney.

Are there times when a court guardianship may be necessary?

In cases of abuse, this frequently happens. If there is mismanagement , there isn’t any family to handle the responsibility or even if there is a dispute about the existing Financial Powers. It is always a last resort when there are problems with the administration of the directives.

Can having all the documentation in place ahead of time avoid Probate court?

Yes, and no, but while you are already putting steps into place, there is no harm in putting probate avoidance tactics into place. Good advanced directives and financial power of attorney documents can go a long way in avoiding probation.

Will Medicare cover Long Term Care?

Medicare was not designed for long term care. It is rehabilitative, and designed to help short term with injury or illness. It doesn’t have the funds to pay for it ether. The chronic issues that require custodial care are generally not going to be covered by Medicare. Lawyers, discharge planners, and geriatric case managers can all be helpful in navigating these complex issues. If you need monitoring of the care provided, these case managers can be extremely helpful. It’s as if they are your eyes and ears on the ground, when you can’t always be present to intercede for your loved one.

You can pay your relatives to provide care for you. Many times it has to be structured and done at fair market value, but there is no reason not to utilize it. You cannot give away money to your children, but you can pay for them to take care of your, without ruining your eligibility.

What does the future of Elder Care look like?

Baby boomers are just now starting to retire. Government is trying to get out of the business of providing long term care. So, there are lots of changes on the horizon. As more people become eligible, it may bring down the cost of providing care. It’s important to have funds available to get yourself into an institution, if necessary. Families are becoming more fractured and living in different locations, so more than ever we will be dependent on these types of programs. The spectrum continues to swing back and forth between, people needing help and private planning for the financial burdens associated with these services.

Resources:

You can reach Andrew at apb@bruskylaw.com

NAELA - National Association of Elder Law Attorneys

lawyers.com - referrals

Local bar association can provide referrals

Alzheimers Associations will have referral lists

Consult neighbors and friends for referrals

Andrew speaks and the NAELA chapters and the Local Bar Association in the Milwaukee area.

Got questions about elder law? Send them to support@medicarenation.com. We will address them in future episodes.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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Welcome Medicare Nation! Today’s guest is Melissa Joy Dobbins, a nationally recognized Dietician with more than 20 years of experience dealing with the nutritional needs of not just Seniors, but people with special dietary needs like diabetes. Melissa will show us how to eat healthy on a fixed income, and the things we can to do use food to help improve our overall health!

Family members and the senior need to feel like you are in control of your own choices. This means you need to take an active role in making great food choices, and feel empowered to make good decisions for yourself.
It’s important for adult children to not be afraid to be a backseat driver for your elderly parent. Intervene when needed, but involve them in as many decisions about their nutrition as possible.

How to eat healthy on a fixed income:

myplate.gov will give you a ton of information.
Fruits and vegetables don’t have to be fresh to provide good nutrition
Eggs are a healthy and affordable addition to the diet, and even though the price has increased recently, they are still cheaper than meat.
Utilize all the healthcare team members you can, in order to make a great nutrition plan for your aging parent. So consult a dietician to help navigate some of these special needs.
The importance of a diabetes educator cannot be understated. Preventative services like these are covered under Medicare Part B, since the Affordable Care Act in 2007. medicare.gov/partb and then go to free preventative services.

Regarding Type II Diabetes:

There are some simple, targeted things you can do that will result in better blood sugar control.
If it is caught early enough, there may be changes you can make that can help to keep you off medication.
Diabetes is a progressive disease, so even once you get your symptoms under control, you may eventually have to increase the prescription therapy to keep it under control.
You can control your blood sugars, much like you can control high blood pressure, through a combination of medication, diet, and exercise. Just because you need one or all of these, does not mean you have failed.

Anytime you have a progressive disease, like diabetes, your treatment plan will constantly change in order to maintain acceptable blood sugar levels. Even if you are doing everything right through diet and exercise, medicine may eventually become necessary because of the progressive nature of the disease, not because you have failed. So it is important to continue to have good nutritional habits even when you get on medication, so that you can control the symptoms.

Melissa has a podcast called Sound Bites, where she delves into the science behind smart nutrition, and also deals with the psychology behind emotional eating, and food triggers. She gives you strategies to help you actually implement all of the sound nutritional advice.

Resources:

www.soundbitesrd.com - Melissa’s podcast and blog with lots of resources

www.americandiabetesassociation.com - American Diabetes Association

www.diabeteseducator.org - American Association of Diabetes Educators

www.myplate.gov - A great resource for simple, affordable, nutritious meal plans

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

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Welcome Medicare Nation! We have a very distinguished guest with us today - Congressman Alan Grayson from the 9th Congressional District in Orlando, FL. Congressman Grayson is here to talk about the bill he recently introduced in Congress, HR3308: Seniors Have Eyes, Ears and Teeth too!

Congressman Grayson lost his Father in 2000, and in the last years of his life, he had a broken front tooth. This is when Congressman Grayson realized that Medicare arbitrarily excludes certain items for Seniors that are very important for their quality of life. After he researched the Medicare details, he realized there were 2 sentences in the legislation that stated, “No care for Eyes and Ears”, and “No care for Teeth” for Seniors.

To rectify this situation, Congressman Grayson introduced a simple bill that just strikes those 2 exceptions from the statute. He feels this is a common sense solution to a problem that affects so many Seniors.

Treating problems with eyes and teeth, can actually be a preventative measure to mitigate much more serious issues like heart disease and blindness, the treatment of which would require a much higher reimbursement from Medicare. Congressman Grayson felt there needs to be a common sense solution to dealing with these normal issues of the ears, eyes and teeth, which are a natural part of aging.

Why has care for eyes, ears and teeth been excluded from Medicare from its inception?

The government is cheap and looks for any way to cut costs. It is indefensible and nothing more than broken promises, for the sake of saving a few bucks. Only circumstances with a medical illness or injury to these body parts would be covered by Medicare, but basic care for routine examinations are not covered.

What would be covered if this bill passes?

Annual eye exams
Basic corrective glasses
Annual hearing test
Basic hearing aid
Basic dental care

The goal is to catch problems while they are small, before they become a bigger problem, and thus a bigger expense for Medicare.

What are the chances of it passing?

We have 76 co-sponsors for this bill, within 2 days of introducing it. I think Congress members overwhelmingly understand that this is something that needs to be provided. Realistically, it will probably not make it for a vote this round. However, many times issues like this have to be brought up again and again, before we can make a difference.

Congressman Alan Grayson is running for Senate on the platform that “Seniors Deserve A Raise!” He realizes that Seniors have been cheated far too long. From the promises that have not been kept, to the double taxation on Social Security, he realizes that it is time to take a stand and treat Seniors with fairness and dignity.

Resources from the show

HR3308 Seniors Have Eyes Ears and Teeth Bill

https://www.congress.gov/bill/114th-congress/house-bill/3308/text

Alan Grayson introduces to Congress- Seniors have Eyes, Ears and Teeth Bill Video

https://youtu.be/myq6y3HFNb4

Congressman Alan Grayson Website

http://grayson.house.gov/

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

www.CallSamm.com

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Hospice and End of Life Resources for Palliative Care

Welcome Medicare Nation! Today we continue with Part 2 of our Death Series, as we talk about end of life resources that Hospice provides. Most people are familiar with Hospice and the services they provide, but I wanted us to take a closer look at Hospice as it relates to Medicare. Hospice provides several different levels of care, but the focus of our conversation today is routine care and respite care.

My guest for today is Judy Lund Person. Judy is with the National Hospice and Palliative Care Association. She has worked in the national office since 2002 and is considered an expert in Compliance and Regulatory Leadership for Palliative Care.

We discuss some very important aspects of Hospice care and Medicare, so for more details on each of these questions below, please listen to the full episode here.

Who qualifies for Hospice services?

Hospice is for patients who have a life expectancy of 6 months or less. Hospice is covered under Part A of Medicare. The key is that the person would be nearing the end of their life, regardless of their age. In Judy’s experience, she has seen patients from 2 days old to 100 years old.

Routine Care:

When should hospice be called in?

Many families feel that hospice should have been called in sooner. Judy encourages you to have a conversation with the physician and begin asking when hospice services should begin. Many times they see patients in the 3-6 months prior to their end of life.

Where can hospice provide care?

95% of the care they provide is in a patient’s home, or where they call home. Hospice does have facilities, but the majority of their patients are in their own homes.

What kinds of services are provided?

Nurse - initial assessment is done
Social Worker
Chaplain
Aide
Therapy including art or other
Hospice Physician who consults with the attending Physician
Patient chooses who they want to be their attending physician, and do as much or as little as the patient wants.

It is very much a team approach to providing services.

How does Medicare work with Hospice?

Medicare covers hospice at 100% under Part A. Medications may need to be paid for out of pocket if hospice doesn’t feel a medication is necessary. Hospice benefits are paid on a daily rate, so it does not matter the amount of services that are provided on a single day, because the rate is the same.

The Hospice team provides intermittent visits, depending on the need. Each patient has an individual care plan.

Medicare pays for two 90 day periods and then there is an extension of 30 days. Physicians can re-certify the patient for coverage to continue. Many patients have hospice for much longer, depending on their need. Length of coverage is on a case by case basis. If you are beyond the score of time set forth, all that needs to be done is for your Physician to re-certify that Hospice service is still needed and it will continue to be provided. There is no need to worry that you will be cut off from services if you outlive the timeframes set forth in the coverage plan.

Respite Care

What is respite care?

If you have a short term period where you as a care provider need a break, hospice will provide respite care in a facility, while the family and caregivers get a break. This service is covered under Medicare Part A. This is different than routine care, but it is still a covered level of care.

Hospice care is considered palliative care, for the comfort of the patient, not to provide a cure for the disease.

Palliative care is comfort care. Maybe it is pain, shortness of breath or other conditions that are difficult to tolerate. Hospice specializes in pain management and pain control, while still keeping the patient alert. They also deal with anxiety and depression that can go along with the terminal condition.

Hospice can help with any sort of distressing symptoms. However, if another issue arises that is unrelated to the hospice issue, the hospice nurse and the care team will consult and determine who can provide treatment and care.

In the last year hospice saw 1.6 million patients. You do not have to have a reimbursement resource to get Hospice care. Most insurance covers hospice care, and if you don’t have coverage, you can still get Hospice care that is un-reimbursed.

Lauren Hill at 19 years old, was a great example of hospice care. She received hospice services, even though all she wanted to do was play basketball with her college. So, she was able to play one basketball game, and be an inspiration for her team, her family and everyone that heard her story. She was able to raise more than 1 million dollars for cancer research because she used this battle as a way to help the cause.

Where can you find out more about hospice?

www.caringinfo.org has lots of information about hospice, terminal illness and support for families.

You can find inspirational stories at www.momentsoflife.org. Lauren’s story is here and many others that will inspire you. You can also memorialize your loved one and their struggle on this website.

Call 1-800-658-8898 if you need information and want to talk to someone in person. This is a toll free number from anywhere in the US.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

Find out more information about Medicare on Diane Daniel’s website!

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