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How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: Category: general
Oct 1, 2017

2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

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

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

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

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

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

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

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

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

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

That is a Medicare Regulation! 

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

FIND A NEW AGENT!

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

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

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

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

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

Annual Deductible 

The 2018 Maximum PDP Annual Deductible is $405.00.

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

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

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

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

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

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

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

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

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

                                    OR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TrOOP costs are -

1. The drug costs paid by the beneficiary

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

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

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

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

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

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

You will pay either:

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

You will pay whichever amount is greater.

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

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

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

 

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

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

Support@TheMedicareNation.com

I'll be happy to answer your question.

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

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

www.TheMedicareNation.com

That's it for this week's show!

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

Go to this link and tell me what you think! 

https://goo.gl/sb3JXo

 

Have a happy, peaceful and prosperous week everyone!

 

Jul 7, 2017

Hey Medicare Nation!

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

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

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

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

Summary of Noncomplliance

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

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

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

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

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

That's a BIG fine! 

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

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

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

The number is - 800-868-5200.

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

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

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

How does something like this happen, you may ask? 

Insufficient training of Fallon customer representatives and agents.

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

Train your employees Fallon! 

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

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

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

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

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

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

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

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

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

2. Call Senior Medicare Patrol.

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

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

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

      www.SMPresource.org

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

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

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

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

We'll see what happens.

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

Report any discrepancies or suspicions right away.

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

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

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

Thank you for listening to Medicare Nation!

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

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

Questions about Medicare or your Medicare Plan you need answered?

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

Have a very happy, peaceful and prosperous week everyone!

Diane Daniels

 

Jun 19, 2017

Hey Medicare Nation!

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

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

The following States were affected by the suspension:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#3. Contact Senior Medicare Patrol

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

        Senior Medicare Patrol

#4.  Contact your State Dept. of Aging

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

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

          Here's the link:

          Healthy Aging List of State Agencies

#5.   Contact Medicare

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

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

 

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

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

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

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

Support@TheMedicareNation.com

You can also visit my website for more information.

www.CallSamm.com

 

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

 

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

Diane 

 

          

Apr 28, 2017

Hey Medicare Nation!

Learn More About Medicare Here

I receive many questions from clients and listeners about Medicare. 

A question that is quite common is:

"What vaccinations are covered under Medicare?"

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

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

1. Flu Shot

2. Hepatitis Shot

3. Pneumococcal Vaccine

 

Flu Shot

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

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

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

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

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

www.Flu.gov

 

Hepatitis B

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

What indicates a Medium or High Risk?

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

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

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

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

Learn More About Hepatitis B

 

Pneumococcal Shot

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

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

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

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

Learn More About Pneumococcal Vaccinations

 

Additional Vaccinations and Shots Available

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

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

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

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

 

Shingles

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

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

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

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

Learn More about Shingles

I also did an ENTIRE EPISODE ON SHINGLES!

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

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

Listen to that episode! It is EXTREMELY educational.

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

Have a peaceful and prosperous week!

Diane

 

 

 

Mar 10, 2017

Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 3, 2017

Hey Medicare Nation!

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

Who should carry their Medicare ID Card?

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

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

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

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

 

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

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

 

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

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

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

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

Follow these steps:

You can ask for a Medicare Replacement Card :

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

                     1. Call 800 - 633 - 4227

                    C. Social Security Office 

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

 

Thanks so much for listening to Medicare Nation!

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

Buy them a Smartphone!

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

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

Download the Stitcher App.

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

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

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

Medicare Nation comes right up!

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

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

Feb 24, 2017

Hey Medicare Nation!

I hope everyone is having an awesome week!

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

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

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

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

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

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

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

123-45-6789A

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

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

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

1. www.ssa.gov

2. Title XVIII of the Social Security Act

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

my website -

www.callsamm.com

 

Thanks for listening to Medicare Nation!

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

 

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!

 

 

 

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

 

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

Jul 1, 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! Join us to learn more!

  • 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.

      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

       

       
Jun 24, 2016

Welcome, Medicare Nation! My guest today is Dr. Steven Loomis, an optometrist in Littleton, CO. Dr. Loomis is also the president of the American Optometric Association. Did you know that June is Cataract Awareness Month? It’s important to know what cataracts are, how they develop, and how to treat them. Dr. Loomis is here to discuss those topics and others related to general eye health. Join us!

  • Many people don’t understand the difference between an optometrist and ophthalmologist. Can you explain? 
    • Think of an optometrist “like a family doctor for your eyes.” These are medical doctors with four years of undergraduate education and four years of specialization. They deal with eye issues such as blurred vision, diabetes, and glaucoma. Optometrists actually diagnosed 240,000 cases of diabetes in 2014! An ophthalmologist is an eye surgeon who works in conjunction with a patient’s optometrist.
  • We know we need comprehensive eye exams, but how often should we get them, and what is included in that exam?
    • An annual exam is recommended unless there is a condition that warrants more frequent care. Specific tests are included, such as visual acuity, auto refraction, an image of the inside of the eye, visual field, blood pressure, and a check of the pupils. The doctor will also ask questions about medical family history. 
  • What exactly does “20/20 vision” mean?
    • Vision is based on the Snellen Acuity Chart, which was invented by Dr. Snellen over 100 years ago. It is the basic eye chart we are all familiar with that has a series of letters or shapes of certain sizes. The “20 foot” standard has been established, meaning that you see what you should see at a distance of 20 feet. A vision of 20/30 or 20/40 means that you see at 20 ft. what the normal eye sees at 30 or 40 ft. Some people see better than normal, like 20/15. It’s interesting how they measure the 20 feet distance, when most exam rooms are not 20 ft. long. The chart might be 12 ft. away from the patient on the wall, and a mirror is placed 8 ft. behind the patient, to make up the 20 ft. distance.
  • As we age, does 20/20 vision decrease?
    • Yes, unfortunately. It’s completely normal because our eyes age as do other parts of our bodies. As your lens ages, cataracts may form and the retina and cornea lose some functionality.
  • What are “floaters,” and can they clear up?
    • Floaters are very common. They can be seen during an eye exam with dilated eyes. What happens is that the vitreous fluid in the eye, which should be firm, solid, and gelatinous, begins to liquefy as we age. This more liquid substance has fibers in it that appear in our vision as floaters. The good news is that they can clear up; they can shrink, sink, and then we THINK they are gone. If floaters increase or change, then see your optometrist to be checked.
  • What is glaucoma?
    • In short, it occurs when the pressure inside the eye damages the optic nerve. Risk factors include family history, racial characteristics, age, and medications. The first symptom is often vision loss. 
  • If glaucoma is indicated, what is the treatment?
    • Medications can control the pressure. Usually eye drops are prescribed once daily and can safely manage the disease.
  • What are cataracts and how are they treated?
    • Cataracts are very, very common and usually show up around age 60. The lens becomes not as clear as it used to be as it loses its clarity and transparency. Exposure to UV rays can cause them, as well as steroids, diabetes, radiation treatments, eye trauma, and eye surgery. The #1 cause? Too many birthdays! There is no treatment needed for early cataracts, but they can worsen to cause hazy vision and nighttime glare. Surgery is the only cure, where the natural lens is removed and an artificial lens is implanted. The good news is that your lens prescription can be incorporated into the artificial lens so your vision is improved on multiple layers. (Tune in to hear a fascinating account of cataract surgery details! Did you know it only takes 5-8 minutes to complete?)
  • How do Medicare benefits factor into cataract surgery?
    • Medicare will pay for a monofocal artificial lens, but the patient can pay for an upgraded lens if desired. Medicare, depending on your plan, will pay a portion of glasses or contacts needed for after surgery.
  • Final words from Dr. Loomis: Keep up with your annual eye exams and discuss options with your doctor when issues arise. Visit www.aoa.org for more information and for their “doctor locator” tool.
  • Question from Eileen in PA: Does Medicare cover eyeglasses? The answer is no, except for what is needed after cataract surgery, and then a portion may be covered under your plan.

 

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

 

 

 

Jun 18, 2016

Welcome Medicare Nation! Today we’re talking about Shingles. I recently had shingles and my eyes were opened to how painful it is. It’s really a terribly painful illness, so I wanted to give you some facts and tips to help you diagnose your symptoms early.

 

 

 

 

What is Shingles?

 

A virus that is a type of herpes zoster virus. You can only get shingles if you’ve had chicken pox. The virus stays dormant in your spine and attach itself to some of the nerves in your spine. Then something comes along and activates it when you have a lower immune system. If you are on auto-immune suppressing drugs, you are more susceptible to the virus.

 

Increased stress can also trigger an outbreak of shingles.

 

 

 

What are the symptoms?

 

A blistery rash that generally starts around your back and wraps around your side. I got a blister on the palm of my hand. About a week before the outbreak, you can begin having pain from the nerve endings being affected. 

 

Patches of blisters will grow and then they are painful. You can have headaches and other pain that goes along with it.

 

The virus starts coming down your nerve path and it becomes extremely painful. The pain is similar to neuropathy pain.

 

 

 

Treatment?

 

Because I sought treatment within 48 hours of the onset of symptoms, I was able to take an anti-viral medication. This caused the pain to being to lessen over the next few days.

 

Anti-Viral medications

 

  • Acyclavir
  • Valacyclavir

 

 

Lidocaine can be given to block the pain.

Advil.,Motrin will also be given to lessen pain.

 

 

 

Anybody can get shingles. More likely to occur in older folks because the immune system is naturally weaker.

 

50% of people over the age of 60 to get shingles.

 

 

Shingles is contagious. It is contagious when the blisters are broken open and oozing. Direct contact with open blisters should be avoided.

 

Shingles Vaccine - given to people 60 and over - Zostavax. There is a 51% chance of not getting the virus when you get the vaccine. 

 

Who should NOT get the vaccine?

-People with allergies to gelatin

  • If you are allergies to neomycin
  • If you have a weekend immune system from AIDS or other illness
  • If you have leukemia or lymphoma
  • If you are pregnant 

 

Info about Shingles Vaccine: 

 

Medicare Advantage plans will require a co-pay. Find out what it costs with your plan by calling customer service with you plan.

 

Original Medicare - you will pay 20%

 

Medigap - you won’t pay anything

 

 

There is no season for shingles. Anyone can get it at any time.

 

You can find out more about shingles here.

 

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

 

Jun 10, 2016

Welcome, Medicare Nation! I’ve had a busy two weeks and have just returned from a conference in Miami for the National Osteoporosis Foundation. I have been flooded with emails, so today’s episode will be a Q&A session in which I address as many of those questions as possible. Join me!

  • From Steve in Texas: “I’m turning 65 in July and your program has been helpful to me. Can I change Part D prescription options over time without having to pass insurability determinations?”
    • The options can be confusing. You can change Part D plans during the annual enrollment period, from October 15-December 7. You can change plans every year, if needed. You should review your plans yearly, based on your prescription needs and usage.

 

  • From Dottie: “I have a Medicare Advantage Plan with Blue Cross. When I get the benefits summary, do the fees reflect those set by Medicare or do the doctors make these up?”
    • Every Medicare insurance carrier negotiates with each doctor and facility so they have a contract for how much the doctor gets paid for services. The summary shows what the doctor usually charges, what your plan covers, and what your co-pay amount is. What you see is what the doctor normally charges, but NOT what you will pay. The negotiated rate will be applied by your plan and you pay your co-pay or co-insurance.

 

  • From Dottie, the 2nd part of her question: “If I want to change to another Medicare Advantage Plan, can I keep my same doctor even if he isn’t in the network?”
    • Remember, Medicare Advantage is all about being in a network. It’s a “pay as you go” plan because you only pay for what you need. If your doctor is not in network, you have to decide what’s more important. Do you have to stay with that doctor or do you value the plan’s benefits more? You may need to change plans or pay out of pocket. This depends upon if your plan is an HMO or a PPO. A PPO has an out of network option but you will pay a higher co-pay. An HMO in Medicare Advantage doesn’t allow any out of network options.

I hope these questions and answers have been helpful to you. If need be, we’ll add another show each week just to cover your questions. So, keep those coming!  Email me: support@themedicarenation.com. Remember, you can visit www.medicare.gov for more information. 

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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