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Medicare Nation

How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.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
May 6, 2016

Today’s topic is the Medicare Savings Program. It can help you pay part of your Medicare premiums. It’s based on certain criteria of your income and resources.

 

2016 Medicare Savings Programs:

 

Resources include stock, bonds, 401K, IRA.

 

It does not include your home, 1 vehicle and other personal items.

 

 

4 Levels of Coverage:

 

QDWI Plan: (Qualified, Disabled, and Working Individual)

Monthly income limit - $4045 (Married $5425) 

Resource limit - $4000 (Married $6000)

 

 

 

QI Plan: (Qualifying Individual)

 

Monthly income limit: $1357 (Married $1823)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

 

 

Specified Low Income Medicare Beneficiary Program (SLIM-B)

 

Monthly income limit: $1208 (Married $1622)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

 

 

Qualified Medicare beneficiary (QMB)

 

Pays Part A, Part B Premium, Deductibles, Co-pays

Monthly income limit: $1010 (Married $1355)

Resources limit: $7280 (Married $10,930)

 

 

How to Apply:

 

  1. Go online to www.ssa.gov. Click “Benefits”, then “Extra Help for RX Drugs”, look on right side for “Application”.
  2. Go to the Social Security office (find locations on ssa.gov) to apply
  3. Go through your state Medicaid Program - Google “medicare” and your state

 

It may take 4-6 weeks for them to send you an acceptance/rejection letter.

 You have to re-qualify annually.

 

Questions? 

 

Call SSA at 800-772-1212

Email me: support@themedicarenation.com

Call me: 855-855-7266

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 29, 2016

Welcome Medicare Nation! 

Today, I want to tell you about the federal government program called The Extra Help program, also called Limited Income Subsidy (LIS).  If you never heard of this program, you may be missing out on some additional subsidies for your prescription drug purchases. So let’s walk through the program to see if you qualify.

Qualifications for the Program:

1. Must be a resident of one of the 50 states in America

2. Your resources (savings, stocks, bonds, 401k etc.) cannot exceed $13,640 (married $27,250)

3. Your annual income cannot be more than $17,820/yr (married $24,030)

4. If you support someone else who resides with you (not your spouse), you may qualify for a higher threshold

 

How to Apply for Extra Help:

The easiest route is to apply through Social Security

1. Apply online: www.ssa.gov - click benefits and then apply for extra help 

2. Call Social Security directly at 800-772-1213

3. Go to your local Social Security office - find locations at www.ssa.gov 

  • Make sure you keep a paper trail of your application. 
  • If you go in person, get them to stamp your application to prove they received it

 

 

Automatic qualifications:

  1. On Medicare and Medicaid you are a dual enrollee
  2. If you receive SSI income
  3. If you receive Medicaid

 

You have to re-qualify every year. Social Security will send you a letter and determine your eligibility for the next year around August.

You can get an overview of the Extra Help program by emailing support@themedicarenation.com and ask for the Extra Help pamphlet.

 

You can call me with questions at 855-855-7266.

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 22, 2016

Welcome Medicare Nation!

Hot Topic – The Comprehensive Care For Joint Replacement Model (CJR Model)

  1. Hip Replacements & Knee Replacements are the MOST COMMON Inpatient Surgery for Medicare Beneficiaries.
  2. In 2014 over 400K procedures were done, which cost Medicare over 7 Billion $ for the Hospitalization for these procedures ALONE.
  3. Hip & Knee Replacement Surgeries can require long recovery time & long Rehab periods.

I KNOW!  I’m not even on Medicare yet, and I’ve had TWO Arthroscopic Knee Surgeries, and each surgery took me about a good 6 MONTHS to recover.

 

This is the SCARY PART!  

The Quality & Care you receive VARIES from one Hospital to the next!

Complications like –

  1. Infections received at the hospital …….OR
  2. Implant Failures

Can be 3X Higher Performed at Some Hospitals More Than Other Hospitals.

To me……that is just NEGLIGENCE! 

When you go into a hospital……you expect to receive the best care, a clean environment and YOU SHOULD NOT  CONTRACT  ANY INFECTION OR DISEASE from the Hospital you’re being treated at!  That’s what you Expect from a Hospital…..NOTHING LESS. But……it is apparently going on RIGHT NOW Nation!

And it takes a CMS LAW or MODEL PROGAM to prevent it from happening in EVERY Hospital? Aye,,yi,,,yi.

 

WHY IS THIS HAPPENING TO YOU?

In episode 34 on Medicare Nation, you listened to Melissa’s Story.

Melissa’s story is about the struggles she had with her mother, who suffered a broken hip and the FRAGMENTED care her mom received while in the hospital and the struggles she had in moving her mom to a skilled care facility and then setting up home care physical therapy for her mom.

That is why all this is happening Nation!

There is a LACK OF COMMUNICATION, between Hospital Staff, other Doctor’s, Skilled Nursing Facilities and Home Care Physical Therapy.

NO ONE is talking to anyone else! The LINKS in the CHAIN of Patient Care is BROKEN, and YOU are paying for it! 

This FRAGMENTATION of Care is causing LONGER RECOVERY TIMES, HIGHER HOSPITAL RE-ADMISSIONS & HIGHER OUT OF POCKET COSTS FOR YOU & FOR MEDICARE.

The Comp Care Joint Replace Model Addresses the LOW QUaLITY CARE & Higher Costs that come from this FRAGMENTED CARE, by –

PROMOTING CO-ORDINATED PATIENT CENTERED CARE!

Imagine that Nation!  Putting the Patient 1st! What a New Concept!

 

HOW  WILL  THE  CJR  MODEL  WORK?

Started  April 1,  2016

  1. The hospital in which the hip or knee replacement and/or other major 

leg procedure takes place, will be accountable for the costs and quality of related care  from the time of the surgery through 90 days after hospital discharge—what is called an   “episode” of care.

  1. Depending on the hospital’s quality and cost performance during the 

episode, the hospital will either 

  1. Earn a financial reward     OR, 
  2. beginning with the second performance year, be required to repay Medicare for a portion of the spending. 
  3. This payment structure gives hospitals an incentive to work with 
  1. physicians, 
  2. home health agencies, 
  3. skilled nursing facilities, 
  4. and other providers to make sure beneficiaries receive the coordinated care they need 

The goal is reducing avoidable hospitalizations and complications. 

Hospitals in the model will be provided access to additional tools – such as spending and utilization data and sharing of best practices -- to improve the effectiveness of care coordination. The model also gives providers additional flexibilities that are not otherwise available under Medicare so they can better manage the care of patients, including patients who are at home.

By “bundling” payments for an episode of care, hospitals, physicians, and other providers have an incentive to work together to deliver more effective and efficient care.

The CJR model is being tested in 67 geographic areas throughout the country, and nearly ALL hospitals in those geographic areas are required to participate.

The CJR model supports Health & Human  Service’s  efforts to transform the health care system towards one focused on better quality care, smarter spending, and healthier people through care transformation and payment reform.

WHAT  AREAS  ARE  PARTICIPATING  IN  THE  CCJR  MODEL

Over 800 Hospitals across the US are participating, in 67 Geographical Locations.

Areas were determined based on statistical population data, with populations of over 50K residents.

Here are a Few selected Areas:

  1. Florida – Broward, Collier County, Gainsville, Hernando, Hillsborough, Indian River County, Lake County, Martin, Miami-Dade, Orange County, Osceola, Palm County, Pensicola area, Pinellas, Pasco, Santa Rosa County, Seminole County and St. Lucia County

 

  1. California – Alemeda County, Contra Costa County, Los Angeles County, Marin County, Orange County, San Francisco County, San Mateo, Stanislaus County, 

 

The rest are on the CMS.gov site. Search “CJR Model Geographical Areas,” To find out if a Hospital or County where you reside is participating.

OR

You can go to my website, www.callsamm.com  and I’ll put up a PDF of the Counties participating in the CJR Model program for you to request.

 

 

You can also download a copy of the Federal Register, which is a daily journal of the US Government.  The FINAL Rule for the CCJR Model is there in LONG Form

https://goo.gl/hN44cm

Federal Register/ Vol. 80, No. 226 / Tuesday, November 24, 2015 / Rules and Regulations 

www.callsamm.com - has all of this information available for you.

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

 

 

 

 

Apr 15, 2016

Welcome Medicare Nation! It’s tax season! Today is April 15th and it’s the dreaded tax deadline day! It’s this time of year that people realize they need to make some changes to their Medicare plan. However, many people don’t realize that you can’t just make changes anytime you want to a Medicare Advantage Plan. There are specific times that you can make changes, and then you have to live with them until the opportunity arises to make changes again.

 

Here’s quick guide to making changes to your Medicare Advantage Plan:

 

  1. You make your initial selection of your Medicare Advantage Plan when you enroll at 65.
  2. During annual enrollment from October 15 to Dec 7th.
  3. You can dis-enroll from January 1- Feb 14th, but you would have to go on to original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
  4. You may have a “Special Election” that allows you to change your plan.

 

That Special Election for Medicare Advantage is what we want to focus on today.  There are certain circumstances that can qualify you to have this option.

 

 

Moving Your Residence:

 

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

 

 

 

Losing Coverage:

 

  1. If you leave a job, or the union through retirement, etc.
  2. If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage, that triggers an SEP. Or if you have had drug coverage through Medicare Cost Plan and left that job.
  3. If you lost coverage through the PACE Plan.
  4. If you had Medicaid and lost eligibility because of the income requirements.

 

 

 

You have a chance to get other coverage:

  1. If you had coverage from an employer and it was better than Medicare, you could go on it.
  2. If your employer had better plan coverage and you wanted to get on that plan.
  3. If you wanted to get into a PACE Plan

 

When there are plan changes with Medicare Contracts:

 

  1. If a provider was sanctioned by CMS, then you would be able to choose another plan.
  2. If Medicare terminated a contract

 

 

Dual Member (Medicare and Medicaid)

 

  1. You may get extra help with drug coverage
  2. May have been on a Medigap plan, changed to a Medicare Advantage Plan and then wanted to change back, you can change to a Medicare Supplement plan during your first year of coverage.
  3. SNIP Plan - for chronic conditions - may leave Medicare Advantage to go on the SNIP, or yu no longer qualify for a SNIP, so you can choose another plan.

 

 

 

If an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.

 

 

*****You cannot get an SEP because your Doctor left the network********

 

 

 

If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP.

 

Precautions:

 

If you have a chronic illness, cancer, cardiovascular disease, a plan does not have to take you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The other company might not take you due to pre-existing conditions and your old plan may not take you back. They can discriminate due to pre-existing conditions.

 

The price of these plans do change as you age, so keep that in mind.

 

Original Medicare:

 

Part A, B and D - you are on all the time, so you don’t make changes unless it is open enrollment or an SEP. 

 

 

www.callsamm.com - has all of this information available for you.

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 8, 2016

Welcome Medicare Nation! Today we wrap up our “trilogy” about Care Coordination by talking to Patient Advocate Karyn Rizzo!

 

Karyn wrote the book - Aging in America - What you need to know about Navigating our Healthcare System

 

Karyn’s book is available on Amazon. It covers everything from finding a primary care physician, choosing Medicare programs, and also some information for LGBT friendly providers, and safety tips, fall prevention etc. It just covers lots of real life issues that you face, including respite and how to take a break from care giving!

 

The book came out of the needs Karyn saw in her work everyday! She knew there was so much information she needed to cover, so she created a powerful resource in the book!

 

Fall prevention tips that Karyn provides in the book:

 

  1. Eliminate rugs in the bathroom and other rooms of the house
  2. Check the types of shoes to make sure they don’t contribute to a fall
  3. Falls happen in the middle of the night going to bathroom, so install rails
  4. Is walker or cane easily accessible from the bed?
  5. Do you have motion sensor lighting?
  6. Medications can contribute to falls

 

Another great resource on fall prevention is mayoclinic,org

 

Advocacy for Patients is important today because of the following factors:

 

  1. Healthcare providers don’t have the time to spend with you explaining things
  2. Insurance companies have complex coverage rules
  3. Healthcare treatment options are more complicated than ever

 

 

 

 

What a Patient Advocate Does:

 

  1. Individuals that directly advocate for the patient
  2. Neutral parties hired by the family - not employed by hospital or insurance company
  3. Evaluate the care plan for the patient
  4. Advocate will put together a care plan that meets the patient's needs
  5. Works through the process of appealing insurance and hospital decisions
  6. They know the system, the lingo, and the rules, so they can use them to the patient’s advantage
  7. Knows what programs the patient is eligible for and how to get you on the right program for them
  8. Advocate can also help involve other specialty Physicians to evaluate the best treatment plan for the patient
  9. Advocates can also help navigate care options for Hospice and understand when it is appropriate and when other options are better for the patient.
  10. Hospice does have a Home Health division and it can be confusing between that and end of life Hospice care, so the patient advocate can make sure you are on the appropriate service.
  11. Healthcare regulations vary from state to state, so it’s important to get accurate help navigating the system.

 

 

 

Where do you find a Patient Advocate?

 

Sometimes called a Geriatric Care Manager, Social Service Agencies - There is a national website that provides a directory of caregivers:

 

 

CareManager.org

CareGiver.org

AgingGuidebook1.com - Karyn’s website has TONS of resources

 

 

What type of Licensing does a Patient Care Advocate have?

 

Every state calls the role something different, but there are programs that certify in each state. 

Generally, they are nurses or social workers, or have equivalent experience.

Licensing or certification is required for this role.

 

 

A Geriatric Care Manager is a position that you will have to pay for. Case managers that are paid by Medicare, the hospital or the insurance company will always represent those organization’s interest first, and yours afterward.

 

It is worth every penny to have someone in the trenches that is representing your best interests!

 

 

Online Tools when you are out of state from the patient:

 

 

ecarediary.com

reunioncare.com

 

These websites create a circle of care that allows everyone in that circle to have access to all the information and take action on different aspects of the care for the patient from where ever they are in the world.

 

 

 

 

Got questions about Patient Advocacy?

 

Karyn could assist in a consultative role if you are not located in FL. She can direct you to resources in your area.

 

 

Karyn can be reached:

 

By Phone: 727-452-1300 

 

By Email: info@agingguidebook1.com

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

Apr 1, 2016

Welcome Medicare Nation! 

After last week’s show with Dr. Jeffrey Burns, I wanted to bring a guest on the show that could talk to us about her experience with the lack of care coordination with Medicare.

Melissa’s Mother fell and broke her hip before Christmas. At only 67, ended up having surgery and being in the hospital and then in a skilled nursing facility. At home she had outpatient therapy.

 

Melissa shares the following about her Mother’s experience:

 

  • She went to stay with her Mother during this time - she lived 4 hours away
  • She felt like she would just provide companionship and help her Mom get back on her feet
  • She quickly realized she would have to be a patient advocate for her Mother
  • She found out that the care for her Mom was good, but communication was terrible
  • She tried to follow up on her Mom's care on a daily basis, but it was overwhelming
  • Melissa wasn’t exactly sure of the medicine her Mother took on a daily basis
  • Melissa didn’t have all the information available about the Doctors that her Mom sees
  • Mom had an app on her cellphone that had all her medical info and also allowed her to call 911
  • Mom lived alone and fell late at night when she was in her garage
  • 1 in 3 people 65 and over will fall and a hip fracture is the #1 injury from that fall
  • She and her Mom text every night and every morning since her Mom lives alone
  • Surgery on the hip was successful, but there were some blood clots to deal with
  • Mom has a high tolerance for pain, but yet still seemed to be in a great deal of pain
  • Melissa found out that there was some miscommunication between the nurses and her Mom regarding pain meds
  • The hospital staff thought that Melissa's Mom had refused one of her pain medications
  • Actually Mom only questioned it because she thought she couldn’t have the 2 meds together
  • It wasn’t a refusal of medication, but her Mom just didn’t understand the issues and was confused
  • Constantly ask questions. Write them down as you remember them. Ask the questions to every staff member at every shift. 
  • Her Mom spent a week in the hospital before she went to rehab. It felt like they wanted to release her too soon.
  • The clinical coordinator for the hospital didn’t have a lot of information on placement options in a city 45 minutes away
  • They used the online site ratings through Medicare to find a skilled nursing facility
  • Minimum requirement is 3 overnight stays in the hospital to qualify to go to skilled nursing facility
  • medicare.gov has the resources to check ratings of skilled nursing facilities.
  • Private Institution ratings are not available on www.medicare.gov
  • Transportation to the skilled nursing facility, 45 minutes away, wasn’t handled by the hospital because the facility she was moving to was out of their "network."
  • The family had to arrange transportation through a private medical transportation service, where Mom could transported in her wheelchair.
  • In the skilled nursing facility, her Mom was there for 5 days before she even saw the nurse practitioner.
  • The physical therapist never actually showed up due to scheduling conflicts.
  • It’s important to find out the schedule that the Doctors will be keeping and seeing your family member and make sure you are there when they make the rounds.
  • Melissa found out that her Mom got confused about what meds she was taking for what ailments, so she wasn’t a help to sort things out.
  • Medicare allows Physicians to write prescriptions for home care therapy and it is provided at no cost to you. As long as a Dr. writes a prescription and the Physical Therapist is an approved Medicare provider and the patient can’t make it out to traditional therapy, it will be provided on most Medicare plans  free of charge.
  • Melissa was shocked at how important it was for her to be involved in her Mother’s care and recovery.
  • The outcome for Melissa’s Mom was good, but there were so many times along the way that could have gone terribly wrong, if Melissa wasn’t there to advocate for her Mom.
  • If you are not physically able to be with a family member during a crisis, you may need to inquire about hiring a Patient Advocate.

 

The Official Medicare website is a starting place for finding skilled nursing facility ratings.

Getting a patient advocate is a good idea if you aren’t prepared or able to assist your loved ones during a medical crisis.

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

Mar 25, 2016

Welcome, Medicare Nation!

March is National Kidney Disease Awareness Month, so I’ve invited Dr. Jeffrey Berns on Medicare Nation. Dr. Berns is the president of the National Kidney Foundation and a professor of medicine and pediatrics at the Perelman School of Medicine at the University of Pennsylvania and the Associate Chief of the Renal Electrolyte and Hypertension Division. He is also the director of the Nephrology Fellowship Training Program and the Associate Dean for Graduate Medical Education. Dr. Berns is a busy and dedicated physician, and I’m grateful he is taking the time to inform us about kidney disease today!

  • Give the listeners an idea of the prevalence of kidney disease in the US.

One in three people are at risk for kidney disease, while one in nine already has some level of kidney disease. Chronic kidney disease is measured in stage 3, 4, and 5. Stage 5 is the level at which dialysis or a transplant is required. Throughout your lifetime, it’s important to avoid exposure to things that can damage the kidneys, and that includes many prescription medications.

  • Is it correct to say that kidney disease if most often a “silent” disease?

It is similar to high blood pressure, which is also an important risk factor for kidney disease. Kidney disease is asymptomatic until permanent damage is done. Some tests can reveal the disease to a doctor, but patients don’t often have symptoms until it’s late in the game.

  • What is the difference between a nephrologist and an urologist?

A nephrologist is a physician with specialized training in medical diseases of the kidney, while a urologist is trained in surgical diseases of the kidney and urinary tract.

  • What are signs and symptoms that would indicate late stage kidney disease?

 

  • Protein in the urine in large amounts
  • Swelling of the feet, hands, legs, and face
  • High blood pressure
  • Fatigue
  • Difficulty concentrating
  • Sexual dysfunction
  • Loss of appetite
  • Metallic taste in the mouth

 

  • When should people see their doctor about kidney disease?

We all have to be aware of the risk. Most older people are at increased risk, and minorities are at a higher risk. If kidney disease is in the family history, then the risk is higher. Diabetes increases the risk, but many cases of mild kidney disease can be managed quite well by a primary care physician.

  • Wouldn’t it be a good idea to check blood levels for patients at yearly checkups?

That would be the perfect time and opportunity for routinely-done tests. Your doctor can monitor you for any change over time, and you can ask your doctor if you have signs of chronic kidney disease.

  • The National Kidney Foundation has partnered with MACC (Medicare Advantage Care Coordination) Task Force, aligned with 35 leading patient-care providers for patients with multiple disorders. Tell us more about MACC.

Many patients with kidney disease also have other issues. MACC allows for their care to be more cohesive and patient-centered instead of fragmented care coordination.

  • What can listeners do to improve care coordination?

Make sure each of your doctors are communicating with each other. Most providers have electronic patient records that every doctor can see. Patients should remind each of their physicians to send their medical records to their primary physician. Your Primary physician is in charge of coordinating your care. Provide your Primary physician with a list of your other providers names and phone numbers. Carry a list of up-to-date medications to every doctor.

  • How is Care Coordination utilized with different types of Medicare Plans ?

Original Medicare provides the most freedom in seeking physicians with no referrals. Lack of communication between physicians causes fragmented care, with no care coordination. Medicare Advantage Plans include networks of physicians, with required referrals to see specialists. This allows continuity and greater communication in care coordination. Medicare Advantage Plans are continually trying to improve payment models and care coordination. Here are several steps individuals should follow to improve care coordination:

  • Know your risk factors.
  • Talk to your primary care doctor and have screening tests.
  • Carry a list of medications with you.
  • Keep a list of numbers and names of care providers.
  • Make sure your plan has care coordination tools.

 

Learn more about Kidney Disease, find helpful resources and support on the National Kidney Foundation's website

Visit www.kidney.org for more information.

To learn more about the Medicare Advantage Care Coordination Task Force :

Visit www.medicarechoices.org

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

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Mar 18, 2016

Welcome, Medicare Nation! It’s March, which is a huge month for awareness. Last week’s show highlighted colon cancer awareness, this week we are discussing MS awareness, and next week’s topic is chronic kidney disease. 

What is MS?

  • MS is multiple sclerosis, which is a disabling disease of the central nervous system. It occurs when there is a disruption of the electrical circuit between the brain and the rest of the body. Nerves have a myelin sheath that covers and protects them; when the sheath is damaged and the electrical impulses are disrupted, then multiple sclerosis is the diagnosis.

What are signs and symptoms of MS?

  • Fatigue that interferes with your ability to function
  • Numbness/tingling in face and extremities
  • Muscle weakness
  • Dizziness/vertigo
  • Pain, significant and chronic
  • Vision problems

How is MS diagnosed?

  • It’s a difficult disorder to diagnose, and can be found using blood tests and MRI’s. Doctors can test the electrical impulses in the brain, and they also pay attention to family history. Medicare covers these diagnostic tests to some degree, so CHECK YOUR PLAN! See your doctor if you experience any symptoms. Over 400,000 people in the US have been diagnosed, with more than 200 newly diagnosed cases each week! Most patients are between 20-50 years old. There is no cure for MS; all doctors can do is to try to slow the progression of the disease.

For more information, visit www.nationalmssociety.org or call 1-800-344-4867 to contact the National MS Society.

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

Mar 12, 2016

The Center for Medicare and Medicaid Services has suspended another Insurance Medicare provider's plan.

CMS has suspended and sanctioned Ultimate Health Plan (UHP) Medicare Advantage Plan. Suspended Feb 26 and effective immediately. They are not allowed to market and sign up new enrollments for the UHP. They have determined that the conduct of UHP failed to provide services in compliance with CMS standards. According to the CMS document, "the failures were determined to be widespread and systemic."

If you are on a UHP plan, you still have your benefits at this time. A Special Enrollment Period has not been granted by CMS at this time.You will need to contact Medicare at 800-633-4227 to request permission to select another plan due to the suspension. Document your conversation with the representative - their name, the date and time that you got the approval, etc.

If you used a "captive" insurance agent, they only offer Medicare plans from the company they are contracted with.  I do not recommended that you contact a "captive" agent, because they will not advise you about other options with insurance carriers that may provide you with better options.

If your family member is on Ultimate Health Plan and has a serious, chronic disease then you may want to look into other Medicare plans in the area in which they reside, to see if a better plan option is available. If you or a family member has Chronic Kidney Disease which requires dialysis or a kidney transplant, they may not be able to switch plans at this time.

Medicare will look at each individual's situation on a case-by-case basis.

If you have questions regarding the sanctions against Ultimate Health Plan, send me an email at:

support@themedicarenation.com

To speak with a Medicare broker or Medicare advisor in your area, simple Google “Medicare Advisor” - and your county or location. An example would be - Medicare Adviser Tampa, Florida

 

Politics and Medicare:

This isn’t an endorsement for any candidate. This is just a summary of the candidates platform for Medicare and/or Healthcare

On The Republican Side:

Donald Trump:

Does not want to make cuts to Medicare

Favors health savings account

Does not favor current Obamacare

Favors taking away boundaries on state lines to encourage competition between states

 

Ted Cruz:

Wants to save Medicare by gradually increasing the eligibility age from 65 to a higher age

Wants to move to a “Premium Support System”, whatever that means

 

Marco Rubio:

Wants to raise the eligibility age gradually

Supports a voucher type program in Paul Ryan’s budget proposal

 

John Kasich:

Hasn’t specifically talked about Medicare, only Healthcare

Believes in the “value over volume” system of Medicare reimbursements

Advocates healthcare savings accounts

 

On The Democratic Side:

Hillary Clinton:

Continue Obamacare and build on it

Protect seniors from rising costs

 

Bernie Sanders:

Advocates a single payer plan - administered by the government

Comprehensive coverage for all Americans paid for by the government

This will be paid by a 6.2% healthcare premium paid by employers

2.2% income based premium per household

This would be a government run system

No matter who you support, please make sure you exercise your right to vote!

 

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

 

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

 

 

Mar 4, 2016

Kevin Harrington, creator of the infomercial and the chairman of the As Seen On TV brand, is my guess today. Kevin has launched over 500 products to the tune of $4 billion! He is one of the original sharks on ABC’s Shark Tank. Kevin is an author who has helped me greatly with this podcast and my book, The Medicare Survival Guide.

  • What would you suggest to people in our generation who might be affected if age requirements for Medicare benefits are changed in the near future due to political change in America?

I would advise people to explore second income opportunities. If you’re working, then keep your job, but plant some seeds in case you need to work an extra 2-5 years than you originally planned. I suggest considering internet and mobile marketing opportunities. Anyone can do these jobs from home, connecting with people and selling products. Many entrepreneurs have started these small businesses and have become very successful for part-time or even full-time income.

  • You have a new book coming out. Would you tell us about it?

My book, Key Person of Influence, was written with Daniel Priestley. It’s an amazing program that takes you step-by-step through establishing yourself as a “guru.” For me, the turning point was becoming a KPI in As Seen On TV products. There are five essential skills, which include raising your profile, developing your pitch, and partnering with people. You can follow the system and become a guru in your industry. 

Visit www.keypersonofinfluence.com!

Visit www.kevinharrington.tv for links to my books and KPI information.

 

  • Changing gears just a bit, today is March 4th, which is Colon Cancer Awareness Day. Last week’s show was about this topic. Let’s all wear our blue today to promote colon cancer awareness!
  • Judy, from Tampa, asked a question about the DNA Stool Test, so I want to give some detailed information. This test is relatively new, done at home, and less invasive than some others. It is covered by some Medicare plans, but you need to check on yours specifically. The test assesses your risk but does not replace the colonoscopy. The test is allowed every 3 years for those ages 50-85 who have no symptoms of colorectal disease, no Crohn’s, IBS, colitis, or polyps. Visit www.cca.org for more information.
  • If you have questions about this show or others, please contact me. I love to hear from you and answer whatever questions you have! Thanks for listening!

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

Feb 27, 2016

Do you know how your Medicare benefits would be affected by the changes in government that would come from a new President? It's time to think about it and weigh in on what you think is best for you and for the country. Listen as Diane talks to real people who have an opinion. 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

Feb 19, 2016

Welcome, Medicare Nation! Today’s guest is Lee Silverstein, who is a colon cancer survivor. Lee is here to discuss the risks, prevalence, and treatments for this disease. Colorectal cancer is the most commonly diagnosed but also the most preventable through proper screening. The American Cancer Society estimates that 95,000 people will be newly diagnosed with colon cancer in 2016. Over their lifetimes, 1 in 21 men and 1 in 23 women will be diagnosed! Colon cancer is clearly not “the old man’s disease” that many of us have been led to believe. Let’s hear Lee’s amazing story!

  • Why has colon cancer become so widespread for people under age 40?

“Over the last few years, the rates for diagnosis have remained steady, with a huge increase in the number of cases in people under age 40. It is scary, alarming, and unexplainable by doctors. I recently attended a conference on colon cancer and met a newly diagnosed 23-year-old. The common risk factors are being overweight, a lack of physical activity, a diet rich in red meat, heavy smoking and alcohol use. Keep in mind that you can have NONE of these risk factors and still be diagnosed with the disease, like what happened to me.”

 

  • Would you mind telling our Medicare Nation listeners your personal story?

“Not at all—I would love to share my story. I had NO risk factors and had just turned 50, living a very health-conscious life. I exercised regularly and was eating smart. I had a colonoscopy in March 2011, and the doctor couldn’t get the scope where he needed it to go. I wasn’t alarmed, but received a call from the doctor two days later saying I had a tumor in my transverse colon. This colonoscopy saved my life!”

 

  • Would you share what your treatment was?

“I had colon cancer and needed to have the tumor removed; the surgeon was confident that he could remove it all. My cancer was classified as Stage 2, which meant it was borderline as to whether there were benefits to undergoing chemotherapy. I got three opinions and determined that the benefits of chemo did NOT outweigh the risk. My follow-up exam included a CT scan and bloodwork, which showed a small spot on my liver. A biopsy was ordered and showed that my colon cancer had spread to my liver, even though it was a small spot and slow-growing. Surgery was recommended and chemotherapy. I went to Sloan-Kettering, which was the hospital I had been treated at as a child when I had a rare kidney cancer. The liver surgeon there was confident that I would be fine. Surgery was scheduled for January 2013 and I finished chemo treatments in August. In 2014, two small spots on my lungs were discovered. The doctor suspected that it was colon cancer that had metastasized to my lungs. He wanted to treat it with SBRT, a cyberknife-type targeted radiation procedure. In normal radiation, low doses are given over a wide area over a long period of time, with damage to the surrounding tissue. In this procedure, pinpointed high doses are given over a short time. I had the treatment with no side effects, and was even able to continue training for a race. The one spot disappeared and the other shrunk significantly. I’m not cancer-free, but I am stable. The goal of colon cancer treatment is to make it a chronic manageable disease.”

 

  • Can you tell Medicare Nation listeners about the Colon Cancer Alliance?

“I found this organization when I was first diagnosed. They are the largest patient support non-profit organization for colon cancer, based in Washington, DC. They do research and provide online support.”

 

  • Medicare  provides several levels of preventive care and testing for colon cancer:
    • Barium enema is allowed every 24 or 48 months, depending on the risk.
    • Colonoscopy is allowed every 120 or 48 months, depending on the risk.
    • Fecal blood tests are allowed every 12 months.
    • Flexible sigmoidoscopy is allowed every 48 months for people over 50.
    • Multitargeted DNA test is allowed every 3 years for people aged 50-85. This is a new test with many stipulations.
    • Plans, coverage, and co-payments differ.
    • Some procedures are free, but related surgical procedures (like to remove polyps) are NOT free.
  • Tell our listeners about your podcast.

“I started The Colon Cancer Podcast about a year ago. I interview survivors, caregivers, and medical professionals. We share stories of struggle, hope, and survival in the face of colorectal cancer.”

 

  • Tell us about the “Undie Run.”

“These are 5K events sponsored by the Colon Cancer Alliance. We run around in our underwear! Events are held 2-3 times each month, in different cities around the country from February through October. The events are to raise funds and raise awareness of the disease.”

Resources:

www.ccalliance.org

877-422-2030

Find the Facebook group: Blue Hope Nation

Special Bonus! Stay tuned to the entire show where Diane Daniels answers listener questions after the interview!

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

Feb 12, 2016

Welcome, Medicare Nation! My guest today is Dr. Andrea Singer, who is a professor of  Obstetrics and Gynecology at Georgetown University Medical Center. Dr. Singer is the Director of Women’s Primary Care and the Director of the Bone Densitometry program. She is a trustee and clinical director for the National Osteoporosis Foundation and a national lecturer on the subject. Dr. Singer has published extensively on many women’s issues and is active in the education of medical students and residents at Georgetown University Medical Center. Dr. Singer is here to teach us about osteoporosis and how it affects our lives and health.

  • Can you define osteoporosis for Medicare Nation listeners?

“Yes—I value this opportunity and hope it can be a call to action for your listeners. Osteoporosis is a disease of the bones in which too much bone is lost or the body simply makes too little bone. The bones become weak and can break from minor falls or simple actions, even like bumping into furniture or sneezing!”

  • How prevalent is osteoporosis in the US?

“It’s a very common disease and I’ll give you some statistics: 50% of people age 50 or older (54 million of the 99 million) have either osteoporosis or low bone mass. The number jumps to 65% of people age 65 or older who are at risk for broken bones.”

  • Do these numbers apply to both genders, or just to women?

“They apply to both genders, even though it’s commonly thought of as a woman’s disease. Interestingly, men have a harder time recovering after a broken bone incident. Of the population age 50 or older, 1 in 2 women and 1 in 4 men will break a bone due to osteoporosis in their remaining years.”

  • What are the risk factors for osteoporosis?

“Risk factors can be broken into two categories: non-modifiable and modifiable factors. Non-modifiable risk factors are those that you can’t control, like age, gender, family history, low body weight/frame, and previous bone fractures. Modifiable risk factors include lack of calcium/vitamin D, inactive lifestyle, smoking, and too much alcohol. Regarding previous fractures, those of the spine, hip, wrist, shoulder, and pelvis are classic osteoporosis fractures. Also, certain medications for other disorders can increase bone loss. If you have these risk factors, you should speak to your health care provider and ask about being evaluated for osteoporosis.”

  • How is osteoporosis diagnosed?

“Doctors will look at risk factors and do physical exams and lab tests, but the only real way to find osteoporosis is to do a bone density test. The lower the bone density, the greater the risk will be. The DXA scan is the bone density test, and is covered under the Welcome to Medicare package for women. Men are not covered for this test unless they fall into one of the following categories: on long-term steroid therapy, diagnosed with hyperparathyroidism, already on osteoporosis therapy, or has a vertebral abnormality or deformity found on an x-ray. The National Osteoporosis Foundation recommends that men be screened at age 70, but the bone density test isn’t covered unless one of the four criteria is met.”

  • Why are there not many people being screened for osteoporosis?

“Osteoporosis is under diagnosed, under recognized, and under treated. It’s thought of as ‘my grandmother’s disease,’ and many people don’t recognize the risk factors. In addition, there are fewer health providers doing DXA scans. For many, they lack the realization that broken bones over age 50 is a strong indicator of osteoporosis. We need to raise awareness so that people who are candidates for osteoporosis will get tested. I hope that this discussion empowers people to take charge of their bone health, be proactive and advocate for yourself to your doctor.”

  • How is the medical community treating osteoporosis?

“People need to get adequate calcium and vitamin D, either through diet or supplements. Weight-bearing, muscle-strengthening exercise can help stimulate the bones to remodel themselves and reduces the risk for falls. Fall prevention is a big part of treatment, and there are medications that can slow the bone breakdown or build new bone.”

  • What are the options for osteoporosis medications?

“Prescription pills can be taken daily, weekly, or monthly. These are covered under Medicare Part D. Injections can be given daily, once yearly, or 4x/year; these are covered under Medicare Part B or Part A, depending on where they are administered. The important point is that there is a medication to fit everyone who is at risk.”

  • Where can Medicare Nation listeners go for more information and resources?

Visit the website of the National Osteoporosis Foundation: www.nof.org. You can also find the Foundation on Twitter: @osteoporosisnof or on Facebook. There is also a new app available on iTunes or Google Play: Food4Bones. Check out these valuable resources for more information!

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

Jan 29, 2016

Welcome, Medicare Nation! My guest today is Dr. Ralph Sacco, who is the Executive Director of the Evelyn F. McKnight Brain Institute at the University of Miami. He is also the Chief of Neurology Services at Jackson Memorial Hospital. Dr. Sacco has published extensively in the areas of stroke prevention, treatment, risk factors, human genetics, and stroke recurrence.  He is the recipient of numerous awards and has lectured at national and international meetings and conferences. He was the first neurologist to serve as president of the American Heart Association and serves as the president-elect of the American Academy of Neurology. Dr. Sacco is here to give us valuable information about strokes and stroke prevention. Join us!

  • Tell us what you do at the University of Miami.

“I’ve been the Chairman of Neurology since 2007. Our department has grown and is ranked 15th in NIH funding. We are leading the way in treating various neurological diseases.”

 

  • Tell our listeners what a stroke is and what the signs and symptoms are.

“Stroke is a huge public health issue, especially as our population ages. About 795,000 strokes occur each year, which is one every 40 seconds! A stroke is like a heart attack in the brain. In a stroke, the brain is injured by bleeding or some other problem with blood vessels. The warning signs are often missed, but our current awareness campaign uses the acronym FAST to help people remember:

F-Face-Drooping on one side 

A-Arm-Weakness in one arm 

S-Speech-Slurred speech 

T-Time-Call 911 immediately!

Other common symptoms are numbness and tingling on one side, severe sudden headache, and difficulty walking.”

 

  • Are there similarities in treating stroke and treating heart attacks?

“Heart attacks usually allow a little more time for treatment than the brain does. With a stroke, you MUST get to a stroke center immediately. TIME IS BRAIN! A clotbuster drug can be used with success in blood vessel blockages up to 4.5 hours after the stroke begins.”

 

  • I’ve heard that people should chew on an aspirin if they feel they are having a heart attack. Is that the same advice for a stroke?

“No, some strokes—about 15%--are bleeding strokes. Aspirin can make it worse. We advise calling 911 and getting to a treatment center. We can use drugs and catheters to remove clots up to six hours after stroke onset. This improves outcomes tremendously.”

 

  • What happens if signs and symptoms aren’t recognized and several hours go by? Is there irreversible brain damage?

“Exactly—the longer we wait in opening that artery, the less chance we have of total recovery. Some recovery can happen between 6-18 hours, but it’s more difficult. Too many people ignore symptoms, and then it’s too late.”

 

  • One side effect of stroke can be paralysis on one side. What exactly causes that?

“Most symptoms occur on one side of the body since one side of the brain controls the opposite side of the body. Everyone should know FAST and know how to activate the 911 call.”

 

  • Are there any foods we can eat to promote good blood vessel health? Is there a type of diet that helps?

“Diet is a big factor of ideal cardiovascular health. The AHA estimates that less than 1% of people have ideal cardiovascular health. There are five key components:

Fruits and Vegetables: 4.5 cups each day

Fish: 2 servings each week

Fiber-rich Whole Grain: 3 servings each day

Lower your sodium intake: Sodium increases blood pressure, and high blood pressure is THE single leading modifiable risk factor for stroke. Most people get 3500 mg/day when the recommended limit is only 1500 mg/day!

Limit sugar-sweetened beverages: This increases the risk for diabetes.”

 

  • What tips can you give about stroke prevention?

“Remember, what’s good for heart health is good for brain health, too. The AHA lists seven key factors, called ‘Life’s Simple Seven’:

  1. Never smoking
  2. Body Mass Index
  3. Physical activity
  4. Diet
  5. Total cholesterol less than 200
  6. Blood pressure not higher than 120/80
  7. Fasting blood glucose less than 100”
  • Doctor, for our seniors—or for anyone—is walking a daily exercise that you recommend?

“Walking is a great exercise. Just 75-100 minutes of walking over a week’s time can really help in the battle for ideal health.”

 

Resources:

  • Remember, part of Medicare benefits and preventive care includes nutrition counseling. You can talk to your primary care doctor for more information on how this service can help you. Visit www.medicare.gov for more information.

www.strokeassociation.org

www.heart.org

The FAST app for your smartphone is now available!

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

 

Dec 25, 2015

Welcome! My guest today is Peter Fitzgerald, who is the Executive Vice President for Policy and Strategy for the National PACE Association (Program of All-Inclusive Care for the Elderly.) The PACE program helps guide the association policy and advocacy efforts at the federal and state levels. The program is always looking to improve services for those needing long-term care.

  • What is the PACE program and its history? PACE provides all the programs that the elderly need, from health care services to long-term care, all designed to keep seniors living in a community-based setting at home. It began as a pilot program in Chinatown in San Francisco, because the Chinese culture is based strongly on keeping elders at home with their families and out of nursing homes. Alternatives were explored to keep them living in the community with some assistance. The program began with a Daycenter that provided meals and healthcare and remedied the social isolation that some seniors feel. Over time, more services were added to the model. Now, people enroll in the program, which is sponsored by local healthcare provider organizations. PACE meets all the healthcare needs of the seniors except housing, but provides transportation, day centers, therapy, rehabilitation, meals, doctor visits, and home care services. The overall goal of the program is to keep seniors living in the community rather than in nursing homes.
  • Is it true that the PACE program is its own network of doctors and facilities combined into one? Yes, it’s designed to be a complete system. PACE programs employ their own doctors, nurses, practitioners, home health aides, home health nurses, and transportation services. The program secures contracts with hospitals for Medicare services and other needs. 
  • Which Medicare coverage will pay for the PACE program? Upon enrollment, the PACE program becomes the source of all Medicare benefits and replaces traditional Medicare or Medicare Advantage Plans. Medicare actually pays the PACE program monthly for patient care, so in reality, it’s like another Medicare Advantage Plan.
  • Who is eligible for PACE? Enrollees must be 55 or older and live within a PACE service area, which is usually about a 45 minute driving radius. The program becomes all-encompassing health care, so patients must have access to a PACE center within a reasonable distance. The program is designed for those with complex and chronic needs. However, if someone has to enter a nursing home during their care, then the program does continue for them, even though they were not able to remain at home.
  • Almost one-half of PACE enrollees have some sort of dementia diagnosis, so do you think those numbers will continue to increase? The dementia and Alzheimer’s diagnoses are a potential area of growth for PACE. The president recently signed into law the creation of some new PACE programs that allow enrollment for some people under age 55. Early intervention may help people improve and maintain their quality of life.
  • What would the average cost be for a private pay patient under the PACE program? It would vary greatly from state to state, but the average would probably be around $3000/month with no co-pay or deductible. The rate is determined by the state, but remember that long-term care is included in the program, AND you get to stay in your home with your loved ones.
  • Is PACE considered “for profit” or “not for profit”? The program originally began as “not for profit,” but has since allowed “for profit” sponsorships. There is currently only one “for profit” PACE program operating in PA, but these will become more widely available in the future.
  • How many PACE programs are there? In 32 states, there are 116 PACE organizations currently serving 220 communities. You can find out more about the program and its availability in your local area by visiting www.pace4u.org or www.npaonline.org. You can also call 703-535-1565, find them on Facebook, or on Twitter @TweetNPA.
  • Can individuals volunteer or donate within the PACE program? YES! There are many ways to volunteer and donations are always accepted. Check with your local organization for further information.

 

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

 

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

 www.CallSamm.com

 
Dec 19, 2015

Welcome! I’m honored to introduce you to my guest today, Dr. Regina Benjamin, who is the former U.S. Surgeon General under President Obama. 

  • There has been some confusion about the position of US Surgeon General, so can you describe the position and tell us what it entails? “Most people associate the US Surgeon General with the warnings on tobacco products about the dangers. That’s not all we do, though. We are responsible to communicate the best health science that we have. The Surgeon General is also the leader of US Public Health Services. We are considered part of the military. I like to say we carry needles, and not guns.”
  • Are you appointed or elected to the position? “The US Surgeon General is nominated by the president, and then confirmed by the Senate. The Senate also assigns the position for a 1-4 year term. I was fortunate to be confirmed unanimously without a hearing.”
  • Can you explain the focus of your mission today? “Part of the division of Science and Communication is to get the word out about health information and raise awareness. I’m partnering with Pfizer to get the word out about pneumococcal pneumonia, especially to older Americans, who are at a greater risk.”
  • Most people probably don’t understand that vaccinations are free under Medicare. Can you explain? “Vaccinations are included in preventive services, and so they are free and without a co-payment, even for those with private insurance. These vaccines are available at doctors’ offices, clinics, health centers, and drugstores. The goal is to make them easy and accessible.”
  • Is there a season in which pneumococcal pneumonia is more prevalent than others? “Not really—this disease is not weather-related. It is more related to the immune system of the patient. For some reason, African-Americans seem to be at a higher risk.”
  • Can an older person get more than one vaccination at a time, like a flu shot AND the pneumococcal pneumonia shot? “It varies according to the person, so it’s important to talk to your doctor. In general, the vaccinations probably can be given together if there aren’t other special conditions.”
  • What are the signs and symptoms of pneumococcal pneumonia? “Anybody can get this disease, even a very healthy person. Those over age 65 are at a greater risk. The symptoms include a sudden onset of high fever, shortness of breath, coughing, and chest pain. The average hospital stay is about five days and it can even cause death. Prevention is the key!”
  • For pneumococcal pneumonia, is there a live strain of the bacteria in the vaccination, or is it a synthetic form? “Most vaccinations today have an ‘attenuated’ form, which means they are live but not active. The goal is for your immune system to ‘think’ you have had the disease when you haven’t, so the antibodies are produced. There are different types and different brands of the vaccine. Your doctor can help decide which form of the vaccine is best for you.”
  • What are the best ways to keep from getting this disease? “Handwashing is the best preventive. You should also exercise, eat well, and live a healthy lifestyle. Pneumococcal pneumonia is spread by coughing and sneezing, or by touching surfaces where someone has coughed or sneezed. We can’t avoid people completely, so that is why the vaccine is so important.”
  • Dr. Benjamin, what was the most wonderful thing about your job as US Surgeon General? “My favorite thing was getting to meet people in their communities and talk about the prevention of disease and the promotion of good health.” 

Resources:

www.knowpneumonia.com

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

 

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

 www.CallSamm.com

 
Oct 22, 2015

Welcome Medicare Nation!  Today’s guest from the American Lung Association is Dr. Norman Edelman.  Dr. Edelman has an years of experience that includes:

 

Norman H. Edelman, M.D. is Professor of Preventive Medicine, Internal Medicine, and Physiology and Biophysics at the State University of New York at Stony Brook. From 1996 - 2006, he served in a dual capacity as Vice President for Health Sciences and Dean of the School of Medicine at Stony Brook.  A graduate of Brooklyn College, Dr. Edelman received his M.D. degree from New York University, where he was elected to the Alpha Omega Alpha honor medical society. He received postgraduate training at Bellevue Hospital in New York City and went on to be a Research Associate at the National Institutes of Health, National Heart Institute, and then Visiting Fellow in Medicine and Advanced Research Fellow of the American Heart Association, Cardiorespiratory Laboratory, Columbia University, College of Physicians and Surgeons, Presbyterian Hospital.

What is the American Lung Association?

It was founded originally to combat tuberculosis, and was quite successful in helping get it under control.  Now it concerns it’s with all lung diseases, an advocate for clean air, and smoking cessation.

What are the benefits of quitting smoking?

Smoking is the leading preventable cause of death in the US, ahead of even obesity.  Stopping smoking can improve your healthy at any age.  Stopping the progression of the disease is important in order to prolong life.

Does Medicare cover Lung Cancer Screening?

Medicare recipients meeting certain criteria, Medicare will pay for a Lung Cancer Screening at no cost to you.  To be eligible, you must meet the following criteria:

 

  • If you smoked at least 30 pack years (a pack a day for 30 years)
  • If you stopped less than 15 yrs ago
  • 55-77 years old

This screening can reduce death from lung cancer by 20%, by detecting nodules in the lungs.

 

COPD and Emphysema - what’s the difference?

They are both cause primarily by smoking and air pollution.  COPD is what used to be called chronic bronchitis.  They now are combined under one diagnosis for ease.

How does one get oxygen for home use?

A physician would determine that you don’t have enough oxygen in your blood when at rest, and then prescribe supplemental oxygen.  Physician would fill out a form that certifies this meets the Medicare criteria, and once this is done, oxygen would be provided at no charge.

What is Pulmonary Rehab and who needs it?

Teaching people how to breathe properly.  Allows people to exercise and condition your heart and muscles so that they require less oxygen to function.  This eases shortness of breath.  If you have chronic lung disease, you should ask your Doctor if you would benefit from pulmonary rehab.

What types of breathing exercises can improve lung function?

The incentive spirometer can be a great exercise to increase oxygen capacity.  Any form of cardio exercises will allow the lungs to improve.

Is there a correlation between early onset asthma and later stage COPD?

Asthma sufferers frequently progress into COPD.  Asthma is a broad term and really can mean a lot of different things to a lot of different people.  They can be different in biology and in our ability to treat them.

How important is an inhaler with these diseases?

 

They can be life saving.  They are very effective for treating asthma and flare ups.  The American Lung Association is concerned about the affordability of inhalers.

 

Who are the lung disease specialists?

 

Start with your primary care physician.  They can then refer you to a Pulmonologist, who specializes in treating lung diseases.

What diseases does the American Lung Association help with?

Pulmonary fibrosis

Lung cancer

Infectious lung diseases

Allergic lung diseases

They also have a helpline and the number is on the website.  

The website is a treasure trove of information - www.lung.org

 

Freedom from Smoking - Smoking Cessation program.  Best treatment  combines an accountability program, along with a pharmaceutical.

 

Got questions about Medicare Services for Lung Disease?  Send them to support@medicarenation.com.  We will address them in future episodes.

 

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

 

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

 www.CallSamm.com

 

Sep 9, 2015

Welcome Medicare Nation!  I have to tell you that today’s show is packed with tons of great information.  The topic of today's show is making end of life decisions and having an advanced care plan for yourself.

 

Today’s guest is Dr. Stanley Terman (founder of Caring Advocates for Advanced Care Planning),a board certified Psychiatrist in Carlsbad, CA, and a published author on today’s topic.  Dr. Terman has spent the last 15 years focused on reducing the pain of terminally ill patients.

 

People’s greatest fear is losing control and it means that other people have to make decisions for you.  It becomes difficult for people to be in a situation where they have to make decisions about your life, based on your wishes, not on your finances.  This instills much fear within all of us as we are aging.

 

Advanced care planning has been painted as “death panels”in the media and has fostered the idea that decisions about your care will be made with bias.  If you learn what your choices are now, you can plan and then not have to worry about it later in life.  There is a freedom that comes when you have made these decisions for yourself, and it allows you to continue enjoying your life.  

 

The majority of people in certain groups do not prepare enough for advance care directives:

  1. Religious people 
  2. African Americans

 

Living Wills tend to be more controversial, we understand that some are reluctant to adopt them.  Doctor Terman created a Natural Dying Living Will, which is an extremely flexible document.

 

You are required to fill out a form of this nature in order to document your wishes.  You don’t need to consult an attorney and you don’t need to spend any money.  You can fill out a living will for free.  The Natural Dying Living Will isn’t free, but it gives you  many options and it is flexible.  The document needs to be strong enough to compel Physicians to follow your specific wishes.  The Natural Dying Living Will accomplishes  this with several layers of protections built in, and it has proven effective to get the attention of the physician.  Once you have filled out all of the paper work,  Dr. Terman recommends making a video where you summarize your wishes in a video directive.

 

**You need a Durable Power of Attorney in order to give someone the authority to make the Physicians follow your Living Will.

 

This will ensure you have the 4 P’s

 

1.  Peaceful

2.  Prompt

3.  Private

4.  Passing

 

Caring Advocates provides a laminated business card with a scannable bar code.  When scanned, it immediately pops up the video of your final wishes, and the necessary documents for your living will.  There’s concern about finding documents or getting documents out of safe keeping, in order to submit them to the Doctor

 

When attending a counseling appointment with a Doctor, bring your end of life documents with you to the session. Then your session becomes getting your Doctor’s opinion on the decisions you have made.  Some services like Palliative Sedation are choices you may make, but a Doctor might not support it.  Better to find this out ahead of time.  Having a discussion about this type of treatment and even Respite Sedation are beneficial.  You need to give your Doctor the tools to help sustain life, and these tools can accomplish that.

 

Once you have this paperwork taken care of, including the Durable Power of Attorney, there are clauses that would allow for the changing of Physicians and even for changing the treatment plan.  So this way of handling your paperwork is comprehensive and it can last through the ages, and the changes that can occur.  

 

Plan now, to die later, to live longer.

 

 

You don’t want to miss Doctor Terman’s offer to assess your existing Living Will for the 3 main scenarios that will likely cause your death.  It’s an unbeatable offer!  Listen to the show for all the details!

 

 

Resources Mentioned in the show:

 

www.caringadvocates.org

 

The Natural Dying Living Will

 

Doctor Terman’s Books:

 

  1. A Lethal Choice - The Best Way To Say Goodbye
  2. Peaceful Transitions - An Ironclad Strategy to Die When and How You Want
  3. Peaceful Transitions - Plan Now, Die Later
  4. My Way Cards - Natural Dying Living Will Cards

 

 

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

 

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

 

www.CallSamm.com 

 

 

 

Sep 3, 2015

In this week’s episode of Medicare Nation, Diane Daniels interviews Max Richtman, the president of the National Committee to Preserve Social Security and Medicare (NCPSSM). In this episode, Diane and Max discuss Medicare’s 50th anniversary, the role of the NCPSSM, the Supreme Court’s challenge to the Affordable Care Act and HR 3308 - Seniors Have Eyes, Ears, and Teeth Bill.  

Main Questions Asked:

  • Tell us what the National Committee to Preserve Social Security and Medicare does?
  • How do you view the importance of the Supreme Court’s challenge to the Affordable Care Act and Medicare’s 50th anniversary?
  • What is your take on Medicare’s financial condition?
  • How can we balance the two schools of political thought when it comes to Medicare?

Key Lessons Learned:

  • 55 million people depend on Medicare for their healthcare.
  • Billions of dollars are lost each year to fraud, healthcare’s rising costs, and increasing numbers of Americans retiring from the workforce.

NCPSSM

  • Former Congressman James Roosevelt, who was the eldest son of FDR, founded The National Committee.
  • The NCPSSM is dedicated to protecting the Social Security and Medicare programs and is the second largest senior citizen lobbying association in the USA, with about 3.5 million members and supporters.
  • The recent focus has been to improve, enhance, and expand the Social Security and Medicare programs.

Supreme Court’s Challenge to the Affordable Care Act

  • $716 billion was saved out of the Medicare program and the Affordable Care Act.
  • These savings came from reducing payments to providers such as Medicare advantage programs and reimbursements to hospitals.
  • Under the Affordable Care Act, Medicare beneficiaries enjoy preventative care with no out-of-pocket costs. This includes cancer screenings, colonoscopies, mammograms, and diabetes testing.
  • The Medicare program is now solvent until the year 2030.

Medicare’s Financial Condition

  • In light of the Obamacare program, the solvency of the Medicare program was expanded for an additional 13 years.
  • As the Affordable Care Act takes hold and reduces health care costs, it will have an impact on Medicare as well.
  • Max is looking forward to additional years being added to the program by virtue of the restraint on costs that will be received due to the Affordable Care Act.
  • Besides reducing reimbursement rates to providers, it has changed the focus on healthcare payments to be tied to value and not volume.
  • Doctors and their staff have to be current and understand what is needed to reduce cost as so much money is depleted through fraud, waste, and abuse.

Diane’s Advice

  • Look at your Medicare statement every month to ensure it is correct with regards to providers and procedures.
  • If you notice a discrepancy, then call your Medicare Plan immediately and report it.
  • Remember, the patient can play the largest role in finding discrepancies and overcharges. This has a significant impact in reducing waste and fraud.

Politics and Medicare

  • There is a significant divide among politicians in how Medicare should function in the future.
  • We hear from the campaign trail that it is fiscally responsible to reform Medicare, but we also hear expansion of Medicare is the best option.
  • We need to ask ‘what does reform mean?’ To some, ‘reform’ is another’s idea of ending the Medicare program.
  • The reason we have a Medicare program in the first place is because insurers didn’t want to insure seniors as it was deemed too expensive.
  • The value of a voucher will not keep up with the increased cost and inflation in healthcare. It will become less valuable over time and less able to provide coverage.
  • Using vouchers is a way to rescind Medicare law and go back to a time when people were on their own and a lot more seniors were living in poverty.

HR 3308 Seniors Have Eyes, Ears, and Teeth Act

  • Congressman Alan Grayson from Florida recently introduced the Eyes, Ears, and Teeth bill.
  • The NCPSSM wrote a letter endorsing the bill that will, for the first time, add coverage under Medicare for vision, hearing, and dental.

Medicare and Hearing

  • One third of people in the 65–74 age group experience hearing loss.
  • Half of people over the age of 75 have hearing loss issues.
  • Congresswoman Debbie Dingle introduced The Medicare Hearing Aid Coverage Act of 2015 that will take a portion of that coverage and add Medicare coverage for hearing testing and hearing aids
  • There is a lot of opposition from the medical industry as providers don’t want to deal with the Medicare regulations even though there would be a massive increase in volume.
  • Dr. Franklin Lin from Johns Hopkins has developed groundbreaking research that makes a link between hearing loss and dementia and Alzheimer’s.
  • Having Medicare cover hearing loss and come up with the financial resources to provide that coverage would pale in comparison to the cost of treating Alzheimer’s patients.

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

www.CallSamm.com

Episode Resources

NCPSSM

1–800–966–1935

Congressman Allan Grayson presents to the House of Representatives

HR 3308 – Seniors Have Eyes, Ears and Teeth Bill

Congresswoman Debbie Dingell presents to the House of Representatives

HR 1653 - The Medicare Hearing Aid Coverage Act of 2015

Medicare

Federal Trade Commission

Click To Tweet - Spread the news!

Are you aware of The Eyes, Ears and Teeth Bill? Find out what it means for you. @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

What is Medicare’s current financial condition? Find out w/ @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

Aug 27, 2015

Summary:

In this week’s episode of Medicare Nation, Diane Daniels interviews Curtis Bailey, who is a practicing Elder Law attorney in the St. Louis, Missouri area. Curtis is also the co-director of the Senior Scam Action Associates and co-host of the ScammerCast Podcast.During this episode, Diane talks with Curtis about one of her biggest pet peeves: people taking advantage of seniors. If you know someone who has fallen victim to a phone scam, Facebook scam, or had his or her identity stolen, then this episode is a must-listen!

Main Questions Asked:

  • How did you get so involved in helping the elderly with scams?
  • Tell us about Senior Scam Action Associates.
  • What are the most common types of scams?
  • What happens if someone realizes they have been scammed and their personal information has been stolen?
  • What are the credit bureau companies a person can contact?
  • What are signs of a scam?
  • How do we know what is a legitimate email?
  • Tell us about your podcast, ScammerCast.

Key Lessons Learned:

  • Scams come in all forms:
  1. Phone scams
  2. E-mail scams
  3. Facebook friend requests
  4. Physical, “in person” scams
  • Senior Scam Action Associates helps seniors, caregivers, and professionals who work with seniors learn how to recognize and prevent scams and fraud.

Common Types of Medicare Scams

  • Unsolicited telephone call from someone claiming to be a Medicare sales representative.
  • A physical scam whereby an alleged ‘official’ agent knocks on the senior’s door.
  • A true Medicare representative will never show up at your door. They will never ask you for money or personal information.
  • Check Medicare statements each month and look at itemized details for each doctor visit and different types of tests and procedures. If you find a discrepancy, contact your insurance carrier or contact Medicare directly as it could be fraud or abuse.

If A Senior Has Been Scammed

  • Report any scams to the authorities such as local law enforcement and the Federal Trade Commission (FTC).
  • If personal identifying information has been given out, check your credit report immediately.
  • Contact any corresponding banks and financial institutions to report your identity theft.

Credit Bureau Companies

  • The three main credit-checking bureaus are Experian, TransUnion, and Equifax.
  • If a consumer contacts one bureau, the other two must be notified about any possible breeches.
  • Even if you haven’t fallen victim to a scam, it’s a good idea to get a free annual credit report.
  • Curtis recommends requesting a free credit report every 4-months. Ex: Request one free credit report from Equifax in January, then Experian in May and finally Trans Union in September.
  • Credit reports are free, but each company is allowed to charge for additional requests such as a credit score.

Giveaways of a Scam

  1. The contact will always be unsolicited.
  2. There will always be urgency involved, and they prey on fear, greed, and anger.
  3. They will ask for personal identifying information.

Tips to Avoid Scams

  • If you are unsure whether an email is a scam, then make it a rule to not click on a link.
  • If you are getting requests that look official but are unsure, follow up through official avenues such as visiting or calling the bank direct.
  • Be aware of friend requests on Facebook from people you haven’t had contact with for a long time.

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

For more information about Medicare, go to Diane Daniels website    www.callsamm.com

Links to Resources Mentioned

Senior Scam Action Associates

ScammerCast Podcast

Huffman Law Offices

Scammed: 3 Steps to Help Your Elder Parents and Yourself

Annual Credit Report

Medicare Website www.Medicare.gov

Federal Trade Commission www.ftc.gov

Equifax  www.equifax.com

Experian  www.experian.com

Trans Union www.transunion.com

 

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