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Medicare Nation

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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 about all the things you want to know about Medicare, but are afraid to ask. 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.callsamm.comGive us feedback on Facebook! www.facebook.com/MedicareNation

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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 about all the things you want to know about Medicare, but are afraid to ask. 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.callsamm.comGive us feedback on Facebook! www.facebook.com/MedicareNation

iTunes Ratings

142 Ratings
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Valuable information

By M.C Laubscher - May 14 2016
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Fantastic resource for everything you want to know about Medicare!

Wow very useful

By Jr0789535 - May 14 2016
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Highly impressed. Great show

iTunes Ratings

142 Ratings
Average Ratings
134
2
3
0
3

Valuable information

By M.C Laubscher - May 14 2016
Read more
Fantastic resource for everything you want to know about Medicare!

Wow very useful

By Jr0789535 - May 14 2016
Read more
Highly impressed. Great show
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Medicare Nation

Latest release on Jun 12, 2020

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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 about all the things you want to know about Medicare, but are afraid to ask. 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.callsamm.comGive us feedback on Facebook! www.facebook.com/MedicareNation

Rank #1: 2019 Medicare Premium & Deductibles MN085

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Hey Medicare Nation!

It's October! Lots of changes going on in the Medicare landscape.

Social Security recently announced the 2019 COLA, and for those of you on Social Security and Social Security Disability, you will be receiving a 2.8% raise in your monthly check.

Social Security raise goes into effect January 1, 2019.

Social Securtiy Disbility goies into effect December 31, 2018.

Some more good news is.....the payroll taxes for Medicare & Social Security are staying the same in 2019. Yeah!!

The combined tax rate for Social Security & Medicare will remain at 7.65% in 2019 for employees.

The combined tax rate for Self Employed will also remain the same in 2019 at 15.30%

When Social Security authorizes a COLA raise, that is the signal that Medicare Part B Premiums may also rise.

For 2019, that's exactly what happened.

Let's take a look at the 2019 Medicare Premiums & Deductibles.

Medicare Part A

In 2019, the Medicare Part A Deductible for being an inpatient in the hospital is going up to $1,364.00 in 2019.

This means, you will have an out-of-pocket deductible when you are admitted to the hospital as an inpatient, whether you stay for one night or sixty consequative nights.

You will have to pay the $1,364.00 each time you are admitted to the hospital, unless you are readmitted to the hospital less than 60 days after you are discharged from the hospital and you are admitted for the exact same reason. 

SNF

A Skilled Nursing Facility (SNF) has 24hr Medical care and specializes in rehabilliation.

A person who had a stroke may be transferred to a SNF, to rehab the loss of sensation in a limb or to improve speech.

A person who recently had hip replacement surgery may be transferred to a SNF to strengthen their leg(s) and learn to walk with a proper gait.

Under Medicare, the first twenty days in a SNF is a benefit with no co-pay. If a person is required to stay day 21 and up to 100 consequative days, the co-pay will be $170.50 per day in 2019, under Medicare Part A.

Medicare Part B

Every person, who is a member of Medicare Part B has a monthly premium.

For those with an income below the Federal threshold, the Medicare Part B Premium is paid by that individual's State Medicaid Program.

For individuals on Medicare Part B, whose annual adjusted gross income is $85,000.00 or less, filing as a single taxpayer, the 2019 Medicare Part B monthly premium will be $135.50

Here is the chart for Medicare beneficiaries with a higher income, who will pay a higher Part B Premium Monthly.

Beneficiaries who file individual tax returns with income: who make Less than or equal to $85,000             $135.50

Married, filing joint returns & make less than or equal to $170,000                                                          $135.50

Beneficiaries who file individual tax returns with income: who make Greater than $85,000 and less than or equal to $107,000                                                          $189.60

Married, filing joint returns & make Greater than $170,000 and less than or equal to $214,000                     $189.60

Beneficiaries who file individual tax returns with income: who make Greater than $107,000 and less than or equal to $133,500                                                         $270.90

Married, filing joint returns & make Greater than $214,000 and less than or equal to $267,000                    $270.90

Beneficiaries who file individual tax returns with income: who make Greater than $133,500 and less than or equal to $160,000                                                         $352.20

Married, filing joint returns & make Greater than $267,000 and less than or equal to $320,000                    $352.20

Beneficiaries who file individual tax returns with income: who make Greater than $160,000 and less than or equal to $500,000                                                         $433.40

Married, filing joint returns & make Greater than $320,000 and less than or equal to $750,000                     $433.40

Beneficiaries who file individual tax returns with income: who make Greater than or equal to $500,000      $460.50

Married, filing joint returns & make Greater than $750,000                                                                        $460.50

Medicare Part B Deductible

Medicare has an Annual Part B Deductible. 

In 2019, the Part B deductible is going up to $185.00.

After you pay your Part B deductible, you will then have to pay 20% of the Medicare Allowable for Part B services.

If you are on a Medicare Advantage Plan, you probably didn't even know you had a Part B Deductible. The majority of Medicare Advantage plans absorb the Part B Deductible into their plan. The Majority of Medicare beneficiaries on a Medicare Advantage Plan do not have a Medical deducatible on their plan. I always say......"You Pay as you go."

If you currently have a Medi-Gap Plan "F" or Plan "C", you also don't pay out of pocket for the Annual  Part B Deductible.

Things will change in 2020, for now.....everyone is good to go. 

The Medicare Annual Enrollment Period is here!

If you have a question......Email it to me!

If I can answer it in one paragraph....I will!

If I have to do ANY kind of research, or my answer requires more than one paragraph....then you may need to hire me to consult with you.

I presently charge $150.00 an hour for consulting on Medicare issues and comparisons.

I can help you with just about anything to do with Medicare.

I have vast knowledge in Medicare and I am very fair. 

Need help with Medicare? I can help you.

Send me an email to Support@TheMedicareNation.com

Things are getting busy with Medicare. 

More updates will be coming soon!

Until then.....I want each of you to have a Happy, peaceful and prosperous week!

Diane Daniels

Oct 13 2018

19mins

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Rank #2: How to Save $1,608 or More in Medicare Costs

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Hey Medicare Nation!

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

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

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

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

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

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

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

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

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

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

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

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

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

Medicare Savings Program

2017 Monthly Income Limit:

Single Person

$1,377.00 

Married (living together)

$1,847.00

2017 Total "Resource" Limit:

Single Person

$7,390

Married (living together)

$11,090

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

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

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

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

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

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

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

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

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

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

Extra Help Program

2017 Monthly Income Limit:

Single Person

$1,507.50 

Married (living together)

$2,030.00

2017 Total "Resource" Limit:

Single Person

$13,820.00

Married (living together)

$27,600.00

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

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

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

www.socialsecurity.gov/locator

That's it for today Nation!

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

Diane

Oct 06 2017

33mins

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Rank #3: Medicare Q and A - Diane Answers Listener Questions

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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 08 2016

17mins

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Rank #4: MN066 Welcome To Medicare Visit vs. Annual Wellness Visit

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

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

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

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

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

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

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

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

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

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

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

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

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

Share Medicare Nation with someone!

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

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

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

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

Feb 17 2017

15mins

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Rank #5: Using a Patient Advocate to Navigate the Healthcare System

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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 08 2016

35mins

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Rank #6: MN063 21 Medicare Advantage Organizations Receive Warnings!

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Hey Medicare Nation!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blue Cross & Blue Shield of Rhode Island - RI

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

Catholic Health Partners - IA,KY, MI, OH

CIGNA  - IL, IA

Community Health Plan of Washington - WA

Emblem Health Inc. - CT, NY, RI

Fallon Community Health - MA

Gateway Health Plan, LP - OH, PA, WV

Health Partners Plans, Inc. - PA

Highmark Health - PA

Humana Inc. - WI

Indiana University Health - IA

Magellan Health Inc. - NY

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

Molina Healthcare, Inc. - UT

Piedmont Community Health Plan - VA

Premera - WA

Samaritan Health Services - OR

SCAN Health Plan - CA

UnitedHealth Group, Inc. - CO

Wellcare Health Plans - IL

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

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

1. Call Medicare - 800-633-4227

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

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

4. VERY IMPORTANT  TO STATE.....

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

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

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

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

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

What do you do now????

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

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

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

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

Do your Due Dilligence Nation!

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

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

Share Medicare Nation with someone!

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

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

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

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

Jan 20 2017

37mins

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Rank #7: MN060 Choose The Medicare Plan That Fits Your Unique Needs

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

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diane Daniels

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

Nov 29 2016

44mins

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Rank #8: MN069 How to Make an Appointment With a Medicare Supplement Plan

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Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 10 2017

33mins

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Rank #9: 2020 Medicare Changes Announced!

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Hey Medicare Nation!

CMS just announced the 2020 Medicare Part B Premium increase!

CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible.

Here's a look at what's changing in 2020:

Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act. 

SOCIAL SECURITY

Increase:    1.6%  (Avg $24 more a month)

Average Monthly SS Check $1,503.00  

2020 - PART A DEDUCTIBLE AND COINSURANCE

Inpatient Hospital Deductible:                       $1408.00

Daily Coinsurance Days 61-90:                    $  352.00

Daily Coinsurance-Lifetime Reserve:           $  704.00

Skilled Nursing Facility-Days 21-100:           $  176.00

2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE

Standard Monthly Premium:                 $ 144.60  ($9.00 More)

Annual Deductible:                                $ 198.00

It's a great time to review your plan for 2020.

Is it the right plan to fit your unique needs?

If so........ keep it!

If not....... change it!

I am available to assist you with your Medicare Plan choices for 2020.

If I can answer your email in one paragraph or less, I WILL answer your question for you!

If the answer to your question requires any research or my response is longer than one paragraph..... I will let you know that you will need to hire me to answer that question.

If you live outside of Florida, you can hire me as your consultant at a rate of $200.00 an hour ( The hourly rate is going up to $250.00 an hour, starting January 1 2020).

If you are a Florida resident, I can assist you in enrolling into the plan that fit's your unique needs at no additional charge. I will receive a commission from the insurance carrier once you are enrolled. The commission is regulated by Medicare.

The Annual Enrollment Period ends December 7th, so make sure you do your "due dilligence" and find the plan that works for you!

Until next time..... Have a Happy, peaceful & prosperous week!

Diane Daniels

Medicare Consultant

855-855-7266

Nov 09 2019

21mins

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Rank #10: MN071 The Special Election Period Medicare Secretly Wont Tell You About

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Hey Medicare Nation!

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

Sound familiar?

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

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

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

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

(1) the number of enrollees affected;

(2) the size of the service area affected;

(3) the timing of the termination;

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

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

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

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

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

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

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

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

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

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

TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD

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

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

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

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

If You Move

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

Losing Coverage:

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

When there are plan changes with Medicare Contracts:

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

Special Circumstances

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

Precautions:

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

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

Need more information on "Special Enrollment Periods?"

See the entire list at www.Medicare.gov

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Apr 07 2017

35mins

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Rank #11: Want to Change Your Medicare Advantage Plan? Get the Info You Must Know First

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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 15 2016

20mins

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Rank #12: 2017 Annual Enrollment is Here. What Plan Will You Be On?

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

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Need help with understanding Medicare?

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

Call 855-855-7266 for more information.

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

Nov 11 2016

39mins

Play

Rank #13: You May Qualify for Extra Prescription Help - A Little Known Government Program

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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 29 2016

15mins

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Rank #14: MN058 Patient's Are At Risk in ER's Across the U.S.

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Welcome, Medicare Nation!

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

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

Sep 16 2016

39mins

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Rank #15: CMS Announces 2018 Medicare Premiums MN078

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Hey Medicare Nation!

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

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

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

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

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

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

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

Such is the case for 2018.

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

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

CMS planned this out perfectly!

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

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

$134.00!

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

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

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

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

Let's look at the remaining 2018 Deductibles:

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

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

That's an increase of $24.00 from 2017.

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

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

You are given 60 lifetime reserve days.

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

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

Works the same way for lifetime reserve days.

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

Skilled Nursing Facility

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

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

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

Part B of Medicare

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

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

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

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

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

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

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

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

Advocacy Groups For Medicare

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

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

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

Nov 18 2017

33mins

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Rank #16: With Two Shingles Vaccines Available, Which One Should I Get?

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Hey Medicare Nation!

www.TheMedicareNation.com

If you are turning 65 or still working on  an employer group insurance plan, you may need assistance in finding the Medicare plan that fits YOUR unique needs.

You may have a loved one in a nursing home or in an assisted living facility, who is not receiving proper care.

Call me! You can hire me as a consultant to assist you with Medicare issues!

Call 855-855-7266

or eMail me at Support@TheMedicareNation.com

Tell me the situation and I'll personally get back to you!

Today, I am speaking to you about Shingles Vaccines!

There are two Shingles vaccines licensed in the United States available.

The first one is the "Zoster Vaccine Live," also known as "Zostavax." Many of you probably have received this vaccine, which is a "Live" vaccine and the CDC reports it as being 51% effective against Shingles.

The second vaccine is the "Recombinant Zoster Vaccine," also known as "Shingrix" has been used since October of 2017.

The CDC reports the Shingrix vaccine is about 91% effective against Shingles.

The cost of the Shingles vaccine is covered under Medicare "Part D."

You can look up the Zostavax vaccine or Shingrix vaccine in your plan's formulary, or you can call the customer service number on the back of your identification card.

Every plan can have a different cost for either vaccine, so it is important you check with your plan, prior to getting the vaccine.

There are side effects that can be associated with either vaccine.

Go to the CDC website to learn more about Shingles and the vaccines 

www.cdc.gov/vaccinesafety

Learn more about how Shingles is transmitted, the sign & symptons and treatment for Shingles here:

www.cdc.gov/shingles

I'm not a doctor!

If you have any health related questions regarding shingles and/or vaccines, due your own due diligence or contact your health care provider for more information.

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Aug 02 2019

21mins

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Rank #17: CMS Approves Ambulatory Blood Pressure Monitors

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Hey Medicare Nation!

www.TheMedicareNation.com

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

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

Use the "Purple" colored icon on an Apple phone or ....

download Stitcher, Himalaya or Player FM when using Android phones.

Search for "Medicare" and "click" on the Medicare Nation logo.

You'll see the "subscribe" button on the page. "Click" subscribe and they'll get the NEWEST Medicare Nation episodes delievered to their phone.

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

CMS Decision Summary Ambulatory Blood Pressure Monitoring  Devices

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

 What is hypertension (high blood pressure)?

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

The blood pressure reading is the result of two forces:

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

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

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

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

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

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

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

  1. General

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

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

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

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

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

  1. For beneficiaries with suspected “white coat hypertension,” which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm … but less than 160 mm … or diastolic blood pressure greater than 80… but less than 100… on two separate clinic/office visits …..with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are 140/90 on at least three separate clinic/office visits with two separate measurements made at each visit;

    1. At least two documented blood pressure measurements taken outside the office which are

Jul 05 2019

21mins

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Rank #18: 1 in 3 Americans are at risk for Kidney Disease. Dr. Jeffrey Berns shares prevention and awareness tips to avoid kidney disease.

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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 25 2016

34mins

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Rank #19: The New CJR Model Explained and What it Means for You

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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 22 2016

30mins

Play

Rank #20: Diabetes Prevention and an Expanded Pilot Program - Get the Details Here!

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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

Jul 15 2016

22mins

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CMS Hands Out Civil Money Penalties To 3 More Medicare Plans

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Hey Medicare Nation!

www.TheMedicareNation.com

Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020!

THREE more plan sponsors to discuss!

CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00!

HUGE Penalty people!

According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees.

HCSC has the right to Appeal CMS Decision.

NEXT Up..... is Triple-S Management Corporation!

CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020.

CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00!

CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration.

Triple-S has the right to Appeal CMS decision.

Last up..... is Tufts Health Plan, Inc. 

CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00.

CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations.

Tufts has the right to Appeal CMS' decision.

If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call.

You can request a "Special Election Period," based on your experience with any of these companies.

Call Medicare at  800 - 633 - 4227  24hrs a day, 7 days a week.

www.TheMedicareNation.com

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Jun 12 2020

26mins

Play

CMS SLAPS Humana With Hefty Civil Money Penalty

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Hey Medicare Nation!

Medicare Nation

CMS Imposes a Civil Money Penalty against HUMANA!

CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019.

Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M.

Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees.

CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........

$257, 262!

Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug. 

This allows you time to speak with your doctor to see if there is an alternative prescription drug on the new plan ...... or......

you can request a "Formulary Exception."

This means your doctor is requiring you to take this medication, because it is the one that is stablizing or correcting your condition, and that you need to continue to take it.

If the drug is NOT on the new plan's formulary and they Approve the formulary exception, you WILL be charged a higher amount for taking a drug that is not on their formulary.

Humana has the right to appeal the decision by requesting a hearing.

The notice is signed by John Scott, Acting Director of the Medicare Parts C and D Oversight and Enforcement Group.

Medicare Nation

NEXT CMS Penalty is given notice to.........

SOLIS Health Plans out of Miami, Florida

On December 4, 2019, CMS gave notice to Mr. Daniel Hernandez - CEO of Solis Health Plans.

CMS imposed a CIVIL MONEY PENALTY of

$41,552.00!

CMS stated in their summary that Agents employed by SOLIS engaged in an aggressive marketing campaign that was conducted by a contractor provider clinic.

Solis Agents conducted a marketing presentation in a secluded area and enroll patients upon conclusion of the presentation.

CMS determined that Solis violated the communication and marketing requirements, which had the substantial likelihood of adversely affecting its enrollees.

Solis Failed to oversee and manage the marketing process to ensure its agents and brokers did not engage in inappropriate marketing practices including "misleading" beneficiaries.

Solis may request a hearing to appeal CMS's determination.

Both notices are signed by John Scott, acting director of the Medicare parts C and D Oversight and Enforcement Group.

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Diane Daniels

May 29 2020

26mins

Play

CMS Imposes BIG Sanctions on Delaware Life Ins. Company

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Hey Medicare Nation!

Medicare Nation

Today, I'm informing you about The Centers For Medicare & Medicaid Services Notice, given to Mr. Art Carlos, CEO of Delaware Life Insurance Company.

In a notice dated January 31, 2020, CMS notified Mr. Carlos that they were immediately imposing Intermediate "Sanctions" against Delaware Life Insurance Company.

CMS determined that Delaware Life Insurance Company is "in substantial violation of Medicare Advantage and Prescription Drug Plan requirements."

SIX specific violations were listed in the notice to Carlos.

LISTEN to the episode to learn about the violations and what you can do if YOU are a beneficiary under one of Delaware Life Insurance Company's Medicare Advantage Plan or Prescription Drug Plan.

www.TheMedicareNation.com

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Diane Daniels

Medicare Consultant

May 15 2020

18mins

Play

How Much Does it Cost For COVID19 Services Under Medicare?

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Hey Medicare Nation!

www.TheMedicareNation.com

Medicare has taken many steps to assist you during the COVID-19 crisis.

  1. Coronavirus tests

Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called COVID-19). This test is covered when your doctor or other health care provider orders the test.

I spoke about testing for COVID-19 in the previous episode, dated April 1, 2020. Listen to episode 101 to learn more about COVID-19 Testing.

Your costs in Original Medicare for COVID-19 Testing.

You pay nothing for this test. NADA!

This includes the newly available COVID-19 “Antibody” test, which determines if you have antibodies in your blood, that were created to recognize the COVID-19 Virus in your body.

  1. Hospitalization

Medicare covers All medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might have been discharged from the hospital after an inpatient stay, but……. instead you need to stay in the hospital under quarantine.

Your costs in Original Medicare

ZERO!

3     VACCINE FOR COVID-19

At this time, there's no vaccine for COVID-19. 

However, If and when one becomes available, it will be covered by all  MEDICARE Prescription Drug plans -  Which is Part D of Medicare.

  1. TELEHEALTH  SERVICES

During the National Emergency for COVID-19, you will be able to receive a specific set of services through telehealth

These services include:

  1. Evaluation and management visits (common office visits),
  2. mental health counseling and
  3. preventive health screenings 
  4. without a copayment if you have Original Medicare. 

Your costs in Original Medicare

 $0  Co-Pay if you have Original Medicare.

You can use your smart phone or computer to access Telehealth services.

5.    Virtual check-ins

virtual check-ins (also called “brief communication technology-based services”) with your doctors and certain other practitioners.

What is it ?

Virtual check-ins allow you to talk to your doctor or certain other practitioners, like nurse practitioners or physician assistants, using a device like your phone, integrated audio/video system on your laptop or computer, or captured video image without going to the doctor’s office.

Your doctor or other practitioner can respond to you using:

  • Phone
  • Audio/visit
  • Secure text messages
  • Email
  • Use of a patient portal

Virtual Check-Ins can be used for treatment for the Coronavirus from ANYWHERE……including places of residences….HOMES. Nursing Homes, AND Assisted Living Facilities.

 

Things to know
  • You must talk to your doctor or other practitioner to start these types of visits.
  • The communication must not be related to a medical visit within the past 7 days and must not lead to the medical visit within the next 24 hours (or the soonest appointment available).
  • You must verbally consent to the virtual check-in, and your consent must be documented in your medical record.
  • Since January 1, 2020 your doctor may obtain a single consent for a year’s worth of these services.

 

     Your costs in Original Medicare

     Normally, you would pay for “Virtual Visits” under Part B of Medicare.

     During the National Emergency, your co-insurance and deductible will be waived, and you will have “No Co-insurance, or deductible” for Virtual Visits for COVID-19 services.

Certain Skilled Nursing Facility Care requirements have been waived during the National Emergency for COVID-19.

  • During the COVID-19 Pandemic, some people may be able to get renewed SNF coverage without first having to start a new benefit period. 
  • Original Medicare covers up to “100 consecutive days” in a Skilled Nursing Facility.”

For each benefit stay. During the National Emergency for COVID-19, your Doctor may request an extension of days for your benefit period.

  • If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get SNF care without a qualifying hospital stay.

  1. if you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described above and many plans have waived Hospital co-pays during the pandemic.
  2. Check with your plan about your coverage and costs for ALL services covered for COVID-19.
  3. Review your Summary of Benefit Booklet for 2020 from your Medicare Advantage Plan Carrier.
  4. Don’t have one……… Go to the plan’s website to download a digital copy. OR…… Call the Customer Service number on the back of your Identification card and ask them to mail you a “Formulary” for your Specific plan.

 

Preparing for healthcare needs

  • Be sure you have over-the-counter medicines and medical supplies like tissues….cough drops…. Tylenol…etc.  to treat fever and other symptoms.

  • Most people will be able to recover from COVID-19 at home.

  • Have enough household items and groceries on hand…..Soup, Macaroni and Cheese, Bread for Toast…. Whatever it is you will eat & drink when you’re sick….so that you'll be prepared to stay at home for a period of time.

Check out the following websites for updates on COVID-19

  1. Centers for Disease and Control - CDC.gov …..  has the latest public health and safety information from the CDC and for the medical and health provider community on COVID-19.

  1. USA.gov -  has the latest information about what the U.S. Government is doing in response to COVID-19.

CoronaVirus.gov - is the source for the latest information about COVID-19 prevention, symptoms, and answers to frequent questions.

  1. Visit your State Department of Health for local COVID-19 Information about YOUR State.

You can search on Google for your State’s Health Dept. by typing in ……… NY State Health Depart……… CA State Health Dept……..Florida State Health Depart……

 Visit my website for a LIST of EVERY State Health Department’s Phone Number……

By going to www.TheMedicareNation.com/COVID19

Many of you are turning 65 and have no idea what to do to enroll in Medicare or what Plan to enroll in.

I invite you to contact me….. so that I can assist you with all this.

Send me your question to Support@TheMedicareNation.com

I answer ALL emails myself! No Assistants, NO Virtual Assistants….. I do!

I will answer your question in one paragraph. If I cannot, I will let you know how to contact me if you wish to reach out to me for a consultation.

Until next time……. Practice Social Distancing…..Do things to Make you Happy……. AND Stay Healthy!!

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

The information on this podcast and/or website is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional, which neither I nor anyone else associated with Medicare Nation LLC is not! Please consult with your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. If you think you may have a medical emergency, call your physician and/or 911 immediately.

Medicare Nation LLC reserves the right to add, remove or edit content on this page at its’ sole discretion.

Apr 10 2020

22mins

Play

COVID19 Update: Testing, Phone Numbers & 50 State Status

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Hey Medicare Nation!

www.TheMedicareNation.com

It’s April 1st and over One Million People have been diagnosed with the COVID-19 Virus Worldwide!

On this week’s episode….. I provide a time-line of the events of the Pandemic as well as updates on COVID-19 testing and Important phone numbers should you have symptoms or questions about COVID-19.

I also have a “list” of phone numbers, for EACH Health Department in All 50 States!

You can email me at  Support@TheMedicareNation.com for the list or check the show notes for an attachment.

Here is an important phone number for the CDC HOTLINE on COVID-19

800 -232- 4636 - CDC Hotline

Advent Health 24hr Hotline -  877 – 847 – 8747

You can also download the Advent Health App on iTunes or Google Play in order to have a “Virtual” visit with an Advent Health Doctor.

Bay Care Virtual Doctor Hotline -  800 – 229 – 2273

You can also go to this website for a “virtual” visit with a Bay Care Doctor –

www.BayCareAnywhere.org

The Florida Department of Health Hotline is 

866 – 779 – 6121

State Health Department List of Phone Numbers

Thank you for listening to Medicare Nation!

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

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

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

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

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

Contact Me!

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

Thanks again for listening!

Apr 01 2020

28mins

Play

Where Do I Go To Get Tested For The Corona Virus?

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Hey Medicare Nation!

We're smack in the middle of a Corona Virus Pandemic!

The Medicare Nation

I wanted to give you an episode that is full of USEFULL information. I know you've been hammered by the news, internet and newspapers about the Corona Virus.

Let's start with a very important fact:

Human coronaviruses were first identified in the mid-1960s.

The 1960's people!

the coronavirus gets its name from a distinctive corona or in a scientists world…a “Crown of Sugary Proteins,” that projects from the surface of the virus.

There are four main types of Human Corona Viruses

  1. Alphacoronavirus
  2. Betacoronavirus
  3. Gammacoronavirus, and 
  4. Deltacoronavirus.

The first two only infect mammals, including bats, pigs, cats, and humans. 

Gammacoronavirus mostly infects birds such as poultry (chickens) and Deltacoronavirus can infect both birds and mammals.

Do you recognize the Virus named SARS?

Severe acute respiratory syndrome abbreviated as …. (SARS-CoV)

SARS-CoV (the beta coronavirus.  Guess what it causes?  It causes severe… acute…..respiratory syndrome,

SARS was first recognized as a distinct strain of coronavirus in 2002. The source of the virus has never been clear, though the first human infections can be traced back to the Chinese province of Guangdong in November of 2002.

The virus then became a pandemic, causing more than 8,000 infections of an influenza-like disease in 26 countries with close to 800 deaths.

In the United States, only eight persons were laboratory-confirmed as SARS cases. There were NO  SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.

By July of 2003….. the World Health Organization declared the outbreak over.

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is….SARS-COV-2 aka coronavirus disease 2019, abbreviated as COVID-19.  ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease.

The Medicare Nation

COVID-19 is a new disease, caused by a novel (or new) “coronavirus” or strain of “Corona Virus” that has not previously been seen in humans.

What are the Symptoms of COVID-19?

 The CDC (Centers of Disease Control) have listed these as the most common symptoms of COVID-19:

  • Fever
  • Cough
  • Shortness of breath

Symptoms may appear 2-14 days after exposure.

Reported illnesses have ranged from mild symptoms….like a dry cough….

to severe illness, with high fever and shortness of breath, requiring hospitalization and there have been deaths reported for confirmed coronavirus disease 2019 (COVID-19) cases.

Currently……according to the WHO… as of March 13th….there are over 132, 758 reported cases of    COVID-19 …. Worldwide.

Of those cases….. there are 4,955 Deaths worldwide.

Over 80% of the reported cases are recovering.

In the U.S…… there are currently 1,629 reported cases…… in 47 of the 50 States.

No reported cases yet….in Idaho, Alabama and West Virginia.

There have been 41 Deaths reported in the U.S. ….. with 37 Deaths coming from the State of Washington. The deaths mainly being reported from a nursing facility, with those being elderly and having underlying medical conditions prior to contracting the CoronaVirus.

What do we mean by Underlying medical conditions???? 

If you have a blood disorder.... like sickle cell disease... or ... you have chronic kidney disease.... you're currently receiving chemotherapy or radiation. You may have congestive heart failure or coronary artery disease.

You may have chronic asthma or chronic obstructive pulmonary disease or you may need oxygen at home.

All of these conditions..... as well as many more..... may raise your risk of contracting COVID-19. You may NOT contract the virus. Just be more cognizant of your surroundings and who you are in contact with.

What do you do if you believe you have symptoms of the COVID-19?

  1. NUMBER 1…. Call your Primary Doctor. Speak with the Nurse or Physician’s Assistant. Tell them your symptoms and they will advise you of what to do.

 IF You CANT get Through to your Doctor…….

  1. If you have a Medicare Advantage Plan…… the Plan most likely has a 24 hr. Nurse’s Line.  CALL THEM!!  Tell the nurse  your symptoms. They will advise you.
  1. Call your STATE Health Department for Advise. Each State has an information line dedicated to the COVID-19 Crisis and will be able to assist you with answering question.
  1. If you have any severe symptoms….. as in Difficulty Breathing, fluid in your lungs, High fever of over 104 degrees…. CALL 911!

If you do have symptoms, and your doctor wants you to have the test to confirm COVID-19…. Where do you go??

According to the FDA….. here is the current list of laboratories across the U.S. that will be offering testing for the COVID-19 very soon

 Advent Health Laboratories

 Lab Corp

Quest Laboratories

As well as many other public health, university and private labs will be available on the FDA list of laboratories to test for the COVID-19.

Medicare IS Covering the Test for COVID-19 as a Preventative Diagnostic Test….and therefore ….. you will have NO COPAY when you take the test.

There are currently  TWO Testing Codes for the COVID-19 Test

  1. Is for having the Test at a Public Health Lab ( your local community Health Department) which is U0001
  2. The 2nd is for having the test at a commercial or private lab (like Lab Corp) which is U0002.

If you are diagnosed with COVID-19, self-quarantine yourself in your home, away from your family members and pets, until you have tested negative.

We ALL need to SELF-Police ourselves and HELP STOP the Spread of COVID-19….. so we can curtail the spread and help stop the pandemic.

 Remember to Drink lots of fluids….. eat plenty of chicken soup and crackers ….. and get lots of REST!!

The Medicare Nation

You can go to the Center for Disease Control website for daily updates on the Corona Virus 19 situation ….. go to….. www.CDC.gov

You can also go to the World Health Organization website…. Go to …. www.who.int

AND…. PLEASE go to your STATE”S Health Department website for local information by “Googling” your State.

 That’s all for today Nation. Call your Parents….. Make sure they’re ok and help them subscribe to Medicare Nation…. So they can hear this episode as well as over 100 other episodes about Medicare and it’s Resources.

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 13 2020

31mins

Play

Medicare NOW Covers Acupuncture

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Hey Medicare Nation!

www.TheMedicareNation.com

It's still January...but February is right around the corner. Spring WILL come. I promise!

Let me give you some good news!

Medicare is now covering Acupuncture!

As of January 21, 2020, The Center for Medicare & Medicaid Services (CMS), will cover acupuncture for "Chronic Low Back Pain."

Let's look at the coverage in the Medicare National Coverage Determination Manual.

Section 1862(a)(1)(A) of the Social Security Act 

Up to "12" visits in 90 days are covered for Medicare Beneficiaries under the following circumstances:

a. Chronic Low Back Pain which lasts "12 weeks or longer,"

b. the Chronic Low Back Pain is "non-specific," in that it has NO identifiable systemic cause (NOT associated with metastatic, inflammatory, infectious, disease).

c. the Chronic Low Back Pain is NOT associated with surgery

d. the Chronic Low Back Pain is NOT associated with pregnancy.

An ADDITIONAL "Eight" (8) sessions WILL be covered for those patients demonstrating an improvement.

No more than "20" acupuncture treatments may be administered annually.

Treatment MUST be discontinued if the patient is NOT improving or is regressing.

The Acupuncture must be Administered under the supervision of a doctor of medicine or osteopathy.

Need more information?  Check out our website www.TheMedicareNation.com

What plans cover Acupuncture?

Acupuncture for Chronic Low Back Pain, will be covered under ORIGINAL Medicare. 

If you present your Medicare ID Card to providers as your Health Insurance..... You may start utilizing this treatment now.

If you present your Medicare ID Card, as well as a Medi-Gap (Medicare Supplement) Plan..... You may start utilizing this treatment now.

If you have a Medicare Advantage Plan, you need to check your Summary of Benefits Book under your plan, to see if they cover Acupuncture. If you can't find it.... call the customer service number on the back of your ID Card and ask the representative.

Acupuncture is NOT covered under Medicare Part D. Part D is ONLY for Prescription Drug Coverage.

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Diane Daniels                                                                            Medicare Consultant

Support@TheMedicareNation.com

Jan 24 2020

16mins

Play

Unhappy With Your Medicare Advantage Plan? Change it Now!

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Hey Medicare Nation!

www.TheMedicareNation.com

It's 2020!  Love the sound of that!

Right now...... the Medicare Advantage Open Enrollment Period is in full swing.

If you are on a "Medicare Advantage Plan," you have the opportunity to make a ONE TIME change, between January 1st through March 31st.

You can change from one Medicare Advantage Plan to another Medicare Advantage Plan.

You can "disenroll" from the Medicare Advantage Plan you're on and go back onto "Original Medicare." With Original Medicare, you can add a stand-alone-prescription drug plan and ..... you can enroll into a Medicare Supplement Plan (aka Medi-gap) to help defray the costs of Original Medicare.

Here are options you can do during the Medicare Advantage Open Enrollment Period: 

  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely

I'm adding the EXACT language from the Medicare Managed Manual, regarding the Medicare Advantage Open Enrollment Period.

30.5 – Medicare Advantage Open Enrollment Period (MA OEP) 42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019) During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP. This chart outlines who can use the MA OEP and when: Who can use the MA OEP: MA OEP occurs:

Individuals enrolled in MA plans as of January 1 – March 31 New Medicare beneficiaries who are enrolled in an MA plan during their ICEP The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to: • MA-PD • MA-only • Original Medicare (with or without a stand-alone Part D plan) The effective date for an MA OEP election is the first of the month following receipt of the enrollment request. NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

You may also go onto Medicare.gov to view information on the Medicare Advantage Open Enrollment Period.

If you decide to make a change during the MA OEP, you will be "locked-in" to the new plan, until the next enrollment period.... which is....the Annual Enrollment Period, from October 15th through December 7th.

You may also make a change to your plan if you have a "special circumstance."

These are listed under the "Special Election Periods" for Medicare on Medicare.gov

You can also LISTEN to my previous show on Special Election Periods..... Episode 051, which was published on July 29, 2016. The episode is titled..... "Special Election Period Q & A"

I go into detail about the Special Elections available.

www.TheMedicareNation.com

Remember Medicare Nation listeners........ an "Insurance Agent," is NOT allowed to "solicit" you during the Medicare Advantage Open Enrollment Period. 

There are strict Medicare regulations regarding this.

YOU must make the first move in contacting or telling your "Agent" or Medicare Specialist, that you are unhappy with your current plan.

No one should be calling you, texting you, emailing you ..... or worse...... knocking on your door, telling you about the Open Enrollment Period. If someone does...... tell them to "Take a Hike!" You don't need a dishonest person like that helping you with your Medicare needs!

If you need help finding a new plan during the OEP, contact you're Medicare Advisor.

If you are all set with your Medicare Advantage Plan for 2020, You don't need to do anything! Just enjoy your family, friends and activities! 

Thank you for listening to Medicare Nation!

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

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

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

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

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

Contact me on my website - www.TheMedicareNation.com

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

Thanks again for listening!

Diane Daniels                                                                          Medicare Consultant                                                                  Medicare Nation LLC.

Jan 03 2020

13mins

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2020 Medicare Changes Announced!

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Hey Medicare Nation!

CMS just announced the 2020 Medicare Part B Premium increase!

CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible.

Here's a look at what's changing in 2020:

Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act. 

SOCIAL SECURITY

Increase:    1.6%  (Avg $24 more a month)

Average Monthly SS Check $1,503.00  

2020 - PART A DEDUCTIBLE AND COINSURANCE

Inpatient Hospital Deductible:                       $1408.00

Daily Coinsurance Days 61-90:                    $  352.00

Daily Coinsurance-Lifetime Reserve:           $  704.00

Skilled Nursing Facility-Days 21-100:           $  176.00

2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE

Standard Monthly Premium:                 $ 144.60  ($9.00 More)

Annual Deductible:                                $ 198.00

It's a great time to review your plan for 2020.

Is it the right plan to fit your unique needs?

If so........ keep it!

If not....... change it!

I am available to assist you with your Medicare Plan choices for 2020.

If I can answer your email in one paragraph or less, I WILL answer your question for you!

If the answer to your question requires any research or my response is longer than one paragraph..... I will let you know that you will need to hire me to answer that question.

If you live outside of Florida, you can hire me as your consultant at a rate of $200.00 an hour ( The hourly rate is going up to $250.00 an hour, starting January 1 2020).

If you are a Florida resident, I can assist you in enrolling into the plan that fit's your unique needs at no additional charge. I will receive a commission from the insurance carrier once you are enrolled. The commission is regulated by Medicare.

The Annual Enrollment Period ends December 7th, so make sure you do your "due dilligence" and find the plan that works for you!

Until next time..... Have a Happy, peaceful & prosperous week!

Diane Daniels

Medicare Consultant

855-855-7266

Nov 09 2019

21mins

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Part D Prescription Drug Plan Info For 2020

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Hey Medicare Nation!

www.TheMedicareNation.com

It's October! That means it's Medicare Time!

The Annual Enrollment Period is just around the corner. Did you receive your "Annual Notice of Changes (ANOC)" for your Medicare Advantage Plan or Prescription Drug Plan?

If not....contact your plan and request the ANOC.

Today......I want to talk with you about Part D Prescription Drug Coverage for 2020!

Medicare has set the maximum Part D Deductible for 2020 at $435.00.

Medicare Advantage Plans and Stand-Alone Prescription Drug Plans have the option to charge the maximum deductible amount of $435.00......

or.......

They can eliminate the Deductible altogether....

or......

They can charge an amount in between.

You MUST do your "Due Dilligence" in determining which Prescription Drug Plan will fit your unique needs for 2020.

Contact your Medicare Specialist and request their assistance in finding a Prescription Drug Plan for 2020.

If you have a question about Medicare or your Prescription Drug Plan....

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

If I can answer your question in ONE Paragraph, I will answer your question!

If I cannot ...... I will request you hire me as your consultant.

I currently charge $199.00 an hour for my consultation services. 

I always do my best to answer your questions in ONE paragraph.

The "initial coverage period (ICP)" for Part D, has a threshold of $4,020.00

When you hand in a prescription, the total amount of the prescription is applied towards the ICP.

If you have a Deductible, that is applied towards the ICP too.

When the total amount of your prescriptions reaches $4,020.00..... you will now enter a new phase called the "coverage gap."

In this stage.... you will now pay 25% of generic drugs....

and you will pay 25% of brand name drugs.

If you reach $5,018.75 you will enter the next stage, which is called....

The "Catastrophic Stage."

In the Catastrophic Stage, you will now pay a 5% co-insurance or $3.60 for Generic Drugs..... or....

$8.95 for Brand or non-preferred Drugs....

which ever is a greater amount.

You will remain in the Catastrophic Stage until your out-of-pocket spending reaches $6,350 or.....

when the ball drops on New Year's Eve!

I know prescription drugs can be very expensive!

There are programs available for those of you with lower incomes.

The program is called "Extra Help," or "Low Income Subsidy."

To apply for Extra Help, go to the social security website -

www.socialsecurity.gov/extrahelp

If your individual income is less than $1,562 a month, you would qualify for the LIS program.

If your income is more than $1,562 a month, but is less than $1,900 a month....APPLY!

You have nothing to lose! All they can say is No!

You can also appy for the "Medicare Savings Program" If you qualify, CMS will pay for your Medicare Part B Premium. Depending on your qualifications, CMS may pay your premium, deductible and co-insurance.

Apply for the Medicare Savings Program here:

https://www.medicare.gov/Contacts/#resources/msps

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Diane Daniels

Oct 04 2019

34mins

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How Do I Get Drugs During A Weather Emergency

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Hey Medicare Nation!

www.TheMedicareNation.com

How Do I get treatment & prescriptions during a weather emergency?

Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety.

What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency?

Or….

What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency?

Let’s take a look at these questions for you.

After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States.  Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian.

What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration.

For example…….

You evacuated your home in Savannah Georgia, to go stay with your relatives in Michigan. Prior to evacuating your home, you were receiving home health care for physical therapy…due to a sprained ankle.

If you are on Original Medicare, you can contact “Any” home health agency that accepts Medicare to re-start your physical therapy at your relative’s home. They should be able to contact Medicare to get copies of the orders you had for the Physical Therapy.

If you’re on a Medicare Advantage Plan, you will need to contact your Plan carrier…… advise them you evacuated from a Public Health Emergency area and that you need to “Resume” physical therapy at home ASAP. The plan should contact a home health care vendor in the area you’re temporarily staying in, to resume your physical therapy.

If you have a Medicare Specialist, call them! You WILL need their help in expediting the process. Remember…… MILLIONS of people have evacuated coastal areas! Don’t Delay!!! If you need to use your Medicare benefits…. CALL as soon as possible.

For Prescription Medications……let’s say in the stress of having to “evacuate,” you forgot all your prescriptions at home.

under a Medicare Advantage Plan, call your carrier & tell them what happened. You should be able to get a “Refill” under the “Emergency Waiver,”  for most prescriptions. If you need an Extension for 60 – 90 days for your prescription, due to being out of the area, call your plan and ask them if they “offer” extended day prescriptions.

If you’re on an “opioid” prescription……… call your plan & advise them of your situation. Hopefully, you can get a refill…. for at least a day…. or two…… under the waiver, until you can be seen by a doctor in the area you’re temporarily staying at.

Your carrier will tell you which Pharmacy is “IN” network…. Where you’re staying.  If there is NO pharmacy “In” Network where you’re staying, ask the carrier if they will “reimburse” you for the cost of the prescriptions.

You will need a receipt with the Pharmacy name,  prescription name, and the price you paid for the prescription on the receipt to submit to your Medicare Advantage Carrier for reimbursement.

If you had Durable Medical Equipment …… Orthotics, Prosthetics,  or Oxygen Supplies for example….. that was lost, destroyed, “irreparably damaged” ….. or otherwise rendered unusable…… you should be able to replace it from a vendor in the area you’re staying….. with the “flexibility” to WAIVE the replacement requirements that are normally in place.

If you are on a Medicare Advantage Plan, contact your carrier for assistance in getting a replacement…. And advise them the “Blanket Waiver” is in place.

They will assist you in finding a local vendor to “Replace” your equipment.

 For those of you needing to stay at a “Skilled Nursing Facility,”Under “Normal” Circumstances…… if you or a loved one needed to enter a “Skilled Nursing Facility,” you would be required to have a “ 3 Day Prior Hospitalization” … prior to entering the Skilled Nursing Facility.

Under the “Blanket Waiver,” the 3 Day prior hospitalization is “waived,” so that you can enter the Skilled Nursing Facility without further delay.

This rule would be in effect “temporarily,” for those who are …… “ evacuated, transferred, or otherwise…. “dislocated” as a result of the emergency.

So….. if you “evacuated” your home in Puerto Rico, Florida, Georgia or South Carolina, due to Hurricane Dorian….. and let’s say you’re temporarily staying with relatives in Pennsylvania………and you need to enter a Skilled Nursing Facility……you would be able to enter the facility without the 3 day prior hospitalization.

If you are on a Medicare Advantage Plan, you must contact your carrier to assist you in determining which “Skilled Nursing Facilities” has room for you to be admitted into.

These are examples of how Medicare “requirements” are more flexible during a Public Health Emergency WITH a “Blanket Waiver.”

How long does the Blanket Waiver Last? Until Secretary AZAR signs an order stating the Public Health Emergency is over.

NOW….. let’s take a look at how FEMA affects enrollment into Medicare.

FEMA… which stands for the Federal Emergency Management Agency, also declared emergencies in Puerto Rico, Florida, Georgia, South Carolina AND the Virgin Islands (which are St. Croix, St. John, St. Thomas AND Water Island) ….., which creates a “Special Election Period” for Medicare Beneficiaries, who needed to enroll in a Medicare Plan during that time, but were unable to ….. due to the effects of Hurricane Dorian.

This means if you needed to enroll in Medicare, or into a Medicare Advantage Plan for September 1st…….. you will be given a Special Election Period to do so….

Under the Emergency “Weather Event.”

So….if you need to enroll into a Medicare Advantage Plan…..OR…. a Stand-Alone Prescription Drug Plan…. you can do so, most likely through the end of October…… or even November in South Carolina & Georgia, under the FEMA Emergency.

You can call Medicare at  800 – 633 – 4227 or your Medicare Specialist for more information.

If you feel you are overly “stressed” with all the information on TV & social media, about Hurricane Dorian…… #1 ….. STOP watching the news continuously!  Listen to some music…. Read a book….. play a board game. Go out for a walk.

Continuously Watching the news about the weather is the worst thing you could do!

If you need to speak with someone, you can call the “Disaster Distress Helpline.”

Call  800 – 985  - 5990 to connect with a trained counselor, who can assist you with your distress.

You can even “TEXT” ….. TALKWITHUS   type the letters all together and send it to…. 66746.

You can also go online to get more Public Health & Safety info by going to

https://www.phe.gov/Dorian

Finally….. if you would like to help those affected by Hurricane Dorian in the Bahamas….OR ….any of the other impacted States…..

Call your local TV Station or go onto their websites to find information on how to volunteer or donate supplies.

If you’d like to “donate” money to a cause…..

For Animals. Go to the Humane Society of the United States website…

HumaneSociety.org/Disaster-Relief

The Humane Society is evacuating animals form Animal Shelters across Florida and the other States. They have already helped transport almost 100 animals here in Florida, that they will place in “safe shelters,” with the hope of being put up for adoption.

If you’d like to contribute to a Humanitarian Charity….. or one that is specifically helping those in the Bahamas…… go to the Charity Navigator website & they have a list of highly ranked charities that are providing relief.

Go to   http://charities.foundation/dorian

To donate to one of these funds.

That’s all for this special show and I wish everyone out there, in the path of Dorian…… that you & your loved ones are safe.

Till next time....

Have a Safe & Peaceful week!

Diane 

Sep 04 2019

20mins

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With Two Shingles Vaccines Available, Which One Should I Get?

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Hey Medicare Nation!

www.TheMedicareNation.com

If you are turning 65 or still working on  an employer group insurance plan, you may need assistance in finding the Medicare plan that fits YOUR unique needs.

You may have a loved one in a nursing home or in an assisted living facility, who is not receiving proper care.

Call me! You can hire me as a consultant to assist you with Medicare issues!

Call 855-855-7266

or eMail me at Support@TheMedicareNation.com

Tell me the situation and I'll personally get back to you!

Today, I am speaking to you about Shingles Vaccines!

There are two Shingles vaccines licensed in the United States available.

The first one is the "Zoster Vaccine Live," also known as "Zostavax." Many of you probably have received this vaccine, which is a "Live" vaccine and the CDC reports it as being 51% effective against Shingles.

The second vaccine is the "Recombinant Zoster Vaccine," also known as "Shingrix" has been used since October of 2017.

The CDC reports the Shingrix vaccine is about 91% effective against Shingles.

The cost of the Shingles vaccine is covered under Medicare "Part D."

You can look up the Zostavax vaccine or Shingrix vaccine in your plan's formulary, or you can call the customer service number on the back of your identification card.

Every plan can have a different cost for either vaccine, so it is important you check with your plan, prior to getting the vaccine.

There are side effects that can be associated with either vaccine.

Go to the CDC website to learn more about Shingles and the vaccines 

www.cdc.gov/vaccinesafety

Learn more about how Shingles is transmitted, the sign & symptons and treatment for Shingles here:

www.cdc.gov/shingles

I'm not a doctor!

If you have any health related questions regarding shingles and/or vaccines, due your own due diligence or contact your health care provider for more information.

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Aug 02 2019

21mins

Play

CMS Approves Ambulatory Blood Pressure Monitors

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Hey Medicare Nation!

www.TheMedicareNation.com

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

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

Use the "Purple" colored icon on an Apple phone or ....

download Stitcher, Himalaya or Player FM when using Android phones.

Search for "Medicare" and "click" on the Medicare Nation logo.

You'll see the "subscribe" button on the page. "Click" subscribe and they'll get the NEWEST Medicare Nation episodes delievered to their phone.

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

CMS Decision Summary Ambulatory Blood Pressure Monitoring  Devices

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

 What is hypertension (high blood pressure)?

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

The blood pressure reading is the result of two forces:

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

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

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

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

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

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

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

  1. General

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

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

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

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

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

  1. For beneficiaries with suspected “white coat hypertension,” which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm … but less than 160 mm … or diastolic blood pressure greater than 80… but less than 100… on two separate clinic/office visits …..with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are 140/90 on at least three separate clinic/office visits with two separate measurements made at each visit;

    1. At least two documented blood pressure measurements taken outside the office which are

Jul 05 2019

21mins

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CMS Slaps Agewell NY With Civil Money Penalty

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Hey Medicare Nation!

www.TheMedicareNation.com

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

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

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

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

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

Enrollees were affected in the following area:

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

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

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

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

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

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

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

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

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

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

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

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

or

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

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

Find Your Local SHIP

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

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

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

Support@TheMedicareNation.com

or 

call me at 855-855-7266

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

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

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

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

Give Medicare Nation a * 5-Star Review on iTunes!

The more reviews we get, the more people can find the show!

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

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

Thanks so much for listening!

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

I appreciate your Support!

Diane Daniels

Jun 21 2019

17mins

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Is ColoGuard Covered Under Medicare?

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Multi Target Stool DNA Test  vs. Fecal Occult Blood Test

 Hey Medicare Nation!

www.TheMedicareNation.com

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

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

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

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

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

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

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

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

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

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

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

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

Medicare Part B offers TWO Preventative Screening Tests

The First…. Is a Fecal Occult Blood Test

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

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

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

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

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

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

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

There are several types of Fecal Occult Blood Tests,

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

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

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

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

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

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

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

OR……..

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

This type of test ISN’T ALWAYS accurate.

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

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

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

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

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

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

ColoGuard …….   addresses several barriers to colorectal screening.

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

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

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

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

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

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

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

ALSO    YOU NEED TO BE…..

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

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

OR……

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

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

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

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

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

Support@TheMedicareNation.com

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

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

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

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

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

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

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

Diane  

Jun 14 2019

18mins

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Are Reverse Mortgages A Scam? MN 091

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Hey Medicare Nation!

www.TheMedicareNation.com

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

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

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

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

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

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

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

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

Here are the highlights of my interview with Michael Banner:

* What is a Reverse Mortgage?

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

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

*  What is a Non-Recourse Loan?

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

*  What is No-Debt Service?

*  Is a Reverse Mortgage Safe?

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

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

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

Want to learn more about Reverse Mortgages?

Reach out to Michael Banner at :

MBanner@PMAnow.com

Website for Professional Mortgage Alliance, LLC

Professional Mortgage Alliance

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

Where to purchase Michael Banner's Book -

MBanner@PMAnow.com

The 62 Who Knew Show

www.WeBeamTV.com

Have Questions About Medicare?

Send me an email to - Support@TheMedicareNation.com

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

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

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

Thanks for listening to Medicare Nation!

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

Give us a Rating & Review on iTunes!

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

www.TheMedicareNation.com

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

Diane Daniels

May 31 2019

43mins

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What's The Difference Between Medicare Supp Plan "G" & Plan "N"

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Hey Medicare Nation!

www.TheMedicareNation.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ASK BEFORE YOU SEE A DR or RECEIVE TREATMENT!

Prices for Medicare Supplements VARY by zipcode!

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

HAVE a Question for ME?

Send it to me at  Support@TheMedicareNation.com

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

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

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

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

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

http://nation.reviews/medicare8

Thanks for listening to Medicare Nation!

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

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

Teach people how to "subscribe" to Medicare Nation!

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

May 17 2019

15mins

Play

MN089 What's The Difference Between Plan F & High Deductible Plan F

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Hey Medicare Nation!

www.TheMedicareNation.com

More than 10,000 people a day are turning 65!

While qualifying for Medicare Part A and Part B, Medicare Beneficiaries are VERY confused as to what type of plan to enroll in, to "supplement" Original Medicare.

By zipcode, a Medicare Beneficiary may have over "100 Plans" to choose from to help supplement their Original Medicare.

That's an ENORMOUS amount of research to do!                  If you have the time and enjoy doing all that research.......go for it!

If you're like most Medicare Beneficiaries, you are retiring and you want to ENJOY LIFE! You don't want to "waste" time researching Medicare Plans.

Call a "Medicare Consultant" or "Medicare Specialist" to assist you in finding the plan that will fit YOUR unique needs.

How do you do that? 

"Google" "Medicare Consultant" or "Medicare Specialist" and add your city or zipcode to that search.

As an example, you would search....Medicare Consultant Tampa FL......or........Medicare Specialist Dallas TX.......

Google will then populate the "Ads" first. Businesses PAY to be on the top of the 1st page of Google.

SCROLL down past the "ADS." Just because a business "Pays" for an ad DOES NOT mean they are the best option for you.

You will start seeing local businesses and names of Medicare Specilaists. 

You should be checking out these "Brokers" and "Medicare Specialists" or "Medicare Consultants."

I'm speaking specifically about Medi-Gap Plan F and the High Deductible F Plan.

The Supplement F Plan to Medicare, is an Insurance Policy you take out on yourself.

Medi-gap Plans are NOT part of Medicare. Medi-Gap Plans are an insurance policy that an Insurance Carrier sells to you.

You are "purchasing" a policy, where you pay a monthly premium to the Insurance Carrier to protect some or all of  your out-of-pocket costs associated with Medicare.

Medi-Gap "F" Plan pays the out-of-pocket costs YOU are responsible for. The "F" Plan will pay your "medically necessary" out-of-pocket costs.

Plan F pays for your Part A In-Patient Hospital Deductible. Plan F pays your co-pay for being in a Skilled Nursing Facility.

Plan F pays your Annual Part B deductible and Plan F pays your 20% co-insurance under Part B.

Plan F pays for all of this, for one monthly premium.

ALL Medicare Plan F Plans have EXACTLY the same benefits. It doesn't matter if you live in Tampa, FL......San Francisco, CA.....or Salt Lake City, Utah.....The BENEFITS under Plan F are the SAME!

What IS different..is the MONTHLY PREMIUM!

In YOUR ZipCode.......there may be up to 50 DIFFERENT Insurance Carriers that offer Plan F....EACH one of those Insurance Carriers offer a DIFFERENT Premium for the SAME Plan F Plan.

You should find the LOWEST Monthly Premium from the Insurance Carrier that has an "A" Financial Rating.

An "A" financial rating means the company WILL pay your claims. That's the Insurance Carrier your looking for.

Plan F is the "Peace of Mind" Medi-Gap Plan. There is NO Network of Doctors and Facilities....because......Plan F is NOT part of Medicare. 

Original Medicare has NO Network.....Original Medicare allows you to see ANY Doctor....or go to ANY Medical Facility in the U.S. that ACCEPTS Medicare!

YOUR Health Insurance IS......Original Medicare.....NOT your Plan F!

So.....if you're looking for a Medicare Supplement Plan that will cover ALL your Medicare Necessary out-of-pocket costs...Then Plan F is for you.

Now.....let's take a look at the High Deductile F Plan.

The High Deductible F Plan.....has a DEDUCTIBLE!

For 2019.....the annual deductible is $2,300.00

That means......you WILL pay-out-of-pocket until......you reach the $2,300 DEDUCTIBLE. When you reach the $2,300 deductible, the plan will then pay all your "medically necessary" out-of-pocket costs that you are responsible for under Medicare, for the remainder of the calendar year.

You will NOT pay the "Cash" price......you will be paying the Medicare Allowable price....BIG difference.

If you go to a cardiologist, and the visit under Medicare, costs a total of $150, Medicare will pay 80% of that amount.... which is $120. you would pay the remaining 20%, which $30.

You would continue to pay out-of-pocket until you reach $2,300.

If you don't see many doctors or have any diagnostic tests, you will ONLY pay for the services you use.

For a healthy person, this could be a very viable option.

If you are a person with a chronic illness, let's say for example...Diabetes......Asthma.....or high cholesterol with high blood pressure.....this plan may NOT be a good choice for you.

It's important for you to take into consideration your own health history, what medications you take, your financial status and what doctors you see, before enrolling in a Medicare Plan.

Next time, I will go over the differences between Plan G and PLan N.

If you are turning 65....or.....you are getting ready to come off of your employer plan and you need to figure out what Medicare Plan will suit your needs best.....

Contact Me!

Reach out to me by email -

Support@TheMedicareNation.com

or.....

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

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

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

for more information.

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

Diane Daniels

Apr 15 2019

34mins

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Does Medicare Pay For Emergency Care While Traveling?

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Hey Medicare Nation!

www.TheMedicareNation.com

It's almost Spring time! For many people, this has been a terrible winter. Many Medicare Nation listeners have been emailing me to find out if Medicare covers "Emergencies" while traveling across the U.S. or abroad.

That's a great question!

Original Medicare and Medicare Advantage Plans Do cover "Emergency Care" AND  Urgent Care ANYWHERE in the United States and it's Territories.

An "Emergency" is Life-Threatening. An example would be if you were having chest pain and you believed you were having a heart attack. In this situation.....you would go to the nearest hospital to seek emergency care.

Even if it turns out you were diagnosed with "heart burn," Original Medicare AND Medicare Advantage plans will cover the medically necessary treatment for this situation because you believed you were in a "life-threatening" situation.

"Urgent Care" is defined by Medicare as:

Care that you get outside of your Medicare health plan's service area for a sudden illness or injury that needs medical care right away but isn’t life threatening. If it’s not safe to wait until you get home to get care from a plan doctor, the health plan must pay for the care.

An "Urgent Care" example would be if you were walking in St. Peter's Square at the Vatican, and you slipped on a banana peel and fell onto the ground, breaking your ankle. That's an injury that isn't life threatening, but requires immediate medical care.

So......if you are traveling ANYWHERE in the U.S. or it's Territories, AND you have an Urgent Care or Emergency situation.....you can go to the nearest hospital or Urgent Care Center to receive care AND it will be covered by Original Medicare and Medicare Advantage Plans.

If you are traveling outside of the U.S. Medicare generally DOES NOT cover emergencies or urgent care needs.

There are a few circumstances where Original Medicare WILL cover Emergency Care AND Urgent Care.

www.TheMedicareNation.com

1.  If you are on a CRUISE and you require EMERGENCY care from a doctor who is stationed on the ship while the ship is in a U.S. port.....Your Emergency Care WILL be covered by Original Medicare.

2. If the ship is Departing or Arriving to/from a U.S. port within 6 hours and you have a medical emergency and require to be treated by the ship's doctor......Your Emergency Care will be covered by Original Medicare.

3. If you are in Alaska and you are traveling directly to another State without unreasonable delay, and you require Emergency Care at a hospital in Canada, because it was the closest hospital at the time of the emergency......Your Emergency Care will be covered by Original Medicare.

If you have a "Medicare Advantage Plan," you may have coverage for Emergency and/or Urgent Care Coverage on your plan.

You must do your own due dilligence to understand the benefits of your plan while you are traveling abroad.

Some Medicare Advantage Plans have a deductible for emergency care outside the U.S.

Some Medicare Advantage Plans have a deductible and a co-pay for emergency care outside the U.S.

There is an annual maximum out-of-pocket amount for your plan. Some are around $1,500.00 all the way up to $6,700.00 

READ Your Plan's EVIDENCE OF COVERAGE Booklet.

Some of you have "Medi-Gap" or Supplement to Original Medicare Plans.

Plans "C" through "G" and also plan "M" and "N" have coverage for Emergency Care while traveling abroad.

Some Medi-Gap plans have a deductible. Some plans have "Maximum Lifetime Amounts." It is important to READ your Medi-Gap Policy to determine coverage while traveling abroad.

Travel Insurance

www.TheMedicareNation.com

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

I use these different websites to look for policies:

1. www.TravelGuard.com

2. www.AllianzTravelInsurance.com

3. www.TravelInsurance.com

Cost will depend on -

a. Total Cost of the Trip

b. Your Age

c. What country you're visiting

d. Types of coverage you're adding (ex: Air evacuation, cancel for any reason etc.)

If you have ANY questions, and I can answer your question in ONE paragrapn, send them to me by email.

Support@TheMedicareNation.com

If I need to do research or write more than one paragraph, I will let you know that I am available for a consultation to solve your problem at $150.00 an hour.

Reach out to me.....I answer all emails personally!

Thanks soo much for listening to Medicare Nation!

I appreciate your time and I love to educate you on all things Medicare!

Diane Daniels

Mar 15 2019

23mins

Play

Medicare Advantage Open Enrollment Period is NOW!

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Hey Medicare Nation!

htpps://www.TheMedicareNation.com

Today, I'm going to speak with you about the Medicare Advantage Open Enrollment Period.

CMS...Centers For Medicare & Medicaid Services has issued a new regulation that began January 1, 2019.

Under 42 CFR 422.62(a)(3)....CMS published the following:

During the MA OEP, MA plan enrolles may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

Who can use the Medicare Advantage Open Enrollment Period?

1. Individuals enrolled in Medicare Advantage plans as of January 1.

2. New Medicare beneficiaries who are enrolled in an Medicare Advantage plan during their Initial enrollment into Medicare

      a. The month of entitlement to Part A and Part B up until the last day of the 3rd month...after the month of their entitlement to Part A and Part B.

Can Medicare Advantage beneficiaries add or drop their Part D coverage during the Medicare Advantage Open Enrollment Period?

Yes. Individuals who are already enrolled in a Medicare Advantage Plan with Prescription Drug Coverage can switch to:

a. Another Medicare Advantage Prescription Drug Plan

b. A Medicare Advantage Plan ONLY (with NO prescription drug coverage)

c. Go back to "Original Medicare" and add a stand-alone prescription drug plan or don't add one.

d. Go back to "Original Medicare" and add a Supplement to Original Medicare Plan. 

How long is the Medicare Advantage Open Enrollment Period?

It runs from January 1st through March 31st each year.

How many times may a Medicare Beneficiary change Medicare Advantage Plans during the MA OEP?

A Medicare Beneficiary may make only ONE change during the MA OEP.

If you have ANY questions regarding the MA OEP....

and you would like me to answer it in ONE paragraph, send me an email to 

Support@TheMedicareNation.com

I ALWAYS answer emails if I can answer them in ONE paragraph.

If I can not answer your question in one paragraph, you may hire me and I charge $150.00 hr.

I can answer ANY question about Medicare and I can solve ANY problem you have with Medicare.

Looking for more information on Medicare?

Go to www.TheMedicareNation.com  website.

Looking for a SPEAKER at your conference or event?

Just click on the "Contact" tab on the website.

Thank you so much for listening to Medicare Nation. I appreciate it very much!

If you feel I'm delivering important content, I would love it if you would leave a rating & review on the Apple Podcasts review page (formerly iTunes).

Until next time Nation.....I want each of you to have a Happy, Peaceful and Prosperous week!

Diane Daniels

Jan 11 2019

18mins

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Valuable information

By M.C Laubscher - May 14 2016
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Fantastic resource for everything you want to know about Medicare!

Wow very useful

By Jr0789535 - May 14 2016
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Highly impressed. Great show