Medicare Nation

How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on Give us feedback on Facebook!
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Now displaying: Category: general
Apr 15, 2019

Hey Medicare Nation!

More than 10,000 people a day are turning 65!

While qualifying for Medicare Part A and Part B, Medicare Beneficiaries are VERY confused as to what type of plan to enroll in, to "supplement" Original Medicare.

By zipcode, a Medicare Beneficiary may have over "100 Plans" to choose from to help supplement their Original Medicare.

That's an ENORMOUS amount of research to do!                  If you have the time and enjoy doing all that research.......go for it!

If you're like most Medicare Beneficiaries, you are retiring and you want to ENJOY LIFE! You don't want to "waste" time researching Medicare Plans.

Call a "Medicare Consultant" or "Medicare Specialist" to assist you in finding the plan that will fit YOUR unique needs.

How do you do that? 

"Google" "Medicare Consultant" or "Medicare Specialist" and add your city or zipcode to that search.

As an example, you would search....Medicare Consultant Tampa FL......or........Medicare Specialist Dallas TX.......

Google will then populate the "Ads" first. Businesses PAY to be on the top of the 1st page of Google.

SCROLL down past the "ADS." Just because a business "Pays" for an ad DOES NOT mean they are the best option for you.

You will start seeing local businesses and names of Medicare Specilaists. 

You should be checking out these "Brokers" and "Medicare Specialists" or "Medicare Consultants."

I'm speaking specifically about Medi-Gap Plan F and the High Deductible F Plan.

The Supplement F Plan to Medicare, is an Insurance Policy you take out on yourself.

Medi-gap Plans are NOT part of Medicare. Medi-Gap Plans are an insurance policy that an Insurance Carrier sells to you.

You are "purchasing" a policy, where you pay a monthly premium to the Insurance Carrier to protect some or all of  your out-of-pocket costs associated with Medicare.

Medi-Gap "F" Plan pays the out-of-pocket costs YOU are responsible for. The "F" Plan will pay your "medically necessary" out-of-pocket costs.

Plan F pays for your Part A In-Patient Hospital Deductible. Plan F pays your co-pay for being in a Skilled Nursing Facility.

Plan F pays your Annual Part B deductible and Plan F pays your 20% co-insurance under Part B.

Plan F pays for all of this, for one monthly premium.

ALL Medicare Plan F Plans have EXACTLY the same benefits. It doesn't matter if you live in Tampa, FL......San Francisco, CA.....or Salt Lake City, Utah.....The BENEFITS under Plan F are the SAME!


In YOUR ZipCode.......there may be up to 50 DIFFERENT Insurance Carriers that offer Plan F....EACH one of those Insurance Carriers offer a DIFFERENT Premium for the SAME Plan F Plan.

You should find the LOWEST Monthly Premium from the Insurance Carrier that has an "A" Financial Rating.

An "A" financial rating means the company WILL pay your claims. That's the Insurance Carrier your looking for.

Plan F is the "Peace of Mind" Medi-Gap Plan. There is NO Network of Doctors and Facilities....because......Plan F is NOT part of Medicare. 

Original Medicare has NO Network.....Original Medicare allows you to see ANY Doctor....or go to ANY Medical Facility in the U.S. that ACCEPTS Medicare!

YOUR Health Insurance IS......Original Medicare.....NOT your Plan F!

So.....if you're looking for a Medicare Supplement Plan that will cover ALL your Medicare Necessary out-of-pocket costs...Then Plan F is for you.

Now.....let's take a look at the High Deductile F Plan.

The High Deductible F Plan.....has a DEDUCTIBLE!

For 2019.....the annual deductible is $2,300.00

That WILL pay-out-of-pocket reach the $2,300 DEDUCTIBLE. When you reach the $2,300 deductible, the plan will then pay all your "medically necessary" out-of-pocket costs that you are responsible for under Medicare, for the remainder of the calendar year.

You will NOT pay the "Cash" will be paying the Medicare Allowable price....BIG difference.

If you go to a cardiologist, and the visit under Medicare, costs a total of $150, Medicare will pay 80% of that amount.... which is $120. you would pay the remaining 20%, which $30.

You would continue to pay out-of-pocket until you reach $2,300.

If you don't see many doctors or have any diagnostic tests, you will ONLY pay for the services you use.

For a healthy person, this could be a very viable option.

If you are a person with a chronic illness, let's say for example...Diabetes......Asthma.....or high cholesterol with high blood pressure.....this plan may NOT be a good choice for you.

It's important for you to take into consideration your own health history, what medications you take, your financial status and what doctors you see, before enrolling in a Medicare Plan.

Next time, I will go over the differences between Plan G and PLan N.

If you are turning are getting ready to come off of your employer plan and you need to figure out what Medicare Plan will suit your needs best.....

Contact Me!

Reach out to me by email -


by phone....... (855) 855 - 7266.

I will help you find the plan that fits YOUR unique needs.

Go to my website.....

for more information.

Until next time.....have a very happy, a very healthy and Prosperous week!


Diane Daniels


Mar 15, 2019

Hey Medicare Nation!

It's almost Spring time! For many people, this has been a terrible winter. Many Medicare Nation listeners have been emailing me to find out if Medicare covers "Emergencies" while traveling across the U.S. or abroad.

That's a great question!

Original Medicare and Medicare Advantage Plans Do cover "Emergency Care" AND  Urgent Care ANYWHERE in the United States and it's Territories.

An "Emergency" is Life-Threatening. An example would be if you were having chest pain and you believed you were having a heart attack. In this would go to the nearest hospital to seek emergency care.

Even if it turns out you were diagnosed with "heart burn," Original Medicare AND Medicare Advantage plans will cover the medically necessary treatment for this situation because you believed you were in a "life-threatening" situation.

 "Urgent Care" is defined by Medicare as:

Care that you get outside of your Medicare health plan's service area for a sudden illness or injury that needs medical care right away but isn’t life threatening. If it’s not safe to wait until you get home to get care from a plan doctor, the health plan must pay for the care.

An "Urgent Care" example would be if you were walking in St. Peter's Square at the Vatican, and you slipped on a banana peel and fell onto the ground, breaking your ankle. That's an injury that isn't life threatening, but requires immediate medical care.

So......if you are traveling ANYWHERE in the U.S. or it's Territories, AND you have an Urgent Care or Emergency can go to the nearest hospital or Urgent Care Center to receive care AND it will be covered by Original Medicare and Medicare Advantage Plans.

If you are traveling outside of the U.S. Medicare generally DOES NOT cover emergencies or urgent care needs.

There are a few circumstances where Original Medicare WILL cover Emergency Care AND Urgent Care.

1.  If you are on a CRUISE and you require EMERGENCY care from a doctor who is stationed on the ship while the ship is in a U.S. port.....Your Emergency Care WILL be covered by Original Medicare.

2. If the ship is Departing or Arriving to/from a U.S. port within 6 hours and you have a medical emergency and require to be treated by the ship's doctor......Your Emergency Care will be covered by Original Medicare.

3. If you are in Alaska and you are traveling directly to another State without unreasonable delay, and you require Emergency Care at a hospital in Canada, because it was the closest hospital at the time of the emergency......Your Emergency Care will be covered by Original Medicare.

If you have a "Medicare Advantage Plan," you may have coverage for Emergency and/or Urgent Care Coverage on your plan.

You must do your own due dilligence to understand the benefits of your plan while you are traveling abroad.

Some Medicare Advantage Plans have a deductible for emergency care outside the U.S.

Some Medicare Advantage Plans have a deductible and a co-pay for emergency care outside the U.S.

There is an annual maximum out-of-pocket amount for your plan. Some are around $1,500.00 all the way up to $6,700.00 


Some of you have "Medi-Gap" or Supplement to Original Medicare Plans.

Plans "C" through "G" and also plan "M" and "N" have coverage for Emergency Care while traveling abroad.

Some Medi-Gap plans have a deductible. Some plans have "Maximum Lifetime Amounts." It is important to READ your Medi-Gap Policy to determine coverage while traveling abroad.

Travel Insurance


I always recommend purchasing "Travel Insurance," while traveling abroad.

I use these different websites to look for policies:




Cost will depend on -

a. Total Cost of the Trip

b. Your Age

c. What country you're visiting

d. Types of coverage you're adding (ex: Air evacuation, cancel for any reason etc.)

If you have ANY questions, and I can answer your question in ONE paragrapn, send them to me by email.

If I need to do research or write more than one paragraph, I will let you know that I am available for a consultation to solve your problem at $150.00 an hour.

Reach out to me.....I answer all emails personally!

Thanks soo much for listening to Medicare Nation!

I appreciate your time and I love to educate you on all things Medicare!

Diane Daniels



Jan 11, 2019

Hey Medicare Nation!



Today, I'm going to speak with you about the Medicare Advantage Open Enrollment Period.

CMS...Centers For Medicare & Medicaid Services has issued a new regulation that began January 1, 2019.

Under 42 CFR 422.62(a)(3)....CMS published the following:

During the MA OEP, MA plan enrolles may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

Who can use the Medicare Advantage Open Enrollment Period?

1. Individuals enrolled in Medicare Advantage plans as of January 1.

2. New Medicare beneficiaries who are enrolled in an Medicare Advantage plan during their Initial enrollment into Medicare

      a. The month of entitlement to Part A and Part B up until the last day of the 3rd month...after the month of their entitlement to Part A and Part B.

Can Medicare Advantage beneficiaries add or drop their Part D coverage during the Medicare Advantage Open Enrollment Period?

Yes. Individuals who are already enrolled in a Medicare Advantage Plan with Prescription Drug Coverage can switch to:

a. Another Medicare Advantage Prescription Drug Plan

b. A Medicare Advantage Plan ONLY (with NO prescription drug coverage)

c. Go back to "Original Medicare" and add a stand-alone prescription drug plan or don't add one.

d. Go back to "Original Medicare" and add a Supplement to Original Medicare Plan. 


 How long is the Medicare Advantage Open Enrollment Period?

It runs from January 1st through March 31st each year.


How many times may a Medicare Beneficiary change Medicare Advantage Plans during the MA OEP?

A Medicare Beneficiary may make only ONE change during the MA OEP.


If you have ANY questions regarding the MA OEP....

and you would like me to answer it in ONE paragraph, send me an email to

I ALWAYS answer emails if I can answer them in ONE paragraph.

If I can not answer your question in one paragraph, you may hire me and I charge $150.00 hr.

I can answer ANY question about Medicare and I can solve ANY problem you have with Medicare.

Looking for more information on Medicare?

Go to  website.

Looking for a SPEAKER at your conference or event?

Just click on the "Contact" tab on the website.


Thank you so much for listening to Medicare Nation. I appreciate it very much!

If you feel I'm delivering important content, I would love it if you would leave a rating & review on the Apple Podcasts review page (formerly iTunes).

Until next time Nation.....I want each of you to have a Happy, Peaceful and Prosperous week!

Diane Daniels

Nov 16, 2018

Hey Medicare Nation!

You are getting ready for Thanksgiving and you haven't even looked at Prescription Drug Plans for 2019.

Don't panic! 

I have your back :)

There are Prescription Drug Plan changes for 2019. 

Listen to this episode to learn about the NEW changes and make a confident decision to enroll in the Medicare Prescription Drug Plan that fits your unique needs.

Here is the link to the website as an additional resoure:

Have a question about Prescription Drug Plans for 2019?

Ask me!

If I can answer your question in ONE PARAGRAPH, I will!

If I need to do "any" type of research or the answer to your question is longer than ONE paragraph, you may have to hire me as a consultant.

I answer ALL emails personally. I'm the expert and I make sure you receive my expertise in answering your questions.

Send your questions to -


I look forward to hearing from you!

Happy Thanksgiving everyone!


Oct 13, 2018

Hey Medicare Nation!

It's October! Lots of changes going on in the Medicare landscape.

Social Security recently announced the 2019 COLA, and for those of you on Social Security and Social Security Disability, you will be receiving a 2.8% raise in your monthly check.

Social Security raise goes into effect January 1, 2019.

Social Securtiy Disbility goies into effect December 31, 2018.

Some more good news is.....the payroll taxes for Medicare & Social Security are staying the same in 2019. Yeah!!

The combined tax rate for Social Security & Medicare will remain at 7.65% in 2019 for employees.

The combined tax rate for Self Employed will also remain the same in 2019 at 15.30%

When Social Security authorizes a COLA raise, that is the signal that Medicare Part B Premiums may also rise.

For 2019, that's exactly what happened.

Let's take a look at the 2019 Medicare Premiums & Deductibles.

Medicare Part A

In 2019, the Medicare Part A Deductible for being an inpatient in the hospital is going up to $1,364.00 in 2019.

This means, you will have an out-of-pocket deductible when you are admitted to the hospital as an inpatient, whether you stay for one night or sixty consequative nights.

You will have to pay the $1,364.00 each time you are admitted to the hospital, unless you are readmitted to the hospital less than 60 days after you are discharged from the hospital and you are admitted for the exact same reason. 


A Skilled Nursing Facility (SNF) has 24hr Medical care and specializes in rehabilliation.

A person who had a stroke may be transferred to a SNF, to rehab the loss of sensation in a limb or to improve speech.

A person who recently had hip replacement surgery may be transferred to a SNF to strengthen their leg(s) and learn to walk with a proper gait.

Under Medicare, the first twenty days in a SNF is a benefit with no co-pay. If a person is required to stay day 21 and up to 100 consequative days, the co-pay will be $170.50 per day in 2019, under Medicare Part A.

Medicare Part B

Every person, who is a member of Medicare Part B has a monthly premium.

For those with an income below the Federal threshold, the Medicare Part B Premium is paid by that individual's State Medicaid Program.

For individuals on Medicare Part B, whose annual adjusted gross income is $85,000.00 or less, filing as a single taxpayer, the 2019 Medicare Part B monthly premium will be $135.50

Here is the chart for Medicare beneficiaries with a higher income, who will pay a higher Part B Premium Monthly.


Beneficiaries who file individual tax returns with income:
who make Less than or equal to $85,000             $135.50

Married, filing joint returns & make less than or equal to $170,000                                                          $135.50

Beneficiaries who file individual tax returns with income:
who make Greater than $85,000 and less than or equal to $107,000                                                          $189.60

Married, filing joint returns & make Greater than $170,000 and less than or equal to $214,000                     $189.60

Beneficiaries who file individual tax returns with income:
who make Greater than $107,000 and less than or equal to $133,500                                                         $270.90

Married, filing joint returns & make Greater than $214,000 and less than or equal to $267,000                    $270.90

Beneficiaries who file individual tax returns with income:
who make Greater than $133,500 and less than or equal to $160,000                                                         

Married, filing joint returns & make Greater than $267,000 and less than or equal to $320,000                    $352.20

Beneficiaries who file individual tax returns with income:
who make Greater than 
$160,000 and less than or equal to $500,000                                                         $433.40

Married, filing joint returns & make Greater than $320,000 and less than or equal to $750,000                     $433.40

Beneficiaries who file individual tax returns with income:
who make Greater than 
or equal to $500,000      $460.50

Married, filing joint returns & make Greater than $750,000


Medicare Part B Deductible

Medicare has an Annual Part B Deductible. 

In 2019, the Part B deductible is going up to $185.00.

After you pay your Part B deductible, you will then have to pay 20% of the Medicare Allowable for Part B services.

If you are on a Medicare Advantage Plan, you probably didn't even know you had a Part B Deductible. The majority of Medicare Advantage plans absorb the Part B Deductible into their plan. The Majority of Medicare beneficiaries on a Medicare Advantage Plan do not have a Medical deducatible on their plan. I always say......"You Pay as you go."

If you currently have a Medi-Gap Plan "F" or Plan "C", you also don't pay out of pocket for the Annual  Part B Deductible.

Things will change in 2020, for now.....everyone is good to go. 


The Medicare Annual Enrollment Period is here!

If you have a question......Email it to me!

If I can answer it in one paragraph....I will!

If I have to do ANY kind of research, or my answer requires more than one paragraph....then you may need to hire me to consult with you.

I presently charge $150.00 an hour for consulting on Medicare issues and comparisons.

I can help you with just about anything to do with Medicare.

I have vast knowledge in Medicare and I am very fair. 

Need help with Medicare? I can help you.

Send me an email to


Things are getting busy with Medicare. 

More updates will be coming soon!

Until then.....I want each of you to have a Happy, peaceful and prosperous week!

Diane Daniels

Jun 22, 2018

Hey Medicare Nation!

Medicare Nation

The topic of Medical Marijuana is BOOMING!

I had to bring back Dr. Rachna Patel to update us on what's going on in the Medical Marijuana Community.

Currently, there are 9 States, plus the District of Columbia (DC), that have "Legalized" the "Recreational" use of Marijuana.

The 9 States are:

1. Alaska

2. California

3. Colorado

4. D.C.

5. Massachusetts

6. Nevada

7. Oregon

8. Vermont

9. Washington

Twenty-Nine (29) States, have Legalized Medical Marijuana usage.

The 29 States are:

1. Alaska

2. Arizona

3. Arkansas

4. California

5. Colorado

6. Connecticut

7. Delaware

8. Florida

9. Hawaii

10. Illinois

11. Maine

12. Maryland

13. Massachusetts

14. Michigan

15. Minnesota

16. Montana

17. Nevada

18. New Hampshire

19. New Jersey

20. New Mexico

21. New York

22. North Dakota

23. Ohio

24. Oregon

25. Pennsylvania

26. Rhode Island

27. Vermont

28. Washington

29. Washington D.C.

30. West Virginia


Dr. Patel commonly treats patient with the following conditions for Medical Marijuana:

1.  Chronic Pain - especially patients with Fibromyalgia, Arthrittis, Back Pain, Migraines, Neuropothy

2. Anxiety

3. Insomnia

Dr. Patel is consulting with patients across the U.S. to help guide patients step-by-step on the usage of Medical Marijuana.

You can reach Dr. Patel by going to her website,

You can also go to her Facebook page,

Here's her YouTube Channel with GREAT videos!

The Medical Marijuana Expert - Dr. Rachna Patel

Thanks for listening to Medicare Nation!

If you find my content interesting, please give us a Review on Apple Podcasts!


May 25, 2018

Hey Medicare Nation!

Millions of people are diagnosed with "Foot Drop."

Some people also call it......"Drop Foot."

Help A Child or Adult Walk Again!

Either way, Foot Drop is a serious matter!

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot, necessary for walking. Foot Drop causes a person to drag the foot and toes, or engage in a high-stepping walk called a steppage gait.

Foot Drop Increases the risk of falling.


Who Can Be Diagnosed With Foot Drop?

Men or Women, at any age.

What are some causes of Foot Drop?

Multiple Sclerosis, Cerebral Paulsy, Stroke, Traumatic Brain Injurey, Spinal Cord Injuries, and other injuries to the Peroneal Nerve in the leg. 

Viruses can cause Foot Drop as well as other infections.

Injuries to the leg and/or the lower back can also cause Foot Drop.

What is a WalkAide?

A WalkAide is a Functional Electrical Stimulation Device, when wore on the calf, sends electric impulses to the affected foot causing the foot and leg to lift. 

Where Can I get information on WalkAides?

Go to the Hanger Clinic website:

Are Other Types of FES Devices Available?

Yes. The Bioness L300 is also available. Go to the Bioness Website for more information.

Who are the Freedom to Walk Foundation?

The Freedom to Walk Foundation is a 5019c)3 non-profit, dedicated to assisting with funds for the purchases of WalkAides for children AND Adults diagnosed with Foot Drop due to:

* Multiple Sclerosis

*Cerebral Palsy

* Stroke

* Incomplete Spinal Cord Injury

* Traumatic Brain Injury

If you want more information about the Freedom to Walk Foundation, go to their website:

Go To 6th Annual Freedom to Walk Foundation GALA

6th Annual Gala Freedom To Walk Foundation

Apr 13, 2018

Hey Medicare Nation!

Do you know what "Drop Foot" is?

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot necessary for walking.

It causes a person to drag the foot and toes, or engage in a high-stepping walk called a "steppage gait."

This increases the risk of falling for individuals. 

There are about 70,000 people diagnosed with Food Drop in the State of Florida alone!

I have teamed up with the Freedom to Walk Foundation, to assist them in raising funds for the purchase of WalkAides.

WalkAides are electronic stimulating devices when worn on the calf, sends electric impulses to the affected foot, causing the muscles to contract and lift the foot and leg.

Children and adults are WALKING agian with the help of WalkAides!

The one major problem, is that most medical insurance companies don't cover WalkAides.

Medicare will only cover WalkAides for those diagnosed with "Incomplete Spinal Cord Injury."

Those diagnosed with Multiple Sclerosis, Cerebal Palsy, stroke, traumatic brain injuries and complete spinal cord injuries, are not covered by most insurance companies.

How can you help?

A WalkAide costs $5,000 to purchase.

A $5.00 or more donation to the Freedom to Walk Foundation will help children and adults purchase WalkAides.

Please be considerate and donate with your heart!

Thank You!

NEW MEDICARE CARDS are being mailed now.

Your New Medicare Cards…….which are now called “Medicare Beneficiary Identifier” or MBI……have started mailing!

  1. People who are enrolling in Medicare for the first time will be among the first in the country to receive the new cards.
  2. Your new card will automatically come to you. You don't need to do anything as long as your address is up to date. If you need to update your address, visit and sign up for MySocialSecurity Account.
  3. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.

Current States Receiving New Medicare Cards




Washington D.C.   AND…..

West Virginia

Want to know when YOUR card has been mailed?

Go to

Enter your email to receive an email when your new Medicare Card is mailed to you.

What do the New Medicare Cards Look Like?

Across the top of the New Medicare Card will read…..Medicare Health Insurance….in “white” letters inside a blue border. There is also an image of an Eagle in white outline.

Your Name will appear on the next line.

The next line will be the NEW set of Characters.

The New Card will have  “11 Characters – both numbers and letters of the alphabet.

All Letters will be Capitalized and spot # 2, 5, 8 & 9 on your card, will ALWAYS be a Letter of the alphabet.


Finally, you’ll see Your effective date of your Part A of Medicare……..

And you’ll see Your effective date of Part B if you enrolled in Medicare Part B.

Here are things to know about your new Medicare card

  1. Your new card will automatically be mailed to you. You don’t have to do anything as long as your address is up to date.

If you need to update your address, go to  and enroll in a My Social Security Account. 

  1. Your Medicare coverage and benefits will stay the same.
  2. Your card may arrive at a different time than your friend’s or neighbor’s. Medicare is mailing over 60 million New Cards. CMS says they will have completed the mailing by April of 2019. We’ll see if that’s true!
  3. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
  4. If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare—Use your Medicare Advantage Plan ID Card whenever you need care.

And, if you have a separate Medicare precrption drug plan, be sure to keep that ID card as well.  

  1. Doctors, other health care providers and facilities know it’s coming and will ask for your new Medicare card when you need care, so carry it with you.
  2. Only give your new Medicare Number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare
  3. If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online.

And….until January 2020, health care providers may use your New Medicare Card or your Social Security number to process claims.


Be Careful!

Scammers are out there  trying to steal your identity!

Medicare will NEVER call you and ask for Personal Information!

The Government can’t even process Medicare Advantage Plan Changes timely…….they certainly don’t have the staff or the time to call Medicare Beneficiaries. So DON”T trust ANYONE who calls and says they are calling you from Medicare.

Your Insurance Agent, Medicare Advisor or a representative from your Medicare Advantage Plan or Medicare Prescription Drug Plan will call you …..WITH YOUR PERMISSION!


If someone calls and says they are calling about your New Medicare card…..



If someone calls and says they are from your Medicare Advantage Plan….

Ask them a few questions to make sure they are legit.

Ask them these questions:


  1. How much is my current premium for my Medicare Plan?

If they are from your Medicare Insurance Plan….they should know the answer!


  1. Ask them who your Primary Doctor is.

Again……they should have that information documented.


  1. Finally……if you are still unsure of who you are talking to…..HANG UP!

Call the customer service number on the back of your Medicare Insurance Plan card and when a representative answers……ask them if they just contacted you.



Feb 2, 2018

Hey Medicare Nation!

Special Election Period Extended through March 31, 2018 for Medicare Beneficiaries Affected by California Wildfires.

The Centers for Medicare & Medicaid Services (CMS) has extended the Special Election Period (SEP) for Medicare Beneficiaries affected by the California Wildfires to March 31, 2018.

Any Medicaer Beneficiary who resides in, or resided in an area for which the Federal Emergency Management Agency (FEMA) declared a disaster area is eligible for the SEP......if......the beneficiary was unable to enroll in a Medicare Advantage Plan or stand-alone-prescription drug plan, during the annual enrollment period (AEP) or other qualifying election period.

Also....if you don't live in the affected counties of California, but you receive assistance from someone living in one of the affected areas that was declared a disaster area, you are eligible for the SEP.

You can call Medicare at 800-633-4227, or you can contact a Medicare Advisor or Medicare Consultant to assist you in finding a plan that will suit your unique needs.

How do you find a Medicare Advisor or Medicare Consultant like me?

Google it!

Type in ......Medicare Consultant Los Angeles California....or Medicare Advisor San Francisco California.

After you get beyond the "ADS" by all the paid will start seeing results for what you asked for.

So here are the COUNTIES  in California affected by the WildFires, which have a SEP:



Los Angeles






San Diego

Santa Barbara




and Yuba.

You can also go to the FEMA website and read more infomation at:

Any questions? Have a special guest you'd like to hear on Medicare Nation?

Send Diane an email to -

Need help with Medicare......Contact Diane and she will schedule a call with you to determine your needs.

Send your request to

Have a Happy, Peaceful and Prosperous Week!


Jan 19, 2018

Hey Medicare Nation!

It's January 2018!

I hope everyone made informed decisions regarding your Medicare Advantage Plans for 2018.

If you missed the last episode, go back and listen to it!

I discussed the Medicare Premiums, co-pays and co-insurance for 2018.

Many of you have sent me emails "asking me" if you can change your Medicare Advantage Plan in January.

The answer is......yes....with specific guidelines.

Currently, it is the Medicare Advantage Plan "Disenrollment Period."

The current Disenrollment Period runs from January 1st through February 14th each year.

During this time, you can "drop" your Medicare Advantage Plan and go back onto Original Medicare.

You do this by contacting MEDICARE by phone     800-633-4227.....and telling the Medicare representative that you would like to "Disenroll from your Medicare Advantage Plan" to go back onto Original Medicare. Medicare may also help you with a Part D prescription Drug Plan if you'd like.

On Original Medicare, you are covered under Part A and Part B of Medicare. 

Under Part are covered for Medicare benefits where you would stay at a location as an "inpatient."

The most common location is .....The Hospital. Another location where you stay overnight as an inpatient is....a Skilled Nursing Facility (SNF).

A SNF is NOT a Nursing Home. An SNF is a location where you are admitted as an inpatient to receive medical care and rehab 24hrs a day.

Also..... if you are diagnosed with a terminal illness, your doctor may suggest you enter Hospice as an inpatient. 

All the services covered in the Hospital, SNF and Hospice are covered under Part A of Medicare.

There is a "Deductible" each time you are admitted to the Hospital. The Deductible cost for being admitted as an inpatient in the hospital is $1,340.00 in 2018. The Deductible is due EACH benefit period you are admitted.

Part B of Medicare is for "Outpatient Services."

Benefits under Medicare for Outpatient Services covered under Part B include, but not limited to:

* Doctor Vists

* MRI's

* Laboratory Blood Draws

* Outpatient Same Day Surgery 

* Oxygen in your home

There is an "Annual Deductible" for Part B of $183.00.

After you pay your $183.00 annual deductible, you will be responsible for the remaining 20% Medicare Allowable Charges for services under Part B.

What does that mean? 

Let's say you already visited your Cardiologist and had bloodwork drawn at Quest or Labcorp.

We'll say your out-of-pocket costs for both cost a total of $183.00.

That takes care of your annual Part B deductible for 2018.

Now....let's say three months need to have an MRI. We'll say the Medicare allowable cost is $1,500.00.

Medicare Part B covers 80% of the $1,500.00, which is $1,200.00.

You will be responsible for the remaining 20%, which is $300.00.

You will pay 20% of ALL Part B Medicare Allowable Charges. There is NO Cap!

You may also need Prescription Drug Coverage.

Prescription Drugs are NOT covered under Part A or Part B in general. Prescription Drugs will be covered while you are admitted to one of the facilities under Part A. 

If you want Prescription Drug coverage, you WILL need to enroll in a stand-alone-prescription-drug-plan.

You can find which Prescription Drug Plan (PDP) is available in your area, by going onto the website and "hover" over the FIRST Blue Box named "Sign Up/Change Plans."

A column will appear and go down to where it reads..."Find Health & Drug Plans."

"Click" on that box and it will bring you to the Medicare Plan Finder site.

Type in your zipcode and follow the instructions.


If you are comfortable with the costs associated with Original Medicare Parts A & Part B.....then that's all you need to do.

If you'd like to add additional coverage to protect you against the on-going out-of-pocket costs associated with Original Medicare, you can purchase a Medicare Supplement (a.k.a. Medi-Gap) Plan.

A Medicare Supplement Plan is an Insurance Policy, where you pay the insurance carrier a monthly premium and the plan will pay Medicare out-of-pocket costs that you have pre-determined.

Medicare Supplement Plans "VARY" in coverage and in premiums.

The "Medicare Benefits" they pay for you, are the SAME, no matter where you live in the U.S.

So.....if you chose a Supplement Plan "F," which is the policy which pays ALL your out-of-pocket costs for Medically Necessary services under Medicare, and you live in Seattle, will be covered for the EXACT SAME Medicare benefits as a person living in Tampa, FL.

What is different you ask?

The difference is in the PREMIUM you pay.

Insurance Carriers that offer Medicare Supplement Policies charge DIFFERENT  Premiums!

You NEED to know what the difference in Premiums are by EACH Insurance Carrier for the SAME TYPE OF PLAN.

Here's an example:

Mary is turning 65 in March of 2018. Mary has a history of heart problems and would like to remain on Original Medicare and purchase a Medicare Supplement Plan "F" so that she can see ANY Cardiologist that is contracted with Medicare.... in ANY State. 

Mary also wants to have a budget for her out-of-pocket health costs and having a Medicare Supplement "F" plan will allow her to do that.

Mary lives in Miami, FL and calls her Medicare Specialist Diane.

Mary discusses purchasing a Medicare Supplement with Diane and asks for her expertise and guidance.

Diane tells Mary that the 3 lowest premiums in her zipcode have the following montly premiums:

1. $239.00 From Acme Insurance Co.

2. $250.00 From Beta Insurance Co.


3. $275.00 From Delta Insurance Co.

These premiums are for the EXACT same Plan with the SAME benefits!

Why would you pay Delta insurance company $275.00 a month, when you can pay Acme Insurance Company $36.00 a month less....for the SAME benefits!

That's why it's soooo important to speak with a Medicare Specialist or Medicare Consultant like myself.

I speak MEDICARE! I care about YOUR best interests! I have NO loyalties to ANY Insurance Company! 

You can also STAY on the Medicare Advantage Plan you are enrolled in.

Do your Due Dilligenct to ensure you are doing what's best for your health and out of pocket costs for 2018.


I'm hear to help you if you need me!

You can contact me by email at

You can contact me by phone: 855-855-7266.

I will even answer your question by email if I can answer it in ONE paragraph!

If I have to do any kind of research, you need to hire me as your consultant.

My time is valuable and I want to do what's best for you!

Thanks for listening Nation!

Would love a Review if you would take a minute to do it for me!

Leave me a "Voice" review at

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Go to iTunes or Stitcher and in the SEARCH bar type in MEDICARE NATION

MY show comes right up. "Click" on Subscribe and then click on Rating or Review.

Leave me your feedback and if you can.....give us 5 stars!

Thank you and have a Happy, Peaceful & Prosperous Week!


Nov 18, 2017

Hey Medicare Nation!

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

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

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

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

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

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

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

Such is the case for 2018.

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

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

CMS planned this out perfectly!

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

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


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

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

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

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

Let's look at the remaining 2018 Deductibles:

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

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

That's an increase of $24.00 from 2017.

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

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

You are given 60 lifetime reserve days.

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

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

Works the same way for lifetime reserve days.

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

Skilled Nursing Facility

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

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

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


Part B of Medicare

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

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

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

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

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

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

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

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


Advocacy Groups For Medicare

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

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

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

Hey Medicare Nation!

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

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

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

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

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

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

Residents of Texas may qualify due to Hurricane Harvey.

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

Go to the FEMA website -

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

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

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

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

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

Call 800-633-4227.

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


Oct 6, 2017

Hey Medicare Nation!

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

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

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


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

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

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

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

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

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

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

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

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

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

Medicare Savings Program

2017 Monthly Income Limit:

Single Person


Married (living together)



2017 Total "Resource" Limit:

Single Person


Married (living together)


To apply for the Medicare Savings Program, go to the official Medicare website

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

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

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

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

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

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

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

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

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

Extra Help Program

2017 Monthly Income Limit:

Single Person


Married (living together)



2017 Total "Resource" Limit:

Single Person


Married (living together)


To Apply for the Extra Help program, go to the official social security website -

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

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

That's it for today Nation!

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


Oct 1, 2017

2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

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

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

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

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

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

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

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

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

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

That is a Medicare Regulation! 

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


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

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

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

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

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

Annual Deductible 

The 2018 Maximum PDP Annual Deductible is $405.00.

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

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

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

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

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

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

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

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

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


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

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

If you requested a drug that was a Tier 1 or Tier 2 on that same plan, you would NOT "trigger" the annual deductible. Therefore, you would just pay the listed co-pay or co-insurance for that Tier 1 or Tier 2 prescription drug on your plan. we used lisinopril in the above example, in this case you would just pay your $2.00 co-pay for the 30 day supply of lisinopril starting right away in January.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TrOOP costs are -

1. The drug costs paid by the beneficiary

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

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

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

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

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

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

You will pay either:

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

You will pay whichever amount is greater.

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

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

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


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

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

I'll be happy to answer your question.

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

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

That's it for this week's show!

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

Go to this link and tell me what you think!


Have a happy, peaceful and prosperous week everyone!


Jul 7, 2017

Hey Medicare Nation!

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

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

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

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

Summary of Noncomplliance

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

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

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

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

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

That's a BIG fine! 

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

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

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

The number is - 800-868-5200.

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

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

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

How does something like this happen, you may ask? 

Insufficient training of Fallon customer representatives and agents.

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

Train your employees Fallon! 

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

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

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

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

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

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

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

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

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

2. Call Senior Medicare Patrol.

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

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

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

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

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

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

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

We'll see what happens.

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

Report any discrepancies or suspicions right away.

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

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

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

Thank you for listening to Medicare Nation!

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

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

Questions about Medicare or your Medicare Plan you need answered?

Send me an email to or go to my website

Have a very happy, peaceful and prosperous week everyone!

Diane Daniels


Jun 19, 2017

Hey Medicare Nation!

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

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

The following States were affected by the suspension:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#3. Contact Senior Medicare Patrol

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

        Senior Medicare Patrol

#4.  Contact your State Dept. of Aging

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

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

          Here's the link:

          Healthy Aging List of State Agencies

#5.   Contact Medicare

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

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


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

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

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

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

You can also visit my website for more information.


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


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




Apr 28, 2017

Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare. 

A question that is quite common is:

"What vaccinations are covered under Medicare?"

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

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

1. Flu Shot

2. Hepatitis Shot

3. Pneumococcal Vaccine


Flu Shot

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

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

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

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

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


Hepatitis B

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

What indicates a Medium or High Risk?

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

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

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

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

Learn More About Hepatitis B


Pneumococcal Shot

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

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

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

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

Learn More About Pneumococcal Vaccinations


Additional Vaccinations and Shots Available

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

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

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

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



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

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

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

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

Learn More about Shingles


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

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

Listen to that episode! It is EXTREMELY educational.

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

Have a peaceful and prosperous week!





Mar 10, 2017

Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

If you have any questions, send them to

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

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

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

Thanks again for listening!

Mar 3, 2017

Hey Medicare Nation!

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

Who should carry their Medicare ID Card?

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

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

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

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


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

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


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

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

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

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

Follow these steps:

You can ask for a Medicare Replacement Card :

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

                     1. Call 800 - 633 - 4227

                    C. Social Security Office 

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


Thanks so much for listening to Medicare Nation!

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

Buy them a Smartphone!

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

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

Download the Stitcher App.

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

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

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

Medicare Nation comes right up!

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

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

Feb 24, 2017

Hey Medicare Nation!

I hope everyone is having an awesome week!

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

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

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

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

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

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

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


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

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

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


2. Title XVIII of the Social Security Act

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

my website -


Thanks for listening to Medicare Nation!

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


Feb 10, 2017

Hey There Medicare Nation!

Today, I'm speaking with a special guest.

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

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

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

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

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

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

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

The Veteran's in Business Show was born!

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

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

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

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

Find the podcast here:


Contact James Van Prooyen:


on Snap Chat - JamesVanProoyen

LinkedIn - James Van Prooyen

James - Thank You for your Service!


Tell a family or friend about Medicare Nation! 

Help someone get on Medicare Nation with a Smart Phone! 

The resources for people 64 and older is so valuable!

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

Help me to help you!

Thanks for listenening!




Jan 20, 2017

Hey Medicare Nation!

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

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

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

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

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

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

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

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


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

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

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

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

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


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


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

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

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

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

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

Blue Cross & Blue Shield of Rhode Island - RI

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

Catholic Health Partners - IA,KY, MI, OH


Community Health Plan of Washington - WA

Emblem Health Inc. - CT, NY, RI

Fallon Community Health - MA

Gateway Health Plan, LP - OH, PA, WV

Health Partners Plans, Inc. - PA

Highmark Health - PA

Humana Inc. - WI

Indiana University Health - IA

Magellan Health Inc. - NY

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

Molina Healthcare, Inc. - UT

Piedmont Community Health Plan - VA

Premera - WA

Samaritan Health Services - OR

SCAN Health Plan - CA

UnitedHealth Group, Inc. - CO

Wellcare Health Plans - IL


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

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

1. Call Medicare - 800-633-4227

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

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


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

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

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

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

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


What do you do now????

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

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

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

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

Do your Due Dilligence Nation!

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

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

Share Medicare Nation with someone!

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

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

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

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


Jan 13, 2017

Hey Medicare Nation!

Medicare has announced the 2017 "5 Star Plans."

What are 5 Star Plans?

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

There are 2 main types of Star Ratings:

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

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

A few areas Medicare reviews for these Star Ratings include:

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

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

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

A plan can receive a 1 to 5 Star Rating.

5 Stars is Excellent

4 Stars is above average

3 Stars is average

2. Stars is below average

and 1 Star is poor.

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

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

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

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

That 5 Star Plan may not fit your unique needs!

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

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

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

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

The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network? should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th. 

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

In this example, you may have another option!

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

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

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

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

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

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

     Company Name                           Service Area

1. KS Plan Administrators, LLC -     4 Counties TX

2. Kaiser Found. HP, INC                 31 Counties CA

3. Kaiser Found. HP of CO               17 Counties CO

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

5. Tufts Assoc. HMO                       10 Counties MA

6. BCBS of MA HMO Blue                11 Counties MA

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

8. Aultcare Health Ins. Corp          12 Counties OH

9. Physicians Health Choice TX     19 Counties TX

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

11. Optimum Healthcare Inc.        25 Counties FL

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

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


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

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

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

Do your Due Diligence! 

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

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

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

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


Send them to

Thanks for listening to Medicare Nation.

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

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

Have a happy, peaceful & prosperous week!                         

Jan 6, 2017

Hello Medicare Nation! Happy New Year to everyone.

I hope everyone had a wonderful holiday season.

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

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

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

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

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

1. Call Medicare 800-633-4227

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

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

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

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

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


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



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

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

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

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

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

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

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

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Have a happy, healthy & prosperous week!



Nov 29, 2016


10 Days left in the Annual Enrollment Period. That's plenty of time to find the plan that fits your needs for 2017,

The one change that everyone is talking about is the increase to the Medicare Part B Premium.

Last month, Social Security announced a .03% COLA for Social Security beneficiaries in 2017.

With the COLA announcement, the hold harmless rule is in effect.                   This means if the social security COLA doesn’t cover the increase to the Medicare Part B base premium, those individuals who already have their Medicare Part B premium taken out of their Social Security benefit check will not see that deduction in their benefit check.

The hold harmless individuals, who make up about 70% of all Medicare beneficiaries, won’t even come close to covering the $134.00 base Part B premium in 2017.  The hold harmless protection will squeak out a Medicare Part B premium increase of about $109.00.

The hold harmless rule does not protect individuals who:

  1. Are enrolling in Medicare Part B for the first time.
  2. Haven’t started receiving their Social Security Benefits and are enrolled in Medicare Part B.
  3. Are directly billed for their Medicare Part B premium
  4. Make an annual income of $85,000.00 or more
  5. Are enrolled in the Medicare Savings Program (States pay the new Medicare Premium increase).
  6. Are enrolled in Medicare and Medicaid, the State pays for the individual’s Medicare premiums.

Individuals who are not protected by the hold harmless rule, and have an annual income of less than $85,000.00, will be paying a base Part B premium of a whopping $134.00 a month in 2017.

Individuals with an annual income of more than $85,000.00, but less than $107,000.00, will pay a Part B premium of $107.50 a month.

Individuals who earn an annual income between $107,000.00 and $160,000.00, will pay a monthly Part B premium of $243.60.

Those who earn an annual income between $160,000.00 up to $214,000.00, will pay $316.70 a month premium for Medicare Part B.

Finally, those individuals who earn an annual income of more than $214,000.00, will pay $389.80 a month.

The Medicare Annual Enrollment Period is in full swing and allows Medicare Advantage enrollees the opportunity to voluntarily make plan changes, which are effective January 1, 2017.

Individuals can make the following changes during the Annual Enrollment Period:

  1. Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  2. Drop their Medicare Advantage Plan and go back to Original Medicare.
  3. Switch from a Stand-alone Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan and vice versa.
  4. Go from Original Medicare onto a Medicare Advantage Plan.
  5. Stay with the Medicare Advantage Plan they currently have.
  6. Switch from a Medicare Supplement Plan to a Medicare Advantage Plan.
  7. Drop a Medicare Advantage Plan and enroll in a Medicare Supplement Plan (underwriting may apply).

But according to a brief published by The Kaiser Family Foundation in September of 2016, from 2007 – 2014, only an average of 10% of Medicare Advantage enrollees voluntarily switched plans each year. (

In my experience, Medicare enrollees do not have enough resources to make informed decisions in selecting a Medicare plan for themselves. During the Annual Enrollment Period, people are bombarded with TV infomercials, newspaper ads, direct mail offerings and inaccurate advice from friends and family. Overwhelming information!

So what is the answer for over 31% of Medicare beneficiaries on Medicare Advantage Plans during the Annual Enrollment Period?

There are several options available.

  1. If you have a Medicare Advisor or Insurance Agent, who can offer you several different Medicare Advantage carriers in their portfolio – call them.

It wouldn’t be in your best interest to contact an insurance agent, who works for only one Medicare insurance carrier. These agents are only able to offer you Medicare Advantage Plans from their one carrier. They will not have your best interest in mind. If they don’t enroll you in one of their plans, they won’t get paid.

Using a Medicare Advisor or insurance agent, who has different Medicare carriers available to you, will have your best interest. They will help find you a Medicare plan that fits your unique needs.  

If you don’t personally know a Medicare Advisor or insurance agent, you can Google “Medicare Advisor + your town.” An example would be – Medicare Advisor Tampa, FL. 

  1. Each State has a Department of Aging, with volunteers to assist you with your Medicare questions.

Advise the representative that you’d like to speak with someone who is knowledgeable with the different Medicare Advantage Plans in your area and they will connect you with a person who is unbiased.

Many States have educational seminars on Medicare at community Senior Centers. Ask if any will be in your area.


  1. Individuals can go onto the website and use the plan finder database, but understand the information is not 100% complete.

 When you are deciding between two plans, go onto the insurance plan's website to look at the plan details to compare out of pocket costs for each plan.

The Medicare Part B premium increase for 2017, is going to make many people anxious and frustrated.  It is in your best interest to plan ahead and research your Medicare plan options at least three to four months prior to turning 65.

If you are still employed and on an employer’s health insurance plan, compare your cost for your employer’s plan against Medicare plans.

Don’t forget to calculate the Medicare Part B premium into your comparison.

You can participate in a credible employer health plan and not have to enroll in Medicare Part B when you turn 65.

In my experience, I have found over 80% of the time, a Medicare Supplement plan is more cost effective than the employer’s plan. The Medicare Supplement plan also provides the freedom to choose any physician in the United States, who is contracted with Medicare. Take your time and do your due diligence.


 “A stitch in time saves nine.” Properly preparing for your initial enrollment in Medicare and choosing a Medicare plan that fits your unique needs, will save you the aggravation and possibly making a poor financial and health coverage decision.


Diane Daniels

Medicare Advisor                                                                                           Senior Advocates For Medicare & Medicaid, LLC                                                 855-855-7266

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