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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 on all things 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.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: October, 2015
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  

 

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