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How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: Category: general
Jul 5, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

Help your PARENTS, Spouses and Friends "SUBSCRIBE" to Medicare Nation!

With almost 100 episodes on Medicare and Medicare Resources available, your loved-one will be able to find answers to their Medicare questions!

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TODAY.... I'm discussing NEW information released from CMS.

 

CMS Decision Summary Ambulatory Blood Pressure Monitoring  Devices

July 2, 2019…..The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries.

 What is hypertension (high blood pressure)?

The American Heart Association (AHA) defines blood pressure as…. a force that pushes blood through a network of arteries, veins and capillaries.

The blood pressure reading is the result of two forces:

  1. the systolic pressure occurs as blood pumps out of the heart and into the arteries;
  2. diastolic pressure is created as the heart rests between heart beats (American Heart Association, 2018).

Elevated blood pressure, or hypertension, leads to harm by causing tiny tears in the interior lining of the arteries and coronary vessels…..stimulating a local immune response in the endothelial cells within the atrial walls.

 In these regions, the arterial intima retains apolipoprotein B, which attracts lipid-rich macrophages (foam cells).  

These preatherotic lesions develop into atherosclerotic plaques which become increasingly fibrotic and can form fissures, hematomas, thrombi, and calcifications (Swirski and Nahrendorf, 2013). The end result is stiff, thickened arteries that narrow the flow of blood to organs and limbs….which both increases pressure on target organs and limits oxygenation of them.

There is also the risk of atherosclerotic plaque rupture, resulting in distal vascular obstruction and ischemia and infarction of end organs, such as stroke in the brain (U.S. Department of Health & Human Services, 2018).

CMS is lowering the blood pressure threshold for hypertension… from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria. 

This will allow more patients to use ABPM and receive appropriate treatment if needed.

  1. General

Ambulatory blood pressure monitoring (ABPM) is a diagnostic test… that allows for the identification of various types of high blood pressure.

ABPM devises are small… portable machines that are connected to a blood pressure cuff worn by patients…. that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities..including sleep.

The recording is interpreted by a physician or non-physician practitioner….and appropriate action is taken based on the findings.

Diagnosis and treatment of high blood pressure is important for the management of various conditions…. including cardiovascular disease and kidney disease.

 

Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries is covered under the following circumstances:

  1. For beneficiaries with suspected “white coat hypertension,” which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm … but less than 160 mm … or diastolic blood pressure greater than 80… but less than 100… on two separate clinic/office visits …..with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are <130/80 mm Hg.
  2. For beneficiaries with suspected “masked hypertension,” which is defined as average office blood pressure between 120 and 129 for systolic blood pressure or between 75 and 79 for diastolic blood pressure on two separate clinic/office visits…. with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥ 130/80

ABPM devices must be:

  • capable of producing standardized plots of blood pressure measurements for 24 hours with daytime and night-time windows and normal blood pressure bands demarcated;
  • provided to patients with oral and written instructions and a test run in the physician’s office must be performed; and
  • interpreted by the treating physician or treating non-physician practitioner.
  • For eligible patients, ABPM is covered once per year.

 

CMS has covered ABPM since 2001 only for those patients with documented suspected white coat hypertension. On January 16, 2003, a technical correction for this National Coverage Determination was issued…. to clarify that a physician is required to perform the interpretation of the data obtained through ABPM…. but that there are no requirements regarding the setting in which the interpretation is performed.

CMS received a complete, formal request for a reconsideration of the national coverage determination from the American Heart Association and American Medical Association.

You can view the formal request letter on the tracking sheet on the CMS website.

Benefit Category

Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.

ABPM may be considered to be within the benefits described under sections:

other diagnostic tests  (§1861(s)(3).

Medicare regulations state in part, that "…diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem." (42 CFR 410.32(a))

  

UNDER APPENDIX C

(Current Section 20.19 of the National Coverage Determination Manual)

Item/Service Description

Ambulatory blood pressure monitoring (ABPM) involves the use of a non-invasive device which is used to measure blood pressure in 24-hour cycles. These 24-hour measurements are stored in the device and are later interpreted by the physician.

Indications and Limitations of Coverage

ABPM must be performed for at least 24 hours to meet coverage criteria.

ABPM is only covered for those patients with suspected white coat hypertension.

Suspected white coat hypertension is defined as:

Office blood pressure >140/90 on at least three separate clinic/office visits with two separate measurements made at each visit;

  1. At least two documented blood pressure measurements taken outside the office which are <140/90 and
  2. No evidence of end-organ damage.
  3. The information obtained by ABPM is necessary in order to determine the appropriate management of the patient. ABPM is not covered for any other uses.

 

In the rare circumstance that ABPM needs to be performed more than once

in a patient, the qualifying criteria described above must be met for each subsequent ABPM test.

For those patients that undergo ABPM and have an ambulatory blood pressure of <135/85 with no evidence of end-organ damage, it is likely that their cardiovascular risk is similar to that of normotensives. Patients should be followed over time.

Patients for which ABPM demonstrates a blood pressure of >135/85 may be at increased cardiovascular risk, and a physician may wish to consider antihypertensive therapy

Resources:    Medicare.gov Website  

 

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Diane Daniels

Jun 21, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200!

CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations. 

From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information.

In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing.

Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services.

Enrollees were affected in the following area:

Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY.

Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs.

CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage.

Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost.

In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0,  you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately. 

Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you.

If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation.

If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240.

You can also make a complaint to Medicare directly by calling 800-633-4227.

If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240.

If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can :

1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan 

or

2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/

when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads -

Find Your Local SHIP

"Click" on that ORANGE buton and a list will come up of all 50 States.

"Click" on the State where you reside, to contact your local SHIP center.

If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either:

Support@TheMedicareNation.com

or 

call me at 855-855-7266

If I can answer your question in ONE paragraph in an email, I will directly answer your question!

If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services. 

I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country!

Please SUBSCRIBE to Medicare Nation so that you will receive EVERY NEW episode that is published!

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Go to www.itunes.com and type MEDICARE NATION in the search bar.

When the page opens, "Click" on the Review tab and leave your review!

Thanks so much for listening!

If you'd like to hear about a specific topic on the show or you'd like a specific guest on the show...... send me an email to Support@TheMedicareNation.com

I appreciate your Support!

Diane Daniels

 

Jun 14, 2019

Multi Target Stool DNA Test  vs. Fecal Occult Blood Test

 Hey Medicare Nation!

www.TheMedicareNation.com

Have you subscribed to Medicare Nation? Don’t know how?

If you have an Apple iPhone……. Click on the “Purple” icon…. With the white microphone. When the page opens….Click on SEARCH. Type in Medicare. Medicare Nation comes right up… WHY……BECAUSE….. it’s a TOP 100 APPLE PODCAST Nation!

Click on that Beautiful Flag “Medicare Nation” Logo. When the page opens….Click on the SUBSCRIBE button! That’s it. You’ll get the latest information on Medicare and you can search through the almost 100 episodes on Medicare Information!

Are Your Parents subscribed to Medicare Nation? Come On “Sandwich Generation” Show your parents HOW to Subscribe to Medicare Nation! Once they subscribe…. They will STOP asking you questions about Medicare, because they WILL Find the answer by listening to Medicare Nation episodes!

Let’s give YOU back some time…. So that YOU can have more time for yourself

 

Today…..I’m going to be talking to you about the Differences Between Multi Target Stool DNA Test  vs. Fecal Occult Blood Test

Medicare offers these Preventative Tests to determine if you have blood in your stool and/or suspected cancerous characteristics.

ColoRectal  cancer (CRC) is the second most frequent cause of cancer DEATH in the United States.  The Most Frequent Cause of Cancer Death is…… Lung Cancer.

This year, an estimated 145,600 adults in the United States will be diagnosed with colorectal cancer.

According to Cancer.net…… an estimated 51,020 of the 145,600 adults will die this year…..due to ColoRectal Cancer.

When colorectal cancer is found early, it can often be cured. CURED Nation!

This is due to improvements in treatment and increased screening….. which finds colorectal changes before they turn cancerous and cancer at earlier stages.

Medicare Part B offers TWO Preventative Screening Tests

The First…. Is a Fecal Occult Blood Test

“Fecal Occult” Blood Test is just a scary way of saying….. “ Looking for Blood in your Poop.”  The test ONLY detects the “presence” or “absence” of blood in your stool. The test does not indicate potential sources of bleeding and it does not “Diagnos” disease.

“Fecal” means……“Stool” or “Poop”….and…. “Occult Blood” means you can’t see the blood in your stool with the “naked eye,” so….. the specimen is sent to the lab for a closer look.

Blood in the stool may indicate polyps…. or it may indicate cancer in the intestine or rectum….though not all cancers or polyps bleed.

If blood is detected through the “Fecal Occult Blood Test,” additional tests may be needed to determine the source of bleeding as well as “diagnosing” an ailment or disease.

Blood in the stool could also mean Hemorrhoids….which are swollen veins in the lowest part of your rectum and anus.

Sometimes the walls of these blood vessels stretch so thin….. that the veins bulge and get irritated, especially when you poop! Straining while pooping is a major factor in Hemorrhoids.  EAT more Fiber Nation! Eat More Vegetables….try Metamucil or Miralax. Straining to poop is not good. Drink more water! You should try to drink at least 96 oz. a day. I use a 24oz bottle I fill 4 x a day….. to get my 96 oz of water. You can do it. It’s important.

Hemorrhoids can cause itching & pain.  Hemorrhoids can also bleed.

There are several types of Fecal Occult Blood Tests,

I’m going to discuss the “newer version,” which is called a “ Immunochemical Fecal Occult Blood Test,” (aka iFOBT or FIT)

The IFOBT or FIT test is less of a mess and easy to administer.

Typically, you have a “spoon-like” device to collect the sample of stool and you place the device into a collection container then seal it.

You either return the collection container to your doctor’s office, or you mail it.

There are no dietary restriction with the iFOB-IT and the test can be performed on any random sample of your stool.

Your Doctor will review the results and there are just two options:

  1. Negative Result, which means no blood was detected in the stool sample you provided.

OR……..

  1. Positive Result, which means blood WAS detected in the stool sample you provided.

 

This type of test ISN’T ALWAYS accurate.

Your fecal occult blood test could show a negative test result when cancer is present (false-negative result) if your cancer or polyps don't bleed.

If you had the test to screen for colon cancer and you're at average risk — you have no colon cancer risk factors other than age — your doctor may recommend waiting one year and then repeating the test.

 If you have a “positive result,” You may need additional testing — such as a colonoscopy — to locate the source of the bleeding.

Under Medicare…… The Fecal Occult Blood Test…. can be given ONCE every 12 months if you’re 50 or older, at ZERO Cost to you.

 

     Now….. let’s take a look at Mult-Target Stool DNA Tests.

You will know the “Multi-Target Stool DNA Test” more commonly known as “ColoGuard.”

ColoGuard …….   addresses several barriers to colorectal screening.

  1. Patient concerns with colonoscopy. Include…having to schedule a separate and lengthy appointment at the testing facility.
  2. The need to undergo a “Stay Close to my Bathroom” bowel preparation
  3. the exposure to sedation or anesthesia……and
  4. the discomfort associated with an invasive imaging process…. Of sticking either the “colono-scope” during a colonoscopy or a flexible sigmoud device up your butt.

 

By comparison, the “Multi Target Stool DNA” screening test is a noninvasive, “multi-marker”, stool-based ColoRectal Cancer screening test…..

that detects altered De-oxyribo-nucleic Acid (DNA), , as well as a fecal immunochemical test (FIT)… for blood released from cancer and precancerous lesions of the colon.

The presence of fecal hemoglobin….. even in the absence of elevated DNA markers…..can lead to a positive result given the weighted nature of the Multi Target Stool DNA algorithm.

Patients may collect and mail stool specimens from their homes with no bowel preparations and no dietary or medication restrictions.

 

Medicare covers this at-home multi-target stool DNA lab test…. once every 3 years…if you meet ALL of these conditions:

 

  • You’re  between the age of  50-85.
  • You show NO CURRENT symptoms of colorectal disease including, but not limited to one of these:
  • Lower gastrointestinal pain
  • Blood in stool
  • Positive Guaiac fecal occult blood test….which is an older version of the Immunochemical Test… where you “smear” stool onto a TEST Card with a wooden applicator or brush. The Guaiac test has dietary restrictions and you are required to collect “TWO” or more samples from the same Stool Sample for the test. Much Messier than the Immunochemical Fecal Blood Occult Test.
  • OR……
  • A Positive Result from a Fecal Blood Occult Test

ALSO    YOU NEED TO BE…..

  • at average risk for developing colorectal cancer, meaning:
    • You have no personal history of  (adenomateous ) polyps”  which are …..  a common type of polyp. They are gland-like growths that develop on the mucous membrane that lines the large intestine. They are also called adenomas:

You have no personal history of  … colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.

OR……

  • You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

 

If you meet the above criteria….. You pay nothing for this test if your doctor…. or other qualified health care provider accepts Medicare.

 

So that’s the difference between Multi Target Stool DNA Tests vs. Fecal Occult Blood Test.

 

If you haven’t had one of these preventative tests, speak to your primary doctor and get one. It could very well SAVE YOUR LIFE!

 

If you have any questions about Medicare…. Send me an email to –

Support@TheMedicareNation.com

 

I answer ALL my emails. As long as I can answer your question in a paragraph, I’ll answer your question.

If my response involves any research or it will take more than one paragraph to answer you….. I’ll send you a suggestion to hire me as your Medicare Consultant.

 

I charge $199.00 an hour. I’m one of the TOP Medicare Experts in the Country Nation…… I could easily command $400 or $500 an hour, but I CARE about each and every one of you! My time is extremely valuable and I want to help as many of you as I can with your Medicare problems and Medicare Plan Comparisons.

 

Also…..if you’d like to have me speak about Medicare … go to the website…  www.TheMedicareNation.com and click on the Contact tab and send me your information.

I’ve already started booking speaking engagements for the Annual Enrollment Period…. Starting in October…so contact me now to schedule me for your corporation or event.

 

Thanks for listening to Medicare Nation! I appreciate your loyalty and referrals.

Until next time…. I want YOU to have a Peaceful, Happy & Prosperous Week!

 

Diane  

 

 

 

 

 

May 31, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

I'm not an expert on Reverse Mortgages......in fact, I don't know much about them.

I have heard about Reverse Mortgages on commercials, in newspapers and on FaceBook feeds. I never had the need to learn about Reverse Mortgages, so...... I never did......until...... a client asked me about them.

When a client asks me a question about Medicare..... I know the answer. I'm a Medicare Expert....I'm in the business of knowing as much as I can about Medicare. 

Because my clients trust me with their Medicare needs and concerns, they ask me all kinds of questions. When I know the answer.... I tell them. When I don't know the answer..... I get the answer for them!

So....when my client asked me about Reverse Mortgages.... I started reading about them.

When I was introduced to Michael Banner, President of Professional Mortgage Alliance, LLC, I had many, many questions.

Michael Banner was very patient and answered every question I had..... truthfully.

An hour and a half later..... I had a much better idea about reverse mortgages, and I invited Michael Banner to come onto The Medicare Nation Podcast to share his knowledge with our Medicare Beneficiaries and Sandwich Generation!

Here are the highlights of my interview with Michael Banner:

* What is a Reverse Mortgage?

*  Do I pay a higher intersest rate with a Reverse Mortgage?

*  If I "Will" my home to my children.... what happens to the      Reverse Mortgage?

*  What is a Non-Recourse Loan?

* What does it mean if the value of my house is "upside              down?"

*  What is No-Debt Service?

*  Is a Reverse Mortgage Safe?

*  If a person leaves the home to live in an assisted living          facility, what happens to the Reverse Mortgage?

*  Can a person "out live" a Reverse Mortgage?

* What are the "5 Ways" payments are made with a Reverse     Mortgage?

Want to learn more about Reverse Mortgages?

Reach out to Michael Banner at :

MBanner@PMAnow.com

Website for Professional Mortgage Alliance, LLC

Professional Mortgage Alliance

Michael Banner's Phone Number -  (727) 224 - 3859

Where to purchase Michael Banner's Book -

MBanner@PMAnow.com

 

The 62 Who Knew Show

www.WeBeamTV.com

 

Have Questions About Medicare?

Send me an email to - Support@TheMedicareNation.com

If you'd like to hire me as a Medicare Consultant, starting 

June 1, 2019.... my rate is $199.00 an hour.  Contact me by either email at .... Support@TheMedicareNation.com

or ... call me ..... 855 - 855 - 7266.

Thanks for listening to Medicare Nation!

SUBSCRIBE to Medicare Nation and get the latest episodes delivered to you!

Give us a Rating & Review on iTunes!

This helps others find Medicare Nation so that they can have their Medicare questions answered too!

www.TheMedicareNation.com

Until next time.... have a happy, peaceful & prosperous week!

Diane Daniels

May 17, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

On the Last episode.....I spoke to you about Medicare Supplement Plan "F" and High Deductible Plan F.

Today....I'm going to talk about Medicare Supplement Plan "G" and Plan "N"

Plan "G" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier......

in return...... Medicare Supplement Plan G, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for ..... The Annual Part B Deductible. YOU will be responsible for the Annual Part B deductible each year.

Currently.... in 2019, the Annual Part B Deductible is $185.00.

So..... when you seek medical care in the beginning of the year.... you will pay out-of-pocket until you hit the $185.00 Part B Deductible.

After you pay the $185.00 Part B Deductible....you will NOT be responsible for ANY other deductibles, co-pays or co-insurance under Medicare Supplement Plan G, that are medically necessary under Medicare.

Plan "N" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier......

in return...... Medicare Supplement Plan N, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for .....

1. The Annual Part B Deductible ($185.00 in 2019)

2. A co-pay of up to $20.00 for each doctor visit.

3. A co-pay of $50.00 if you go to the Emergency Room and you are "Discharged" from the Emergency Room.

If you are "admitted" to the hospital from the ER... you will NOT incur a $50.00 co-pay.

If you have paid all of your Part B Deductible, you will have NO other out-of-pocket costs while you are an inpatient in the hospital.

4. If you seek treatment, testing or diagnostic testing from a physician or facility that does NOT accept Medicare, you WILL be responsible for 100% of the cost of that service.

The provider or facility can legally charge you 15% above and beyond the Medicare Allowable charge.

It is vital that you always ask prior to receiving care, a test or doctor visit....if the physician or facility "accepts Medicare." 

If they do.....your charges are outlined above.

If they do not accept Medicare..... you may be responsible for ALL of the charges, up to 15% of the Medicare Allowable charge.

ASK BEFORE YOU SEE A DR or RECEIVE TREATMENT!

Prices for Medicare Supplements VARY by zipcode!

Get quotes from MANY different insurance carriers prior to enrolling in a plan. You could save hundreds....sometimes over a thousand dollars a year!

HAVE a Question for ME?

Send it to me at  Support@TheMedicareNation.com

I will answer ALL emails I receive.... personally!

If the answer to your question will take me more than 1 paragraph to answer... or .... it is necessary to do some research for you in order to answer the question.... I will respond and advise you to hire me as your consultant.

Many of your questions may be answered on the official Medicare website - www.Medicare.gov

Always do YOUR Due Dilligence before you enroll in a Medicare Plan!

Consider leaving a review & rating on the Medicare Nation Podcast page in iTunes. 

http://nation.reviews/medicare8

 

Thanks for listening to Medicare Nation!

Show your Parents how to "Subscribe" to Medicare Nation. With over 100 episodes... most of their questions will be answered by listening to my episodes.

This way... your parents are NOT bothering YOU for information about Medicare! Enjoy time for yourself and your family!

Teach people how to "subscribe" to Medicare Nation!

YOU will be responsible for the Annual Part B deductible each year.

Apr 15, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

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!

What IS different..is the MONTHLY PREMIUM!

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 means......you WILL pay-out-of-pocket until......you 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" price......you 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 65....or.....you 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 -

Support@TheMedicareNation.com

or.....

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

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

Go to my website..... www.TheMedicareNation.com

for more information.

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

 

Diane Daniels

 

Mar 15, 2019

Hey Medicare Nation!

www.TheMedicareNation.com

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 situation.....you 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 situation.....you 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.

www.TheMedicareNation.com

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 

READ Your Plan's EVIDENCE OF COVERAGE Booklet.

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

www.TheMedicareNation.com

 

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

I use these different websites to look for policies:

1. www.TravelGuard.com

2. www.AllianzTravelInsurance.com

3. www.TravelInsurance.com

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.

Support@TheMedicareNation.com

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!

htpps://www.TheMedicareNation.com

 

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 

Support@TheMedicareNation.com

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 www.TheMedicareNation.com  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 Medicare.gov website as an additional resoure:

www.medicare.gov

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 -

Support@TheMedicareNation.com

 

I look forward to hearing from you!

Happy Thanksgiving everyone!

Diane

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. 

SNF

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                                                         
$352.20

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
                                                                       $460.50

 

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 Support@TheMedicareNation.com

 

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,

www.drrachnapatel.com

You can also go to her Facebook page,

Facebook.com/DoctorRachnaPatel

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:

https://goo.gl/9UuX7Y

Are Other Types of FES Devices Available?

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

https://goo.gl/FMXr5i

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:

FreedomToWalkFoundation.org

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!

www.FreedomtoWalkFoundation.org/donate

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 ssa.gov 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

 Delaware

Pennsylvania

Virginia

Washington D.C.   AND…..

West Virginia

Want to know when YOUR card has been mailed?

Go to Medicare.gov/NewCard

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 www.ssa.org  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.

FINALLY…..

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…..

HANG UP THE PHONE ON THEM!          

 

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.

RESOURCES:

ssa.org

www.medicare.gov/newcard

 

Feb 2, 2018

Hey Medicare Nation!

www.TheMedicareNation.com

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 advertisers.....you will start seeing results for what you asked for.

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

Butte

Lake

Los Angeles

Mendocino

Napa

Nevada

Orange

Riverside

San Diego

Santa Barbara

Solano

Sonoma

Ventura

and Yuba.

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

www.fema.gov/disasters

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

Send Diane an email to - 

Support@TheMedicareNation.com

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

Send your request to Support@TheMedicareNation.com

Have a Happy, Peaceful and Prosperous Week!

www.TheMedicareNation.com

 

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 A....you 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 later.....you 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 Medicare.gov 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, WA.......you 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.

and 

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 Support@TheMedicareNation.com

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 www.TheMedicareNation.com

or ...... an iTunes review.

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!

Diane

Nov 18, 2017

Hey Medicare Nation!

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

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

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

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

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

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

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

Such is the case for 2018.

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

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

CMS planned this out perfectly!

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

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

$134.00!

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

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

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

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

Let's look at the remaining 2018 Deductibles:

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

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

That's an increase of $24.00 from 2017.

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

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

You are given 60 lifetime reserve days.

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

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

Works the same way for lifetime reserve days.

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

Skilled Nursing Facility

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

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

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

 

Part B of Medicare

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

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

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

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

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

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

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

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

 

Advocacy Groups For Medicare

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

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

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

Hey Medicare Nation!

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

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

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

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

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

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

Residents of Texas may qualify due to Hurricane Harvey.

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

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

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

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

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

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

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

Call 800-633-4227.

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

 

Oct 6, 2017

Hey Medicare Nation!

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

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

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

 

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

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

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

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

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

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

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

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

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

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

Medicare Savings Program

2017 Monthly Income Limit:

Single Person

$1,377.00 

Married (living together)

$1,847.00

 

2017 Total "Resource" Limit:

Single Person

$7,390

Married (living together)

$11,090

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

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

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

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

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

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

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

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

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

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

Extra Help Program

2017 Monthly Income Limit:

Single Person

$1,507.50 

Married (living together)

$2,030.00

 

2017 Total "Resource" Limit:

Single Person

$13,820.00

Married (living together)

$27,600.00

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

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

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

www.socialsecurity.gov/locator

That's it for today Nation!

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

Diane

Oct 1, 2017

2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

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

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

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

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

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

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

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

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

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

That is a Medicare Regulation! 

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

FIND A NEW AGENT!

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

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

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

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

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

Annual Deductible 

The 2018 Maximum PDP Annual Deductible is $405.00.

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

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

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

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

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

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

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

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

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

                                    OR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TrOOP costs are -

1. The drug costs paid by the beneficiary

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

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

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

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

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

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

You will pay either:

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

You will pay whichever amount is greater.

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

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

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

 

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

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

Support@TheMedicareNation.com

I'll be happy to answer your question.

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

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

www.TheMedicareNation.com

That's it for this week's show!

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

Go to this link and tell me what you think! 

https://goo.gl/sb3JXo

 

Have a happy, peaceful and prosperous week everyone!

 

Jul 7, 2017

Hey Medicare Nation!

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

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

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

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

Summary of Noncomplliance

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

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

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

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

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

That's a BIG fine! 

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

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

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

The number is - 800-868-5200.

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

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

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

How does something like this happen, you may ask? 

Insufficient training of Fallon customer representatives and agents.

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

Train your employees Fallon! 

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

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

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

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

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

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

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

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

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

2. Call Senior Medicare Patrol.

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

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

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

      www.SMPresource.org

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

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

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

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

We'll see what happens.

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

Report any discrepancies or suspicions right away.

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

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

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

Thank you for listening to Medicare Nation!

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

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

Questions about Medicare or your Medicare Plan you need answered?

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

Have a very happy, peaceful and prosperous week everyone!

Diane Daniels

 

Jun 19, 2017

Hey Medicare Nation!

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

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

The following States were affected by the suspension:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#3. Contact Senior Medicare Patrol

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

        Senior Medicare Patrol

#4.  Contact your State Dept. of Aging

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

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

          Here's the link:

          Healthy Aging List of State Agencies

#5.   Contact Medicare

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

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

 

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

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

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

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

Support@TheMedicareNation.com

You can also visit my website for more information.

www.CallSamm.com

 

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

 

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

Diane 

 

          

Apr 28, 2017

Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare. 

A question that is quite common is:

"What vaccinations are covered under Medicare?"

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

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

1. Flu Shot

2. Hepatitis Shot

3. Pneumococcal Vaccine

 

Flu Shot

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

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

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

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

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

www.Flu.gov

 

Hepatitis B

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

What indicates a Medium or High Risk?

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

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

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

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

Learn More About Hepatitis B

 

Pneumococcal Shot

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

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

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

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

Learn More About Pneumococcal Vaccinations

 

Additional Vaccinations and Shots Available

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

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

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

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

 

Shingles

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

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

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

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

Learn More about Shingles

I also did an ENTIRE EPISODE ON SHINGLES!

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

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

Listen to that episode! It is EXTREMELY educational.

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

Have a peaceful and prosperous week!

Diane

 

 

 

Mar 10, 2017

Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 3, 2017

Hey Medicare Nation!

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

Who should carry their Medicare ID Card?

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

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

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

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

 

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

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

 

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

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

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

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

Follow these steps:

You can ask for a Medicare Replacement Card :

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

                     1. Call 800 - 633 - 4227

                    C. Social Security Office 

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

 

Thanks so much for listening to Medicare Nation!

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

Buy them a Smartphone!

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

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

Download the Stitcher App.

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

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

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

Medicare Nation comes right up!

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

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

Feb 24, 2017

Hey Medicare Nation!

I hope everyone is having an awesome week!

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

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

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

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

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

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

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

123-45-6789A

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

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

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

1. www.ssa.gov

2. Title XVIII of the Social Security Act

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

my website -

www.callsamm.com

 

Thanks for listening to Medicare Nation!

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

 

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