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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: Page 2
Apr 28, 2017

Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare. 

A question that is quite common is:

"What vaccinations are covered under Medicare?"

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

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

1. Flu Shot

2. Hepatitis Shot

3. Pneumococcal Vaccine

 

Flu Shot

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

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

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

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

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

www.Flu.gov

 

Hepatitis B

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

What indicates a Medium or High Risk?

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

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

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

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

Learn More About Hepatitis B

 

Pneumococcal Shot

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

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

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

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

Learn More About Pneumococcal Vaccinations

 

Additional Vaccinations and Shots Available

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

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

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

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

 

Shingles

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

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

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

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

Learn More about Shingles

I also did an ENTIRE EPISODE ON SHINGLES!

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

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

Listen to that episode! It is EXTREMELY educational.

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

Have a peaceful and prosperous week!

Diane

 

 

 

Apr 7, 2017

Hey Medicare Nation!

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

Sound familiar?

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

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

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

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

(1) the number of enrollees affected;

(2) the size of the service area affected;

(3) the timing of the termination;

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

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

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

 

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

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

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

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

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

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

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

 

TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD

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

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

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

 

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

If You Move

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

Losing Coverage:

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

 

When there are plan changes with Medicare Contracts:

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

 

Special Circumstances

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

Precautions:

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

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

 

Need more information on "Special Enrollment Periods?"

See the entire list at www.Medicare.gov

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Mar 17, 2017

Hey Medicare Nation!

March is colon cancer awareness month!

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

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

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

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

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

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

www.medicare.gov

 

How often is it covered?

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

 

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

 

Who's eligible?

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

People of any age are eligible for a colonoscopy.

 

Your costs in Original Medicare

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

 

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

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

 

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

 

Mar 10, 2017

Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 3, 2017

Hey Medicare Nation!

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

Who should carry their Medicare ID Card?

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

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

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

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

 

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

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

 

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

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

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

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

Follow these steps:

You can ask for a Medicare Replacement Card :

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

                     1. Call 800 - 633 - 4227

                    C. Social Security Office 

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

 

Thanks so much for listening to Medicare Nation!

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

Buy them a Smartphone!

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

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

Download the Stitcher App.

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

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

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

Medicare Nation comes right up!

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

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

Feb 24, 2017

Hey Medicare Nation!

I hope everyone is having an awesome week!

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

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

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

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

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

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

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

123-45-6789A

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

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

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

1. www.ssa.gov

2. Title XVIII of the Social Security Act

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

my website -

www.callsamm.com

 

Thanks for listening to Medicare Nation!

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

 

Feb 17, 2017

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

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

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

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

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

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

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

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

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

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

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

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

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

 

Share Medicare Nation with someone!

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

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

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

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

 

Feb 10, 2017

Hey There Medicare Nation!

Today, I'm speaking with a special guest.

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

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

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

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

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

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

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

The Veteran's in Business Show was born!

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

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

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

TheMilitaryPodcastNetwork@gmail.com

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

Find the podcast here:

veterans-in-business-show

Contact James Van Prooyen:

@JamesVanProoyen

on Snap Chat - JamesVanProoyen

LinkedIn - James Van Prooyen

James - Thank You for your Service!

 

Tell a family or friend about Medicare Nation! 

Help someone get on Medicare Nation with a Smart Phone! 

The resources for people 64 and older is so valuable!

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

Help me to help you!

Thanks for listenening!

 

 

 

Feb 3, 2017

Hey Medicare Nation!

This week I’m discussing Medical Marijuana!

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

www.weedmaps.com

http://medicalmarijuana.procon.org/

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

Here are links for Dr. Patel.

Website – www.Dr.RachnaPatel.com

Facebook page: www.facebook.com/DoctorRachnaPatel

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

How to Choose a Medical Marijuana Doctor that You Can Trust

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

 

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

 

 

Jan 20, 2017

Hey Medicare Nation!

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

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

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

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

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

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

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

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

 

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

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

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

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

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

 

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

 

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

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

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

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

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

Blue Cross & Blue Shield of Rhode Island - RI

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

Catholic Health Partners - IA,KY, MI, OH

CIGNA  - IL, IA

Community Health Plan of Washington - WA

Emblem Health Inc. - CT, NY, RI

Fallon Community Health - MA

Gateway Health Plan, LP - OH, PA, WV

Health Partners Plans, Inc. - PA

Highmark Health - PA

Humana Inc. - WI

Indiana University Health - IA

Magellan Health Inc. - NY

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

Molina Healthcare, Inc. - UT

Piedmont Community Health Plan - VA

Premera - WA

Samaritan Health Services - OR

SCAN Health Plan - CA

UnitedHealth Group, Inc. - CO

Wellcare Health Plans - IL

 

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

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

1. Call Medicare - 800-633-4227

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

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

4. VERY IMPORTANT  TO STATE.....

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

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

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

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

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

 

What do you do now????

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

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

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

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

Do your Due Dilligence Nation!

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

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

Share Medicare Nation with someone!

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

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

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

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

 

Jan 13, 2017

Hey Medicare Nation!

Medicare has announced the 2017 "5 Star Plans."

What are 5 Star Plans?

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

There are 2 main types of Star Ratings:

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

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

A few areas Medicare reviews for these Star Ratings include:

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

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

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

A plan can receive a 1 to 5 Star Rating.

5 Stars is Excellent

4 Stars is above average

3 Stars is average

2. Stars is below average

and 1 Star is poor.

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

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

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

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

That 5 Star Plan may not fit your unique needs!

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

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

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

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

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

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

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

In this example, you may have another option!

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

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

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

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

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

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

     Company Name                           Service Area

1. KS Plan Administrators, LLC -     4 Counties TX

2. Kaiser Found. HP, INC                 31 Counties CA

3. Kaiser Found. HP of CO               17 Counties CO

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

5. Tufts Assoc. HMO                       10 Counties MA

6. BCBS of MA HMO Blue                11 Counties MA

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

8. Aultcare Health Ins. Corp          12 Counties OH

9. Physicians Health Choice TX     19 Counties TX

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

11. Optimum Healthcare Inc.        25 Counties FL

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

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

 

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

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

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

Do your Due Diligence! 

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

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

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

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

Questions??

Send them to Support@TheMedicareNation.com

Thanks for listening to Medicare Nation.

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

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

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

Have a happy, peaceful & prosperous week!                         

Jan 6, 2017

Hello Medicare Nation! Happy New Year to everyone.

I hope everyone had a wonderful holiday season.

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

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

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

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

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

1. Call Medicare 800-633-4227

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

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

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

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

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

Support@TheMedicareNation.com

OR

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

 

SPECIAL NEED PLANS

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

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

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

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

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

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

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

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

https://goo.gl/uAhvLe

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

I appreciate you listening to Medicare Nation!

Have a happy, healthy & prosperous week!

 

 

Nov 29, 2016

 

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

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

 

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

 

Diane Daniels

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

Nov 11, 2016

The Center for Medicare & Medicaid Services, has recently announced the costs for Medicare in 2017. 

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

 

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

 

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

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

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

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

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

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

 Need help with understanding Medicare?

Call SAMM is available throughout the Annual Enrollment Period to help educate you about Medicare plans.

Call 855-855-7266 for more information.

You can also send an email to Support@TheMedicareNation.com

 

Sep 16, 2016

Welcome, Medicare Nation!

I’m excited about our guest and our important topic today. We’re discussing the confusion surrounding advanced directives. Have you ever thought about what would happen if you can’t speak for yourself and are in an emergency health situation? Who will express your wishes, and will the health care professionals understand? Dr. Ferdinando (Fred) Mirarchi is the ER Director of University of Pittsburgh Medical Center-Hamot. He has a solution! 

  • Tell us about health care directives and the issues that commonly arise when people come to the ER.
    • There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise the safety concerns.
  • What happens when someone comes to the ER with no accompanying family and no papers?
    • It’s not just an ER situation, but anywhere in the hospital, for any medical procedure. “You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means.” About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you’re an end of life care patient and don’t want care. Many don’t understand the difference between being critically ill and being in an “end of life” situation.
  • If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
    • Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn’t compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
  • Can you explain the difference in a Living Will and a DNR?
    • A Living Will is a legal document, not a medical document. It is for use in situations when someone can’t speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it’s a DNR, then it can affect care and treatment of any medical emergency. “It’s a coin toss with a 50% chance of being treated or not being treated.”
  • You’ve developed a solution to help people explain their wishes about receiving treatment. Can you explain?
    • At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
  • Will this ID card work in any medical office, hospital, or ER?
    • Yes, and it’s in clear and understandable medical language so that any professional will know what to do.
  • Can you explain how to find out more and what the service includes?
    • Visit our website: www.institutehcd.com or email us: info@institutehcd.com. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you’re at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry.
    • Here is the news story video of the 57y.o. man who was mistakenly noted as "DNR" in his hospital file
  •           whistle blower 9 Investigative news

 

 

 

 

 

 

Sep 9, 2016

Hello Medicare Nation listeners!

Today, I’ve put together a few questions from our audience that I’d like to read on the air. Many of you ask the same questions, so I’d like to help out as many of you as I can.

 

Wendy from King of Prussia, Pennsylvania asks???

HOW DO I GET A REPLACEMENT MEDICARE CARD?

If you are on Original Medicare, your Medicare ID card is proof of your Medicare insurance. , If your Medicare card was lost, stolen, destroyed or illegible, you can ask for a replacement card by going online and logging in to your Social Security account at www.ssa.gov

If you don’t have an online social security account, you can register one on the www.ssa.gov website.

Once you’ve logged into your account, select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.”  Your replacement Medicare card will arrive in the mail in about 30 days, at the address on file with Social Security.

If you moved and you did not update Social Security with your new address, you must update your new address into the database, or Social Security will be sending your replacement Medicare card to your old address!

If you don’t have the internet, a computer or you just want to call Social Security, here’s the number to call:

800-772-1213

You can also go to your nearest Social Security office to get a Medicare card replacement. To find the nearest social security office, get on the home page of www.ssa.gov  “click” on the social security office location tab and type in your zip code for the nearest social security office.

 

Kenny from Rio Rancho, New Mexico asks??????

WHAT INTERNET BROWSER CAN I USE TO VIEW THE MEDICARE.GOV WEBSITE?

The official Medicare.gov website states –

For optimal results, use Internet Explorer 8.0 or 9.0. You can also view in Firefox, Chrome and Opera.

 

June from San Diego – California asks????

WHAT DOES MEDICALLY NECESSARY MEAN?

Medicare will only pay for services that are considered to be medically necessary. According to Medicare.gov,  services or supplies are considered medically necessary if they:

  • Are needed for the diagnosis, or treatment of your medical condition.
  • Are provided for the diagnosis, direct care, and treatment of your medical condition.
  • Meet the standards of good medical practice in the medical community of your local area.
  • Are not mainly for the convenience of you or your doctor.                       AN EXAMPLE of NOT “Medically Necessary,” is cosmetic surgery. Maybe you don’t like your nose because it’s too big for your face. Medicare will not pay for cosmetic surgery to make you look pretty. It must be “Medically Necessary.”  A better example would be if your face was disfigured due to a car accident, a fire or a severe dog bite. You will need treatment to stop the bleeding and to prevent infection, so Medicare will pay for the treatment of those types of injuries.

 Thanks for listening!

 Send your questions to Support@TheMedicareNation.com

Sep 2, 2016

How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary.

MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary.

Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions.

If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period.

You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016.

Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016.

Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area.

How do you compare plans to find the right one for you or your loved one?

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

  1. You’ll see a Dark Blue Bar under Medicare.gov
  2. Hover your cursor over the tab that reads “Drug Coverage.”
  3. Click on the last item in the column labeled “Find Health & Drug Plans.”
  4. Add your zip code & click on “Find Plans.”
  5. Check the box that pertains to you.

Original Medicare?

Health Plan (MAPD)?

  1. Check the box that pertains to you in regards to assistance.

Do you receive extra help?

I Don’t Know?

  1. Click “Continue.”
  2. Now enter your drugs. All of them.

When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.”

If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later.

  1. Select “My Drug List is Complete.”
  2. You’ll see on the right side a grayish box that has a Prescription ID#

Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver!

  1. Now select a pharmacy you use.
  2. Then select “Continue to plan results”
  3. On this page, you’ll see a summary of your search.
  4. Select the box that pertains to your plan.

   Either Prescription Drug Plan with Original Medicare or

   Health Plan with Prescription Drug Plan (MAPD).

      All the drug plans in your geographical area available to you will be displayed.

      Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.

      You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.

      You have several options.

      With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.

      Start getting your list together, so it will be easier for you to check out 2017 plans!

 Here's the link to read the guidelines your Primary Doctor uses in prescribing you scheduled drugs.

www.cdc.gov/drugoverdose/prescribing/guideline

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       

Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me!

No other equipment is needed!

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

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

www.CallSamm.com

 

 

Aug 27, 2016

How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary.

MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary.

Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions.

If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period.

You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016.

Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016.

Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area.

How do you compare plans to find the right one for you or your loved one?

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

  1. You’ll see a Dark Blue Bar under Medicare.gov
  2. Hover your cursor over the tab that reads “Drug Coverage.”
  3. Click on the last item in the column labeled “Find Health & Drug Plans.”
  4. Add your zip code & click on “Find Plans.”
  5. Check the box that pertains to you.                                                 Original Medicare?                                                                           Health Plan (MAPD)?
  6. Check the box that pertains to you in regards to assistance.                     Do you receive extra help?                                                                      I Don’t Know?
  7. Click “Continue.”
  8. Now enter your drugs. All of them.

When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.”

If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later.

  1. Select “My Drug List is Complete.”
  2. You’ll see on the right side a grayish box that has a Prescription ID#   Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver!
  1. Now select a pharmacy you use.
  2. Then select “Continue to plan results”
  3. On this page, you’ll see a summary of your search.
  4. Select the box that pertains to your plan.                                           Either Prescription Drug Plan with Original Medicare or                         Health Plan with Prescription Drug Plan (MAPD).

All the drug plans in your geographical area available to you will be displayed.

Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.

You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.

      You have several options.

With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.

 Start getting your list together, so it will be easier for you to check out 2017 plans!

 

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       

Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me!

No other equipment is needed!

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

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

www.CallSamm.com

 

Aug 19, 2016

Welcome Medicare Nation!

I just had my annual eye exam and what a surprise I got! 

I was diagnosed with Narrow Angle Glaucoma! 

How could I be diagnosed with Glaucoma being just 54 years old?   Not only was I diagnosed, but I had to have immediate laser surgery to correct it. I don't want any of you to be diagnosed with Narrow Angle Glaucoma, so I'm going to discuss glaucoma with you to help you understand this disease.

There are several types of glaucoma. The two main types I will be discussing today are open-angle and narrow angle glaucoma. These types of glaucoma are marked by an increase of pressure inside the eye.

 

Open-Angle Glaucoma

Open-angle glaucoma, (also called  Chronic Glaucoma), is the most common form of glaucoma, accounting for at least 90% of all glaucoma cases:

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve can occur. It is a lifelong condition and needs to be monitored.

It is the most common type of glaucoma, affecting about 3 million Americans, many of whom do not know they have the disease, because you will not have signs or symptoms until it is too late.

You are at increased risk of glaucoma if your parents or siblings have the disease, if you are African-American or Latino, and possibly if you are diabetic or have cardiovascular disease. The risk of glaucoma also increases with age.

 

The 2nd type of Glaucoma is called -

Narrow Angle Glaucoma

Narrow Angle Glaucoma, also called acute glaucoma, is a less common form of glaucoma – less than 5% of the general population develops Narrow Angle Glaucoma.

Far sighted people are more common to have narrow angle glaucoma, since their Front Chamber of their eye is smaller than normal.

The Iris can “bow” forward, thinning the angle that drains fluid from the eye. Fluid builds up and so does the pressure inside the eye.

This happens when the drainage canals get blocked.  Such as When you put a drainage stopper in the sink or something clogs the drain.

With angle-closure glaucoma, the iris (which is the colored portion of your eye – your brown eyes, your blue eyes etc.) is not as wide and open as it should be. The outer edge of the iris can bunch up over the drainage canals, when the pupil enlarges too much or too quickly. This can happen when entering a dark room.

Unlike open-angle glaucoma, narrow angle glaucoma is a result of the angle between the iris and cornea closing quickly.

 

What are some Symptoms of Angle-Closure Glaucoma?

  • Hazy or blurred vision
  • The appearance of rainbow-colored circles around bright lights
  • Severe eye and head pain
  • Nausea or vomiting (accompanying severe eye pain)
  • Sudden sight loss 

Treatment

Treatment for Glaucoma an involve eye drops, laser or conventional surgery. Everyone is unique and may require different treatment.

Eye drops

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. The medications are intended to reduce elevated pressure in your eye and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye. Combination drugs are available for patients who require more than one type of medication. 

2 Types of Laser Surgeries Are:

Micropulse Laser Trabeculoplasty (MLT) is a common procedure for the treatment of primary open-angle glaucoma 

MLT provides pressure-lowering effects. It is unique in that it uses a specific diode laser to deliver laser energy in short microbursts. MLT is a relatively new laser procedure.

Laser Peripheral Iridotomy (LPI)

For the treatment of narrow angles and narrow-angle glaucoma.

Narrow-angle glaucoma (also known as acute angle glaucoma).           LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain. In general, surgery for narrow angle glaucoma is successful and long lasting. Regular checkups are still important though, because a chronic form of glaucoma could still occur.

 

Conventional Surgery

MIGS  stands for minimally invasive glaucoma surgery.

The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve.

Standard glaucoma surgeries are major surgeries. While they are very often effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications. The MIGS group of operations have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries.

MIGS procedures work by using microscopic-sized equipment (tiny, tiny tubes & shunts) and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety.

 

Get Your Annual Exam so your Optometrist can detect any issues with your eyes early!

 

A Comprehensive Glaucoma Exam

Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

Tonometry measures the pressure within your eye. During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device called a tonometer to measure the inner pressure of the eye.

Eye pressure is unique to each person.

Ophthalmoscopy 

This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil, so that the doctor can see through your eye to examine the shape and color of the optic nerve.

If the pressure within your eye is not within the normal range or if the optic nerve looks unusual, your doctor may ask you to have one or two more glaucoma exams: perimetry and gonioscopy.

 

Perimetry 

Perimetry is a visual field test that produces a map of your complete field of vision. This test will help a doctor determine whether your vision has been affected by glaucoma. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a "map" of your vision.

 

Gonioscopy

This diagnostic exam helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye. A hand-held contact lens is gently placed on the eye. This contact lens has a mirror that shows the doctor if the angle between the iris and cornea is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).

Pachymetry 

Pachymetry is a simple, painless test to measure the thickness of your cornea – (the clear window at the front of the eye over the pupil).

Diagnosing glaucoma is not always easy, and careful evaluation of the optic nerve is needed for diagnosis and treatment.

Always get a second opinion of any diagnosis of open angle or narrow angle glaucoma.

 

Resources:

http://www.glaucoma.org/glaucoma/video-narrow-angle-glaucoma.php

 

www.glaucoma.org

www.worldglaucoma.org

 

Do you have a Medicare Question? Send it to Support@TheMedicareNation.com

Tell a friend or family member to SUBSCRIBE to Medicare Nation. They’ll get a new episode on their laptop, tablet, or phone every Friday so they won’t miss an episode

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation.

Go to my website www.callsamm.com

And “Click” on the contact tab.

You’ll see a blue button that says “ Start Recording."

You’ll be able to leave a short message of what you’ve enjoyed over the past year on medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me you want  to be ON Medicare Nation.  

Aug 12, 2016

The NOTICE ACT

On August 6, 2016, The Notice of Observation Treatment and Implication for Care Eligibility Act, went into effect.

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services(Medicre) to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive (Observation Services) which:

  • explains the individual's status as an outpatient and not as an inpatient and the reasons why;
  • explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility;
  • includes appropriate additional information;
  • is written and formatted using plain language and made available in appropriate languages; and
  • is signed by the individual or a person acting on the individual's behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.

 

 Here is the link to the Federal Register, which explains in more detail Procedures Applicable to Beneficiaries Receiving Observation Services:

https://www.gpo.gov/fdsys/pkg/FR-2016-04-27/pdf/2016-09120.pdf

 

Medicare Advantage Plans

 “A beneficiary enrolled in a Medicare Advantage or other Medicare health plan would receive the required notice under the existing rules that apply to hospitals and CAHs under a provider agreement governed by the provisions of section 1866(a)(1)(Y) of the Act.”

 

If you are enrolled in a Medicare Advantage Plan, you are covered under the provisions of your plan. READ your plan’s Evidence of Coverage (EOC) to determine what your out-of-pocket expenses will be in this situation.

 

I am urging each of you to be Pro Active with your own Health Care!

If you or a loved one goes to the Emergency Room or a Critical Access Hospital, be prepared to speak up!

Speak to the Physician in the ER who is treating you. Ask the physician specifically…..”Am I being ADMITTED to the hospital as an INPATIENT?”

If the answer is “Yes,” you will be covered under Medicare Part A benefits.

 If the answer is…. “No…..you are UNDER OBSERVATION. OR……”No……you are receiving OUTPATIENT SERVICES.”  You WILL more than likely be responsible for co-payments, co-insurance or maybe ALL charges!

Call your Primary Physician or Specialist. Tell the office or Answering Service that you or your Family member is in so and so Emergency Room, so and so hospital and you want your Doctor to either:

  1. Come to the hospital and examine you to determine if you should be admitted to the hospital as an inpatient

                                           OR

  1. Have your doctor speak to the Emergency Room physician who is treating you, in order to determine if you will be admitted or able to be discharged from the Emergency Room.

 

You Should NOT have to be in an Emergency Room for up to 23 and a quarter hours UNDER OBSERVATION!

Your Primary Doctor is the “Quarterback of your health team!”

Your Primary Doctor is in charge of your health care! That is what they get paid to do all that extra paperwork for! Put them to work for you!

 

Do you have a Medicare Question? Send it to Support@TheMedicareNation.com

Tell a friend or family member to SUBSCRIBE to Medicare Nation. They’ll get a new episode on their laptop, tablet, or phone every Friday so they won’t miss an episode

Don’t know how to subscribe? Visit my short video to show you how to do it – step by step.

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks.

I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation.

Go to my website www.callsamm.com

And “Click” on the contact tab.

You’ll see a button that says “ Record Your Message Here.” Click on it and start talking! No equipment required!

You’ll be able to leave a short message of what you’ve enjoyed over the past year on Medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me

“I want to be ON Medicare Nation.”    

Thank you for being part of Medicare Nation’s Anniversary!

Aug 5, 2016

Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

An Advance Beneficiary Notice (ABN), also known as a waiver of liability is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover.

ABNs only apply if you have Original Medicare, are on a Medicare Supplement Plan. ABNs do not apply if you are in a Medicare Advantage private health plan. If you receive an ABN and you're on a Medicare Advantage Plan, ask to speak to the office manager.

Providers must give you an ABN when the service or item could be covered by Medicare, but the provider expects that Medicare will not find the care to be medically necessary and will, therefore, deny coverage.

The ABN must list the reason why the provider doubts Medicare will cover care. For example, an ABN might say, “Medicare only pays for this test once every ten years.” That would be the case for a colonoscopy, since Medicare pays for a low-risk colonoscopy once every ten years.

You should not be receiving an ABN for services or items that are never covered by Medicare, such as hearing aids. 

In order to receive an official decision from Medicare, you must:

1. First receive the care or receive the item                                                       2. You must sign the ABN form, agreeing to pay for it yourself if Medicare rejects       coverage.

Also, you must select Option 1 on the ABN form in order for the doctor or supplier to bill Medicare! Selecting this option requires your provider to bill Medicare after providing you with the service or item.

If you don't select Option 1 on the ABN, you have no chance, nada, zilch chance of Medicare coverage because your doctor is not required to submit the claim.

You will receive a Medicare Summary Notice (MSN) from Medicare. The Medicare Summary Notice will show if Medicare has denied payment for a service or item.   If Medicare denies your claim, you should file an appeal.

Just because you filled out an ABN does not prevent you from filing an appeal.

Medicare has specific rules about an ABN and how it should look. If these rules are not followed, there is a good chance you may not be responsible for the cost of the care. Remember, first you will have to file an appeal to prove your case.

Here are a few reasons you would not be responsible for the charges on an ABN

  • Is difficult to read or hard to understand.
  • Is given by the provider (except a lab) to every single patient with no reason to believe the claims may be denied by Medicare.
  • The ABN does not list the actual service provided 
  • The ABN is signed after the date the service was provided.
  • The ABN is handed to you during an emergency or is handed to you just prior to receiving a service (ex:You're on the xray table & they hand you an ABN)
  • An ABN was not given to you when it should have.

 You can file an appeal by going to your Medicare Supplement website and search for Appeal Form, call your Medicare Supplement Health Insurance Carrier or you can call Medicare at 800-633-4227 and ask them to mail you an appeal form.

Thanks for listening to Medicare Nation!

I appreciate you taking your time to listen to the show!

Send me your questions to Support@TheMedicareNation.com

I might read your question on the air!

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

 

Jul 29, 2016

Welcome Medicare Nation! We have a question today and I know many of you need this information!

 

MEDICARE SPECIAL ENROLLMENT PERIOD SHOW NOTES

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

 

  1. You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65.
  2. During the Annual Enrollment Period which is between October 15th through Dec 7th every year.
  3. You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
  4. You may have a “Special Election” that qualifies you to change your plan.

 

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

If You Move

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

Losing Coverage:

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

 

When there are plan changes with Medicare Contracts:

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

 

Special Circumstances

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

 

*****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 for Medicare Supplement Plans.

 

 

Precautions:

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

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

 

Need more information on "Special Enrollment Periods?"

www.callsamm.com - has all of this information available for you. Download the Quick PDF List for Special Election Periods.

 

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

 

Jul 22, 2016

Welcome, Medicare Nation! Today I want to explain a brand new bill being introduced in the US House and Senate. It’s the BENES Act (Beneficiary Enrollment Notification and Eligibility Simplification Act). This bill impacts people eligible for Medicare, specifically those who are nearing the age 65 enrollment period for Part B. The bill was introduced by Rep. Raul Ruiz (Dem.-CA) and Rep. Patrick Mann (Rep.-PA) in the House and by Sen. Bob Casey (Dem.-PA) and Sen. Chuck Schumer (Dem.-NY) in the Senate. I hope I can clear up any confusion for you!

Let’s look at the current PROBLEM, which boils down to a LACK OF INFORMATION:

  • The current system lets CERTAIN people know when to enroll in Medicare. If you are receiving SSI(disability) or SS benefits, then you will receive a letter as your 65th birthday approaches, advising you of your enrollment period and Medicare effective date. What about those NOT receiving those benefits? THAT is the problem!
  • If you don’t receive current SSI or SS benefits, then the government has no “trigger” to alert you that it’s time to enroll as you approach age 65. If you don’t enroll during your initial enrollment period (three months prior to, including, and following your BIRTHDAY MONTH—for a total of seven months), then significant late penalties can apply. These can raise the premium you pay by as much as 30%! In 2014, ONE MILLION people paid a late penalty. The average monthly premium is $105 and the average late penalty adds an average of 30% to your monthly premium—EVERY MONTH! 
  • Remember the following:
    • If you have worked for 10 years (40 quarters paid into FICA), then you have paid the minimum to qualify for Medicare Part A, premium-free. Part A is the “accommodations” part of Medicare, meaning it covers overnight stays in medical care facilities.
    • Part B covers outpatient services, which includes everything you might need in health care, excluding overnight stays.
    • Under current law, the government will NOT send you any notification of your approaching enrollment period, and then they will assess you a substantial late penalty if you don’t enroll when you should. “It’s all about the mighty dollar, folks!”

Let’s look at what the BENES Act will do to correct the PROBLEM:

  • The Act will make it possible for those turning 65 (10,000 Americans EVERY DAY!) to avoid mistakes and will give uniform information about the Part B enrollment process. Each individual will receive a “clear and detailed” notice of Part B enrollment rules that will help them make informed decisions. The government will send a notification when you are 64, letting you know that your initial enrollment period (that 7-month window around your birthday) is approaching. I’m excited about the possibilities of this new law, but it has to get passed first. Congress will reconvene on September 6 after their summer break, and if you want to stay informed about the progress of the BENES Act, then see our resources section.

Here’s a listener question from Teresa in Philadelphia:

  • How do I enroll in Medicare?

Well, Teresa, there are some options. If you are turning 65 and not currently receiving SSI or SS benefits, then you need to visit www.ssa.gov, go under Menu—Benefits—Medicare, and then scroll down to “Apply for Medicare only.” Click on “Start a New Application” and follow the directions. It should take about 10 minutes! Do it prior to your 65th birthday. My caution is that your personal information must have been updated with the Social Security Administration or there will be delays. If you have moved to a new address, changed your marital status or name, then you will have to go to the local SS office to enroll. You can call 800-772-1213 to enroll over the phone, but it is a LONG process.

If you are over 65 and still working and are covered by your employer’s credible insurance plan, and NOT under Part B---then you will have to go to the local office and have two forms with you: the Employer Attestation Form (to prove there have been no gaps in insurance coverage since your 65th birthday) and the Application to enroll in Part B. Find these forms at www.ssa.gov or email me at support@the medicarenation.com and request copies. Thanks for the question, Teresa, and I hope this helps you!

Resources:

www.medicare.gov  and    www.callsamm.gov can give you information NOW about Medicare enrollment.

www.congress.gov  (Keep up with the BENES Act progress—reference House Bill 5772.)

www.medicarerights.org   (For great information and resources!)

 

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

 

Jul 15, 2016

Welcome, Medicare Nation! Today’s topic is Diabetes Prevention, based on the expansion of a pilot program instituted by the CMS (Centers for Medicare/ Medicaid Services). I’ll be explaining the program’s components and the results. Join me!

What you’ll hear in this episode:

  • Statistics about diabetes:
    • There are currently more than 30 million Americans with Type 2 diabetes.
    • There are TWO deaths every FIVE minutes from diabetes!
    • There are 86 million Americans at a high risk of developing diabetes.
    • One out of three adults have “pre-diabetes,” which means they have higher than normal (normal is <100) blood glucose levels and are at an increased risk to develop diabetes within the next ten years.
    • The sad fact is that most diabetes cases ARE preventable!

 

  • Basics of the Diabetes Prevention Program:
    • The DPP began in 2011, when the US Department of Health and Human Services provided, through the Affordable Care Act, $11.8 million for the pilot program to be administered by the YMCA.
    • The program included weekly meetings with lifestyle coaches for dietary and behavioral changes, and monthly follow-up meetings.
    • The target was for each participant to achieve 5% weight loss, which was accomplished. That is enough to substantially reduce the diabetes risk!
    • About 80% of the program participants attended at least 4 weekly meetings.

 

  • Results of the Diabetes Prevention Program:
    • The 5% weight loss goal was reached.
    • The estimated healthcare cost savings per participant, when compared to those NOT enrolled in the program, was $2650.
    • The Dept. of Health and Human Services wants to invest in programs like this, because of the cost savings and the improved health.
    • The program’s success is relevant to Medicare, employers, and insurers.
    • The pilot program will now be expanded to benefit more people, and be put in place by January, 2018.
    • The expansion program will include 16 intensive core group sessions, focusing on nutrition, physical activity, and behavior changes (with follow-up sessions also).

 

  • Ideal eligibility factors for participants:
    • A BMI (body mass index) of 25 or higher (23 for Asians)
    • Hemoglobin ANC-1 level of 5.7-6.4%
    • Fasting glucose level of 110-125
    • Glucose tolerance test level of 140-199
  • Visit www.callsamm.com to take the quiz to assess YOUR diabetes risk. Remember, PREVENTION is always the best medicine! If you have questions about Medicare, email me: support@themedicarenation.com. Hey-our ONE YEAR anniversary is coming up next week! Visit our website to help us celebrate and record your message about how the show has helped you. I would love to play those on the show as we celebrate together!

 

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

Jul 8, 2016

Welcome, Medicare Nation!

Today’s episode is a Q & A in which I answer questions from two listeners. If you have a question for me about Medicare, then email me: support@themedicarenation.com.  Let’s jump right in!

  • From Mike, in Pleasanton, CA: If my doctor drops out of my HMO network, can I change to a Medicare Advantage plan that the doctor currently takes?
    • Here’s the thing, Mike: when you enroll in Medicare Advantage, you are in a “locked-in” period unless you have a “special election.” A special election can occur for a number of reasons: if you moved to a different county with new plans, or if CMS (Center for Medicare Services) decided to terminate a Medicare Advantage policy and you need to find a new one. Another situation for special election would be if you are still working, at age 65 or over, and are covered under your employer’s plan and aren’t on Part B. If you need to drop your employer’s coverage and enroll in Part B, then a special election would exist. Unfortunately, doctors can drop out of an HMO or PPO anytime, although they do have to give 60 days’ notice. 

Mike, you will have to change doctors unless this occurs between October 15 and December 7, which is the open enrollment period, or unless you have a special election period. Your situation would not be considered for special election. It’s unfortunate, but it is very common and happens to many people each year. The doctors do this because of money, but keep in mind that if you follow a doctor to another plan, then the same thing can occur again. I hope this helps. Visit www.callsamm.com or www.medicare.gov for more information.

 

  • From Sharon, in Austin, TX: How much will I have to pay to be in the hospital for 7 days?
    • Well, Sharon, the answer depends upon your plan. If you have original Medicare, Part A, then you have what I like to call  “accommodations insurance.” This means overnight stays are covered, with a deductible of $1288 for any stay of 1-60 days. All services and procedures in the hospital would then be covered for you. From days 61-90, you would pay $322/day for the same coverage. Of any stay of more than 90 consecutive days, you can draw on your lifetime reserve of 60 days at a cost of $644/day. Keep in mind, though, that those extra 60 days are a “lifetime piggy bank” of days, and you can’t get them back once you use them. The old adage, "You use them - You lose them," applies here.

If you have a Medicare Advantage plan, then they are all different. An HMO will have a smaller network, and your co-pay will range from $0-$250/day. A PPO network is larger, therefore, your co-pay for an inpatient hospital stay will range from $0-$425/day. You would need to contact your Medicare Advantage Carrier to determine the exact amount of what your inpatient hospital co-pay will be. There are also Medicare Supplements (MediGap) plans, such as the F plan, G plan, and N plan. For these plans, you pay your monthly premium, but then have $0 out-of-pocket "medically necessary" inpatient hospital stays. Other Medicare Supplement (MediGap) Plans have a Part A deductible. Again, you need to contact your Medicare Plan customer service representative to determine your exact cost.

Sorry, I can’t be more specific since I don’t know your plan, Sharon, but I hope this information is helpful for you. Thanks for the question!

 

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

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