Info

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 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
RSS Feed Subscribe in Apple Podcasts
Medicare Nation
2018
August
June
May
April
February
January


2017
November
October
July
June
April
March
February
January


2016
November
September
August
July
June
May
April
March
February
January


2015
December
November
October
September
August


Categories

All Episodes
Archives
Categories
Now displaying: 2017
Nov 18, 2017

Hey Medicare Nation!

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

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

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

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

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

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

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

Such is the case for 2018.

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

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

CMS planned this out perfectly!

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

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

$134.00!

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

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

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

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

Let's look at the remaining 2018 Deductibles:

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

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

That's an increase of $24.00 from 2017.

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

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

You are given 60 lifetime reserve days.

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

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

Works the same way for lifetime reserve days.

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

Skilled Nursing Facility

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

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

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

 

Part B of Medicare

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

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

That is the same amount as 2017. There will be on increase in the Part B deductible.

Once you pay your Part B deductible, you will be responsible for 20% of the remaining Medicare allowable charge....under Original Medicare.

Let's say you had to visit a Cardiologist and the Medicare allowable charge was $100.00

Medicare would pay 80% of the $100.00 and you would pay the remaining 20%.

So....Medicare pays $80 and you would pay $20.

You will continue to pay 20% of all Medicare allowable charges under Part B.

 

Advocacy Groups For Medicare

Here are some national advocacy groups, fighting for your rights under Medicare, Medicaid and Social Security.

Help the cause by volunteering or donating a few bucks to ensure the fight for your rights continue.

 
The National Committee is dedicated to protecting Social Security and Medicare benefits for all communities and generations.
 
 
The Center for Medicare Advocacy’s mission is to advance access to comprehensive Medicare coverage and quality health care for older people and people with disabilities by providing exceptional legal analysis, education, and advocacy.
 
 
provide free, in depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands, and are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).
 
 
Consulting During Medicare Annual Enrollment
 
If you would like to hire me as a consultant to assist you in comparing Medicare Plans or employer coverage, I am available to assist you.
 
Send me an email to Support@TheMedicareNation.com
and send me your information and how I can assist you.
 
You can also go to the website - www.TheMedicareNation.com and "click" on the contact tab.
 
I am also available as a professional speaker or emcee for your event.
 
Thank you for listening to Medicare Nation!
 
I appreciate your support!
 
Diane Daniels
 
Nov 3, 2017

Hey Medicare Nation!

It's Medicare Annual Enrollment Time! The Medicare Annual Enrollment Period runs from October 15th through December 7th, each year.

Many of you are looking at different Medicare Advantage Plans and Prescription Drug Plans for 2018.

Some of you are staying with the Medicare Advantage Plan you're already on.

What many of you don't know.......is that the Center for Medicare & Medicaid Services (CMS) has added a Special Election Period for individuals affected by weather related disaster's since September.

Anyone that resides in Alabama, Florida, Georgia, Puerto Rico, South Carolina or the U.S. Virgin Islands, may qualify for this special election period, due to hurricane Irma.

Anyone residing in Louisiana and Mississippi may qualify for the Special Election Period, due to Tropical Storm Nate.

Residents of Texas may qualify due to Hurricane Harvey.

To determine if you qualify for this special election period, CMS has deferred the locations affected by Weather Disaster's to FEMA.

Go to the FEMA website - www.fema.gov/disasters

and click on the weather related emergency, to see if your location was declared an emergency by FEMA.

If your county or State has been declared an emergency due to the unique weather event, you will be granted an SEP by CMS, to change your Medicare Advantage Plan or stand alone Prescription Drug Plan. 

In addition, the weather related special election period is available to..... those individuals who don't live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas.

Go to www.fema.gov and click on the link for the weather related disaster in your State, to see if you qualify for this special election period.

You can call Medicare if you have questions regarding the "weather event" special election period.

Call 800-633-4227.

The "weather event" special election period runs till December 31, 2017.

 

Oct 6, 2017

Hey Medicare Nation!

It's October, and that means it's Medicare season!

If you need help navigating the 2018 Medicare Advantage Plans or Medicare Prescription Drug Plans, I'm available to help!

Go to my website...... www.TheMedicareNation.com  and click on the "contact" button. Send me a short email of how I can assist you and I'll get back to you with details.

 

How many of you receive excess letters, brochures and booklets from Medicare insurance companies? I'm sure most of you do.

How many of you, in the past, have received an "official looking" postcard or letter, that you believed came from Medicare or the Social Security Administration...... only to find out it's a "scam?"  Again.....I'm certain many of you did.

Right now, many of you or your parents, have or will be receiving an actual letter from the social security administration, that is real! I'm serious.....it's not a scam!

That's right...... in a joint venture to promote the Medicare Savings Program and the Extra Help Program, the federal government has been sending letters to Medicare beneficiaries, who may qualify for one or both programs.

The letter details the criteria to qualify for the programs, as well as how to apply for each program.

So..... what is the Medicare Savings Program?

The Medicare Savings Program is run by your State's Medicaid Program. The program assists those who can't afford Medicare premiums or Medicare deductibles, co-insurance and/or co-payments.

To qualify for a Medicare Savings Program, your "monthly" income and total "resources" (like money in the bank, stocks, annuities etc.) must be at or below the amounts the program has set as "The Threshold." 

The house you live in, as well as one car you own, does not count towards the "resource" level.

Let's take a look at those "thresholds" now.

Medicare Savings Program

2017 Monthly Income Limit:

Single Person

$1,377.00 

Married (living together)

$1,847.00

 

2017 Total "Resource" Limit:

Single Person

$7,390

Married (living together)

$11,090

To apply for the Medicare Savings Program, go to the official Medicare website www.Medicare.gov/contacts

or.... call Medicare and ask them for your State's Medicaid office telephone number (800-633-4227).

Now....let's take a look at the "Extra Help" program.

The "Extra Help" program is run by the Social Security Administration. 

Extra Help is a Medicare program that may help you or your parents pay Medicare prescription drug (Part D) deductibles, premiums, co-insurance and/or co-payments.

You must be enrolled in Medicare Part D to be considered for the Extra Help program.

You don't have to file two separate applications to apply for the Extra Help and the Medicare Savings Program.

When you apply for the Extra Help program, Social Security will send your information to your State Medicaid office, to see if you also qualify for the Medicare Savings Program.

If you don't want to apply for the Medicare Savings Program, you will need to indicate that on the application or advise the State Medicaid representative that you do not want to apply for the Medicare Savings Program.

Let's take a look at the criteria for the Extra Help program.

Extra Help Program

2017 Monthly Income Limit:

Single Person

$1,507.50 

Married (living together)

$2,030.00

 

2017 Total "Resource" Limit:

Single Person

$13,820.00

Married (living together)

$27,600.00

To Apply for the Extra Help program, go to the official social security website - www.socialsecurityl.gov/extrahelp

or call Medicaid......800-772-1212 to ask for an application.

You can also go to your local Social Security office and wait in line if you'd like...... go here to find your local office -

www.socialsecurity.gov/locator

That's it for today Nation!

I"ll see you next week with more Medicare information and resources!

Diane

Oct 1, 2017

2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

As of October 1st, licensed health insurance agents may begin speaking about 2018 Medicare Advantage Plans and stand-alone prescription drug plans.

If you have a relationship with a licensed health insurance agent, Medicare Specialist or Medicare Consultant, they will more than likely start contacting you about your current plan.

This is the time to discuss your concerns with your Medicare Specialist. You need to determine if all your prescription drugs are listed in the plan's 2018 formulary. 

You also need to determine what your 2018 monthly costs will be for all your prescription medications.

Ask yourself......."Have my out-of-pocket prescription drugs costs remained feasible on my current plan for 2018?"

If so..... that's great! If not, it may be time to take a look at a new stand-alone-prescription drug plan.

If you're on a Medicare Advantage Drug Plan, you will need to determine if your physicians are still in your plan's network and if your medical out-of-pocket costs are reasonable before you make any decisions.

It is important to remember........

Medicare Specialists cannot take an enrollment application from you .......BEFORE October 15th!

That is a Medicare Regulation! 

If a Medicare licensed agent tries to take a signed application from you PRIOR to October 15th.......

FIND A NEW AGENT!

As a reminder........ NO ONE from Medicare will be knocking on your door or CALL you on the phone.

Medicare will send you mail from the Social Security Administration ONLY!

Any post cards or any letters with a return address from anywhere else on this Earth other than the Social Security Administration........ is not from MEDICARE! 

It is most likely a solicitation from an Insurance Agent trying to get your business. Throw it out!

Ok......let's take a look at the 2018 changes to Part D Prescription Drug Plans.

Annual Deductible 

The 2018 Maximum PDP Annual Deductible is $405.00.

That's an increase of $5.00 from $400.00 in 2017.

Starting January 1st of 2018....... if you are on a Medicare Advantage Prescription Drug Plan or Stand-Alone-Prescription Drug Plan...... that has a annual deductible, you will fit in one of two categories:

1. You will need to pay your annual deductible right away        prior to your plan's benefits kicking-in. 

As of January 1, 2018, when you hand in a prescription for a listed drug on your plan's formulary, you will be expected to pay the full cost of that drug or the listed annual prescription deductible, whichever is less.

For example, your stand-alone prescription drug plan has an annual prescription deductible of $405 on all tiers.

You hand in your first prescription for lisinopril, which is listed as a Tier 1 on your plan's formulary. The listed      co-pay for a Tier 1 drug on your plan is $2.00.

The total cost for a 30 day supply of lisinopril at your preferred pharmacy is $100.00. Since you have a $405.00 deductible, the cost for the 30 day supply of lisinopril  at $100.00 would be a lower out-of-pocket cost than the full $405.00 deductible. Therefore, you pay the $100.00 and deduct that amount from the $405.00 annual deductible, leaving you with a balance of $305.00.

You will pay $100.00 for February, March and April for your lisinopril and in May you will pay the remaining balance of your deductible, which is $5.00. Then, your prescription drug benefits will kick in and you will also pay your $2.00 co-pay.

Beginning in June, you will pay a $2.00 co-pay for your lisinopril for the remainder of the year. 

                                    OR

2. You will pay the annual deductible if and when you            "trigger" the deductible.

As an example, You would trigger the annual deductible if you requested a prescription for a drug that was a Tier 3, Tier 4 or Tier 5 on your Medicare Advantage Drug Plan or Stand-Alone Prescription Drug Plan.

If you requested a drug that was a Tier 1 or Tier 2 on that same plan, you would NOT "trigger" the annual deductible. Therefore, you would just pay the listed co-pay or co-insurance for that Tier 1 or Tier 2 prescription drug on your plan.

So.....as we used lisinopril in the above example, in this case you would just pay your $2.00 co-pay for the 30 day supply of lisinopril starting right away in January.

This is because lisinopril is listed as a Tier 1 drug on your plan's formulary. You wouldn't pay an annual deductible, since you haven't requested a prescription that was a Tier 3, Tier 4 or Tier 5 drug.

You will continue to pay a $2.00 co-pay for your lisinopril for the remainder of 2018.

The next portion of cost-sharing under prescription drug plans is called the Initial Coverage Period (ICP)

During this portion of cost-sharing, the total amount spent during the Initial Coverage Period (ICP) is $3,750.00.

The costs of covered drugs are shared - 25% by the beneficiary and 75% by the plan.

If you do not have an annual deductible for prescription coverage, the maximum a beneficiary would spend out of pocket during the ICP is $937.50. The plan would pay the remaining balance, which is $2,812.50 ($3,750.00 - $2,812.50 = $937.50)

You pay your co-pays and/or co-insurance, which is placed towards the $937.50. The plan pays the remaining balance of the Medicare negotiated price for the prescription, which is applied towards the $2,812.50.

Once the total amount of your prescription drug costs (from your out of pocket costs and the plan's contributions) reach $3,750.00, you move into the next phase of cost-sharing.

The next phase of Part D cost-sharing is called, The Coverage Gap, or commonly known as the "Donut Hole."

During this phase, you will pay more for your prescription drugs.

You will pay 35% for Brand name drugs and 44% for Generic drugs.

Let's use Lisinopril again to look at the costs during the Donut Hole. 

We stated a 30 day supply of Lisinopril from a preferred pharmacy is $100.00. Lisinopril is a generic drug, listed as a Tier 1 on your plan. In the Donut Hole, you are required to pay 44% of the Medicare negotiated price for Generics. In this example, you would pay $44.00 for a 30 day supply of Lisinopril in the Donut Hole.

You are also paying a "Dispensing Fee," (about $1-$3 per drug) while in the Donut Hole.

If you have a Brand prescription drug that is listed on a Tier 3, Tier 4 or Tier 5 on your plan, you will pay 35% of the Medicare negotiated price, while in the Donut Hole.

Only True out-of-pocket (TrOOP) costs are counted toward the cost-sharing amount in the Donut Hole.

TrOOP costs are -

1. The drug costs paid by the beneficiary

2. A 50% discount on Brand-Name drugs that is provided by the drug manufacturer.

Payments made by the "plan" during the Donut Hole on Brand Name drugs DO NOT count toward TrOOP.

If you DO have an annual deductible for your prescription drug coverage, the amount you pay out-of-pocket for your deductible is applied towards the ICP of $3,750.00.

The maximum amount you would pay out-of-pocket during the Donut Hole portion of cost-sharing is $3,758.75

If the total cost-sharing amount reaches $3,758.75 in the Donut Hole phase, you will then move into the final phase of cost-sharing for 2018, which is called the "Catastrophic Stage."

In the Catastrophic Stage, you will pay reduced co-pays and or co-insurance.

You will pay either:

A 5% co-insurance or a $3.35 co-pay for Generic drugs or a $8.35 co-pay for Brand drugs.

You will pay whichever amount is greater.

Let's use our example of Lisinopril one more time. With a total cost of Lisinopril being $100.00, a 5% co-insurance would be $5.00.

With $5.00 being greater than $3.35 for Generic drugs, you would pay $5.00 for the 30 day supply of Lisinopril.

You will remain in the "Catastrophic Phase" until January 1, 2019, when the slate is wiped clean and we start all over again.

 

I hope that answers your questions regarding changes to Prescription Drug Costs for 2018.

If you have a question, and I can answer it in ONE paragraph or less, send me an email to -

Support@TheMedicareNation.com

I'll be happy to answer your question.

If my answer requires more than one paragraph, or I need to research an answer....... you will need to hire me as a consultant to assist you.

Go to this link and request a consultation from the "contact" tab.

www.TheMedicareNation.com

That's it for this week's show!

I would love for you to rate & review Medicare Nation!

Go to this link and tell me what you think! 

https://goo.gl/sb3JXo

 

Have a happy, peaceful and prosperous week everyone!

 

Jul 7, 2017

Hey Medicare Nation!

Here I am bringing you yet another Medicare Advantage Plan Sponsor, being slapped by CMS, for failing to comply with Medicare requirements related to Part C (Medicare Choice) and Part D (Medicare Prescription Drug Plans).

Today, I will be discussing the CMS Civil Money Penalty (CMP) that was imposed on Fallon Community Health Plan.

On June 29, 2017, a letter was issued to Mr. Richard Burke, the President and CEO of Fallon Community Health Plan, from Vikki Ahern, Director of the Medicare Parts C and D Oversight and Enforcement Group.

The letter was written relating to a "Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Numbers: H2411, H2470 and H9001.

Summary of Noncomplliance

CMS conducted an audit of Fallon's Medicare operations from February 16, 2016 through February 26, 2016.

In the audit report issued on July 20, 2016, CMS auditors reported that Fallon failed to comply with Medicare requirements related to...."Part C and Part D organization/coverage determinations, appeals and grievances in violation of 42 CFR" (Code of Federal Regulations). 

The audit report lists the exact subsections of 42 CFR that were violated

The letter goes on to state....Fallon's failures in these areas were systemic and resulted in enrollees inappropriately experiencing delayed or denied access to benefits and/or increased out-of-pocket costs.

CMS made a determination to impose a civil money penalty (CMP) for Fallon's failure to comply, in the amount of $344,100.00.

That's a BIG fine! 

Fallon Comunity Health Plan was founded in 1977. They have a product portfolio of group and individual health plan options.

Fallon also has a Senior Care Services Division, oversees all products, programs and solutions which focus on the senior population.

If you are a member of a Fallon Medicare Advantage Plan and you have questions regarding your plan, I would call the Senior Care Services Division.

The number is - 800-868-5200.

If you are a current member of a Fallon Medicare Advantage Prescription Drug Plan, your benefits are intact and working for you. 

The $300,100 CMP was issued due to the incorrect classifications of "grievances", "organization determinations" for Part C complaints or "coverage determinations" for Part D complaints by members.

These incorrect classifications resulted in members not receiving the required level of review, and/or experiencing delayed access to medically necessary or life-sustaining treatments.

How does something like this happen, you may ask? 

Insufficient training of Fallon customer representatives and agents.

Employers like Fallon, need to ensure their employees are properly trained in CMS Medicare Advantage Plan and Medicare Part D regulations as well as Fallon's Medicare Health Plans and benefits.

Train your employees Fallon! 

Fallon needs to ensure their employees are competent and complying with Medicare rules & regulations relating to Medicare Advantage Part C and Medicare Part D. 

What Should You Do if You or Your Parent(s) are on a Fallon Medicare Advantage Prescription Drug Plan?

Pay attention to your MONTHLY Explanation of Benefits (EOB) letter.

Look the document over and ensure all the prescriptions you filled that month are correct!

Look and make sure the provider(s) listed on your EOB are doctors or facilities you visited. Ensure any treatments or diagnostic tests were ones you actually did!

If you find a discrepancy, call Fallon customer service to notify them of it.

A Fallon customer service rep should be able to assist you with this issue.

If Fallon customer service is unable to assist you or if they refuse to assist you, you have two good options:

1. Call your Medicare Agent or Medicare Advisor. They enrolled you in the Fallon Medicare plan and should be a liaison between you and Fallon.

2. Call Senior Medicare Patrol.

     Senior Medicare Patrol (SMP) is an awesome resource that is available to you for free!

     SMP Volunteer's are seniors and understand what you're going through. They are trained to investigate or notify the agency who can investigate, suspicious or fraudulent charges on your EOB statement.

     Go to the SMP website to find an SMP location near you:

      www.SMPresource.org

If you believe you were denied coverage or delayed in receiving your benefits, you have a right to appea

Ask your Medicare Agent or Medicare Advisor to assist you and explain your options.

Your coverage and benefits are intact and not in danger at Fallon Health Plan.

Fallon has the right to appeal the CMS CMP by August 29, 2017. 

We'll see what happens.

In the meantime, due your due-dilligence and monitor your EOB statements no matter which Medicare Advantage or Medicare Prescription Drug Plan you are on.

Report any discrepancies or suspicions right away.

I am available for consultations if you feel you have been denied a claim or your benefits were delayed due to an incorrect classification.

I also can initiate a reconsideration appeal for Part C claims or a redetermination appeal for Part D claims.

Contact me at Support@TheMedicareNation if you'd like me to consult with you.

Thank you for listening to Medicare Nation!

I appreciate you taking the time to learn more about Medicare and Medicare Plans.

Help your parents and grandparents learn about Medicare, by showing them how to gain access to the Medicare Nation Podcast!

Questions about Medicare or your Medicare Plan you need answered?

Send me an email to Support@TheMedicareNation.com or go to my website www.callsamm.com

Have a very happy, peaceful and prosperous week everyone!

Diane Daniels

 

Jun 19, 2017

Hey Medicare Nation!

I'm so happy to be here and tell you the latest, regarding Cigna-HealthSpring (Cigna) Medicare Advantage Prescription Drug Plans (MAPD) and Prescription Drug Plans (PDP).

In January of 2016, CMS suspended Cigna from enrolling NEW Medicare Beneficiaries into their Medicare Advantage and stand-alone Prescription Drug Plans.

The following States were affected by the suspension:

Alabama, Arizona, Florida, Georgia, North Carolina, Pennsylvania, South Carolina and Tennesse.

ON June 16, 2017, CMS released the suspension of marketing and enrollment sanctions on Cigna.....with a big BUT.

On March 17, 2017, CMS received an attestation from Cigna, stating Cigna had corrected all  the violations that were listed in the CMS sanction notice.

Quoted from the letter CMS sent to Cigna interim CEO & COO Mr. Shawn Moore -

"CMS required Cigna to hire an independent auditor to conduct a validation audit provide CMS with the results of the audit.

CMS used the information in the audit report to determine whether Cigna corrected the deficiencies that formed the basis for the sanction."

Based on the results of the audit report, CMS determined that......"Cigna's deficiencies have been sufficiently corrected." Therefore, effective June 16, 2017, CMS is lifting the intermediate sanctions for Cigna's contracts and Cigna will return to normal marketing and enrollment status."

Further down in the CMS document, on page 2, paragraph 1, line 3, it states...."In addition, during the independent validation audit, several findings were indentified, none of which prevent CMS from releasing Cigna from sanctions, but some of which merit additional monitoring and reporting.

.......For up to one year, CMS will also conduct targeted monitoring in certain areas to ensure that Cigna continues to improve its operations. 

What does that mean if you are currently a Medicare beneficiary on a Cigna-HealthSpring MAPD or PDP Plan?

First of all, you are completely covered. Your benefits are intact and current.

What you need to do now is become more "diligent" in reviewing your "explanation of benefits" (EOB) statement.

Your EOB statement will contain information regarding prescription drugs, medical visits, diagnostics etc. 

You should be ensuring the prescriptions listed on your EOB are the ones you received and that each doctor, diagnostic tests & procedures, hospitalizations etc. were actually done!

Mistakes happen more than you know. Human errors and computer errors happen frequently. When you look at your EOB Statement every month you help eliminate these errors. 

It is soooo important to review your EOB statement each month.

If you find an error on your EOB statement, you have several options to rectify it.

#1. Call Cigna Customer Support (800-668-3813)

       Explain to customer support the "discrepency" you          found on your EOB statement. That may easily              correct the issue you found. 

#2. Call your Medicare Consultant, Medicare                  Advisor or Agent.

       Your Medicare Agent, who "sold" you this             policy, should be available to assist you with questions  or issues with your Cigna plan.

#3. Contact Senior Medicare Patrol

       Go to the Senior Medicare Patrol website to look up resources in your area.

        Senior Medicare Patrol

#4.  Contact your State Dept. of Aging

         Every State has a Department of Aging or Department of Elder Affairs, which will assist you with many types of issues.

         The "Healthy Aging" website has a list of each State's contact information for their Department of Aging or Elder Affairs. 

          Here's the link:

          Healthy Aging List of State Agencies

#5.   Contact Medicare

         As a last resort, call Medicare directly. Government "downsizing" has caused delays in telephone correspondence, but it is still a reliable source.

         Expect to be on hold from ten minutes to an hour, depending on the day and season.

 

Expect to see Cigna hit the airwaves and your mailboxes with advertisements regarding their Medicare Advantage and Prescription Drug plans.

If you are not sure if you should remain on a Cigna Medicare Advantage Plan for 2018 and you have no one to speak to for assistance, call me!

I am available for consulting and I do so on an hourly basis. I charge $150.00 an hour and I assure you, I am very honest in my time.

If you have an interest in contacting me for consulting, send me an email to:

Support@TheMedicareNation.com

You can also visit my website for more information.

www.CallSamm.com

 

I thank each of you for listening to Medicare Nation and I look forward to hearing from you with any questions you have regarding Medicare.

 

Until next time, have a happy, peaceful and prosperous week!

Diane 

 

          

Apr 28, 2017

Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare. 

A question that is quite common is:

"What vaccinations are covered under Medicare?"

That's what this week's episode is all about.... vaccinations!

There are currently three vaccinations that are covered under preventative and screening services under Medicare:

1. Flu Shot

2. Hepatitis Shot

3. Pneumococcal Vaccine

 

Flu Shot

If you are enrolled in Medicare Part B, you can receive a Flu Shot from your doctor or other qualified health provider, who accepts Medicare assignment for administering the flu shot. 

The cost for the Flu Shot under this scenario is $0 out-of-pocket for you.

If your doctor or other healthcare provider does not accept Medicare assignment, your out-of-pocket cost be up to 100% of the cost of the Flu shot.

Ensure your doctor or healthcare physician is contracted with Medicare before receiving treatment.

For more information on the Flu, I'm sending you to this website:

www.Flu.gov

 

Hepatitis B

The Hepatitis B shot is available to individuals who are enrolled in Medicare Part B, have a doctor or other qualified health provider, who accepts Medicare assignment and you are at a "Medium" or "High" Risk to contract Hepatitis B.

What indicates a Medium or High Risk?

Well....there are many answers, but if you have certain diseases like hemophilia, ESRD (End Stage Renal Failure), Diabetes or other conditions that lower your resistance to infection are some good examples.

If you have any questions regarding your eligibility for the Hepatitis B shot, ask your doctor.

Since the Hepatitis B shot is covered under the Preventative and Screening Services of Medicare, there is $0 out-of-pocket cost to you.

To learn more about Hepatitis B, I'm giving you the link to the Center for Disease Control and Prevention (CDC).

Learn More About Hepatitis B

 

Pneumococcal Shot

You are entitled to a Pneumococcal Shot if your doctor believes you need one, he or she is a qualified health provider, who accepts Medicare assignment and you are enrolled in Medicare Part B.

There is also a second, different Pneumococcal shot that is administered one year after the first shot is given. Medicare Part B will cover this additional shot if your doctor says you need the two shots.

You should always discuss your options and your concerns with your primary doctor.

Here is the link to the CDC website on additional information about pneumococcal vaccinations:

Learn More About Pneumococcal Vaccinations

 

Additional Vaccinations and Shots Available

Other commercially administered vaccinations are available under Medicare Part "D"

Tetanus, Diptheria and Pertussis (Whooping Cough) are examples of Part D coverage. A "Booster" shot, given to adults, adolescents and children is available as Tdap.

Depending on what type of Prescription Drug Plan you are on, will depend on your out-of-pocket cost.

You should contact your Medicare Insurance Carrier customer service department to request such information.

 

Shingles

The Shingles Vaccine (Herpes Zoster) is also available under Part "D" of Medicare.

The Shingles Vaccine out-of-pocket costs will vary by plan. You must contact your Medicare Plan Carrier's customer service department to determine your out-of-pocket cost for the Shingles Vaccine. 

If you are not enrolled in Medicare Part D, you may have to pay up to 100% of the cost for the Shingles Vaccine.

Here is the link to the CDC website for information on Shingles.

Learn More about Shingles

I also did an ENTIRE EPISODE ON SHINGLES!

Go to Apple Podcasts and search in the Medicare Nation "Feed" directory.

You'll see the episode is number 46, and was published on June 17, 2016.

Listen to that episode! It is EXTREMELY educational.

As the Medicare season has slowed down, I will be taking a break from the weekly publishing for the next few months.

I'll post a new episode about every 3-4 weeks until September, when I'll pick right up and publish weekly shows again.

Thank you soooo much for being a loyal Medicare Nation listener! 

If you are enjoying Medicare Nation, give us a 5 Star Review on Apple Podcasts!

The more people we can reach, the more people will learn more about Medicare. It' as simple as that!

Thank you for listening to Medicare Nation!

I'm so happy you are here! Share Medicare Nation with your family and friends, so they can learn more about Medicare and their benefits.

Have a peaceful and prosperous week!

Diane

 

 

 

Apr 7, 2017

Hey Medicare Nation!

Over 17.5 Million of you are on a Medicare Advantage plan. And many of you have been, or know of a situation where your doctor has left the “network” and you are told by your Medicare Advantage Plan Carrier that you must find a new doctor. You tell your Medicare Advantage Plan carrier that you would like to change plans to keep your doctor, and they will tell you something that goes like this….”I’m sorry, you are unable to change plans mid-year. You will have to wait until the Annual Enrollment Period occurs to change plans, unless you have a special election. So….you’ll need to change doctors at this time.”

Sound familiar?

Well…..on today’s show, I’m going to discuss a “special election (SEP),” called – “Significant Network Change,” that many, many Insurance Agents don’t even know about.

Revisions were made to the Medicare Managed Care Manual, which went into effect on April 22, 2016.

The Significant Network Change Special Election Period, as written in the Medicare Managed Care Manual is listed as:

“Pursuant to 42 CFR § 422.62(b)(4), enrollees who meet the exceptional conditions of being substantially affected by a significant no-cause provider network termination may be afforded a special election period (SEP). If CMS determines that an MAO’s network change is significant with substantial enrollee impact, then a “significant network change SEP” may be warranted. CMS will use a variety of criteria for making this determination, such as:

(1) the number of enrollees affected;

(2) the size of the service area affected;

(3) the timing of the termination;

(4) whether adequate and timely notice is provided to enrollees,

(5) and any other information that may be relevant to the particular circumstance(s).

The Medicare Advantage Organization will be required to notify eligible enrollees of the significant network change SEP if the SEP is granted by CMS. SEPs will not be granted when MAOs make changes to their network that are effective on January 1 of the following contract year, as long as affected enrollees are notified of the changes prior to the AEP.

 

According to the rules, if a Medicare Insurance Carrier makes a  “significant change” to one of their Medicare Advantage plan’s networks, that plan’s beneficiaries could possibly be granted a Special Election Period. This provider network change SEP allows beneficiaries “three months” to switch to traditional Medicare, with or without a stand-alone Prescription Drug Plan, or switch to a different Medicare Advantage plan, with or without Part D coverage. Whether or not beneficiaries qualify for this SEP is entirely up to CMS.

CMS states in the Medicare Managed Care Manual that they may grant a provider network change SEP to beneficiaries based on some of the following factors:

  • The amount of beneficiaries affected
  • Whether or not beneficiaries received adequate and timely advance notice of the provider terminations
  • The size of the plan’s service area
  • The time of the year that the plan made changes to its provider network

So…..if you have lost your primary care doctor, due to a non-cause termination in your Medicare Advantage Network, and it has caused you a “significant change” to your healthcare due to your doctor’s termination from the network, call Medicare and fight for this SEP!

If Medicare denies your request for a SEP and you honestly feel you qualify under one or more of the criteria stated……. Call me and hire me to contact Medicare on your behalf!

I have listed other Special Enrollment instances when you can make changes to your Medicare Advantage Plan outside of the Annual Enrollment Period.

For a complete list, go to www.Medicare.gov

 

TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD

Here’s quick guide to when you can make changes to your Medicare Advantage Plan:

You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65.

  1. During the Annual Enrollment Period which is between October 15th through Dec 7th every year.
  2. You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
  3. You may have a “Special Election” that qualifies you to change your plan.

 

The Special Election Period that qualifies you to change your Medicare Advantage Plan, is what we want to focus on today.  There are certain circumstances which allow you to qualify for this option.

If You Move

  1. If you move and your new residence is not in your plan service area. You would need to notify Medicare as soon as possible, because you have the rest of the current month you are moving and the following 2 full months as the Special Election Period.
  2. If you move to a new address and your plan is still in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of the new option plans.
  3. Snowbirds that live in 2 locations, have to determine which of those residences is your primary residence. Where you vote and where you pay taxes are going to determine which is your primary residence.
  4. If you move out of the country for a period of time and now you are coming back to live in the US,  that will trigger a Special Election Period.
  5. If you are moving into a long term care facility or a Skilled Nursing Facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are residing in the facility and when you move out of the facility. 

Losing Coverage:

  1. If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc.
  2. If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage(credible coverage), that triggers a SEP. Or if you have had drug coverage through a Medicare Cost Plan and you leave the Cost Plan.
  3. If you leave a PACE (Program All-Inclusive Care for the Elderly) Program.
  4. If you had Medicaid and lost eligibility because of income requirements.

 

When there are plan changes with Medicare Contracts:

  1. If your Medicare Advantage Plan was sanctioned by CMS, then you would be able to contact Medicare directly to request a Special Election Period  to choose another Medicare Advantage Plan.
  2. If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.

 

Special Circumstances

  1. You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like!
  2. If you qualify for LIS (Limited Income Sources) you may get extra help with prescription drug coverage and a Special Election Period to enroll in a different Medicare Advantage Plan.
  3. During your Initial Enrollment Period for Medicare, you may have enrolled in a Medigap plan, and decided to change to a Medicare Advantage Plan during your first enrollment year. If you decide you want to change back to a Medicare Supplement Plan during your first year of coverage, you qualify.
  4. SNP Plan - for chronic conditions (Diabetes, Heart Disease, COP) - may change your current Medicare Advantage Plan to enroll in a SNP plan, or you may no longer qualify for a SNP, so you can choose another Medicare Advantage Plan.
  5. f an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.
  6. If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP for Medicare Supplement Plans.

Precautions:

If you have a chronic illness, cancer, cardiovascular disease or other medical conditions, a Medicare Supplement (MediGap) plan does not have to enroll you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The Medicare Supplement carrier may not take you due to pre-existing conditions and once you drop your Medicare Advantage Plan, you may be "locked out" and not able to re-enroll until the next open enrollment period..Medicare Supplement Carriers can discriminate due to pre-existing conditions!

The price of Medicare Supplement plans do change as you age, and where you live. Keep that in mind.

 

Need more information on "Special Enrollment Periods?"

See the entire list at www.Medicare.gov

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Mar 17, 2017

Hey Medicare Nation!

March is colon cancer awareness month!

Medicare offers different types of "preventative" tests and exams, which aid in diagnosing illnesses and diseases, such as colon cancer.

Always speak with your primary care physician or specialist doctor, to discuss your medical history, family history regarding illness and diseases, as well as any signs & symptoms you may have.

This will assist your physician in determining which type of "preventative" test or exam, is best for you.

A special "Thank You," goes out to Phillip, from Kenosha, Wisconsin, who asks the question:

"I don't like going through a colonoscopy. Are other options available and how often do I need one?"

Let's look at Medicare's official website, to find out more about "preventative" Colo rectal cancer screenings.

www.medicare.gov

 

How often is it covered?

Medicare Part B covers several types of colo rectal cancer screening tests to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

 

  • Screening barium enema:When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it once every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer.
  • Screening colonoscopy: Medicare covers this test once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, Medicare covers this test once every 120 months (ten years), or… 48 months after a previous flexible sigmoidoscopy.
  • Screening fecal occult blood test: Medicare covers this lab test once every 12 months if you're 50 or older.
  • Multi-target stool DNA test: Medicare covers this at-home test once every 3 years for people who meet allof these conditions:
  •  
    • The Medicare Beneficiary is between 50–85.
    • show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
    • They’re at average risk for developing colorectal cancer, meaning:
      • They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
      • They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
    • Screening flexible sigmoidoscopy: Medicare covers this test once every 48 months for most people 50 or older. If you aren't at high risk, Medicare covers this test 120 months (ten years) after a previous screening colonoscopy.

 

Who's eligible?

All people age 50 or older with Part B are covered.

People of any age are eligible for a colonoscopy.

 

Your costs in Original Medicare

  • For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. In a hospital outpatient setting, you also pay a co-payment or co-insurance
  • You pay nothing for a multi-target stool DNA test.
  • You pay nothing for the screening colonoscopy or screening flexible sigmoidoscopy, if your doctor accepts assignment (contracted with Medicare or is an out-of-network physician who accepts assignment).
  • If a screening colonoscopy or screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you may have to pay co-insurance and/or a co-payment, but the Part B deductible doesn't apply.
  • You pay nothing for the screening fecal occult blood test. This screening test is covered if you get a referral from your doctor, physician assistant, nurse practitioner, or clinical nurse specialist.

 

 Early detection of cancer is critical to successful treatment and may prove to be life-saving!

Get your preventative colorectal screening done as soon as your physician recommends it!

 

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

 

Mar 10, 2017

Hey Medicare Nation!

I receive many phone calls from clients, who say they were unable to schedule an appointment with a new doctor; even though they are on a Medicare Supplement Plan

I made many phone calls, with my clients to physician offices, in order to fix these issues.

What I found out didn't surprise me.

Many of the staff at physician office's across the country are inadequately trained in the different types of Medicare Plans.

I decided to educate you on how to make an appointment with a physician, lab, hospital, SNF or radiology center, if you have a Medicare Supplement Plan.

Having a Medicare Supplement Plan allows you the freedom to see any physician or provider you want.....,as long as the provider "accepts assignment" with Medicare.

Let's take an example.

If you wanted to make an appointment with a new Cardiologist,

1. call the office you want to be seen in.

2. Tell the person, who is scheduling your appointment, that          Medicare is your Primary Insurance.

3. You may be asked if you have a "secondary insurance." If you are enrolled in a Medicare Supplement Plan, the answer is .... "Yes, I have a Medicare Supplement Plan."

If you are enrolled in a Medicare Advantage Plan, the Medicare Advantage Plan is your "Primary Insurance."

Most likely, you don't have another plan.

When you visit the physician's office for the first time, show the receptionist your Medicare Supplement ID Card. You may be asked if you have your Medicare ID Card. Hopefully, you've made a copy of your Medicare ID Card and have left your original Medicare ID Card at home in a safe place. You shouldn't be carrying your Original Medicare ID Card!

The staff will bill Medicare and the Medicare Supplement Plan for the amount you would have owed, if on Original Medicare.

You should not receive any paperwork to submit to Medicare or a Medicare Insurance Carrier. 

Prior to any physician visits or procedures, call and ask if you have any co-pay, co-insurance or deductible if you are enrolled in a Medicare Supplement Plan that is not designated by the letter "F."

Medicare Supplement Plans are designated by Letters of the Alphabet and those "letter" plans can be offered by many different Insurance Companies. 

Each "lettered" plan pays co-pays, co-insurance or deductibles, on your behalf, based on the plan you select. 

After the physician's staff has your Medicare Supplement Plan info on file, they shouldn't require you to show them your card the next time you come in for an appointment.

Hopefully, this has helped you understand what is going on in the real world, and it will make it a less frustrating place for you!

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 3, 2017

Hey Medicare Nation!

Many of you carry your Medicare ID card in your wallet or purse. If you are a Medicare Advantage beneficiary, you have a “separate” medical ID card from the insurance carrier. It is not necessary to carry your Medicare ID card, If you have a Medicare Advantage ID card.

Who should carry their Medicare ID Card?

If the official Medicare program is your “primary” insurance, you should be carrying your Medicare ID card.

Now….. let me discuss with you how you can carry your Medicare ID card in a safer way.

Currently, your Medicare ID Card has your Social Security number on it, with a letter at the end of your Social Security number.  If you have your social security number memorized, take these steps to help prevent “identity theft.”

  1. Make a copy of your Medicare ID Card
  2. Place your original Medicare ID Card in a safe place.
  3. Take a Black Permanent Marker and “black out” all of the numbers of your social security number( except the last four numbers and the letter), on the copy.
  4. Laminate the copy
  5. Put this copy of your Medicare ID card in your wallet or purse.

 

If you are on a Medicare Advantage Plan or a Supplement to Medicare Plan, you should be carrying the Medical ID card the insurance carrier provided you.

If you have a stand-alone prescription drug plan, you will also have a separate card for your prescriptions. You will need to carry this card in your wallet or purse also.

 

How Do I Replace My Medicare ID Card if I Lost it or it Was Stolen?

If you made a copy of your Medicare ID Card like I described above, you won’t have a problem.

You can retrieve your Medicare ID Card from it’s safe place and make a new copy of the card.

If you didn’t make a copy of your Medicare ID Card, you will need to ask the Social Security Administration for a replacement card.

Follow these steps:

You can ask for a Medicare Replacement Card :

  1. Online
  2. By phone
  3. At a local Social Security office location                                                            A.Online
    1. Go to ssa.gov
    2. You’ll see pretty pictures on the home page. On the left side is a picture, with the caption… “Learn What You Can Do Online.”
    3. “Click” on the that photo.
    4. When the next page opens, look down to about the 7th
    5. It will read….”If you get Social Security benefits or have Medicare you can….”
    6. “Click” on that line.
    7. Sign in or Register for a “My Social Security Account.”
    8. 5th line down should read….. “Get a Replacement Medicare Card”
    9. Select – “Replacement Documents” tab.
    10. Fill out the required information.
    11. If the site “accepts” your information, you are all set! You should receive your replacement Medicare Card in 30 – 60 days.
    12. If the site shows any kind of “error” or “red flags,” you will need to physically go down to a local Social Security location.             B. By Phone

                     1. Call 800 - 633 - 4227

                    C. Social Security Office 

                     1. Click on the "Social Security Location" tab and put in your                          zip code to find the nearest location to you.

 

Thanks so much for listening to Medicare Nation!

I appreciate the time you took to listen. If you have a parent or grandparent, who is approaching Medicare age (65) or is already receiving Medicare benefits, help them “Subscribe” to Medicare Nation.

Buy them a Smartphone!

If you buy them an Apple phone…show them the “purple” podcast icon on the phone and how they access Medicare Nation. Once the Medicare Nation page loads….. click on “subscribe.” All current shows will load automatically once a week for them!

If you buy them an Android phone, just go to Google Play and “Search” for the app – “Stitcher.”

Download the Stitcher App.

When you open Stitcher, they will need to sign up with an email address and password.

Once the home page opens, show them how to “swipe” to the left, until they reach the “last page.” This is the “Search” page.

In the “search” bar…. Type in “Medicare Nation.”

Medicare Nation comes right up!

“Click” on the Subscribe button…… they are set!

Help your parents “search” for other types of podcasts they would have an interest in. You will be opening up a brand new world for them and they WILL thank you for it!

Feb 24, 2017

Hey Medicare Nation!

I hope everyone is having an awesome week!

Say goodbye to February! I know all of you Northerners are thrilled to see it go! Bring it on March!

You know, I see many, many clients and one of the top questions I am asked is, "What does the letter on my Medicare ID card mean?"

It happens so often, I figured I better dedicate an episode to just that!

The Social Security Administration (SSA) assigns a letter and a number, (if you fit into a sub-group) when you apply for Social Security Benefits and/or Medicare.

The letter (and number if it applies) is found on your Medicare ID Card, right after your social security number.

As an example, if you have worked and contributed to FICA (Federal Insurance Contribution Act), and started receiving your Social Security benefits at age 64, and you enrolled in Medicare at age 65, the letter "A" will be designated to you.

The "claim" number would look like this on your Medicare ID Card:

123-45-6789A

Just as "Different Strokes for different Folks," the Social Security Administration assigns "claim" numbers for different situations.

"Where Do I find the full list of Social Security claim letters?"

You can go to the following locations to see a full list of claim letters:

1. www.ssa.gov

2. Title XVIII of the Social Security Act

3. For a Free List of the Codes Listed by the Social Security Administration on their website, go to

my website -

www.callsamm.com

 

Thanks for listening to Medicare Nation!

Please SHOW someone how to "subscribe" to Medicare Nation, so they can learn about their Medicare benefits and what type of Medicare Plan they should be on!

 

Feb 17, 2017

What is the Difference Between a Welcome to Medicare Visit  vs. an Annual Wellness Visit?

 A "Welcome to Medicare" preventive visit: Is an introductory visit only within the first 12 months you have Medicare Part B. This visit includes a review of your medical and social history with your Primary Physician, as well as possibly including preventive services, including:

  • Certain screenings, shots, and referrals for other care, if needed
  • Height, weight, and blood pressure measurements
  • A calculation of your body mass index
  • A simple vision test
  • A review of your potential risk for depression and your level of safety
  • An offer to talk with you about creating "Advanced Directives"
  • A written plan letting you know which screenings, shots, and other preventive services you need. 

This visit is covered one time. You don’t need to have this visit as a "prerequisite," to be covered for yearly "Wellness" visits.

Annual "Wellness" visits: If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan. This plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:

  • A review of your medical and family history
  • Developing or updating a list of current providers and prescriptions
  • Height, weight, blood pressure, and other routine measurements
  • Detection of any cognitive impairment
  • Personalized health advice
  • A list of risk factors and treatment options for you
  • A screening schedule (like a checklist) for appropriate preventive services. 

This visit is covered once every 12 months (11 full months must have passed since the last visit).

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment with Medicare  The Part B deductible doesn’t apply for annual wellness visits.

However, you may have to pay coinsurance, and the Part B deductible may apply if:

  • Your doctor or other health care provider performs additional tests or services during the same visit (ex: an EKG or draws blood).
  • The additional tests or services aren't covered under the preventive benefits.

An "Annual Exam" is where your Primary Care Physician will provide a "hands on" examination of you and you may have tests like an EKG or have blood drawn.

Co-pays, coinsurance and deductibles will apply for Annual Exams.

 

Share Medicare Nation with someone!

Teach your parents, your grandparents how to access this podcast! Buy them a smartphone. Show them how to access iTunes & Stitcher.

The more they know, the less they will ask you for help.

It's not easy being the "Sandwich Generation."

So...... do yourself and your parents a favor and help them listen to Medicare Nation! 

 

Feb 10, 2017

Hey There Medicare Nation!

Today, I'm speaking with a special guest.

I'm speaking with my good friend James Van Prooyen. James recently retired from the military, where he spent twenty years in the Air Force.

James didn't always want to serve in the Military. At first, James wanted to follow in his grandfather's footsteps and become an electrician.

While James was a senior in High School, in Northern Michigan, he was introduced to a recruiting officer. James learned a great deal about being in the Military, and James wanted to serve - for four years! 

Shortly approaching his fourth year in the Air Force, James thought about his future. He had a wonderful wife and a new baby. James loved working with his Air Force family, and he decided to enlist again for four more years. Those four years soon turned into twenty, and James found himself retiring and not knowing what to do next. 

James kept very busy after retiring from the Air Force by helping his wife with her nutritional business and helping to take care of his daughter.

James soon began networking and found himself part of the Tampa Bay Business Owners Association, and he soon learned he wanted to be an entrepreneur.

James learned about Podcasting and new he wanted to have a Military Show.

The Veteran's in Business Show was born!

James wants the Veteran's in Business Show to be a conduit for veterans who already own a business, to guide and teach veterans who will be leaving the military in the coming year. Veteran's who want to start their own business, will learn from other veterans, who have done it before them.

Resources for veteran's. James wants to make the transition easier for his brother and sister veterans.

If you are a veteran business owner and would like to be interviewed on Jame's podcast..... send him an email to 

TheMilitaryPodcastNetwork@gmail.com

If you know of a veteran who would love to learn how to start their own business, tell them to listen to the Veteran's in Business Show with James Van Prooyen.

Find the podcast here:

veterans-in-business-show

Contact James Van Prooyen:

@JamesVanProoyen

on Snap Chat - JamesVanProoyen

LinkedIn - James Van Prooyen

James - Thank You for your Service!

 

Tell a family or friend about Medicare Nation! 

Help someone get on Medicare Nation with a Smart Phone! 

The resources for people 64 and older is so valuable!

I'm counting on my "Sandwich Generation" to help out and get their parents on the show!

Help me to help you!

Thanks for listenening!

 

 

 

Feb 3, 2017

Hey Medicare Nation!

This week I’m discussing Medical Marijuana!

2017 has issued in with additional States Legalizing Marijuana for Medicinal purposes. I am speaking with Dr. Rachna Patel, The Medical Marijuana Expert this week on Medicare Nation.

Dr. Rachna Patel completed her undergraduate studies at Northwestern University in Illinois and her Medical studies at Touro University in Vallejo, CA.

Dr. Patel is a licensed practitioner in the State of California and is in impeccable standing with the State of California Medical Board. She has been practicing in the area of Medical Marijuana (cannabis) since 2012, and she has treated countless patients!

Dr. Patel is known for her “bedside manner” with her patients and does things differently than other Medical Marijuana doctors. Dr. Patel sees her patients “in person” and not by phone or virtually. Dr. Patel spends a thorough amount of time with patients to ensure she is guiding them step-by-step through the Medical Marijuana process.

Dr. Patel may “recommend” medical marijuana for conditions and diagnoses such as, but not limited to:

  • Chronic Pain (nerve, muscular)
  • Auto-Immune Conditions
  • Anxiety
  • Insomnia
  • Cancer

Dr. Patel may “not” recommend medical marijuana for conditions and diagnoses such as, but not limited to:

  • Spinal Stenosis
  • Severe “Shingles” Case
  • Bi-Polar Disorder
  • History of Heart Attack/Stroke

 

Medical Marijuana is “Googled” daily by tens-of-thousands of people.

According to ProCon.org , Colorado residents show the most interest in “searching” information on Medical Marijuana.  This may be due to the fact that Colorado was the first State to legalize “recreational use” of marijuana, and has set a "standard" for other States to follow.

According to the website ProCon.org, as of March of 2016, there are over 1,250,000.00 people using marijuana medicinally. As more States legalize the use of Medical Marijuana, those numbers will steadily rise.

The following 21 States have passed legislation for the use of Medicinal Marijuana:

Montana, North Dakota, Minnesota, Michigan, Ohio, Pennsylvania, New York, Vermont, New Hampshire, Rhode Island, Connecticut, New Jersey, Delaware, Hawaii.

The following Nine States have passed legislation for the recreational use of marijuana:

Washington, Oregon, California, Nevada, Alaska, Colorado, Maine, Massachusetts, D.C.

 That’s 30 States Total that have legalized Medicinal Marijuana.

Here are a few links to learn more about Medical Marijuana:

www.weedmaps.com

http://medicalmarijuana.procon.org/

Would you like to contact Dr. Rachna Patel to learn more about Medical Marijuana and/or her practice?

Here are links for Dr. Patel.

Website – www.Dr.RachnaPatel.com

Facebook page: www.facebook.com/DoctorRachnaPatel

YouTube                                                                                                       https://www.youtube.com/channel/UCNtN7JXpNKHAYA7ZdWzpi1A    

How to Choose a Medical Marijuana Doctor that You Can Trust

28 Legal Medical Marijuana States and DC: Laws, Fees, and Possession Limits

 

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

 

 

Jan 20, 2017

Hey Medicare Nation!

How many of you have just found out your Doctor is leaving the Medicare Advantage Network you're in?

I'm certain there are "Thousands of you."

That is the #1 complaint I receive from clients, is that their "Doctor" is leaving or has left their Medicare Advantage Plan (MAPD) Network.

Medicare has regulations about how a Medicare Advantage Organization (MAO) can "terminate" a Doctor contracted in their network and in reverse, there are regulations on how a Doctor can leave a MAO.

There are also regulations on how a MAO publishes it's "Provider Directory" for their network.

Chapter 4, Section 110.1.1 of the Medicare Managed Care Manual, titled, Provider Network Standards, lists in part.... 

"MAO's are required to establish and maintain provider networks that:

...... Are accurately reflected in up-to-date directories. Plans are responsible for verifying and regularly updating their network directories to ensure that providers included in the directories are available to their enrollees (ie, listed providers accept new patients who are enrolled in the plan).

 

In section 110.2.2 labeled Provider Directory Updates, it states in part:

....MAO's must include information regarding all contracted network providers in directories at the time of enrollment. Directories must include information about the number, mix, and distribution of all network providers. MAO's may have separate directories for each geographic area they serve (e.g. metropolitan areas, surrounding county areas), provided that all directories together cover the entire service area.

Provider Directories must be updated anytime the MAO becomes aware of changes. They have 30 days to update the changes or be non-compliant.

When there is a change to the provider network (a provider is terminated or the provider is leaving the network), The MAO "must make a good faith effort to provide a written notice of a termination of a contracted provider at least 30 calendar days before the termination effective date to all enrollees who are patients seen on a regular basis by the provider whose contract is terminating."

In regards to termination of "Primary Care Physicians," all enrollees who are patients of that primary care professional must be notified."

 

So.....what's being done about all the inaccuracies to provider directories?

 

CMS conducted it's first review of 54 Medicare Advantage Organizations (MAO's) online provider directories, between February and August of 2016.

The finding......45% of provider directory locations listed in these online directories were inaccurate!

About one-third of all MAO's with 5,832 providers were reviewed in total.

Twenty-One MAO's received warning letters from CMS around January 6th, and they have 30 days to fix the errors or face possible fines or sanctions, which could include suspending marketing and enrollment of medicare beneficiaries.

Here are the Medicare Advantage Plans that received warning letters from CMS to immediately fix the errors in their provider directories.

Blue Cross & Blue Shield of Rhode Island - RI

Rhode IslandBlue Cross Blue Shield of Michigan - FL MI, MO WI

Catholic Health Partners - IA,KY, MI, OH

CIGNA  - IL, IA

Community Health Plan of Washington - WA

Emblem Health Inc. - CT, NY, RI

Fallon Community Health - MA

Gateway Health Plan, LP - OH, PA, WV

Health Partners Plans, Inc. - PA

Highmark Health - PA

Humana Inc. - WI

Indiana University Health - IA

Magellan Health Inc. - NY

Moda, Inc. AK, ID, MT, NM, OR, WA

Molina Healthcare, Inc. - UT

Piedmont Community Health Plan - VA

Premera - WA

Samaritan Health Services - OR

SCAN Health Plan - CA

UnitedHealth Group, Inc. - CO

Wellcare Health Plans - IL

 

Now.... if you are a member of one of these MAO plans that received a "warning letter," you may qualify for a "Special Enrollment Period," from Medicare.

What should you do?........

1. Call Medicare - 800-633-4227

2. Tell the Medicare employee that you are a member of the ________ Medicare Advantage Plan, that received a "Warning Letter" from CMS for non-compliance of their provider directory.

3. State (if it's true!) that you were not notified by your physician or the MAO of the termination of your doctor, and your directory wasn't updated.

4. VERY IMPORTANT  TO STATE.....

    Tell the Medicare employee you RELY on the directory to locate an in-network provider, and by the Medicare Advantage Plan & the Doctor NOT informing you that he/she was LEAVING the network, it caused a SIGNIFICANT access to care barrier for you! 

Because now...... You can't see your doctor who has taken such good care of you..... due to the error.

5. Ask for a Special Election Period, so that you can choose a Medicare Advantage Plan where your Doctor is in-network.

6. If they grant you the Special Election Period, tell the Medicare employee which Medicare Advantage Plan you want to be on.

7. If they say "NO,"  Thank the Medicare Representative for their help and say goodbye.

 

What do you do now????

See if you qualify for a different Special Election Period. Listen to my earlier episode on SEP's.

Listen to Last Friday's episode on 5 STAR Plans.

Listen to the episode on the Medicare Advantage Disenrollment Period. It also includes information on Special Need Plans.

If NONE of these ideas offer you the opportunity to change your Medicare Advantage Plan to a better option, than you will have to remain on the Medicare Advantage Plan you are on until the Annual Enrollment Period to change plans.

Do your Due Dilligence Nation!

Don't enroll in another Medicare Advantage Plan.... just because the doctor who is leaving the network is on that one!

Make sure the plan will fit your Medical, financial and prescription needs for 2017!

Share Medicare Nation with someone!

Teach your parents, your grandparents how to access this podcast! Buy them a smartphone.

The more they know, the less they will ask you for help.

It's not easy being the "Sandwich Generation."

So...... do yourself and your parents a favor and help them listen to Medicare Nation! 

 

Jan 13, 2017

Hey Medicare Nation!

Medicare has announced the 2017 "5 Star Plans."

What are 5 Star Plans?

Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing.

There are 2 main types of Star Ratings:

1. Overall Star Rating that combines all of the plan's scores.

2. A Summary Star Rating that focuses on a plan's medical or prescription drug services.

A few areas Medicare reviews for these Star Ratings include:

1. How plan members rate their plan's services and care.

2. How well a plan's network of doctors detect illnesses and keep members healthy.

3. How well a plan helps it's members use recommended and safe prescription medications.

A plan can receive a 1 to 5 Star Rating.

5 Stars is Excellent

4 Stars is above average

3 Stars is average

2. Stars is below average

and 1 Star is poor.

You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is available in your area.

You can only switch to a 5 Star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once from December 8th to November 30th of the next year.

Once you use your election to enroll in a 5 Star Plan, you cannot use it again.

If a Medicare Advantage Plan or a Stand-Alone Prescription Drug Plan has received a 5 Star Rating from Medicare, it doesnot mean you automatically go out and enroll in the 5 Star Plan.

That 5 Star Plan may not fit your unique needs!

The option is available..... if you need it!

Some people enroll in a Medicare Advantage Plan during the Annual Enrollment Period, and only switched plans because they received an incentive from the new plan.

Ex: Your neighbor "Phil" tells you he is on the greatest Medicare Advantage Plan. He receives $30 in "Bandaids" from his plan every month. He tells you to "switch" plans so you can get $30 worth of over-the-counter supplies every month. Phil hands you his "Agent's" card.

You call Phil's "Agent," who gladly comes out and enrolls you into the same exact plan that Phil has. The plan goes into effect January 1st. You call your Primary Doctor on February 6th for an appointment because you think you have the flu. 

The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network?

Sorry......you should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th. 

Maybe you were better off on the plan you originally were on.

In this example, you may have another option!

You find out in January, that XYZ Medicare Advantage Plan has a 5 Star Rating in your area. You can look up the XYZ Plans and determine if one of their plans accepts your Primary Doctor in their network. Check the co-pays, co-insurance and deductibles on the new plan. Check that all your prescription drugs are in the new 5 Star Plan's formulary.

If you like what you found out about the 5 Star Rating Plan that is available in your area, you are allowed to "switch" one time from the Medicare Advantage Plan you are stuck on, to the 5 Star Rating Plan available in your area. 

Once you make the election to switch to the 5 Star Plan, you cannot enroll into another plan - whether it has 5 Stars or not. 

Only a criteria that fits a Special Election Period will be allowed.

Look on the www.Medicare.gov website for the list of Special Election Period examples.

The 14 Medicare advantage Plans that received "5 Star Ratings" for 2017 are:

     Company Name                           Service Area

1. KS Plan Administrators, LLC -     4 Counties TX

2. Kaiser Found. HP, INC                 31 Counties CA

3. Kaiser Found. HP of CO               17 Counties CO

4. Kaiser Found. of the Mid-            D.C. &         Atlantic States                              11 Counties MD                                                             9 Counties VA

5. Tufts Assoc. HMO                       10 Counties MA

6. BCBS of MA HMO Blue                11 Counties MA

7. Group Health Plan (MN)            87 Counties MN                                                           8 Counties WI

8. Aultcare Health Ins. Corp          12 Counties OH

9. Physicians Health Choice TX     19 Counties TX

10. Gundersen Health Plan            1 County IA,                                                                 8 Counties WI

11. Optimum Healthcare Inc.        25 Counties FL

12. Kaiser Found. HP of NW          9 Counties OR                                                            4 Counties WA

13. Sierra Health & Life Ins.         1 County CO,                   1 County KS, 2 Counties MA, 3 Counties MD.             1 County MI, 2 Counties NJ, 2 Counties PA,               2 Counties TX, 1 County in VA

 

If you live in the service area of the above 5 Star Rated Plans, you should go onto the Medicare.gov website and compare the 5 Star Plan to the Plan you are currently on. Make sure your doctors are in the network. Make sure ALL your prescription drugs are covered in the formulary. Look at the co-pays, co-insurance and any deductibles.

Make sure the "5 Star Plan," is worth "switching" too!

Just because it was given a 5 Star Rating from Medicare, doesn't mean the plan will automatically be the best choice for your unique needs.

Do your Due Diligence! 

You can check the Medicare.gov site for any 5 Star Prescription Drug Plans in your service area and Medicare Advantage Plans that are health plans only and do not offer prescription drug coverage on that particular plan.

You can also listen to episode MN061. I give you information on the Medicare Advantage Disenrollment period and information on Special Need Plans.

You don't have to be "stuck" on a Medicare Advantage Plan that doesnot suit your needs.

This is the time of year to make changes. Make sure you switch to a better plan this time!

Questions??

Send them to Support@TheMedicareNation.com

Thanks for listening to Medicare Nation.

If you like the information that is provided, give us a 5 Star Review on iTunes!

The more reviews we get, the more exposure iTunes will give Medicare Nation, and that means more people will be able to find the show.

https://itunes.apple.com/us/podcast/medicare-nation/id1031060767?mt=2

Have a happy, peaceful & prosperous week!                         

Jan 6, 2017

Hello Medicare Nation! Happy New Year to everyone.

I hope everyone had a wonderful holiday season.

The Annual Enrollment Period is over. I hope each of you did your due diligence in deciding which plan will fit you best for 2017.

I have many episodes available for you to learn all about Medicare Advantage Plans, Original Medicare and Part D of Medicare.

If you determine the Medicare Advantage Plan you are on is not suitable for you or a loved one in 2017, you may have other options available to you.

Right now, you are in the Medicare Advantage Disenrollment Period. It started on December 8th and will end on February 14th of 2017.

Here is how you "dis-enroll" from a Medicare Advantage Plan during this time period.

1. Call Medicare 800-633-4227

2. Advise the Medicare Representative that you would like to "dis-enroll" from your current Medicare Advantage Plan and go back onto Original Medicare.

3. You can enroll in a stand-alone Part D prescription drug plan.

4. You can also enroll in a Supplement to Original Medicare plan, that will assist you in paying your out of pocket costs for Part A & Part B. 

Each Supplement to Original Medicare Plan (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan J, Plan K, Plan L and Plan N.) cover different out of pocket Medicare costs. Research each one prior to enrolling in the Supplement plan to determine the plan that will fit your health & financial needs for 2017.

If you find it difficult to figure out if Original Medicare and enrolling in a Part D and/or a Supplement to Original Medicare Plan is right for you, contact me at either - 

Support@TheMedicareNation.com

OR

Go to my website..... www.CallSamm.com and tell me in the "Contact Me" how I can assist you.

 

SPECIAL NEED PLANS

Are you a Diabetic? Do you have COPD? Do you have Cardiovascular Disease?

If you answered "yes" to any of these questions, you may be eligible to enroll in a special needs plan.

A special needs plan is a Medicare Advantage Plan. If you are diagnosed with any of the conditions I listed above, you may use a special election to change to a special needs plan one time during the year.

How do you determine if you have Special Need Plans in your area?

Go to www.medicare.gov and click on the "find health and drug plans." The database will take you through several screens and you should select "special needs plan," when you advise Medicare what type of plan you are on.

The database will provide you with the special need plans in your area.

You can also look under special election periods, to determine if you have a qualified reason to change.

If you like Medicare Nation, please give us a 5 Star Review on iTunes!

https://goo.gl/uAhvLe

When you leave us a great review, iTunes gives Medicare Nation more exposure. More exposure means individuals who need advise about Medicare will find the show!

I appreciate you listening to Medicare Nation!

Have a happy, healthy & prosperous week!

 

 

1