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Medicare Nation

How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you about all the things you want to know about Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.callsamm.com Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: 2015
Dec 25, 2015

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.

 

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

 
Dec 19, 2015

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

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

 
Dec 11, 2015

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.)

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

 

 

Dec 5, 2015

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.

 

  1. 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.
  2. 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.

3.  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. 

 

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

 

 

Dec 5, 2015

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

 

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

 

Nov 27, 2015

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.

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

 

Nov 19, 2015

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!

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!

 

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

 

Nov 12, 2015

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!

 

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

 

Nov 5, 2015

 

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

 

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

 

Oct 29, 2015

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

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  

 

 

 

 

Oct 22, 2015

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.

 

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

 

Oct 15, 2015

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!

 www.CallSamm.com  

 

 

 

 

 

 

 

Oct 8, 2015

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!

  

1.  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.

 

2.  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:

 

  1. myplate.gov will give you a ton of information.
  2. Fruits and vegetables don’t have to be fresh to provide good nutrition
  3. Eggs are a healthy and affordable addition to the diet, and even though the price has increased recently, they are still cheaper than meat.
  4. 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.  
  5. 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)    

Find out more information about Medicare on Diane Daniel’s website!

 www.CallSamm.com  

 

Oct 1, 2015

 

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  

 

Sep 17, 2015

 

Welcome Medicare Nation!  Today my guest is Dr. Fernando Mirarchi, who is the Medical Director of the University of Pittsburgh Medical Center.  He is the  principal investigator of the TRIAD report.  His research has led to a spiral report that presents the confusion and risk around Living Wills and DNR orders.  Dr. Mirachi has written a book and several articles about this topic.  

 

Dr. Mirarchi practices Emergency Medicine, but he is also the Chairman of the Medical Ethics Committee, so he has a special insight into end of life care and the breakdown around it.

 

Having confusion around a Living Will and DNR is a real possibility to the general public and it is a reality that many will be dealing with in the future.  

 

What is a Living Will?

 

A way for a patient to document, in writing, their wishes for their end of life care.  The problem with this definition is, in medicine, everything can be terminal, if not properly treated.  The difference between an Effective and an Enacted Document are also misperceived as to when a document becomes enacted.  “The Living Will” will not prevent care from being provided, in order to save your life.

 

What is a DNR (Do Not Resuscitate)?

 

A document that says that medical providers will not administer CPR, in the event that you are found not breathing and with no pulse.  The name of the document causes confusion, because people think it means you aren’t going to get treatment for a medical condition.  In legal terms, it only means the CPR will not be administered if you are found without a pulse and not breathing.  In order to refuse all types of care if you are critically ill, then you would have to sign a document indicating you don’t want any care administered. Period.

 

What is a POLST Order?

 

This is enacted when you would be in cardiac arrest, and a Provider would have to use this document to immediately chart the treatment for the cardiac arrest.  There are multiple options and this can also cause some confusion as to when it can supersede a DNR.  This process can also cause conflicts because it is a metric by which insurance companies are rewarding Providers financially.  

 

What caused you to do the TRIAD (The Realistic Interpretation of Advanced Directives) Studies?

 

Dr. Mirarchi had a situation first hand, where he was being faced with paperwork that was being misinterpreted, and almost caused him not to save a life.  Luckily, another Physician was around nearby, who understood what the paperwork meant and intervened for a good outcome for the patient.  This and a few other circumstances caused him to write the book, Understanding Your Living Will. (available on Amazon and Atticus Books)

 

 

One of the criticisms of the book was that there was no research backing up the claims in the book.  This thought was what led Dr. Mirarchi to start the TRIAD Studies.  

 

Dr. Mirachi views these decisions as a Patient Safety issue, rather than an end of life decision.

 

He created a checklist to help facilitate the conversation about these decisions from a Medical perspective and also from the patient perspective.  There is a checklist of the Medical Provider and also for the lay person.  Each checklist provides the ABCD for each role.

 

A - Announcing your end of life documents

B - Be clear with regard to treatment with regard to the document.                 

      Understanding whether the issues are terminal or chronic illnesses.

C - Communicate and coordinate with family members.

D - Discussing the next steps and designing the plan for the patient. 

 

You can download the checklist and cut it out and place it in your wallet (link)

 

There is a company called My Directives, which has digitized all of the end of life paperwork, so you can carry the paperwork with you at all times.

 

The checklist for the lay person basically spells out the same information, but in terms that anyone can understand.  

 

The aging population is being unintentionally targeted in an effort to control healthcare costs, so it is important that every patient understand their options and having the ability to make it a two-sided conversation.

 

Resources discussed in the show:

 

National Patient Safety Article

 

http://www.npsf.org/blogpost/1158873/200782/A-New-Nationwide-Patient-Safety-Concern-Related-to-Living-Wills-DNR-Orders-and-POLST-Like-Documents

 

 

Dr. F. Mirarchi’s book

 

“Understanding Your Living Will: What you need to know Before an Emergency”

http://goo.gl/WAv9Bc

 

Advanced Care Directives

https://mydirectives.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  

 

 

 

Sep 17, 2015

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!

 

www.CallSamm.com 

 

 

 

Sep 9, 2015

Welcome Medicare Nation!  I have to tell you that today’s show is packed with tons of great information.  The topic of today's show is making end of life decisions and having an advanced care plan for yourself.

 

Today’s guest is Dr. Stanley Terman (founder of Caring Advocates for Advanced Care Planning),a board certified Psychiatrist in Carlsbad, CA, and a published author on today’s topic.  Dr. Terman has spent the last 15 years focused on reducing the pain of terminally ill patients.

 

People’s greatest fear is losing control and it means that other people have to make decisions for you.  It becomes difficult for people to be in a situation where they have to make decisions about your life, based on your wishes, not on your finances.  This instills much fear within all of us as we are aging.

 

Advanced care planning has been painted as “death panels”in the media and has fostered the idea that decisions about your care will be made with bias.  If you learn what your choices are now, you can plan and then not have to worry about it later in life.  There is a freedom that comes when you have made these decisions for yourself, and it allows you to continue enjoying your life.  

 

The majority of people in certain groups do not prepare enough for advance care directives:

  1. Religious people 
  2. African Americans

 

Living Wills tend to be more controversial, we understand that some are reluctant to adopt them.  Doctor Terman created a Natural Dying Living Will, which is an extremely flexible document.

 

You are required to fill out a form of this nature in order to document your wishes.  You don’t need to consult an attorney and you don’t need to spend any money.  You can fill out a living will for free.  The Natural Dying Living Will isn’t free, but it gives you  many options and it is flexible.  The document needs to be strong enough to compel Physicians to follow your specific wishes.  The Natural Dying Living Will accomplishes  this with several layers of protections built in, and it has proven effective to get the attention of the physician.  Once you have filled out all of the paper work,  Dr. Terman recommends making a video where you summarize your wishes in a video directive.

 

**You need a Durable Power of Attorney in order to give someone the authority to make the Physicians follow your Living Will.

 

This will ensure you have the 4 P’s

 

1.  Peaceful

2.  Prompt

3.  Private

4.  Passing

 

Caring Advocates provides a laminated business card with a scannable bar code.  When scanned, it immediately pops up the video of your final wishes, and the necessary documents for your living will.  There’s concern about finding documents or getting documents out of safe keeping, in order to submit them to the Doctor

 

When attending a counseling appointment with a Doctor, bring your end of life documents with you to the session. Then your session becomes getting your Doctor’s opinion on the decisions you have made.  Some services like Palliative Sedation are choices you may make, but a Doctor might not support it.  Better to find this out ahead of time.  Having a discussion about this type of treatment and even Respite Sedation are beneficial.  You need to give your Doctor the tools to help sustain life, and these tools can accomplish that.

 

Once you have this paperwork taken care of, including the Durable Power of Attorney, there are clauses that would allow for the changing of Physicians and even for changing the treatment plan.  So this way of handling your paperwork is comprehensive and it can last through the ages, and the changes that can occur.  

 

Plan now, to die later, to live longer.

 

 

You don’t want to miss Doctor Terman’s offer to assess your existing Living Will for the 3 main scenarios that will likely cause your death.  It’s an unbeatable offer!  Listen to the show for all the details!

 

 

Resources Mentioned in the show:

 

www.caringadvocates.org

 

The Natural Dying Living Will

 

Doctor Terman’s Books:

 

  1. A Lethal Choice - The Best Way To Say Goodbye
  2. Peaceful Transitions - An Ironclad Strategy to Die When and How You Want
  3. Peaceful Transitions - Plan Now, Die Later
  4. My Way Cards - Natural Dying Living Will Cards

 

 

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 

 

 

 

Sep 3, 2015

In this week’s episode of Medicare Nation, Diane Daniels interviews Max Richtman, the president of the National Committee to Preserve Social Security and Medicare (NCPSSM). In this episode, Diane and Max discuss Medicare’s 50th anniversary, the role of the NCPSSM, the Supreme Court’s challenge to the Affordable Care Act and HR 3308 - Seniors Have Eyes, Ears, and Teeth Bill.  

Main Questions Asked:

  • Tell us what the National Committee to Preserve Social Security and Medicare does?
  • How do you view the importance of the Supreme Court’s challenge to the Affordable Care Act and Medicare’s 50th anniversary?
  • What is your take on Medicare’s financial condition?
  • How can we balance the two schools of political thought when it comes to Medicare?

Key Lessons Learned:

  • 55 million people depend on Medicare for their healthcare.
  • Billions of dollars are lost each year to fraud, healthcare’s rising costs, and increasing numbers of Americans retiring from the workforce.

NCPSSM

  • Former Congressman James Roosevelt, who was the eldest son of FDR, founded The National Committee.
  • The NCPSSM is dedicated to protecting the Social Security and Medicare programs and is the second largest senior citizen lobbying association in the USA, with about 3.5 million members and supporters.
  • The recent focus has been to improve, enhance, and expand the Social Security and Medicare programs.

Supreme Court’s Challenge to the Affordable Care Act

  • $716 billion was saved out of the Medicare program and the Affordable Care Act.
  • These savings came from reducing payments to providers such as Medicare advantage programs and reimbursements to hospitals.
  • Under the Affordable Care Act, Medicare beneficiaries enjoy preventative care with no out-of-pocket costs. This includes cancer screenings, colonoscopies, mammograms, and diabetes testing.
  • The Medicare program is now solvent until the year 2030.

Medicare’s Financial Condition

  • In light of the Obamacare program, the solvency of the Medicare program was expanded for an additional 13 years.
  • As the Affordable Care Act takes hold and reduces health care costs, it will have an impact on Medicare as well.
  • Max is looking forward to additional years being added to the program by virtue of the restraint on costs that will be received due to the Affordable Care Act.
  • Besides reducing reimbursement rates to providers, it has changed the focus on healthcare payments to be tied to value and not volume.
  • Doctors and their staff have to be current and understand what is needed to reduce cost as so much money is depleted through fraud, waste, and abuse.

Diane’s Advice

  • Look at your Medicare statement every month to ensure it is correct with regards to providers and procedures.
  • If you notice a discrepancy, then call your Medicare Plan immediately and report it.
  • Remember, the patient can play the largest role in finding discrepancies and overcharges. This has a significant impact in reducing waste and fraud.

Politics and Medicare

  • There is a significant divide among politicians in how Medicare should function in the future.
  • We hear from the campaign trail that it is fiscally responsible to reform Medicare, but we also hear expansion of Medicare is the best option.
  • We need to ask ‘what does reform mean?’ To some, ‘reform’ is another’s idea of ending the Medicare program.
  • The reason we have a Medicare program in the first place is because insurers didn’t want to insure seniors as it was deemed too expensive.
  • The value of a voucher will not keep up with the increased cost and inflation in healthcare. It will become less valuable over time and less able to provide coverage.
  • Using vouchers is a way to rescind Medicare law and go back to a time when people were on their own and a lot more seniors were living in poverty.

HR 3308 Seniors Have Eyes, Ears, and Teeth Act

  • Congressman Alan Grayson from Florida recently introduced the Eyes, Ears, and Teeth bill.
  • The NCPSSM wrote a letter endorsing the bill that will, for the first time, add coverage under Medicare for vision, hearing, and dental.

Medicare and Hearing

  • One third of people in the 65–74 age group experience hearing loss.
  • Half of people over the age of 75 have hearing loss issues.
  • Congresswoman Debbie Dingle introduced The Medicare Hearing Aid Coverage Act of 2015 that will take a portion of that coverage and add Medicare coverage for hearing testing and hearing aids
  • There is a lot of opposition from the medical industry as providers don’t want to deal with the Medicare regulations even though there would be a massive increase in volume.
  • Dr. Franklin Lin from Johns Hopkins has developed groundbreaking research that makes a link between hearing loss and dementia and Alzheimer’s.
  • Having Medicare cover hearing loss and come up with the financial resources to provide that coverage would pale in comparison to the cost of treating Alzheimer’s patients.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

www.CallSamm.com

Episode Resources

NCPSSM

1–800–966–1935

Congressman Allan Grayson presents to the House of Representatives

HR 3308 – Seniors Have Eyes, Ears and Teeth Bill

Congresswoman Debbie Dingell presents to the House of Representatives

HR 1653 - The Medicare Hearing Aid Coverage Act of 2015

Medicare

Federal Trade Commission

Click To Tweet - Spread the news!

Are you aware of The Eyes, Ears and Teeth Bill? Find out what it means for you. @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

What is Medicare’s current financial condition? Find out w/ @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

Aug 27, 2015

Summary:

In this week’s episode of Medicare Nation, Diane Daniels interviews Curtis Bailey, who is a practicing Elder Law attorney in the St. Louis, Missouri area. Curtis is also the co-director of the Senior Scam Action Associates and co-host of the ScammerCast Podcast.During this episode, Diane talks with Curtis about one of her biggest pet peeves: people taking advantage of seniors. If you know someone who has fallen victim to a phone scam, Facebook scam, or had his or her identity stolen, then this episode is a must-listen!

Main Questions Asked:

  • How did you get so involved in helping the elderly with scams?
  • Tell us about Senior Scam Action Associates.
  • What are the most common types of scams?
  • What happens if someone realizes they have been scammed and their personal information has been stolen?
  • What are the credit bureau companies a person can contact?
  • What are signs of a scam?
  • How do we know what is a legitimate email?
  • Tell us about your podcast, ScammerCast.

Key Lessons Learned:

  • Scams come in all forms:
  1. Phone scams
  2. E-mail scams
  3. Facebook friend requests
  4. Physical, “in person” scams
  • Senior Scam Action Associates helps seniors, caregivers, and professionals who work with seniors learn how to recognize and prevent scams and fraud.

Common Types of Medicare Scams

  • Unsolicited telephone call from someone claiming to be a Medicare sales representative.
  • A physical scam whereby an alleged ‘official’ agent knocks on the senior’s door.
  • A true Medicare representative will never show up at your door. They will never ask you for money or personal information.
  • Check Medicare statements each month and look at itemized details for each doctor visit and different types of tests and procedures. If you find a discrepancy, contact your insurance carrier or contact Medicare directly as it could be fraud or abuse.

If A Senior Has Been Scammed

  • Report any scams to the authorities such as local law enforcement and the Federal Trade Commission (FTC).
  • If personal identifying information has been given out, check your credit report immediately.
  • Contact any corresponding banks and financial institutions to report your identity theft.

Credit Bureau Companies

  • The three main credit-checking bureaus are Experian, TransUnion, and Equifax.
  • If a consumer contacts one bureau, the other two must be notified about any possible breeches.
  • Even if you haven’t fallen victim to a scam, it’s a good idea to get a free annual credit report.
  • Curtis recommends requesting a free credit report every 4-months. Ex: Request one free credit report from Equifax in January, then Experian in May and finally Trans Union in September.
  • Credit reports are free, but each company is allowed to charge for additional requests such as a credit score.

Giveaways of a Scam

  1. The contact will always be unsolicited.
  2. There will always be urgency involved, and they prey on fear, greed, and anger.
  3. They will ask for personal identifying information.

Tips to Avoid Scams

  • If you are unsure whether an email is a scam, then make it a rule to not click on a link.
  • If you are getting requests that look official but are unsure, follow up through official avenues such as visiting or calling the bank direct.
  • Be aware of friend requests on Facebook from people you haven’t had contact with for a long time.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

For more information about Medicare, go to Diane Daniels website    www.callsamm.com

Links to Resources Mentioned

Senior Scam Action Associates

ScammerCast Podcast

Huffman Law Offices

Scammed: 3 Steps to Help Your Elder Parents and Yourself

Annual Credit Report

Medicare Website www.Medicare.gov

Federal Trade Commission www.ftc.gov

Equifax  www.equifax.com

Experian  www.experian.com

Trans Union www.transunion.com

 

Aug 16, 2015

I like to call Medicare Part A “The Accommo- dations” part of Medicare.

If you went on vacation and stayed at your brother’s house in Miami for one week, your brother’s house would be your“accommodations.”  Staying overnight at your brother’s house would also provide you with necessary services –

  1. Bathing
  2. Using the toilet
  3. Eating meals
  4. OTC Medications you may need
  5. A bed to sleep in

Medicare Part A provides similar services – and more, while staying overnight at a

  1. Hospital
  2. Hospice
  3. Skilled Nursing Facility

Medicare Part A has a deductible when you are an inpatient in the hospital. Each year the deductible may change. In the episode, the deductible was $1,216.00. Currently, the deductible is $1,260.00. Starting in 2016, it may change again.

In this episode, you will also learn:

  1. How to qualify for Medicare Part A
  2. If you don’t qualify how to “Buy-In” to Medicare Part A

You will also learn:

  1. The Services covered under Part A
  2. A helpful phrase to help you remember Part A Services

Links mentioned:      www.medicare.gov       www.callsamm.com

Aug 16, 2015

JFK wanted a national healthcare system for our older citizens. He even appeared on national TV to promote the campaign in 1962. I’m certain JFK would have seen his legacy if he hadn’t been brutally assassinated.

When VP Lyndon B. Johnson took over as President, he continued the work JFK started, and on July 30, 1965, Medicare became the law of the land.

Many changes have been made to Medicare over the last 50 years. And today, it’s still “a work in progress.”

Items Mentioned in this podcast

Part A of Medicare

Part B of Medicare

In this episode you will learn:

  1. What is Part A of Medicare
  2. What is Part B of Medicare

Links mentioned

  1. The official Medicare website – medicare.gov
  2. Senior Advisors For Medicare & Medicaid – callsamm.com

Let’s keep up the discussion on Twitter. Follow us @MedicareNation

Visit us on Facebook and tell us what you think – www.facebook.com/MedicareNation

Want to hear a particular guest on Medicare Nation? Let us know on our website

www.TheMedicareNation.com

Aug 16, 2015

This is Medicare Nation. The go-to-resource for your Medicare education.

The problem with Medicare, is there is an overwhelming amount of information and not enough resources to help educate you about Medicare and your benefits.

We solve that problem. Each episode will have a wealth of education about Medicare.

We will take a look at the history of Medicare, the components of Medicare and Medicare benefits. I will also interview guests who are experts in the health and wellness field, who will discuss Medicare related topics on illnesses, nutrition, diseases and injuries. I will update you on changes in Medicare benefits and legislature that is in the news.

Join me as I discuss:

  1. How I solved the Medicare problem
  2. Why I’m so passionate about Medicare

Mentioned Links:

  1. The Medicare Survival Guide –  http://goo.gl/TfLICa
  2. The Official Medicare website – medicare.gov
  3. Senior Advisors For Medicare & Medicaid – callsamm.com

Talk about this episode on Twitter:  @MedicareNation

Visit us on Facebook – www.facebook.com/MedicareNation

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