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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: August, 2016
Aug 27, 2016

How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary.

MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary.

Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions.

If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period.

You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016.

Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016.

Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area.

How do you compare plans to find the right one for you or your loved one?

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

  1. You’ll see a Dark Blue Bar under Medicare.gov
  2. Hover your cursor over the tab that reads “Drug Coverage.”
  3. Click on the last item in the column labeled “Find Health & Drug Plans.”
  4. Add your zip code & click on “Find Plans.”
  5. Check the box that pertains to you.                                                 Original Medicare?                                                                           Health Plan (MAPD)?
  6. Check the box that pertains to you in regards to assistance.                     Do you receive extra help?                                                                      I Don’t Know?
  7. Click “Continue.”
  8. Now enter your drugs. All of them.

When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.”

If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later.

  1. Select “My Drug List is Complete.”
  2. You’ll see on the right side a grayish box that has a Prescription ID#   Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver!
  1. Now select a pharmacy you use.
  2. Then select “Continue to plan results”
  3. On this page, you’ll see a summary of your search.
  4. Select the box that pertains to your plan.                                           Either Prescription Drug Plan with Original Medicare or                         Health Plan with Prescription Drug Plan (MAPD).

All the drug plans in your geographical area available to you will be displayed.

Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.

You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.

      You have several options.

With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.

 Start getting your list together, so it will be easier for you to check out 2017 plans!

 

Do you have questions or feedback? I’d love to hear it!

I may answer one of your questions on the air!

email me:

support@themedicarenation.com       

Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me!

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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

 

Aug 19, 2016

Welcome Medicare Nation!

I just had my annual eye exam and what a surprise I got! 

I was diagnosed with Narrow Angle Glaucoma! 

How could I be diagnosed with Glaucoma being just 54 years old?   Not only was I diagnosed, but I had to have immediate laser surgery to correct it. I don't want any of you to be diagnosed with Narrow Angle Glaucoma, so I'm going to discuss glaucoma with you to help you understand this disease.

There are several types of glaucoma. The two main types I will be discussing today are open-angle and narrow angle glaucoma. These types of glaucoma are marked by an increase of pressure inside the eye.

 

Open-Angle Glaucoma

Open-angle glaucoma, (also called  Chronic Glaucoma), is the most common form of glaucoma, accounting for at least 90% of all glaucoma cases:

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve can occur. It is a lifelong condition and needs to be monitored.

It is the most common type of glaucoma, affecting about 3 million Americans, many of whom do not know they have the disease, because you will not have signs or symptoms until it is too late.

You are at increased risk of glaucoma if your parents or siblings have the disease, if you are African-American or Latino, and possibly if you are diabetic or have cardiovascular disease. The risk of glaucoma also increases with age.

 

The 2nd type of Glaucoma is called -

Narrow Angle Glaucoma

Narrow Angle Glaucoma, also called acute glaucoma, is a less common form of glaucoma – less than 5% of the general population develops Narrow Angle Glaucoma.

Far sighted people are more common to have narrow angle glaucoma, since their Front Chamber of their eye is smaller than normal.

The Iris can “bow” forward, thinning the angle that drains fluid from the eye. Fluid builds up and so does the pressure inside the eye.

This happens when the drainage canals get blocked.  Such as When you put a drainage stopper in the sink or something clogs the drain.

With angle-closure glaucoma, the iris (which is the colored portion of your eye – your brown eyes, your blue eyes etc.) is not as wide and open as it should be. The outer edge of the iris can bunch up over the drainage canals, when the pupil enlarges too much or too quickly. This can happen when entering a dark room.

Unlike open-angle glaucoma, narrow angle glaucoma is a result of the angle between the iris and cornea closing quickly.

 

What are some Symptoms of Angle-Closure Glaucoma?

  • Hazy or blurred vision
  • The appearance of rainbow-colored circles around bright lights
  • Severe eye and head pain
  • Nausea or vomiting (accompanying severe eye pain)
  • Sudden sight loss 

Treatment

Treatment for Glaucoma an involve eye drops, laser or conventional surgery. Everyone is unique and may require different treatment.

Eye drops

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. The medications are intended to reduce elevated pressure in your eye and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye. Combination drugs are available for patients who require more than one type of medication. 

2 Types of Laser Surgeries Are:

Micropulse Laser Trabeculoplasty (MLT) is a common procedure for the treatment of primary open-angle glaucoma 

MLT provides pressure-lowering effects. It is unique in that it uses a specific diode laser to deliver laser energy in short microbursts. MLT is a relatively new laser procedure.

Laser Peripheral Iridotomy (LPI)

For the treatment of narrow angles and narrow-angle glaucoma.

Narrow-angle glaucoma (also known as acute angle glaucoma).           LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain. In general, surgery for narrow angle glaucoma is successful and long lasting. Regular checkups are still important though, because a chronic form of glaucoma could still occur.

 

Conventional Surgery

MIGS  stands for minimally invasive glaucoma surgery.

The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve.

Standard glaucoma surgeries are major surgeries. While they are very often effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications. The MIGS group of operations have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries.

MIGS procedures work by using microscopic-sized equipment (tiny, tiny tubes & shunts) and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety.

 

Get Your Annual Exam so your Optometrist can detect any issues with your eyes early!

 

A Comprehensive Glaucoma Exam

Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

Tonometry measures the pressure within your eye. During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device called a tonometer to measure the inner pressure of the eye.

Eye pressure is unique to each person.

Ophthalmoscopy 

This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil, so that the doctor can see through your eye to examine the shape and color of the optic nerve.

If the pressure within your eye is not within the normal range or if the optic nerve looks unusual, your doctor may ask you to have one or two more glaucoma exams: perimetry and gonioscopy.

 

Perimetry 

Perimetry is a visual field test that produces a map of your complete field of vision. This test will help a doctor determine whether your vision has been affected by glaucoma. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a "map" of your vision.

 

Gonioscopy

This diagnostic exam helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye. A hand-held contact lens is gently placed on the eye. This contact lens has a mirror that shows the doctor if the angle between the iris and cornea is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).

Pachymetry 

Pachymetry is a simple, painless test to measure the thickness of your cornea – (the clear window at the front of the eye over the pupil).

Diagnosing glaucoma is not always easy, and careful evaluation of the optic nerve is needed for diagnosis and treatment.

Always get a second opinion of any diagnosis of open angle or narrow angle glaucoma.

 

Resources:

http://www.glaucoma.org/glaucoma/video-narrow-angle-glaucoma.php

 

www.glaucoma.org

www.worldglaucoma.org

 

Do you have a Medicare Question? Send it to Support@TheMedicareNation.com

Tell a friend or family member to SUBSCRIBE to Medicare Nation. They’ll get a new episode on their laptop, tablet, or phone every Friday so they won’t miss an episode

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation.

Go to my website www.callsamm.com

And “Click” on the contact tab.

You’ll see a blue button that says “ Start Recording."

You’ll be able to leave a short message of what you’ve enjoyed over the past year on medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me you want  to be ON Medicare Nation.  

Aug 12, 2016

The NOTICE ACT

On August 6, 2016, The Notice of Observation Treatment and Implication for Care Eligibility Act, went into effect.

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services(Medicre) to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive (Observation Services) which:

  • explains the individual's status as an outpatient and not as an inpatient and the reasons why;
  • explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility;
  • includes appropriate additional information;
  • is written and formatted using plain language and made available in appropriate languages; and
  • is signed by the individual or a person acting on the individual's behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.

 

 Here is the link to the Federal Register, which explains in more detail Procedures Applicable to Beneficiaries Receiving Observation Services:

https://www.gpo.gov/fdsys/pkg/FR-2016-04-27/pdf/2016-09120.pdf

 

Medicare Advantage Plans

 “A beneficiary enrolled in a Medicare Advantage or other Medicare health plan would receive the required notice under the existing rules that apply to hospitals and CAHs under a provider agreement governed by the provisions of section 1866(a)(1)(Y) of the Act.”

 

If you are enrolled in a Medicare Advantage Plan, you are covered under the provisions of your plan. READ your plan’s Evidence of Coverage (EOC) to determine what your out-of-pocket expenses will be in this situation.

 

I am urging each of you to be Pro Active with your own Health Care!

If you or a loved one goes to the Emergency Room or a Critical Access Hospital, be prepared to speak up!

Speak to the Physician in the ER who is treating you. Ask the physician specifically…..”Am I being ADMITTED to the hospital as an INPATIENT?”

If the answer is “Yes,” you will be covered under Medicare Part A benefits.

 If the answer is…. “No…..you are UNDER OBSERVATION. OR……”No……you are receiving OUTPATIENT SERVICES.”  You WILL more than likely be responsible for co-payments, co-insurance or maybe ALL charges!

Call your Primary Physician or Specialist. Tell the office or Answering Service that you or your Family member is in so and so Emergency Room, so and so hospital and you want your Doctor to either:

  1. Come to the hospital and examine you to determine if you should be admitted to the hospital as an inpatient

                                           OR

  1. Have your doctor speak to the Emergency Room physician who is treating you, in order to determine if you will be admitted or able to be discharged from the Emergency Room.

 

You Should NOT have to be in an Emergency Room for up to 23 and a quarter hours UNDER OBSERVATION!

Your Primary Doctor is the “Quarterback of your health team!”

Your Primary Doctor is in charge of your health care! That is what they get paid to do all that extra paperwork for! Put them to work for you!

 

Do you have a Medicare Question? Send it to Support@TheMedicareNation.com

Tell a friend or family member to SUBSCRIBE to Medicare Nation. They’ll get a new episode on their laptop, tablet, or phone every Friday so they won’t miss an episode

Don’t know how to subscribe? Visit my short video to show you how to do it – step by step.

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation.

Go to my website www.callsamm.com

And “Click” on the contact tab.

You’ll see a button that says “ Record Your Message Here.” Click on it and start talking! No equipment required!

You’ll be able to leave a short message of what you’ve enjoyed over the past year on Medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me

“I want to be ON Medicare Nation.”    

Thank you for being part of Medicare Nation’s Anniversary!

Aug 5, 2016

Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

An Advance Beneficiary Notice (ABN), also known as a waiver of liability is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover.

ABNs only apply if you have Original Medicare, are on a Medicare Supplement Plan. ABNs do not apply if you are in a Medicare Advantage private health plan. If you receive an ABN and you're on a Medicare Advantage Plan, ask to speak to the office manager.

Providers must give you an ABN when the service or item could be covered by Medicare, but the provider expects that Medicare will not find the care to be medically necessary and will, therefore, deny coverage.

The ABN must list the reason why the provider doubts Medicare will cover care. For example, an ABN might say, “Medicare only pays for this test once every ten years.” That would be the case for a colonoscopy, since Medicare pays for a low-risk colonoscopy once every ten years.

You should not be receiving an ABN for services or items that are never covered by Medicare, such as hearing aids. 

In order to receive an official decision from Medicare, you must:

1. First receive the care or receive the item                                                       2. You must sign the ABN form, agreeing to pay for it yourself if Medicare rejects       coverage.

Also, you must select Option 1 on the ABN form in order for the doctor or supplier to bill Medicare! Selecting this option requires your provider to bill Medicare after providing you with the service or item.

If you don't select Option 1 on the ABN, you have no chance, nada, zilch chance of Medicare coverage because your doctor is not required to submit the claim.

You will receive a Medicare Summary Notice (MSN) from Medicare. The Medicare Summary Notice will show if Medicare has denied payment for a service or item.   If Medicare denies your claim, you should file an appeal.

Just because you filled out an ABN does not prevent you from filing an appeal.

Medicare has specific rules about an ABN and how it should look. If these rules are not followed, there is a good chance you may not be responsible for the cost of the care. Remember, first you will have to file an appeal to prove your case.

Here are a few reasons you would not be responsible for the charges on an ABN

  • Is difficult to read or hard to understand.
  • Is given by the provider (except a lab) to every single patient with no reason to believe the claims may be denied by Medicare.
  • The ABN does not list the actual service provided 
  • The ABN is signed after the date the service was provided.
  • The ABN is handed to you during an emergency or is handed to you just prior to receiving a service (ex:You're on the xray table & they hand you an ABN)
  • An ABN was not given to you when it should have.

 You can file an appeal by going to your Medicare Supplement website and search for Appeal Form, call your Medicare Supplement Health Insurance Carrier or you can call Medicare at 800-633-4227 and ask them to mail you an appeal form.

Thanks for listening to Medicare Nation!

I appreciate you taking your time to listen to the show!

Send me your questions to Support@TheMedicareNation.com

I might read your question on the air!

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