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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.callsamm.com Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: December, 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

 

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