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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: Category: health
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!

 

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 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!

 

 

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!

Like our Facebook page! Go to https://www.facebook.com/MedicareNation

 

Feb 5, 2016

 

 

Welcome Medicare Nation! I have some alerts for your today for some important changes to Medicare that are going on right now. I want you to know if you are affected, and what you need to do to make sure you have coverage. There are 2 main topics we need to discuss today:

 

  1. Dis-Enrolling from Medicare Advantage Plan
  2. Cigna Suspension

 

 

 

Jan 1- Feb 14 - the period in which you can dis-enroll from your Medicare Advantage plan - if you don’t like it.

 

  • You cannot then switch to another Medicare Advantage Plan during this period
  • You would only be able to go back to original Medicare when you disenroll
  • You would have Part A and Part B
  • This means you have deductibles and co-insurance
  • There is no network - any provider contracted with Medicare will work for you
  • Part B deductibles are either $104.90 or $121.80, depending on your situation
  • Part A deductibles are $1288 for each new occurrence during the coverage period
  • First 60 days you are covered by the deductible
  • Day 61-90 you pay co-insurance of $322/day
  • Day 91-100 you pay $644/day
  • After that you have your 60 lifetime reserve days at $644/day also
  • Part B has annual deductible of $166 for 2016
  • After the deductible you pay 20% of Medicare allowable cost for every procedure
  • You can purchase a Medicare Supplement plan for which you would pay a monthly premium

 

Need Help?

 

 

 

Cigna Suspension:

 

The States - AL, AZ, FL, GA, NC, PA, SC, TN - are affected. They cannot enroll any new people for the plan. If you had it, you can stay on it. Or you can leave. This was a sanction from CMS for failing to comply with the Medicare Standards. They found that Cigna has a long standing history of non-compliance with CMS standards. The suspension is indefinite.

 

This sanction opens a “Special Enrollment Period”. This allows you to enroll in a different Medicare Plan. 

 

Need Help?

Contact Medicare - 1-800-633-4227

Medicare Website - www.medicare.gov/contacts

support@themedicarenation.com

 

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

 

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

 

 

 

Jan 22, 2016

 

Welcome Medicare Nation! Everyone keeps asking me about the changes to Medicare for 2016. There are quite a few changes, so today I will focus on the biggest ones you want to know about today.

 

How much will you pay for Medicare Part B (Outpatient Services)?

 

There is no COLA (Cost of Living Adjustment) for 2016. The Hold Harmless Rule comes into play. If there is no COLA, then there can be no increase in Medicare Part B. 

 

For everyone who is already on Medicare and receiving SS benefits, your Part B stays the same at $104.90. That’s 75% of the people that are on it. 

 

If you are turning 65 in 2016 and you are on Medicare, your premium will increase. If you delayed taking SS benefits because you continued working, your premium will increase. If you are on Medicare and Medicaid, your premium will go up. You may qualify for the state reimbursement for Medicaid costs. New premiums will be $121.80. Recommendations were that Medicare Part B premiums should be up around $159, but Congress limited the increase to $121.80. In actuality, Congress gave you a loan for the difference between $121.80 and $159, and charged you a fee for the loan until it can be repaid.

 

Over $65 Billion of Medicare dollars is lost to fraud. Instead of worrying about the fraud, your politicians gave you a loan! Oy Vey!

 

If you make over $85K in income, your premium will increase to a different amount, which you can reference on the website.

 

 

Medicare Part D (Drugs) - Medicare Advantage Plan majority will have drug coverage included already.

 

For 2016, know your deductible situation (max $360). Some have them and you will have to pay out first, and others will only be triggered with a brand name drug.

 

 

The Donut Hole - You don’t want to be in this category. $3310 is the maximum expense for this category. When you add up the amount of money you have paid and the plan has paid, and it exceeds $3310 and now you are in the donut hole. 

 

Now the government wants you to start paying more for your coverage. The new threshold is $4850 for this level. You will now pay 45% of the cost of the brand name drug and you will pay 58% for a generic drug. What you pay out of pocket plus a 50% manufacturer discount. Once you meet $4850, you now fall into the catastrophic coverage phase.

 

Catastrophic Phase - Last through the end of the calendar year. You will pay 5% of the cost of the drug or $7.40, whichever is higher. For generics you pay 5% of the cost of the drug or $2.95, whichever is higher.

 

The slate gets wiped clean as of Jan. 1 and your classification starts all over again.

 

 

Medicare Payout for Providers:

 

For 2016, payments will be reduced by 30%

 

They are looking at tying procedures together when there are multiple issues stemming from the procedure. Payment will be reduced when you are re-admitted to the hospital within a certain timeframe.

 

When a patient contracts an infection during a hospital stay, the payments will also be reduced.

 

They are looking at “Value over Volume”.

 

 

 

If you have been on Medicare for a year, you can have an annual Wellness medicare checkup. This isn’t your annual physical, but a Wellness Medicare Exam.

 

 

From now thru Feb. 14, you can drop your Medicate Advantage Plan and go back to original Medicare and have coverage for Part A and Part B. Then you would need to purchase Part D separately.  

 

  • No premium for Part A (overnight stays in any type of facility) $1288 is the amount you pay for 60 days. Day 61-90, you pay an additional $322/day and after day 90, you pay $644/day. Every person has 60 lifetime reserve days for one time use only.
  • In skilled nursing 0-20, 21-100 (max) you pay $161/day.
  • Part B has a one time deductible of $166, and then 20% of Medicare allowable cost. Find out your co-insurance payment prior to the appointment.

 

Stand Alone Prescription Drugs Plans:

 

  • All have premiums
  • Check for the deductibles too
  • You can apply for a supplement for Medicare to help cover the cost of Original Medicare

 

 

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

 

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

 

 

Jan 15, 2016

Welcome! My guest today is Dr. Vincent Bufalino from Illinois. He is board certified in Internal Medicine and Cardiovascular Disease. He is the Senior Vice President of the Advocate Heart Institute and the Senior Medical Director of Cardiology of Advanced Medical Group (AMG). AMG is ranked as one of the top five health systems in the US and has 140 physicians in cardiology practice! Let’s hear more from Dr. Bufalino!

  • Tell us what you do at AMG.

“We care for patients in 12 hospitals in the Chicago area. Last year, over 20,000 cardiac procedures were performed at AMG. We provide expert medical care to those with high blood pressure, high cholesterol, and diabetes. Our surgical program provides the latest in technology to provide the highest level of quality health care.”

 

  • Do you treat patients from all around the US?

“We service most of northern Illinois and have outreach clinics even in the rural communities. Most of our patients are from this area, but some continue to access our care for follow-ups, even after they’ve moved to other states.”

 

  • What is meant by the term “heart disease”?

“We look at risk factors, which are not managed as well as they should be. High cholesterol is very common, and we have many tools to treat it although not everyone needs to be on medications. Some people can be treated with diet and exercise, but those over age 35-40 with family risk factors should be evaluated. Those that are experiencing symptoms should be evaluated. The death rate from heart attacks has decreased from about 20% a few decades ago to just 2% today. Unfortunately, some patients develop heart failure and require advanced care, but there are still many treatment options available.”

 

  • What are some common signs and symptoms of heart attacks?

“Exertion-related symptoms are common, like discomfort, pressure, tightness, and burning. The two most common symptoms are chest discomfort and shortness of breath. You should also pay attention to rapid heartbeat and fluttering in the chest. Acid indigestion CAN be a symptom, especially if it doesn’t subside when you take an antacid.”

 

  • What is a stroke?

“Essentially, a stroke is damage to the brain, usually from a blood clot or a ruptured blood vessel. Sometimes a “warning” occurs, known as a TIA (transient ischemic attack). It is accompanied by numbness/weakness on one side, vision loss, and slurred speech. Time is critical since permanent damage can be done. Within the first 60-90 minutes, we can intervene and dissolve the clot.”

 

  • What are some procedures that Medicare allows to detect heart disease?

“For those over age 65, an ultrasound is allowed to assess the risk of Abdominal Aortic Aneurysm (AAA), which is the ballooning of the main artery going down into the abdomen. The ultrasound detects any enlargement of the aorta. Those with a family history of aneurysm, men with high blood pressure, and smokers have an increased risk.”

 

  • Can you explain the Cardiac Disease Screening under Medicare?

“There is a ‘Welcome to Medicare’ physical exam that is allowed during the 12-month period after you turn 65. There are also nutritional therapy services available, and most people don’t even know about them or take advantage of them. The purpose is to try to give people tips that can make a difference and help them live healthier lifestyles.”

 

  • How is salt tied to heart disease?

“Salt is tied to high blood pressure, and this isn’t just from the salt shaker! Sodium is packed into processed foods, so it’s important to read labels.”

 

  • You were president of the American Heart Association in Illinois. How can the AHA help people?

“The AHA supports the work we do at AMG with patient education and research. Their website offers resources and even cookbooks. Find them at www.heart.org.” 

 

  • Do you have any tips that people can follow RIGHT NOW to prevent heart disease?

“The two most important things are to eat better and exercise more.”

Resources:

www.heart.org

www.advocatehealthcare.com

www.meetup.com  (Find walking groups all around the country.)

 

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

 

 

Jan 8, 2016

Welcome! Today’s guest is Brad Hubbard of National Flood Experts. He has built a company and a career dedicated to helping people save huge amounts of money! Join us for more!

  • What is your background that led you to start National Flood Experts? 

“I worked for 12 years as a civil engineer, working with FEMA (Federal Emergency Management Agency) on flood zone issues. When I grew tired of working as an engineer, I began working as an insurance agent specializing in flood issues. I noticed how many homeowners were required to carry flood insurance even though there was almost no risk for flood. I found out FEMA has a process to take these homes out of the flood zone and save the homeowner from paying for flood insurance. Before long, I helped 20-30 clients and then created NFE to help millions of Americans who shouldn’t be paying for flood insurance.”

 

  • Why would someone be required to have flood insurance?

“There are two requirements to have flood insurance: having a mortgage and living in a flood zone, as determined by FEMA. Being near water doesn’t necessarily mean you MUST have flood insurance, and both residential and commercial properties are subject to these requirements.”

 

  • How are flood insurance rates determined?

“There are different factors that vary according to different agents. The rates are not standardized but are affected by how high the home is built and how high the speculated flood may be.”

 

  • Is FEMA in charge of determining flood zones?

“Yes. FEMA created the NFIP (National Flood Insurance Program, which oversees all federal flood insurance in conjunction with local municipalities. They categorize flood zones and update maps every 10-15 years. NFE actually benefits FEMA by helping make their maps more accurate.”

 

  • So, as homeowners, is it accurate to say that we can actually CHALLENGE FEMA’s flood zone designation?

“Yes. Challenge is exactly the right word for what we can do. Most people don’t even know that this is possible, because we assume when the government says something, then that’s the end of it.”

 

  • Can you give us an example of how NFE can help a client?

“Yes. I have a client who lives in a 55+ neighborhood and was paying $1800/year for flood insurance. Our company did an Elevation Certificate and determined that we could help her. We charged her $500 for our services, submitted our report to FEMA, and they took her out of the flood zone within three days. She talked with her mortgage lender and her insurance agent and received a $900 refund from her escrow account and $1800 back from her previous year’s flood insurance. When you are taken out of a flood zone, then you’re entitled to a refund of every penny that you paid in flood insurance from the previous year! In addition to the $2700 refund, her mortgage payment dropped by $200/monthly—all of this was accomplished in just a few days’ time!”

 

  • How do homeowners get an Elevation Certificate?

“It’s part of the package with a survey and appraisal when you purchase a home or purchase flood insurance. Only about 20% of people don’t have one. Our crew can complete an Elevation Certificate for $150-500. If your home has been built or improved upon in the last 20-30 years, then an Elevation Certificate probably exists. Every municipality is required to keep these as public record in order to have FEMA participation.”

 

  • Does your service fee vary according to whether a home is in a low-value area or a high-dollar area?

“No, our services are based on a flat rate no matter where you live.”

 

  • What can NFE do for Medicare recipients?

“In all 50 states, Puerto Rico, and anywhere that FEMA regulates, NFE has a way to make it easy. There is a 24-hour recorded message line: 888-289-3134. You can access our free consumer’s guide to purchasing flood insurance. Our services are 100% guaranteed, with a total refund if we can’t help them, so there is NO RISK! If you mention this podcast when you call, then you will receive a $50 discount.”

 

  • Tell us what you can do to help our listeners.

“For some, we can get you out of a flood zone designation and eliminate your need for flood insurance. For others, we can reduce your insurance premium in several different ways in reviewing your property and options.”

 

  • Can you give us a summary of what your company does when a client calls?

“When you call and leave a message, all we need is your name and address to begin our research. We will be in touch with you within 24 hours and give our recommendations regarding how we can help. There is no payment required until a determination is made that we can help. The initial review is free and the only charge happens when we KNOW that we can help (and don’t forget the MONEY-BACK GUARANTEE!)”

 

  • How does your fee differ from residential and commercial clients?

“The pricing is a little different, based on how much we can save a commercial client in a year, but the process and the guarantee are the same!”

 

  • What if a residential homeowner has had flooding? Can they still contact you?

“Yes and no. If you’ve had a flood claim, then FEMA is not going to remove you from the flood zone, but there still are things you can do to reduce your premium. Keep in mind that FEMA defines a “flood” as rising water over more than two acres and where two or more properties are affected. Flooding does NOT include broken pipes or a water main break. Your normal homeowners’ insurance covers those water damage issues.

 

If you are paying for flood insurance, you should give NFE a call at 888-289-3134 or visit their website: www.nationalfloodexperts.com.

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

 

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

 www.CallSamm.com

 

 

 

 

Dec 11, 2015

Welcome! My guest today is Jim Jenson, who is the owner of “Fit for Life,” an adaptive fitness business. He is a certified fitness instructor and the host of the podcast, “The Essential Boomer.” Jim is here to talk about the specific fitness needs for baby boomers.

  • Tell us about “Fit for Life” and what adaptive fitness is.  I have been in business for about ten years, located 20 miles south of San Francisco. I work with special fitness issues like MS, wheelchair-bound clients, and balance issues. I usually travel in a 10-15 mile radius to visit clients in their homes to work with them. I love helping people improve their lifestyle and their health!

 

  • How are you certified to do what you do? I’m certified through the National Academy of Sports Medicine (NASM), with both basic and advanced certifications. Special training is essential to prevent injuries, so Baby Boomers need to make sure to work with someone trained in disabilities and chronic issues.

 

  • At this time of year, there are many offerings of “free memberships” in fitness programs. How can people get the most from this benefit? Always work with a trainer, and be sure they are certified for your needs and goals. You really need one-on-one training for success and injury prevention. Don’t be afraid to ask about their certification, and check with your primary doctor about beginning a fitness program.

 

  • What kinds of exercises do you teach those with special challenges? I am a big fan of resistance bands and I take them everywhere! They allow core exercises even while sitting and help with balance and stability. Recumbent bikes are great for cardio workouts. I even use foam swords for “sword fights” with wheelchair-bound clients! Check out my website for Predator Bands and a video about a total body workout with bands!

 

  • What are the primary causes of balance problems? De-conditioning is the biggest problem. This is due to the lack of use of the core muscles. Other causes include medication interaction, chronic conditions, and vision/hearing changes. Remember, a previous fall increases your chances for another fall!

 

  • What exercises can be done at home to reduce the risk of a fall? Strengthen your core muscles and practice your balance. Don’t be ashamed to use a cane or a walker for extra safety. You can even work with a certified trainer to improve your gait.

 

  • What about exercises to strengthen the core? There are many “mat work” exercises, and yoga that is geared toward seniors can increase core strength and flexibility. One of my very favorite resources is The Core Program: 15 Minutes a Day That Can Change Your Life, by Peggy Brill.

 

  • What other things can boomers do to maintain active lifestyles? For longevity, cardiovascular exercise is preferred. It’s GOOD to huff and puff and then let your body recover. For quality of life, resistance exercises (like bands) are a great option. Dancing is also wonderful for balance, stability, cardiovascular exercise, and FUN! 

 

  • Do you take any insurance in your fitness business? No, there is no insurance that pays for personal trainers except on the rare occasion when it may be included in a workman’s comp claim.

 

  • Tell us about your podcast, The Essential Boomer. It is the Baby Boomer’s Survival Guide! It’s my passion and what feeds my soul. I started it in May, and it has grown. I interview knowledgeable guests to give information to Baby Boomers. The podcast is connected to a private Facebook group by the same name.

 

Resources:

The Core Program: 15 Minutes a Day That Can Change Your Life by Peggy Brill

www.essentialboomer.guide  (Jim’s website)

jim@essentialboomer.guide (Jim’s email)

650-704-0377 (Jim’s phone number)

www.nasm.org  or 800-460-6276 (Contact NASM for certified trainers in your area.)

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

 

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

 www.CallSamm.com

 

 

Dec 5, 2015

It's annual enrollment time and I know that the prescription drug coverage options can be confusing.  So, today I wanted to try to clarify what you need to look for in the best drug coverage plan for you.

Original Medicare requires a stand alone plan for prescription drugs.

These plans are a pain, and that’s exactly why this episode exists.

 

  1. Do not be loyal to any particular drug plan.  You want the plan with the least out of pocket expense, and the ones that carry your drugs.
  2. You will pay a monthly premium, either a lower ($16-18 to $30-35) premium and then a higher deductible.  Or you can have a high premium (up to $180 monthly) and then almost no deductible.

3.  Make sure your particular drugs are on the plan before you commit to any plan.  This list is always changing and you have to double check it from year to year.

 

If you have several drugs, you could easily meet your deductible in the first month of the new year.

It is important to do the math and see what your overall out of pocket expenses are going to be.

Don’t assume that the generic drugs are always cheaper.  Check your plan!

 

The Donut Hole:

Jan 1 you have $3310 to use towards prescriptions.  This is a combination of copays and what the plan pays.  Once you reach $3310 total, then everything else is in the donut hole.

So now, your cost of prescriptions will change.  Once you reach $4850, you get out of the donut hole.  After $4850, then you are now in the catastrophic phase of the plan.  So you either pay the higher of 5% of the total price or the designated price for that prescription.

In 2020, the donut hole is eliminated, and then everyone will pay a flat 25% of the cost of the drug.

Silver Scripts - owned by CVS - it has a pretty good premium ($25.60 monthly in FL) and then you have no deductible.  You just have to make sure your drugs are on the plane. silverscripts.com will tell you what the tiers are for the drugs and the monthly costs.  

 

Always look at plans year to year and make sure you get the best plan for you.

 

If you have questions, you can reach out to me:

 

Call 855-855-7266

Twitter.com/medicarenation

themedicarenation.com

facebook.com/medicarenation

You always have an alternative as well, if none of this fits you.  If you decide you made a mistake, you still can drop your plan in January and go back to Original Medicare and a stand alone plan.  Listen to the episode and Diane will tell you what your options are. 

 

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

 

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

 www.CallSamm.com

 

 

Dec 5, 2015

It’s that time of year!  You have 5 days left to choose your Medicare plan for the coming year.

 

Did you choose the right plan?

 

If you are confused, this is the episode for you!  I’m going to tell you exactly what you need to know to make the right choice.  

 

3 Choices:

Original Medicare - Part A and Part B

Medicare Advantage

Medigap to Original Medicare

 

Medicare for 62 and older and it was never designed to be free,

 

Part A - Stay overnight

Part B - (Outpatient) Everything where you don’t stay overnight

annual deductibles

copayments

 

Medicare Advantage - networks, HMO and PPO healthcare providers.

 

HMO is smaller and PPO’s are larger and carry Medicare products in different states.

Supplement is a private insurance (F Plan) and it is expensive, but the coverage is comprehensive.

 

  • All will have the same basics of Original Medicare Plan.
  • Most of them include prescription drug coverage with co-pays
  • Some have premiums and some do not - you just have to research.  I don’t recommend plans with a monthly premium.
  • Don’t get a plan with a deductible
  • Max out of pocket is $6400 for the year for Medicare - so look for the lower maximum out of pocket expenses.  It is for the same coverage.
  • Don’t fall for the plans that give you a discount on over the counter items.  It isn’t worth it.
  • No monthly premium
  • No drug deductible
  • Lowest maximum out of pocket expenses
  • Make sure your doctors are on the plan that you are choosing

 

There is no binding agreement that keeps Doctors in the network, so they may come and go.

 

If you have the plan with no monthly premium, no drug deductible and a low maximum deductible with $3000 or so, then that is a great plan!

 

If you are looking for supplemental plans, you need to realize that the benefits are standardized.  The F Plan is the most comprehensive and it will go away in 2019.  They are also eliminating the C Plan in 2019 as well.  The C Plan just doesn’t cover excessive charges.  The G Plan means you are responsible for your Part B premium and also for excessive charges.

 

Compare the prices for the F Plan under each insurance agency, because they will be different and then you need to know what the financial rating of that company is.  AAA+ is the best rating and F is the worst.  

 

You can find more information and keep in touch with us in the following places.

 

855-855-7266 - Call us and we will help you!

 

www.themedicarenation.com

 

facebook.com/medicarenation

 

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

 

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

 www.CallSamm.com

 

Nov 27, 2015

Welcome! My guest today is Dr. Jeffrey Berns, who is the president of the National Kidney Foundation. He is a professor of Medicine and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Dr. Burns is the Associate Chief of the Renal, Electrolyte, and Hypertension Division and the Director of the Nephrology Fellowship Training Program and the Associate Dean for Graduate Medical Education.

Dr. Berns addresses the following aspects of kidney disease and its risks:

  • What is the National Kidney Foundation (NKF), its mission, and your role? The central office is in NY, but there are offices around the country, each manned by a wonderful staff. Dr. Berns’ role is to talk about the NKF, kidney disease and be a spokesperson and advisor to the board. The mission of the NKF is to help those with chronic kidney disease (CKD) identify the diseases. About 80% of kidney function can actually be lost to CKD with no noticeable symptoms! The NKF also focuses on education about CKD, risk factors, and causes, and research to identify treatments and cures.
  • What are the most common risk factors for CKD? One out of three adults is at risk, and up to 10% may already have CKD but be unaware of it. The most common causes are high blood pressure and diabetes; these diseases cause over 60% of all CKD that requires dialysis or transplant. Family history is a risk factor, as well as minority ethnicity and being over age 60. The ethnicity risk is tied to some socioeconomic factors and some genetic markers that seem to predispose African-Americans to CKD. Kidney disease is an important disease and is under-recognized in the US.
  • For patients with hypertension or diabetes, what tests can be done to screen for kidney disease? The most common tests are a blood test called a Serum Creatinine Level to test kidney function and a urine test to detect protein in the urine. Simply assessing urine output is not an accurate indicator.
  • Are urinary tract infections (UTI’s) a determinant in CKD? These infections are not really a risk factor, but recurrent kidney stones and kidney infections may be precursors to CKD.
  • How would someone know if they have CKD? Blood and urine tests are the only way to detect the disease until symptoms advance to a very serious stage. Discolored urine and swelling of the feet and ankles may be symptoms. The blood and urine tests are most commonly done at the ER and doctors’ offices in conjunction with other exams and other issues.
  • What kinds of resources are available through the NKF? Visit their website at www.kidney.org. You will find information there about the prevention of kidney disease as well as information about kidney function, tests, organ donation, and transplantation. NKF Cares is the patient information Helpline, available in English and Spanish. The website also includes a Peer Support program for patients, information about insurance, and My Food Coach, which has nutritional guidelines.
  • How does Medicare coverage factor into CKD? Those over age 65 are already at higher risk for kidney disease, and Medicare is the primary payer for those patients. A co-pay of 20% is required unless you have co-insurance, and most services are covered under Medicare Part B. For people under 65, coverage is a little trickier. After 30 months, Medicare becomes the primary provider for those on dialysis, but the rules vary according to the type of dialysis that people require. Medicare coverage kicks in immediately for transplant patients, but only lasts three years. The NKF is working to change those coverage limits.
  • For kidney donors, are exact matches required? Kidneys are matched with compatible blood types. An identical sibling is an ideal match, but any living donor is preferred over a deceased donor. Family members, friends and co-workers can be donors.
  • How good is the function of only one kidney if you’ve become a donor? Potential donors are extensively screened to assure a very low risk for future kidney disease. There are small risks, as with any surgical procedure, but the remaining kidney will adapt and actually increase its function after the removal of one kidney.
  • What is the name of a kidney specialist? A kidney specialist is called a “nephrologist,” not to be confused with a urologist, who is a surgeon specializing in the urinary tract. A nephrologist has studied internal medicine and chosen to specialize in kidney diseases and treatments.
  • Visit the NKF website for more information about becoming a donor or a volunteer. You may also call 1-855-NKF-CARES.

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

 

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

 www.CallSamm.com

 

Nov 19, 2015

Welcome! My guest today is Rosemary Gibson, who is an author and renowned speaker and presenter on the subject of healthcare. Rosemary is currently the senior advisor at the Hastings Center, and the founding editor of Less is More narratives in JAMA internal medicine. In 2014, she was the recipient of the highest honor from the American Medical Writers Association in the field of medical communication. Her books include Medicare Meltdown: How Wall Street and Washington and Ruining Medicare and How to Fix it, The Battle over Healthcare, The Treatment Trap, and Wall of Silence.

  • Tell us what the Hastings Center is and what you do there.

The Hastings Center is a healthcare think tank that looks at ethical issues from the perspective of public interest. It’s a non-partisan, non-profit organization with whom I’m proud to be affiliated. We seek to inform the public on critical healthcare issues of the day. I do this work as a public service because we have the right to know!

 

  • Where are healthcare costs headed for beneficiaries?

Costs keep going up! The reason is that hospitals, doctors, and medical device companies can keep billing for whatever they want and as often as they want. There is no one to stop it! Their motto is “Bill, Baby, Bill!” Medicare is taking a larger and larger share of social security tax. Millions are facing a 50% increase in their Medicare Part B premium. Your Medicare card is the credit card for those doctors, hospitals, and medical device companies and you can’t do anything about it! When Medicare started, there were no healthcare companies on the Fortune 100 list, but now there are 15! The system is full of corruption that is off the charts!

 

  • What is the answer? How can we stop this?

You have to take charge of your health and not trust it to anyone else! Healthcare is something they want to SELL to all of us, and we cannot assume that they want the best for us. Rosemary calls our condition “The Marinated Mind,” because we’ve been marinated to believe that any procedure recommended by a doctor is ok. Baby boomers have been brainwashed to NEVER question what the doctor says. Rosemary teaches you her “exit strategy,” where you can respectfully decline a procedure, ask for more time to think about it, and discuss it with the doctor at a later date. Listen in for details! The truth has been hidden from us, but we need to become empowered to make our own decisions!

Medicare Nation listeners, you know I’m always reminding you that we each play a part in reducing Medicare fraud. We all have to do our part. Always examine your monthly summary statement for anything that looks suspicious. One more tip: It’s Medicare enrollment time, so STAY AWAY from the high-pressure seminars! Read the material and visit www.medicare.gov or www.samm.com for more information. Do your research or find the right advisor who has your best interests in mind. Thanks for listening!

 

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

 

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

 www.CallSamm.com

 

Nov 12, 2015

Welcome! My guests today are Catherine McMahon and Anna Howard. Catherine provides in-depth analysis for legislative and regulatory priorities for all levels of government and develops public policy principles for cancer prevention. Anna helps develop public policy principles in issues related to healthcare coverage for individuals with cancer. She is also the consumer representative for the National Association for Insurance Commissioners.

Catherine and Anna are here to help listeners understand the resources available for those diagnosed with cancer and for those whose loved ones have been diagnosed. People over 65 account for 65% of all new malignancies and about 70% of cancer deaths in the US. Listening to this podcast will help you understand how to use Medicare benefits in the best ways to prevent cancer.

  • What is the Cancer Action Network, and what does it do? The CAN is the nonprofit, advocacy affiliate of the American Cancer Society that supports legislative solutions to defeat cancer. One purpose is to give patients and their families a voice in government. There is a federal lobbying team in Washington, DC and staff in every state working on the local level. The CAN works to prevent cancer and to help patients find access to care. (The complete abbreviation is ACSCAN.)
  • Why are preventive services so important? Screening tests, counseling, and preventive medications work together to prevent illness before symptoms occur. 50% of cancers can be prevented with these services, including tobacco cessation screening, obesity screenings, and cancer screenings to detect early stage cancer. The ACS has made cancer prevention a top priority.
  • What is the function of the US Preventive Services Task Force? The USPSTF is an independent, voluntary panel of national experts in preventive medicine. Their clinical recommendations will become the appropriate insurance coverage for preventive services.
  • What preventive services does Medicare cover for cancer screenings? The USPSTF updates their recommendations periodically, but currently, an initial physical exam and annual physical exams are covered.  Some of the screenings are a colorectal exam, lung cancer screening, breast and cervical cancer screening. To be eligible for the lung cancer screening, a patient must by 55-77 years old and be either currently smoking or have quit smoking in the last 15 years.  They must have a “smoking history” such as a pack a day and have a written order from their doctor for the screening. A colonoscopy is another screening that is covered, but the problem occurs if the doctor removes polyps during the exam because that qualifies as surgery and will make the patient subject to out of pocket costs.
  • What legislation is currently being introduced to Congress? The ACSCAN is pushing for new laws to include removal of polyps in screening exams instead of calling it “surgery.”  The bill is called “Removing Barriers to Colorectal Cancer Screening Act and is HR 1220 in the House and S624 in the Senate. Listeners are encouraged to call their members of Congress and urge them to co-sponsor and pass this legislation ASAP!
  • What choices are available to Medicare beneficiaries? Patients can choose Traditional Medicare, Parts A, B, or D, or they can choose a Private Plan Option called Medicare Advantage. Over 30% of Medicare users choose an Advantage plan.
  • What should you ask your doctor about screenings? First of all, take advantage of the annual wellness exam, but talk to your doctor about what’s going on with your heath and your medications.
  • Visit www.acscan.org for information, tips, and fact sheets. You can find volunteer opportunities at www.cancer.org or call 1-800-227-2345 to ask questions of the ACs 24/7. Check out these resources for the maximum use of your Medicare benefits!

 

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

 

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

 www.CallSamm.com

 

Nov 5, 2015

 

Welcome!  My guest today is Dr. Steven Loomis, who is an optometrist in Colorado.  He has been a member of the American Optometric Association Board of Trustees since 2007 and is the newly elected president of the AOA since 2015.  He has served on numerous other professional boards and received many awards.  

During this Medicare enrollment season, there are many questions about eyeglasses, hearing aids, and dental care, which are not part of regular Medicare benefits.  You may be wondering what to do.  Dr. Loomis is here to answer some relevant questions:

  • How did you decide to become an optometrist?  “I had decided to be a pediatrician when I realized I might not want to be with children ALL DAY LONG.  A friend suggested optometry, so I considered it.”  Dr. Loomis has found the perfect niche over the past 30 years, and he is confident that he made the right decision.

 

  • Can you clarify the difference between optometrist and ophthalmologist?  An optometrist treats most eye diseases and injuries to the eye, along with providing exams for glasses and contacts. Optometrists provide 70% of primary eye care to patients. An ophthalmologist is an eye surgeon who works closely with an optometrist to treat patients.  They even sub-specialize in specific eye care fields.

 

  • Are most optometrists Medicare providers?  Yes, all that I know of are.  We have been full Medicare participants since 1986.

 

  • What will Medicare cover for vision care?  Medicare will cover any eye disease or injury, inflammation, glaucoma, but does not cover routine well vision exams.  Those diagnosed eye diseases have their regular exams covered to monitor their problems.  Medicare Advantage Plans DO cover preventative eye care services, but you MUST know and understand your plan.

 

  • Can you explain diabetic retinopathy?  The retina is sensory tissue in the back of your eye that transmits pictures to the brain.  Diabetes attacks the tiny blood vessels in the eye, but a special photo must be taken to view the vessels.  Diabetics and pre-diabetics must have yearly exams to monitor the condition.

 

  • Why should a Medicare Nation listener get an annual eye exam if they aren’t having a problem?  The two leading causes of blindness are diabetic retinopathy and glaucoma.  Glaucoma is a condition in which pressure inside the eye damages nerve fibers. Macular degeneration is another eye disease. These eye diseases are asymptomatic, which means that they can exist without initial symptoms until vision is severely affected.

 

  • How would a senior make the most of their Medicare dollars?  They must understand their plan; participants in Parts A & B are eligible, but the amounts vary from state to state.  Usually, patients have to pay about 20% of approved amounts.  If they have met their deductibles, then now is a good time to get it done.  For example, the Part B deductible is only $147, so must people have already met that by the time the 4th quarter rolls around.

 

  • How else can uncorrected eye problems or undiagnosed eye problems affect seniors’ quality of life?  Most seniors want to maintain their vision for reading, watching TV, and other daily activities.  Also, falls are a big problem that can devastate a senior, and a significant number of falls occur because of poor vision.

 

Links and Resources:  

www.aoa.org

 

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

 

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

 www.CallSamm.com

 

Oct 29, 2015

Welcome to today’s episode, which covers Medicare fraud.  The Medicare Strike Force and the Health Insurance Preventive Enforcement Action Team (HEAT) exist to stop fraud in its tracks.  Do you think fraud is a widespread problem?  Take a look at the statistics:  in 2011, $15-60 billion was lost to Medicare fraud, and the Center for Medicare Services (CMS) predicts that $65 billion yearly is issued in error.  Those are huge numbers!  My guest today will  help explain the ongoing efforts to stop the fraud!

Anne Frederickson works for one of the volunteer programs trying to help in the fight against fraud.  Ann is a project manager in Ohio for the Senior Medicare Patrol at Pro-Seniors, which is a non-profit, long-term care and advocacy program in Cincinnati.  Ann has been in this position since 2002, and has also worked in geriatrics and hospital administration for 30+ years.  Ann hosts a weekly radio program, “Medicare Moment” on WMKV 89.3 FM.

Explain what Senior Medicare Patrol (SMP) is all about.

SMP volunteers help Medicare and Medicaid beneficiaries prevent, detect, and report potential fraud.  Across the state of Ohio, there are 3 paid staff members and 50 trained volunteers.  The SMP program exists in all 50 states and US territories.

Tell us about the background of the SMP program.

The program began in 1995 as part of Operation Restored Trust (ORT) in partnership with the Department of Health and Human Services and the Center for Medicare Services.  The push to institute the program was spearheaded by two senators from Iowa.

What exactly do the volunteers in the SMP do?

Volunteers do outreach and group presentations, manage exhibits at health fairs and events, and help with one-on-one counseling.  Their “bible” is a personal health care journal, which is a tool to record information from health care providers.  Beneficiaries are encouraged to use the journal to keep track of their information.  Nationwide, SMP volunteers have recovered $106 million for Medicare and Medicaid.  They also seek to educate people to detect fraud and abuse.

What are some examples of the kinds of fraud SMP volunteers would find?

  • Billing for services and/or supplies never provided
  • Luring beneficiaries into providing Medicare numbers for free services, and then billing Medicare
  • Equipment or insurance plan providers tricking senior center participants into giving up their personal information

What advice can you give about fraudulent calls during this open enrollment time?

NO ONE calls a senior and asks for any information unless they are the agent of record that has already been dealing with the beneficiary.  You can put your phone number on the DO NOT CALL list, which subjects callers to severe fines if they violate.  Many states also have programs with access to free information.  Call the SMP about anything that looks suspicious on your monthly summary notices.  DO NOT ever be reluctant to call when you have questions.  The Fraud Hotline is 866-357-6677.

How do listeners get involved and learn more about SMP?

The best way is to visit the website at www.smpresource.org.  There is a drop-down menu for each state.  Online training is available, along with group education training and one-on-one training.

Are people allowed to donate to the SMP?

YES!  It’s best to contact your local group.  All SMP’s are hosted by local non-profit community groups, a state agency, or local county agency.

Would you like to tell us briefly about your radio show?

The show is “Medicare Moment,” and airs on public radio.  It features different guests who talk about health care topics, Medicare, Social Security, and other subjects for seniors and caregivers.  The 15-minute show airs weekly on WMKV FM.

Resources:

www.stopmedicarefraud.gov

www.smpresource.org

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

 

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

 www.CallSamm.com  

 

 

 

 

Oct 15, 2015

Welcome Medicare Nation!  Today’s discussion spells out the essential elements of Elder Law, and how the specialty is necessary for so many circumstances.  That’s why I am talking to an expert in the field today, who can help us clarify some common misconceptions, and also point us to the right resources to make sure you and your family are protected.

 

My guest today is Andrew Brusky, who is an attorney who specializes in elder law, offering services designed to provide greater options and security for the elderly and disabled.  Mr. Brusky regularly handles cases and is a frequent speaker on issues involving Medicaid eligibility, health care and financial powers of attorney, trust documents, as well as long-term care options for the elderly.  Andrew has worked for Legal Assistance to the Elderly in San Francisco, California and as an intern with the Center for Public Representation in Madison, Wisconsin.  Mr. Brusky received his Undergraduate degree in psychology and gerontology from Santa Clara University and his law degree from the University of Wisconsin Law School.  He is a member of the Milwaukee and Wisconsin Bar Associations (State Bar Elder Law Section Board Member and Past Chair, founding member of the Milwaukee Bar Elder Law Section serving as its Past Chair), the National Academy of Elder Law Attorneys, past chair and board member for the Greater Milwaukee Interfaith Older Adult Program, and is currently a member of the Life Navigators trust committee in Wauwatosa.  Andrew has been listed in The Best Lawyers in America in the specialty area of Elder Law and Wisconsin Super Lawyer.

 

What is Elder Law and the difference between estate planners, etc?

 

Elder law attorneys are looking at your estate, looking at what counts and what doesn’t.  They determine what needs to be spent down, and what steps you need to take for estate recovery.  There are also considerations for post-eligibility estate planning as well.  There are so many nuances to the law for each specific situation, such as considering what happens if the healthy spouse passes prior to the nursing home spouse, so it really is imperative to have a specialist to make sure there are no surprises down the road.  You want to leave yourself and your estate in the best situation possible in regards to taxation, etc.

 

What is Divestment and how is that associated with Elder Law?

 

It helps to think of it in terms of gifting, because you are not getting anything in return for the asset you transfer.  It’s problematic because it can be a barrier to qualifying for Medicaid.  Currently there is a 5 year period prior to eligibility that you cannot conduct these transactions.  An elder law attorney will be able to do things on the front end to make sure you aren’t losing your option for Medicaid.  There are many mitigating actions if this isn’t done correctly from the start, but it takes more time and money than if you did it the right way from the beginning.

 

Can Financial Powers of Attorney be helpful in the context of Elder Law?

 

Yes, many times the spouse who has all or part of ownership, isn’t able to administer it themselves, so someone else will need to do it for them.  Many of the pitfalls can be alleviated with a well drafted Financial Power of Attorney.

 

Are there times when a court guardianship may be necessary?

 

In cases of abuse, this frequently happens.  If there is mismanagement , there isn’t any family to handle the responsibility or even if there is a dispute about the existing Financial Powers.  It is always a last resort when there are problems with the administration of the directives.

 

Can having all the documentation in place ahead of time avoid Probate court?

 

Yes, and no, but while you are already putting steps into place, there is no harm in putting probate avoidance tactics into place.  Good advanced directives and financial power of attorney documents can go a long way in avoiding probation.

 

Will Medicare cover Long Term Care?

 

Medicare was not designed for long term care.  It is rehabilitative, and designed to help short term with injury or illness.  It doesn’t have the funds to pay for it ether.  The chronic issues that require custodial care are generally not going to be covered by Medicare.  Lawyers, discharge planners, and geriatric case managers can all be helpful in navigating these complex issues.  If you need monitoring of the care provided, these case managers can be extremely helpful.  It’s as if they are your eyes and ears on the ground, when you can’t always be present to intercede for your loved one.

 

You can pay your relatives to provide care for you.  Many times it has to be structured and done at fair market value, but there is no reason not to utilize it.  You cannot give away money to your children, but you can pay for them to take care of your, without ruining your eligibility.  

 

What does the future of Elder Care look like?

 

Baby boomers are just now starting to retire.  Government is trying to get out of the business of providing long term care.  So, there are lots of changes on the horizon.  As more people become eligible, it may bring down the cost of providing care.  It’s important to have funds available to get yourself into an institution, if necessary.  Families are becoming more fractured and living in different locations, so more than ever we will be dependent on these types of programs.  The spectrum continues to swing back and forth between, people needing help and private planning for the financial burdens associated with these services.

 

Resources:

 

You can reach Andrew at apb@bruskylaw.com

 

NAELA - National Association of Elder Law Attorneys

lawyers.com - referrals

Local bar association can provide referrals

Alzheimers Associations will have referral lists

Consult neighbors and friends for referrals 

 

Andrew speaks and the NAELA chapters and the Local Bar Association in the Milwaukee area.

 

Got questions about elder law?  Send them to support@medicarenation.com.  We will address them in future episodes.

 

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

 

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

 www.CallSamm.com  

 

 

 

 

 

 

 

Oct 8, 2015

Welcome Medicare Nation!  Today’s guest is Melissa Joy Dobbins, a nationally recognized Dietician with more than 20 years of experience dealing with the nutritional needs of not just Seniors, but people with special dietary needs like diabetes.  Melissa will show us how to eat healthy on a fixed income, and the things we can to do use food to help improve our overall health!

  

1.  Family members and the senior need to feel like you are in control of your own choices.  This means you need to take an active role in making great food choices, and feel empowered to make good decisions for yourself.

 

2.  It’s important for adult children to not be afraid to be a backseat driver for your elderly parent. Intervene when needed, but involve them in as many decisions about their nutrition as possible.

           

How to eat healthy on a fixed income:

 

  1. myplate.gov will give you a ton of information.
  2. Fruits and vegetables don’t have to be fresh to provide good nutrition
  3. Eggs are a healthy and affordable addition to the diet, and even though the price has increased recently, they are still cheaper than meat.
  4. Utilize all the healthcare team members you can, in order to make a great nutrition plan for your aging parent.  So consult a dietician to help navigate some of these special needs.  
  5. The importance of a diabetes educator cannot be understated.  Preventative services like these are covered under Medicare Part B, since the Affordable Care Act in 2007. medicare.gov/partb and then go to free preventative services.  

 

 

 

 

Regarding Type II Diabetes:

 

  • There are some simple, targeted things you can do that will result in better blood sugar control.
  • If it is caught early enough, there may be changes you can make that can help to keep you off medication.
  • Diabetes is a progressive disease, so even once you get your symptoms under control, you may eventually have to increase the prescription therapy to keep it under control.
  • You can control your blood sugars, much like you can control high blood pressure, through a combination of medication, diet, and exercise.  Just because you need one or all of these, does not mean you have failed.

 

 

Anytime you have a progressive disease, like diabetes, your treatment plan will constantly change in order to maintain acceptable blood sugar levels.  Even if you are doing everything right through diet and exercise, medicine may eventually become necessary because of the progressive nature of the disease, not because you have failed.  So it is important to continue to have good nutritional habits even when you get on medication, so that you can control the symptoms.

 

Melissa has a podcast called Sound Bites, where she delves into the science behind smart nutrition, and also deals with the psychology behind emotional eating, and food triggers.  She gives you strategies to help you actually implement all of the sound nutritional advice.  

 

 

Resources:

 

www.soundbitesrd.com - Melissa’s podcast and blog with lots of resources

www.americandiabetesassociation.com - American Diabetes Association

www.diabeteseducator.org - American Association of Diabetes Educators

www.myplate.gov - A great resource for simple, affordable, nutritious meal plans

 

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

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

 www.CallSamm.com  

 

Oct 1, 2015

 

Welcome Medicare Nation!  We have a very distinguished guest with us today - Congressman Alan Grayson from the 9th Congressional District in Orlando, FL.  Congressman Grayson is here to talk about the bill he recently introduced in Congress, HR3308: Seniors Have Eyes, Ears and Teeth too!

 

Congressman Grayson lost his Father in 2000, and in the last years of his life, he had a broken front tooth.  This is when Congressman Grayson realized that Medicare arbitrarily excludes certain items for Seniors that are very important for their quality of life.  After he researched the Medicare details, he realized there were 2 sentences in the legislation that stated, “No care for Eyes and Ears”, and “No care for Teeth” for Seniors.

 

To rectify this situation, Congressman Grayson introduced a simple bill that just strikes those 2 exceptions from the statute.  He feels this is a common sense solution to a problem that affects so many Seniors.

 

Treating problems with eyes and teeth, can actually be a preventative measure to mitigate much more serious issues like heart disease and blindness, the treatment of which would require a much higher reimbursement from Medicare.  Congressman Grayson felt there needs to be a common sense solution to dealing with these normal issues of the ears, eyes and teeth, which are a natural part of aging.

 

 

 

Why has care for eyes, ears and teeth been excluded from Medicare from its inception?

 

The government is cheap and looks for any way to cut costs.  It is indefensible and nothing more than broken promises, for the sake of saving a few bucks.  Only circumstances with a medical illness or injury to these body parts would be covered by Medicare, but basic care for routine examinations are not covered.

 

What would be covered if this bill passes?

 

  • Annual eye exams
  • Basic corrective glasses
  • Annual hearing test
  • Basic hearing aid
  • Basic dental care

 

The goal is to catch problems while they are small, before they become a bigger problem, and thus a bigger expense for Medicare.

 

What are the chances of it passing?

 

We have 76 co-sponsors for this bill, within 2 days of introducing it.  I think Congress members overwhelmingly understand that this is something that needs to be provided.  Realistically, it will probably not make it for a vote this round.  However, many times issues like this have to be brought up again and again, before we can make a difference.

 

  Congressman Alan Grayson is running for Senate on the platform that “Seniors Deserve A Raise!” He realizes that Seniors have been cheated far too long.  From the promises that have not been kept, to the double taxation on Social Security, he realizes that it is time to take a stand and treat Seniors with fairness and dignity.

 

Resources from the show

 

HR3308 Seniors Have Eyes Ears and Teeth Bill

 

https://www.congress.gov/bill/114th-congress/house-bill/3308/text

 

 

Alan Grayson introduces to Congress- Seniors have Eyes, Ears and Teeth Bill Video

 

https://youtu.be/myq6y3HFNb4

 

Congressman Alan Grayson Website 

 

http://grayson.house.gov/

 

 

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

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

 

www.CallSamm.com  

 

Sep 17, 2015

 

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

 

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

 

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

 

What is a Living Will?

 

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

 

What is a DNR (Do Not Resuscitate)?

 

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

 

What is a POLST Order?

 

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

 

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

 

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

 

 

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

 

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

 

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

 

A - Announcing your end of life documents

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

      Understanding whether the issues are terminal or chronic illnesses.

C - Communicate and coordinate with family members.

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

 

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

 

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

 

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

 

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

 

Resources discussed in the show:

 

National Patient Safety Article

 

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

 

 

Dr. F. Mirarchi’s book

 

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

http://goo.gl/WAv9Bc

 

Advanced Care Directives

https://mydirectives.com/

 

 

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

 

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

 

www.CallSamm.com  

 

 

 

Sep 17, 2015

Hospice and End of Life Resources for Palliative Care

 

Welcome Medicare Nation!  Today we continue with Part 2 of our Death Series, as we talk about end of life resources that Hospice provides.  Most people are familiar with Hospice and the services they provide, but I wanted us to take a closer look at Hospice as it relates to Medicare.  Hospice provides several different levels of care, but the focus of our conversation today is routine care and respite care.

 

My guest for today is Judy Lund Person. Judy is with the National Hospice and Palliative Care Association.  She has worked in the national office since 2002 and is considered an expert in Compliance and Regulatory Leadership for Palliative Care. 

 

 

We discuss some very important aspects of Hospice care and Medicare, so for more details on each of these questions below, please listen to the full episode here.

 

 

Who qualifies for Hospice services?

 

Hospice is for patients who have a life expectancy of 6 months or less. Hospice is covered under Part A of Medicare.  The key is that the person would be nearing the end of their life, regardless of their age.  In Judy’s experience, she has seen patients from 2 days old to 100 years old.

 

 

Routine Care:

 

When should hospice be called in?

 

Many families feel that hospice should have been called in sooner.  Judy encourages you to have a conversation with the physician and begin asking when hospice services should begin.  Many times they see patients in the 3-6 months prior to their end of life.  

 

Where can hospice provide care?

 

95% of the care they provide is in a patient’s home, or where they call home.  Hospice does have facilities, but the majority of their patients are in their own homes.

 

What kinds of services are provided?

 

  • Nurse - initial assessment is done
  • Social Worker
  • Chaplain
  • Aide
  • Therapy including art or other
  • Hospice Physician who consults with the attending Physician
  • Patient chooses who they want to be their attending physician, and do as much or as little as the patient wants.

 

It is very much a team approach to providing services.

 

 

How does Medicare work with Hospice?

 

Medicare covers hospice at 100% under Part A. Medications may need to be paid for out of pocket if hospice doesn’t feel a medication is necessary.  Hospice benefits are paid on a daily rate, so it does not matter the amount of services that are provided on a single day, because the rate is the same.

 

The Hospice team provides intermittent visits, depending on the need. Each patient has an individual care plan.

 

Medicare pays for two 90 day periods and then there is an extension of 30 days.  Physicians can re-certify the patient for coverage to continue.  Many patients have hospice for much longer, depending on their need.  Length of coverage is on a case by case basis.  If you are beyond the score of time set forth, all that needs to be done is for your Physician to re-certify that Hospice service is still needed and it will continue to be provided.  There is no need to worry that you will be cut off from services if you outlive the timeframes set forth in the coverage plan.

 

 

Respite Care

 

What is respite care?

 

If you have a short term period where you as a care provider need a break, hospice will provide respite care in a facility, while the family and caregivers get a break.  This service is covered under Medicare Part A.  This is different than routine care, but it is still a covered level of care.

 

 

 

Hospice care is considered palliative care, for the comfort of the patient, not to provide a cure for the disease.

 

Palliative care is comfort care.  Maybe it is pain, shortness of breath or other conditions that are difficult to tolerate.  Hospice specializes in pain management and pain control, while still keeping the patient alert.  They also deal with anxiety and depression that can go along with the terminal condition.

 

Hospice can help with any sort of distressing symptoms.  However, if another issue arises that is unrelated to the hospice issue, the hospice nurse and the care team will consult and determine who can provide treatment and care.

 

In the last year hospice saw 1.6 million patients.  You do not have to have a reimbursement resource to get Hospice care.  Most insurance covers hospice care, and if you don’t have coverage, you can still get Hospice care that is un-reimbursed.

 

Lauren Hill at 19 years old, was a great example of hospice care.  She received hospice services, even though all she wanted to do was play basketball with her college.  So, she was able to play one basketball game, and be an inspiration for her team, her family and everyone that heard her story.  She was able to raise more than 1 million dollars for cancer research because she used this battle as a way to help the cause.

 

Where can you find out more about hospice?

 

www.caringinfo.org has lots of information about hospice, terminal illness and support for families.

 

You can find inspirational stories at www.momentsoflife.org.  Lauren’s story is here and many others that will inspire you.  You can also memorialize your loved one and their struggle on this website.

 

Call 1-800-658-8898 if you need information and want to talk to someone in person.  This is a toll free number from anywhere in the US.

 

 

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

 

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

 

www.CallSamm.com 

 

 

 

Aug 16, 2015

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

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

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

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

  1. Hospital
  2. Hospice
  3. Skilled Nursing Facility

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

In this episode, you will also learn:

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

You will also learn:

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

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

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