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How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: Page 3
Aug 12, 2016

The NOTICE ACT

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

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

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

 

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

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

 

Medicare Advantage Plans

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

 

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

 

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

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

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

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

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

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

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

                                           OR

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

 

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

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

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

 

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

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

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

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

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

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

Go to my website www.callsamm.com

And “Click” on the contact tab.

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

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

“I want to be ON Medicare Nation.”    

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

Aug 5, 2016

Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanks for listening to Medicare Nation!

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

Send me your questions to Support@TheMedicareNation.com

I might read your question on the air!

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

 

Jul 29, 2016

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

 

MEDICARE SPECIAL ENROLLMENT PERIOD SHOW NOTES

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

 

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

 

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

If You Move

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

Losing Coverage:

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

 

When there are plan changes with Medicare Contracts:

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

 

Special Circumstances

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

 

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

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

 

 

Precautions:

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

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

 

Need more information on "Special Enrollment Periods?"

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Jul 22, 2016

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

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

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

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

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

Here’s a listener question from Teresa in Philadelphia:

  • How do I enroll in Medicare?

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

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

Resources:

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

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

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Jul 15, 2016

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

What you’ll hear in this episode:

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

 

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

 

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

 

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Jul 8, 2016

Welcome, Medicare Nation!

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

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

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

 

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

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

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

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

 

Jun 3, 2016

Welcome, Medicare Nation! Can you believe the month of June is here? The year is rolling right along, and you may not be aware that June is Aphasia Awareness Month. If you’re not familiar with aphasia, you should know that it’s an acquired disorder that affects a person’s ability to speak and to process language, but it does not affect intelligence. Let’s learn more about this disorder.

Here are a few basic facts about aphasia:

  • Often, aphasia is the result of brain injury, brain tumor, neurological disease, or stroke. (25-40% of stroke survivors will have aphasia.)
  • About 2 million Americans are affected by aphasia, with 180,000 acquiring it yearly.
  • Aphasia can affect any age, race, ethnicity, and gender. Those over age 60 have the highest aphasia rates, with those over age 40 being the second highest. The rate of occurrence is the same for all other age groups.
  • Aphasia can’t be cured but can be treated and improved with speech and occupational therapy, and these are covered by Medicare, depending on the plan.
  • Some helpful therapies can be done via an app or on a computer. Many of these costs can be reimbursed, depending on your Medicare plan.
  • Aphasia is self-diagnosable because the signs are noticeable, and may include social isolation, repeated actions/words, and jumbled/slurred speech.

There are several types of aphasia:

  • Global aphasia is the most severe form. It leaves the person unable to speak more than a few words and they can’t understand spoken words or read.
  • Broca’s aphasia has characteristics of reduced speech output, limited vocabulary, but the person can understand language and read.
  • Mixed Non-fluent aphasia makes it hard to speak and limits comprehension. The person cannot read or write beyond the elementary school level.
  • Wernicke’s aphasia leaves the person fluent, where they can grasp the overall meaning of a sentence, but may not comprehend individual word meanings.
  • Primary progressive aphasia is a rare neurological syndrome in which brain tissue degenerates.

To find out more about aphasia, visit the website for the National Aphasia Association: www.aphasia.org. You may contact them via email: naa@aphasia.org or find them on Facebook: Aphasia Recovery Connect.

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

 

 

May 27, 2016

Welcome Medicare Nation! Today’s episode is Part 2 of our interview series live from the Interdisciplinary Symposium on Osteoporosis held by the National Osteoporosis Foundation in Miami, FL. Today’s episode features some of the leading Osteoporosis practitioners in the country, as well as an important summary of Medicare Benefits that relate to the treatment of Osteoporosis.

 

Today’s episode features:

 

 

Medicare Benefits for Bone Mass Measurement (Bone Density) Testing

 

 

How often is it covered?

 

Medicare Part B (Medical Insurance) covers this test, which helps to see if you're at risk to broken bones, once every 24 months (more often if medically necessary) for people who meet the criteria below. Medicare only covers this test when it's ordered by a doctor or other qualified provider.

 

Who's eligible?

 

All qualified people with Part B who are at risk for osteoporosis and meet one or more of these conditions:

•A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings

•A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures

•A person taking prednisone or steroid-type drugs or is planning to begin this treatment

•A person who has been diagnosed with primary hyperparathyroidism

•A person who is being monitored to see if their osteoporosis drug therapy is working

 

Your costs in Original Medicare

 

You pay nothing for this test if the doctor or other qualified health care provider accepts assignment.

 

 

Some good times to talk to your Physician about this testing:

 

  • During your “new to Medicare” visit to Dr. visit, discuss preventative exams with Dr, they can suggest bone density.

 

  • Annual wellness visit to Dr - talk about bone density exam

 

 

Listen to this episode to hear interviews from the following professionals:

 

 

  • Dr. Thomas Olinginski - Tom Olenginski, MD, FACP is an associate in Rheumatology at Geisinger Medical Center. A graduate of the Pennsylvania State University and Penn State College of Medicine, he completed both his General Internal Medicine Residency and Rheumatology Fellowship at Geisinger Medical Center. Since 2008, he has been Co-Director of Geisinger’s High-Risk Osteoporosis Clinic. He is Chair of Geisinger’s Bone Density Committee and is responsible for Geisinger’s Osteoporosis Curriculum within its Rheumatology Fellowship. He has also served as a member of the NBHA Secondary Fracture Prevention Committee. His major interests are daily clinical care as a rheumatologist, teaching within Geisinger’s Rheumatology Fellowship and Internal Medicine Residency, as well as metabolic bone disease and system-based osteoporosis care, clinically-oriented bone density interpretation, and Geisinger’s Fracture Liaison Service.
  • Sherri Betz - SHERRI BETZ, PT, GCS, CEEAA, PMA®-CPT is a 1991 graduate of the Louisiana State University Medical Center's School of Physical Therapy. Sherri actually began her career as a national gymnastics competitor and as a group fitness instructor and personal trainer for Nautilus Fitness Centers in the 1980's. Inspired by the work of a physical therapist in one of the clubs where she trained, Sherri pursued a degree in physical therapy. Selected to serve on the Foundation for Osteoporosis Research and Education (FORE) Professional Education Committee and the NOF Exercise and Rehabilitation Advisory Council, Sherri is involved in improving awareness about bone health for the lay public, exercise teachers and for healthcare professionals. These committees review the latest updates in research, develop guidelines and design educational programs for physicians and allied health professionals. She has developed the "Do It Right and Prevent Fractures Booklet" for FORE/American Bone Health.
  • Dr. Steven Harris - Steven Harris, MD is a board-certified internist and endocrinologist with a subspecialty focus on osteoporosis, metabolic bone disease and disorders of mineral metabolism. He received his medical degree from the University of California, San Francisco, and completed a residency and chief residency in Internal Medicine at the same institution. He completed a clinical and research fellowship in Endocrinology and Metabolism at Massachusetts General Hospital in Boston. In 1983, he returned to the University of California, San Francisco, where he is a Clinical Professor of Medicine. Dr. Harris has spent many years working on a variety of clinical research projects to examine the effects of nutrition, calcium supplements, vitamin D, hormone therapy, bisphosphonates, calcitonin, PTH and SERMs upon the prevention and treatment of osteoporosis. Dr. Harris maintains an active consultative practice in metabolic bone disease, but is also engaged in a wide variety of educational initiatives related to osteoporosis.
  • Dr. Sandesh Nagamani - graduated from the J S S MED COLL, MYSORE UNIV, MYSORE, KARNATAKA, INDIA in 2000. He works in Houston, TX and specializes in Genetics, Medical. Dr. Sreenath Nagamani is affiliated with Methodist Hospital and St Lukes Hospital At The Vintage. He speaks English and Spanish. As an adult clinical geneticist, he provides clinical care for adult patients with a wide variety of heritable conditions. Dr. Nagamani serves as the Director of the Clinic for Metabolic and Genetic disorders of bone that caters to adult subjects with OI, heritable disorders of bone, early-onset osteoporosis, and other common forms of metabolic bone diseases.

     

 

Check out the Food4Bones app for iPhone and Android

 

www.nof.org

 

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

 

May 20, 2016

Welcome Medicare Nation! I interviewed clinicians and global experts in the bone health field gathered during the Interdisciplinary Symposium on Osteoporosis  held in Miami, Florida from May 12 to 15, 2016. May is the National Osteoporosis Awareness Month. Clinicians and Academicians Joined  the National Osteoporosis Foundation to Identify Solutions for Reducing the Two Million Broken Bones Caused by Osteoporosis Each Year.

This conference was sponsored by the National Osteoporosis Foundation (NOF), the organization dedicated to preventing osteoporosis, promoting strong bones, and reducing human suffering through education, advocacy, and research.  NOF is committed to promoting bone health among the elderly through healthy diet and safe exercise.  Both can help stop the loss of bone mass and help prevent fractures. 

 

Leading medical and scientific experts in the bone health field discussed  the latest information on preventing broken bones and lead in-depth educational sessions on the prevention, diagnosis and treatment of osteoporosis.

 

I met brilliant doctors, nurses, and therapists from all over the world and learned about:

 

  • Prevention and treatment of  osteoporosis 
  • Education for prevention of people at risk
  • There are 54 million Americans who suffer from osteoporosis 
  • To address this significant care gap, the ISO 2016 included training on preventive care model that operates under the supervision of a bone health specialist and seeks to prevent repeat fractures. 
  • The Fracture Liaison Service (FLS) Model of Care Training Course is designed to help doctors, nurse practitioners, physician assistants, registered nurses and other healthcare professionals improve the care management of post-fracture patients and navigate the complicated coordination of care process across hospitals, medical offices and multiple medical specialties through the application of best practices.
  • The FLS model of care is the key to sparing millions of American from breaking bones due to osteoporosis.
  • This 2016 ISO includes updated FLS training, and the introduction of Bone Health ECHO (Extension for Community Healthcare Outcomes), a strategy of telementoring FLS coordinators and healthcare professionals of all levels, with the aim of reducing the osteoporosis treatment gap  said E. Michael Lewiecki, MD, FACP, FACE, New Mexico Clinical Research & Osteoporosis Center, Co-Chair ISO Planning Committee 2016. 
  • If you are over 50 and have hip or back fracture, then you have osteoporosis. 
  • Secondary fractures can occur, too. 
  • Every year, osteoporosis is responsible for two million broken bones, yet fewer than 25 percent of older women and men who suffer from a fracture are tested or treated for osteoporosis. 

So many things can happen, secondary fracture, pneumonia, 

You can find the best information about osteoporosis from  www.nof.org   National Osteoporosis Foundation.

 

Listen to the first part of a 2-part interview. Learn about food for the bones, calcium-enriched diet, safe exercises for the elderly.  We are on iTunes, and Google Play.  Please tell your friends about medicare nation, and the 3 other shows I have.  You shouldn’t be breaking your hip or back. If you get fractured, you have osteoporosis.

  1. Susan Randall  

 

  • Osteoporosis  is the condition where the bone is weakened and impaired and more prone to rapture.  
  • Causes of osteoporosis include: aging and decline in estrogen and testosterone
  • Women and men both have the same hormones. Both lose these key  hormones as we age  
  • These hormones influence other bodily functions.  As the hormones decline, bone strength and quality are affected 
  • Treatment for breast cancer  put on a class of medications  that are aromataste  inhibitor 
  • Primary and secondary causes of osteoporosis. It’s multifactorial 

 

2.   Dr. Sanjeev Arora  

 

  • Dr. Arora, MD,  is the Keynote speaker , head of Project ECHO and  Improving Health in Underserved Populations through Technology;  
  • He is from the University of New Mexico;  
  • Project ECHO,  Extension for  Community Health Outcome use the FLS model to improve efficiencies and democratize medical knowledge.
  • Project ECHO uses video conferencing technology where conference participants  can talk  via skype about the best  treatment  in underserved nations.  It’s a new platform for medicine 
  • Project ECHO is based on the  idea that a multidisciplinary team of providers  can attract outcome in the internet 
  • The project targets meeting the medical needs of a billion people by 2020. It currently connects 13 countries and hundreds of universities and clinics.
  • Additional ISO16 Highlights include:
  • Sessions exploring the controversies in osteoporosis treatment and care;
  • New tools for assessing fracture risk;
  • Interactive sessions on safe exercises for people with osteoporosis;
  • Evidence-based answers to the most common patient questions on osteoporosis and fracture prevention;
  • Professional development workshops on patient education and new coding and reimbursement for osteoporosis;

 3.  Karen Kemmis   

  • Karen is a Physical Therapist specializing in safe exercises and movements.
  • Silver sneakers – use  gyms medicare vantage plan 
  • Some exercise and moves  could be dangerous for the elderly 
  • Many fitness instructors are not well versed with  chronic  conditions we have to be careful  what is safe for their particular condition
  • Anything in the upright position is safe  for the low-density bone mass
  • Dangerous moves include forward bending  such as toe touches, twisting hard, full rotation, sit-ups  
  • Safe exercise moves include  lying on the back;  lay grazing, isometric exercise,  
  • To work safely with a fitness instructor  tell them about your bone concern, go to www. nof.org, search  positive exercises,  print those materials and bring to instructor 

4.  Dr Maria Pesquera  

  • Is a primary physician in Albany, New York  and has a lot of patients who have osteoporosis. 
  • Her medical team is  having issues with medication used for treating osteoporosis
  • She favors exercise alternatives such as yoga and pilates.
  • She promotes a Holistic method of treatment that includes  healthy diet

 

Resources: 

 

  • National Osteoporosis website:  www.nof.org 
  • The best way to contact ECHO and Dr. Arora is via the website:  echo.unm.edu  

 

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

 

May 13, 2016

May 10th was World Lupus Day. So today, we wanted to highlight the disease so that we can get the word out.

 

 

Linda Ruescher, author, public speaker and Lupus advocate is our guest today. Linda actually has Lupus as well.

 

How many people in the US have Lupus?

 

1.5 Million people in the US.

 

What is LUPUS?

 

An auto-immune disease in which your body mistakes other body parts are toxins and invaders and tries to kill them. Lupus doesn’t have one particular body part that it targets. It can go after any part of your body.

 

Lupus can be difficult to diagnose because:

 

  1. It flares instead of being chronic
  2. The symptoms are the same as other diseases
  3. There is no definitive test for Lupus
  4. Generally they try to diagnose other things first
  5. A rheumatologist can be necessary to get a diagnosis

 

 

Lupus is like having a never-ending flu. The symptoms are the same, and the body reacts in the same way.

 

After 38 years undiagnosed, Linda was diagnosed in 2003. She is treated today with immune-suppressing drugs. She also takes a chemotherapy drug. It is important to know that Lupus is not cancer. The reason chemo drugs are used is because the side effect of weakening your immune system is desirable for Lupus patients.

 

 

Lupus primarily affects women in their child-bearing years. 

 

UVA/UVB light can cause flares, so Lupus patients should stay out of the sun.

 

If you are on Medicare, and IV infusion would be covered under Medicare Part A.

 

 

Linda’s book, The 100 Questions and Answers About Chronic Illness. was written after she exhausted the reading of all the other books and getting peeved that she couldn’t find the information she needed.

 

You can find her book on amazon.com, and in the paperback and Kindle versions.

 

Lupus Symptoms:

 

•Fatigue and fever

•Joint pain, stiffness and swelling

•Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose

•Skin lesions that appear or worsen with sun exposure (photosensitivity)

•Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)

•Shortness of breath

•Chest pain

•Dry eyes

•Headaches, confusion and memory loss

 

 

If you have 3 or more symptoms, see your Dr. If you aren’t getting anywhere with your Dr, then go see a Rheumatologist (or get a referral to one).  

 

Resources:

 

www.rheumatology.org - find a Dr. by zip code

 

 

Lupus Foundation of America - www.lupus.org

 

Lupus Florida - www.lupusflorida.com

 

 

Contact Linda Ruescher:

 

On Twitter: www.twitter.com/chronicillness

On Facebook: www.facebook.com/Linda Ruescher

Email: linda.ruescher@gmail.com

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

May 6, 2016

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

 

2016 Medicare Savings Programs:

 

Resources include stock, bonds, 401K, IRA.

 

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

 

 

4 Levels of Coverage:

 

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

Monthly income limit - $4045 (Married $5425) 

Resource limit - $4000 (Married $6000)

 

 

 

QI Plan: (Qualifying Individual)

 

Monthly income limit: $1357 (Married $1823)

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

Pays Part B Premium - $104.90

New to Medicare - $121.80

 

 

Specified Low Income Medicare Beneficiary Program (SLIM-B)

 

Monthly income limit: $1208 (Married $1622)

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

Pays Part B Premium - $104.90

New to Medicare - $121.80

 

 

Qualified Medicare beneficiary (QMB)

 

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

Monthly income limit: $1010 (Married $1355)

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

 

 

How to Apply:

 

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

 

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

 You have to re-qualify annually.

 

Questions? 

 

Call SSA at 800-772-1212

Email me: support@themedicarenation.com

Call me: 855-855-7266

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 29, 2016

Welcome Medicare Nation! 

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

Qualifications for the Program:

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

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

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

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

 

How to Apply for Extra Help:

The easiest route is to apply through Social Security

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

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

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

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

 

 

Automatic qualifications:

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

 

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

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

 

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

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 22, 2016

Welcome Medicare Nation!

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

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

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

 

This is the SCARY PART!  

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

Complications like –

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

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

To me……that is just NEGLIGENCE! 

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

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

 

WHY IS THIS HAPPENING TO YOU?

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

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

That is why all this is happening Nation!

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

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

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

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

PROMOTING CO-ORDINATED PATIENT CENTERED CARE!

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

 

HOW  WILL  THE  CJR  MODEL  WORK?

Started  April 1,  2016

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

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

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

episode, the hospital will either 

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

The goal is reducing avoidable hospitalizations and complications. 

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

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

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

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

WHAT  AREAS  ARE  PARTICIPATING  IN  THE  CCJR  MODEL

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

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

Here are a Few selected Areas:

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

 

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

 

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

OR

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

 

 

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

https://goo.gl/hN44cm

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

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

 

 

 

 

Apr 15, 2016

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

 

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

 

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

 

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

 

 

Moving Your Residence:

 

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

 

 

 

Losing Coverage:

 

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

 

 

 

You have a chance to get other coverage:

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

 

When there are plan changes with Medicare Contracts:

 

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

 

 

Dual Member (Medicare and Medicaid)

 

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

 

 

 

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

 

 

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

 

 

 

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

 

Precautions:

 

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

 

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

 

Original Medicare:

 

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

 

 

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

Apr 8, 2016

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

 

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

 

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

 

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

 

Fall prevention tips that Karyn provides in the book:

 

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

 

Another great resource on fall prevention is mayoclinic,org

 

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

 

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

 

 

 

 

What a Patient Advocate Does:

 

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

 

 

 

Where do you find a Patient Advocate?

 

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

 

 

CareManager.org

CareGiver.org

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

 

 

What type of Licensing does a Patient Care Advocate have?

 

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

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

Licensing or certification is required for this role.

 

 

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

 

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

 

 

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

 

 

ecarediary.com

reunioncare.com

 

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

 

 

 

 

Got questions about Patient Advocacy?

 

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

 

 

Karyn can be reached:

 

By Phone: 727-452-1300 

 

By Email: info@agingguidebook1.com

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

Apr 1, 2016

Welcome Medicare Nation! 

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

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

 

Melissa shares the following about her Mother’s experience:

 

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

 

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

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

 

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

 

 

Mar 25, 2016

Welcome, Medicare Nation!

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

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

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

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

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

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

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

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

 

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

 

  • When should people see their doctor about kidney disease?

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

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

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

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

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

  • What can listeners do to improve care coordination?

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

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

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

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

 

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

Visit www.kidney.org for more information.

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

Visit www.medicarechoices.org

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

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Mar 18, 2016

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

What is MS?

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

What are signs and symptoms of MS?

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

How is MS diagnosed?

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

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

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

Mar 12, 2016

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

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

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

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

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

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

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

support@themedicarenation.com

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

 

Politics and Medicare:

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

On The Republican Side:

Donald Trump:

Does not want to make cuts to Medicare

Favors health savings account

Does not favor current Obamacare

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

 

Ted Cruz:

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

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

 

Marco Rubio:

Wants to raise the eligibility age gradually

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

 

John Kasich:

Hasn’t specifically talked about Medicare, only Healthcare

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

Advocates healthcare savings accounts

 

On The Democratic Side:

Hillary Clinton:

Continue Obamacare and build on it

Protect seniors from rising costs

 

Bernie Sanders:

Advocates a single payer plan - administered by the government

Comprehensive coverage for all Americans paid for by the government

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

2.2% income based premium per household

This would be a government run system

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

 

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

 

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

 

 

Mar 4, 2016

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

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

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

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

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

Visit www.keypersonofinfluence.com!

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

 

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

 

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

Feb 27, 2016

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

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

 

email me:

support@themedicarenation.com

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

 

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

 www.CallSamm.com

 

 

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