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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

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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

139 Ratings
Average Ratings
133
2
2
0
2

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

Listen to:

Cover image of Medicare Nation

Medicare Nation

Updated 3 days ago

Read more

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

2016 Medicare Changes You Need to Know About Now!

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Welcome Medicare Nation! Everyone keeps asking me about the changes to Medicare for 2016. There are quite a few changes, so today I will focus on the biggest ones you want to know about today.

How much will you pay for Medicare Part B (Outpatient Services)?

There is no COLA (Cost of Living Adjustment) for 2016. The Hold Harmless Rule comes into play. If there is no COLA, then there can be no increase in Medicare Part B. 

For everyone who is already on Medicare and receiving SS benefits, your Part B stays the same at $104.90. That’s 75% of the people that are on it. 

If you are turning 65 in 2016 and you are on Medicare, your premium will increase. If you delayed taking SS benefits because you continued working, your premium will increase. If you are on Medicare and Medicaid, your premium will go up. You may qualify for the state reimbursement for Medicaid costs. New premiums will be $121.80. Recommendations were that Medicare Part B premiums should be up around $159, but Congress limited the increase to $121.80. In actuality, Congress gave you a loan for the difference between $121.80 and $159, and charged you a fee for the loan until it can be repaid.

Over $65 Billion of Medicare dollars is lost to fraud. Instead of worrying about the fraud, your politicians gave you a loan! Oy Vey!

If you make over $85K in income, your premium will increase to a different amount, which you can reference on the website.

Medicare Part D (Drugs) - Medicare Advantage Plan majority will have drug coverage included already.

For 2016, know your deductible situation (max $360). Some have them and you will have to pay out first, and others will only be triggered with a brand name drug.

The Donut Hole - You don’t want to be in this category. $3310 is the maximum expense for this category. When you add up the amount of money you have paid and the plan has paid, and it exceeds $3310 and now you are in the donut hole. 

Now the government wants you to start paying more for your coverage. The new threshold is $4850 for this level. You will now pay 45% of the cost of the brand name drug and you will pay 58% for a generic drug. What you pay out of pocket plus a 50% manufacturer discount. Once you meet $4850, you now fall into the catastrophic coverage phase.

Catastrophic Phase - Last through the end of the calendar year. You will pay 5% of the cost of the drug or $7.40, whichever is higher. For generics you pay 5% of the cost of the drug or $2.95, whichever is higher.

The slate gets wiped clean as of Jan. 1 and your classification starts all over again.

Medicare Payout for Providers:

For 2016, payments will be reduced by 30%

They are looking at tying procedures together when there are multiple issues stemming from the procedure. Payment will be reduced when you are re-admitted to the hospital within a certain timeframe.

When a patient contracts an infection during a hospital stay, the payments will also be reduced.

They are looking at “Value over Volume”.

If you have been on Medicare for a year, you can have an annual Wellness medicare checkup. This isn’t your annual physical, but a Wellness Medicare Exam.

From now thru Feb. 14, you can drop your Medicate Advantage Plan and go back to original Medicare and have coverage for Part A and Part B. Then you would need to purchase Part D separately.  

  • No premium for Part A (overnight stays in any type of facility) $1288 is the amount you pay for 60 days. Day 61-90, you pay an additional $322/day and after day 90, you pay $644/day. Every person has 60 lifetime reserve days for one time use only.
  • In skilled nursing 0-20, 21-100 (max) you pay $161/day.
  • Part B has a one time deductible of $166, and then 20% of Medicare allowable cost. Find out your co-insurance payment prior to the appointment.

Stand Alone Prescription Drugs Plans:

  • All have premiums
  • Check for the deductibles too
  • You can apply for a supplement for Medicare to help cover the cost of Original Medicare

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

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Jan 22 2016

37mins

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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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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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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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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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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

Play

Broken Bones Can Hurt You! How to Prevent Osteporosis

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

  • Can you define osteoporosis for Medicare Nation listeners?

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

  • How prevalent is osteoporosis in the US?

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

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

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

  • What are the risk factors for osteoporosis?

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

  • How is osteoporosis diagnosed?

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

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

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

  • How is the medical community treating osteoporosis?

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

  • What are the options for osteoporosis medications?

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

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

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

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

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Feb 12 2016

27mins

Play

Is Medical Marijuana the Drug of Choice For Pain? MN083

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Hey Medicare Nation!

Medicare Nation

The topic of Medical Marijuana is BOOMING!

I had to bring back Dr. Rachna Patel to update us on what's going on in the Medical Marijuana Community.

Currently, there are 9 States, plus the District of Columbia (DC), that have "Legalized" the "Recreational" use of Marijuana.

The 9 States are:

1. Alaska

2. California

3. Colorado

4. D.C.

5. Massachusetts

6. Nevada

7. Oregon

8. Vermont

9. Washington

Twenty-Nine (29) States, have Legalized Medical Marijuana usage.

The 29 States are:

1. Alaska

2. Arizona

3. Arkansas

4. California

5. Colorado

6. Connecticut

7. Delaware

8. Florida

9. Hawaii

10. Illinois

11. Maine

12. Maryland

13. Massachusetts

14. Michigan

15. Minnesota

16. Montana

17. Nevada

18. New Hampshire

19. New Jersey

20. New Mexico

21. New York

22. North Dakota

23. Ohio

24. Oregon

25. Pennsylvania

26. Rhode Island

27. Vermont

28. Washington

29. Washington D.C.

30. West Virginia

Dr. Patel commonly treats patient with the following conditions for Medical Marijuana:

1.  Chronic Pain - especially patients with Fibromyalgia, Arthrittis, Back Pain, Migraines, Neuropothy

2. Anxiety

3. Insomnia

Dr. Patel is consulting with patients across the U.S. to help guide patients step-by-step on the usage of Medical Marijuana.

You can reach Dr. Patel by going to her website,

www.drrachnapatel.com

You can also go to her Facebook page,

Facebook.com/DoctorRachnaPatel

Here's her YouTube Channel with GREAT videos!

The Medical Marijuana Expert - Dr. Rachna Patel

Thanks for listening to Medicare Nation!

If you find my content interesting, please give us a Review on Apple Podcasts!

Jun 22 2018

42mins

Play

MN084 FDA Issues Recall of Levothyroxine (Thyroid Tablets)

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Hey Medicare Nation!

I have a special show for you today.

The FDA has issued a "Voluntary Recall" on Westminster Pharmaceuticals of all lots of their Levothyroxine and Liothyronine (Thyroid Tablets).

Westminster Pharmaceuticals, LLC, which has its Corporate HQ in Tampa, Florida, is voluntarily recalling all lots, within the expiration date, of Levo-thyroxine and Lio-thyronine (Thyroid Tablets) dosages of 15 mg, 30 mg, 60 mg, 90 mg, & 120 mg up to the wholesale level.

These products are being recalled by Westminster Pharmaceuticals as a precaution, because they were manufactured using active pharmaceutical ingredients that were sourced, prior to the FDA’s “Import Alert”  of Sichuan Friendly Pharmaceutical Co., Ltd., which is out of China.  

The Recall comes as a result of a 2017 inspection where deficiencies were found with “Current Good Manufacturing Practices” (cGMP). Substandard cGMP practices…..could represent……the possibility of risk….. being introduced into the manufacturing process.

To date, Westminster Pharmaceuticals has not received any reports of adverse events related to this product.

Levothyroxine and Liothyronine (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands. Thyroid tablets contain both tetra-io-do-thyronine sodium (T4 levothyroxine) and lio-thy-ronine sodium (T3 liothyronine).

Levothyroxine and Liothyronine tablets (thyroid tablets, USP) are indicated as replacement or  supplemental therapy in patients with hypothyroidism.

Because these products may be used in the treatment of serious medical conditions, patients taking the recalled medicines should continue taking their medicine until they have a replacement product.

According to the U.S. Food & Drug Administration Report.....

[8/17/2018] FDA is alerting active pharmaceutical ingredient (API) repackagers and distributors, finished drug manufacturers, and compounders that Sichuan Friendly Pharmaceutical Co. Limited, China, is recalling certain lots of porcine thyroid API due to inconsistent quality of the API. FDA recommends that manufacturers and compounders not use Sichuan Friendly’s porcine thyroid API received since August 2015. This thyroid API comes from porcine (pig) thyroid glands and is used to make a non-FDA approved  drug product, composed of levothyroxine and liothyronine, to treat hypothyroidism (underactive thyroid).

FDA laboratory testing confirmed the Sichuan Friendly API has inconsistent levels of the active ingredients – levothyroxine and liothyronine – and should not be used to manufacture or compound drugs for patient use. Risks associated with over or under treatment of hypothyroidism could result in permanent or life-threatening adverse health consequences.

These lots were distributed nationwide in the USA to Westminster’s direct accounts.

These lots were distributed nationwide in the USA 

NDC Product Lot Expiration 69367-159-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15mg X 100ct 15918VP03 2/29/2020 15918VP02 2/29/2020 15918VP01 2/29/2020 15918007 3/31/2020 15918006 3/31/2020 15918005 2/29/2020 15918004 12/31/2019 15918003 12/31/2019 15918002 12/31/2019 15918001 12/31/2019 15917VP03 10/31/2019 15917VP02 10/31/2019 15917VP01 10/31/2019 69367-155-04

Levothyroxine and Liothyronine (Thyroid Tablets, USP) 30mg X 100ct

15517VP01 8/31/2019 15517VP02 8/31/2019 15517VP03 8/31/2019 15518001 12/31/2019 15518002 3/31/2020 69367-156-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 60mg X 100ct 15618011 3/31/2020 15618009 2/29/2020 15618008 2/29/2020 15618004 12/31/2019 15618002 12/31/2019 15617VP06 11/30/2019 15617VP05 11/30/2019 15617VP04 12/31/2019 15617VP03 7/31/2019 15617VP01 7/31/2019 15617VP-02 7/31/2019 69367-157-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 90mg X 100ct 15717VP-01 7/31/2019 15717VP-02 7/31/2019 15717VP-03 7/31/2019 15718004 3/31/2020 15717002 12/31/2019 69367-158-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 120mg X 100ct 15817VP-01 9/30/2019 15817VP-02 9/30/2019 15817VP-03 9/30/2019 15818001 3/31/2020

Westminster is notifying its direct accounts by email and by phone to immediately discontinue distribution of the product being recalled.

The FDA Advises Consumers who have the recalled products, should not discontinue use before contacting their physician for further guidance.

There are several manufacturers who make “generic” Levothyroxine and Liothyronine (thyroid tablets) that your doctor can give you a new prescription for.  Call the Pharmacy where you receive your Levothyroxine or Liothyronine, and ask the pharmacist who the manufacturer of their supply is. They should be able to easily tell you that.

Customers and patients with medical-related questions, information about an adverse event or other questions about the Westminster’s product’s being recalled……. should contact Westminster’s Regulatory Affairs department by phone at: 888-354-9939 ….. Live calls are received Monday-Friday, 9:00AM - 5:00PM EST with voicemail available 24 hours/day, 7 days/week

or you can send an email to  recalls@wprx.com.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online…..by regular mail……or by fax.

To Complete and submit the report Online…....just “click” on the link & it will take you directly to the FDA MedWatch Page.

FDA Med Watch Page

If you’d like to report Adverse Reactions or quality problems by Mail or Fax: Download form

www.fda.gov/MedWatch/getforms.htm 

Med Watch Reporting Form

or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form……or…….submit by

Fax to 1-800-FDA- 0178

It’s almost the Annual Enrollment Period!

Beginning Monday, October 15th through Friday, December 7th, many of you will be able to switch Medicare Advantage Plans, Switch Medicare Prescription Drug Plans or return to Original Medicare, with the majority of you having NEW effective dates of January 1, 2019.

There are MANY Changes coming to Medicare for 2019, so I will be busy Posting Changes for you Starting the Week of October 1st.

Medicare Nation, will be going back to a “weekly” episode during the Annual Enrollment Period, so that I can bring to you the most up-to-date information I can.

Remember, I am here to answer ANY Medicare question you have, as long as I can answer your question in ONE paragraph.

If I need to “research” anything or…..if it takes me more than one paragraph to answer your question, I will advise you that you can contact me to help you with your Medicare needs by hiring me to “consult” with you about your Medicare needs.

Many of you contacted me last Medicare Annual Enrollment Period for consultations and I am here again to assist you or your parent’s Medicare Questions or concerns.

Need help choosing a Medicare Advantage Plan or Prescription Drug Plan where you live? I can help you with that.

Need help comparing your employer insurance plan benefits to a Medicare plan?

I can help you with that too.

Contact me by email at Support@TheMedicareNation.com or call the toll free number 855-855-7266 and tell me how I can help you with your Medicare Needs.

If you like Medicare Nation, I’d love for you to give Medicare Nation an honest Rating and Review on Apple Podcasts.  

How to leave an iTunes rating or review for a podcast from your iPhone or iPad
  1. Launch Apple's Podcast
  2. Tap the Search
  3. Enter Medicare Nation in the search field.
  4. Tap the blue Searchkey at the bottom right.
  5. Tap the album art for Medicare Nation.
  6. Tap the Reviews
  7. Tap Write a Reviewat the bottom.
  8. Enter your iTunes passwordto login.
  9. Tap the Starsto leave a rating.
  10. Enter title text and content to leave a review.
  11. Tap Send.

If you have an ANDROID phone…..open up your “Stitcher” App or Download the Stitcher App from your Google Play App.

OR……just go to ……. subscribe on Android.com

When the page opens, just type in Medicare Nation into the field. Hit enter and voila!

Click on the Medicare Nation Full LOGO and “click” Subscribe on Android.

That’s it! Folks You now will receive my up to date Medicare Weekly episode to get you through the AEP

Thanks for listening to Medicare Nation! I appreciate it.

Until next time….I want each of you to have a …..Happy, Healthy and Prosperous Week!

Aug 24 2018

18mins

Play

You Can Win the Fight Against Colon and Colorectal Cancer

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

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

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

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

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

  • Would you share what your treatment was?

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

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

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

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

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

  • Tell us about the “Undie Run.”

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

Resources:

www.ccalliance.org

877-422-2030

Find the Facebook group: Blue Hope Nation

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

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

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Feb 19 2016

1hr 10mins

Play

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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Lupus Awareness! It's not easy to diagnose; know the symptoms

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

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

How many people in the US have Lupus?

1.5 Million people in the US.

What is LUPUS?

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

Lupus can be difficult to diagnose because:

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

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

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

Lupus primarily affects women in their child-bearing years. 

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

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

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

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

Lupus Symptoms:

•Fatigue and fever

•Joint pain, stiffness and swelling

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

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

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

•Shortness of breath

•Chest pain

•Dry eyes

•Headaches, confusion and memory loss

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

Resources:

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

Lupus Foundation of America - www.lupus.org

Lupus Florida - www.lupusflorida.com

Contact Linda Ruescher:

On Twitter: www.twitter.com/chronicillness

On Facebook: www.facebook.com/Linda Ruescher

Email: linda.ruescher@gmail.com

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

May 13 2016

24mins

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MN057 Q&A From The Audience

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Hello Medicare Nation listeners!

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

Wendy from King of Prussia, Pennsylvania asks???

HOW DO I GET A REPLACEMENT MEDICARE CARD?

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

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

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

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

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

800-772-1213

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

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

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

The official Medicare.gov website states –

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

June from San Diego – California asks????

WHAT DOES MEDICALLY NECESSARY MEAN?

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

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

 Thanks for listening!

 Send your questions to Support@TheMedicareNation.com

Sep 09 2016

16mins

Play

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

MN055 How to Find a New Prescription Drug Plan

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How to Find a New Prescription Drug Plan

Welcome Medicare Nation!

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

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

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

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

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

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

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

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

Use the official Medicare Website Plan Finder’s database.

Go to www.Medicare.gov

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

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

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

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

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

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

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

      You have several options.

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

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

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

No other equipment is needed!

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

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

www.CallSamm.com

Aug 27 2016

24mins

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What Happens When You Can't Speak for Yourself During a Medical Emergency

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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! Join us to learn more!

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

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

      I may answer one of your questions on the air!

      email me:

      support@themedicarenation.com

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

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

      www.CallSamm.com

Jul 01 2016

36mins

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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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MN053 Are You Being Admitted to the Hospital or Are You Under Observation

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The NOTICE ACT

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

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

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

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

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

Medicare Advantage Plans

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

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

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

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

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

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

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

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

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

                                           OR

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

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

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

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

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

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

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

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

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

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

Go to my website www.callsamm.com

And “Click” on the contact tab.

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

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

“I want to be ON Medicare Nation.”

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

Aug 12 2016

34mins

Play

What Are Advance Beneficiary Notices?

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Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanks for listening to Medicare Nation!

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

Send me your questions to Support@TheMedicareNation.com

I might read your question on the air!

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

Aug 05 2016

23mins

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Melissa's Story of Care Under Medicare

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Welcome Medicare Nation! 

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

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

Melissa shares the following about her Mother’s experience:

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

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

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

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Apr 01 2016

46mins

Play

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

Play

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

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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

Play

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

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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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Choosing a Medicare Prescription Drug Plan for 2019

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Hey Medicare Nation!

You are getting ready for Thanksgiving and you haven't even looked at Prescription Drug Plans for 2019.

Don't panic! 

I have your back :)

There are Prescription Drug Plan changes for 2019. 

Listen to this episode to learn about the NEW changes and make a confident decision to enroll in the Medicare Prescription Drug Plan that fits your unique needs.

Here is the link to the Medicare.gov website as an additional resoure:

www.medicare.gov

Have a question about Prescription Drug Plans for 2019?

Ask me!

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

If I need to do "any" type of research or the answer to your question is longer than ONE paragraph, you may have to hire me as a consultant.

I answer ALL emails personally. I'm the expert and I make sure you receive my expertise in answering your questions.

Send your questions to -

Support@TheMedicareNation.com

I look forward to hearing from you!

Happy Thanksgiving everyone!

Diane

Nov 16 2018

26mins

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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

Play

MN084 FDA Issues Recall of Levothyroxine (Thyroid Tablets)

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Hey Medicare Nation!

I have a special show for you today.

The FDA has issued a "Voluntary Recall" on Westminster Pharmaceuticals of all lots of their Levothyroxine and Liothyronine (Thyroid Tablets).

Westminster Pharmaceuticals, LLC, which has its Corporate HQ in Tampa, Florida, is voluntarily recalling all lots, within the expiration date, of Levo-thyroxine and Lio-thyronine (Thyroid Tablets) dosages of 15 mg, 30 mg, 60 mg, 90 mg, & 120 mg up to the wholesale level.

These products are being recalled by Westminster Pharmaceuticals as a precaution, because they were manufactured using active pharmaceutical ingredients that were sourced, prior to the FDA’s “Import Alert”  of Sichuan Friendly Pharmaceutical Co., Ltd., which is out of China.  

The Recall comes as a result of a 2017 inspection where deficiencies were found with “Current Good Manufacturing Practices” (cGMP). Substandard cGMP practices…..could represent……the possibility of risk….. being introduced into the manufacturing process.

To date, Westminster Pharmaceuticals has not received any reports of adverse events related to this product.

Levothyroxine and Liothyronine (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands. Thyroid tablets contain both tetra-io-do-thyronine sodium (T4 levothyroxine) and lio-thy-ronine sodium (T3 liothyronine).

Levothyroxine and Liothyronine tablets (thyroid tablets, USP) are indicated as replacement or  supplemental therapy in patients with hypothyroidism.

Because these products may be used in the treatment of serious medical conditions, patients taking the recalled medicines should continue taking their medicine until they have a replacement product.

According to the U.S. Food & Drug Administration Report.....

[8/17/2018] FDA is alerting active pharmaceutical ingredient (API) repackagers and distributors, finished drug manufacturers, and compounders that Sichuan Friendly Pharmaceutical Co. Limited, China, is recalling certain lots of porcine thyroid API due to inconsistent quality of the API. FDA recommends that manufacturers and compounders not use Sichuan Friendly’s porcine thyroid API received since August 2015. This thyroid API comes from porcine (pig) thyroid glands and is used to make a non-FDA approved  drug product, composed of levothyroxine and liothyronine, to treat hypothyroidism (underactive thyroid).

FDA laboratory testing confirmed the Sichuan Friendly API has inconsistent levels of the active ingredients – levothyroxine and liothyronine – and should not be used to manufacture or compound drugs for patient use. Risks associated with over or under treatment of hypothyroidism could result in permanent or life-threatening adverse health consequences.

These lots were distributed nationwide in the USA to Westminster’s direct accounts.

These lots were distributed nationwide in the USA 

NDC Product Lot Expiration 69367-159-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15mg X 100ct 15918VP03 2/29/2020 15918VP02 2/29/2020 15918VP01 2/29/2020 15918007 3/31/2020 15918006 3/31/2020 15918005 2/29/2020 15918004 12/31/2019 15918003 12/31/2019 15918002 12/31/2019 15918001 12/31/2019 15917VP03 10/31/2019 15917VP02 10/31/2019 15917VP01 10/31/2019 69367-155-04

Levothyroxine and Liothyronine (Thyroid Tablets, USP) 30mg X 100ct

15517VP01 8/31/2019 15517VP02 8/31/2019 15517VP03 8/31/2019 15518001 12/31/2019 15518002 3/31/2020 69367-156-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 60mg X 100ct 15618011 3/31/2020 15618009 2/29/2020 15618008 2/29/2020 15618004 12/31/2019 15618002 12/31/2019 15617VP06 11/30/2019 15617VP05 11/30/2019 15617VP04 12/31/2019 15617VP03 7/31/2019 15617VP01 7/31/2019 15617VP-02 7/31/2019 69367-157-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 90mg X 100ct 15717VP-01 7/31/2019 15717VP-02 7/31/2019 15717VP-03 7/31/2019 15718004 3/31/2020 15717002 12/31/2019 69367-158-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 120mg X 100ct 15817VP-01 9/30/2019 15817VP-02 9/30/2019 15817VP-03 9/30/2019 15818001 3/31/2020

Westminster is notifying its direct accounts by email and by phone to immediately discontinue distribution of the product being recalled.

The FDA Advises Consumers who have the recalled products, should not discontinue use before contacting their physician for further guidance.

There are several manufacturers who make “generic” Levothyroxine and Liothyronine (thyroid tablets) that your doctor can give you a new prescription for.  Call the Pharmacy where you receive your Levothyroxine or Liothyronine, and ask the pharmacist who the manufacturer of their supply is. They should be able to easily tell you that.

Customers and patients with medical-related questions, information about an adverse event or other questions about the Westminster’s product’s being recalled……. should contact Westminster’s Regulatory Affairs department by phone at: 888-354-9939 ….. Live calls are received Monday-Friday, 9:00AM - 5:00PM EST with voicemail available 24 hours/day, 7 days/week

or you can send an email to  recalls@wprx.com.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online…..by regular mail……or by fax.

To Complete and submit the report Online…....just “click” on the link & it will take you directly to the FDA MedWatch Page.

FDA Med Watch Page

If you’d like to report Adverse Reactions or quality problems by Mail or Fax: Download form

www.fda.gov/MedWatch/getforms.htm 

Med Watch Reporting Form

or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form……or…….submit by

Fax to 1-800-FDA- 0178

It’s almost the Annual Enrollment Period!

Beginning Monday, October 15th through Friday, December 7th, many of you will be able to switch Medicare Advantage Plans, Switch Medicare Prescription Drug Plans or return to Original Medicare, with the majority of you having NEW effective dates of January 1, 2019.

There are MANY Changes coming to Medicare for 2019, so I will be busy Posting Changes for you Starting the Week of October 1st.

Medicare Nation, will be going back to a “weekly” episode during the Annual Enrollment Period, so that I can bring to you the most up-to-date information I can.

Remember, I am here to answer ANY Medicare question you have, as long as I can answer your question in ONE paragraph.

If I need to “research” anything or…..if it takes me more than one paragraph to answer your question, I will advise you that you can contact me to help you with your Medicare needs by hiring me to “consult” with you about your Medicare needs.

Many of you contacted me last Medicare Annual Enrollment Period for consultations and I am here again to assist you or your parent’s Medicare Questions or concerns.

Need help choosing a Medicare Advantage Plan or Prescription Drug Plan where you live? I can help you with that.

Need help comparing your employer insurance plan benefits to a Medicare plan?

I can help you with that too.

Contact me by email at Support@TheMedicareNation.com or call the toll free number 855-855-7266 and tell me how I can help you with your Medicare Needs.

If you like Medicare Nation, I’d love for you to give Medicare Nation an honest Rating and Review on Apple Podcasts.  

How to leave an iTunes rating or review for a podcast from your iPhone or iPad
  1. Launch Apple's Podcast
  2. Tap the Search
  3. Enter Medicare Nation in the search field.
  4. Tap the blue Searchkey at the bottom right.
  5. Tap the album art for Medicare Nation.
  6. Tap the Reviews
  7. Tap Write a Reviewat the bottom.
  8. Enter your iTunes passwordto login.
  9. Tap the Starsto leave a rating.
  10. Enter title text and content to leave a review.
  11. Tap Send.

If you have an ANDROID phone…..open up your “Stitcher” App or Download the Stitcher App from your Google Play App.

OR……just go to ……. subscribe on Android.com

When the page opens, just type in Medicare Nation into the field. Hit enter and voila!

Click on the Medicare Nation Full LOGO and “click” Subscribe on Android.

That’s it! Folks You now will receive my up to date Medicare Weekly episode to get you through the AEP

Thanks for listening to Medicare Nation! I appreciate it.

Until next time….I want each of you to have a …..Happy, Healthy and Prosperous Week!

Aug 24 2018

18mins

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Is Medical Marijuana the Drug of Choice For Pain? MN083

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Hey Medicare Nation!

Medicare Nation

The topic of Medical Marijuana is BOOMING!

I had to bring back Dr. Rachna Patel to update us on what's going on in the Medical Marijuana Community.

Currently, there are 9 States, plus the District of Columbia (DC), that have "Legalized" the "Recreational" use of Marijuana.

The 9 States are:

1. Alaska

2. California

3. Colorado

4. D.C.

5. Massachusetts

6. Nevada

7. Oregon

8. Vermont

9. Washington

Twenty-Nine (29) States, have Legalized Medical Marijuana usage.

The 29 States are:

1. Alaska

2. Arizona

3. Arkansas

4. California

5. Colorado

6. Connecticut

7. Delaware

8. Florida

9. Hawaii

10. Illinois

11. Maine

12. Maryland

13. Massachusetts

14. Michigan

15. Minnesota

16. Montana

17. Nevada

18. New Hampshire

19. New Jersey

20. New Mexico

21. New York

22. North Dakota

23. Ohio

24. Oregon

25. Pennsylvania

26. Rhode Island

27. Vermont

28. Washington

29. Washington D.C.

30. West Virginia

Dr. Patel commonly treats patient with the following conditions for Medical Marijuana:

1.  Chronic Pain - especially patients with Fibromyalgia, Arthrittis, Back Pain, Migraines, Neuropothy

2. Anxiety

3. Insomnia

Dr. Patel is consulting with patients across the U.S. to help guide patients step-by-step on the usage of Medical Marijuana.

You can reach Dr. Patel by going to her website,

www.drrachnapatel.com

You can also go to her Facebook page,

Facebook.com/DoctorRachnaPatel

Here's her YouTube Channel with GREAT videos!

The Medical Marijuana Expert - Dr. Rachna Patel

Thanks for listening to Medicare Nation!

If you find my content interesting, please give us a Review on Apple Podcasts!

Jun 22 2018

42mins

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99% of Individuals With Foot Drop Don't Know About WalkAides MN082

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Hey Medicare Nation!

Millions of people are diagnosed with "Foot Drop."

Some people also call it......"Drop Foot."

Help A Child or Adult Walk Again!

Either way, Foot Drop is a serious matter!

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot, necessary for walking. Foot Drop causes a person to drag the foot and toes, or engage in a high-stepping walk called a steppage gait.

Foot Drop Increases the risk of falling.

Who Can Be Diagnosed With Foot Drop?

Men or Women, at any age.

What are some causes of Foot Drop?

Multiple Sclerosis, Cerebral Paulsy, Stroke, Traumatic Brain Injurey, Spinal Cord Injuries, and other injuries to the Peroneal Nerve in the leg. 

Viruses can cause Foot Drop as well as other infections.

Injuries to the leg and/or the lower back can also cause Foot Drop.

What is a WalkAide?

A WalkAide is a Functional Electrical Stimulation Device, when wore on the calf, sends electric impulses to the affected foot causing the foot and leg to lift. 

Where Can I get information on WalkAides?

Go to the Hanger Clinic website:

https://goo.gl/9UuX7Y

Are Other Types of FES Devices Available?

Yes. The Bioness L300 is also available. Go to the Bioness Website for more information.

https://goo.gl/FMXr5i

Who are the Freedom to Walk Foundation?

The Freedom to Walk Foundation is a 5019c)3 non-profit, dedicated to assisting with funds for the purchases of WalkAides for children AND Adults diagnosed with Foot Drop due to:

* Multiple Sclerosis

*Cerebral Palsy

* Stroke

* Incomplete Spinal Cord Injury

* Traumatic Brain Injury

If you want more information about the Freedom to Walk Foundation, go to their website:

FreedomToWalkFoundation.org

Go To 6th Annual Freedom to Walk Foundation GALA

May 25 2018

29mins

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NEW Medicare Cards Are Mailing Out Now MN081

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Hey Medicare Nation!

Do you know what "Drop Foot" is?

Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot necessary for walking.

It causes a person to drag the foot and toes, or engage in a high-stepping walk called a "steppage gait."

This increases the risk of falling for individuals. 

There are about 70,000 people diagnosed with Food Drop in the State of Florida alone!

I have teamed up with the Freedom to Walk Foundation, to assist them in raising funds for the purchase of WalkAides.

WalkAides are electronic stimulating devices when worn on the calf, sends electric impulses to the affected foot, causing the muscles to contract and lift the foot and leg.

Children and adults are WALKING agian with the help of WalkAides!

The one major problem, is that most medical insurance companies don't cover WalkAides.

Medicare will only cover WalkAides for those diagnosed with "Incomplete Spinal Cord Injury."

Those diagnosed with Multiple Sclerosis, Cerebal Palsy, stroke, traumatic brain injuries and complete spinal cord injuries, are not covered by most insurance companies.

How can you help?

A WalkAide costs $5,000 to purchase.

A $5.00 or more donation to the Freedom to Walk Foundation will help children and adults purchase WalkAides.

Please be considerate and donate with your heart!

www.FreedomtoWalkFoundation.org/donate

Thank You!

NEW MEDICARE CARDS are being mailed now. Your New Medicare Cards…….which are now called “Medicare Beneficiary Identifier” or MBI……have started mailing!
  1. People who are enrolling in Medicare for the first time will be among the first in the country to receive the new cards.
  2. Your new card will automatically come to you. You don't need to do anything as long as your address is up to date. If you need to update your address, visit ssa.gov and sign up for MySocialSecurity Account.
  3. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
Current States Receiving New Medicare Cards  Delaware Pennsylvania Virginia Washington D.C.   AND….. West Virginia Want to know when YOUR card has been mailed? Go to Medicare.gov/NewCard Enter your email to receive an email when your new Medicare Card is mailed to you. What do the New Medicare Cards Look Like? Across the top of the New Medicare Card will read…..Medicare Health Insurance….in “white” letters inside a blue border. There is also an image of an Eagle in white outline. Your Name will appear on the next line. The next line will be the NEW set of Characters. The New Card will have  “11 Characters – both numbers and letters of the alphabet. All Letters will be Capitalized and spot # 2, 5, 8 & 9 on your card, will ALWAYS be a Letter of the alphabet.   Finally, you’ll see Your effective date of your Part A of Medicare…….. And you’ll see Your effective date of Part B if you enrolled in Medicare Part B. Here are things to know about your new Medicare card
  1. Your new card will automatically be mailed to you. You don’t have to do anything as long as your address is up to date.

If you need to update your address, go to www.ssa.org  and enroll in a My Social Security Account. 

  1. Your Medicare coverage and benefits will stay the same.
  2. Your card may arrive at a different time than your friend’s or neighbor’s. Medicare is mailing over 60 million New Cards. CMS says they will have completed the mailing by April of 2019. We’ll see if that’s true!
  3. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
  4. If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare—Use your Medicare Advantage Plan ID Card whenever you need care.

And, if you have a separate Medicare precrption drug plan, be sure to keep that ID card as well.  

  1. Doctors, other health care providers and facilities know it’s coming and will ask for your new Medicare card when you need care, so carry it with you.
  2. Only give your new Medicare Number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare
  3. If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online.

And….until January 2020, health care providers may use your New Medicare Card or your Social Security number to process claims.

FINALLY…..

Be Careful!

Scammers are out there  trying to steal your identity!

Medicare will NEVER call you and ask for Personal Information!

The Government can’t even process Medicare Advantage Plan Changes timely…….they certainly don’t have the staff or the time to call Medicare Beneficiaries. So DON”T trust ANYONE who calls and says they are calling you from Medicare.

Your Insurance Agent, Medicare Advisor or a representative from your Medicare Advantage Plan or Medicare Prescription Drug Plan will call you …..WITH YOUR PERMISSION!

If someone calls and says they are calling about your New Medicare card…..

HANG UP THE PHONE ON THEM!          

If someone calls and says they are from your Medicare Advantage Plan….

Ask them a few questions to make sure they are legit.

Ask them these questions:

  1. How much is my current premium for my Medicare Plan?

If they are from your Medicare Insurance Plan….they should know the answer!

  1. Ask them who your Primary Doctor is.

Again……they should have that information documented.

  1. Finally……if you are still unsure of who you are talking to…..HANG UP!

Call the customer service number on the back of your Medicare Insurance Plan card and when a representative answers……ask them if they just contacted you.

RESOURCES:

ssa.org

www.medicare.gov/newcard

Apr 13 2018

28mins

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Special SEP For Medicare Beneficiaries Affected by California Wildfires MN080

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Hey Medicare Nation!

www.TheMedicareNation.com

Special Election Period Extended through March 31, 2018 for Medicare Beneficiaries Affected by California Wildfires.

The Centers for Medicare & Medicaid Services (CMS) has extended the Special Election Period (SEP) for Medicare Beneficiaries affected by the California Wildfires to March 31, 2018.

Any Medicaer Beneficiary who resides in, or resided in an area for which the Federal Emergency Management Agency (FEMA) declared a disaster area is eligible for the SEP......if......the beneficiary was unable to enroll in a Medicare Advantage Plan or stand-alone-prescription drug plan, during the annual enrollment period (AEP) or other qualifying election period.

Also....if you don't live in the affected counties of California, but you receive assistance from someone living in one of the affected areas that was declared a disaster area, you are eligible for the SEP.

You can call Medicare at 800-633-4227, or you can contact a Medicare Advisor or Medicare Consultant to assist you in finding a plan that will suit your unique needs.

How do you find a Medicare Advisor or Medicare Consultant like me?

Google it!

Type in ......Medicare Consultant Los Angeles California....or Medicare Advisor San Francisco California.

After you get beyond the "ADS" by all the paid advertisers.....you will start seeing results for what you asked for.

So here are the COUNTIES  in California affected by the WildFires, which have a SEP:

Butte

Lake

Los Angeles

Mendocino

Napa

Nevada

Orange

Riverside

San Diego

Santa Barbara

Solano

Sonoma

Ventura

and Yuba.

You can also go to the FEMA website and read more infomation at:

www.fema.gov/disasters

Any questions? Have a special guest you'd like to hear on Medicare Nation?

Send Diane an email to - 

Support@TheMedicareNation.com

Need help with Medicare......Contact Diane and she will schedule a call with you to determine your needs.

Send your request to Support@TheMedicareNation.com

Have a Happy, Peaceful and Prosperous Week!

www.TheMedicareNation.com

Feb 02 2018

15mins

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You CAN Disenroll From Your Medicare Advantage Plan NOW! MN079

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Hey Medicare Nation!

It's January 2018!

I hope everyone made informed decisions regarding your Medicare Advantage Plans for 2018.

If you missed the last episode, go back and listen to it!

I discussed the Medicare Premiums, co-pays and co-insurance for 2018.

Many of you have sent me emails "asking me" if you can change your Medicare Advantage Plan in January.

The answer is......yes....with specific guidelines.

Currently, it is the Medicare Advantage Plan "Disenrollment Period."

The current Disenrollment Period runs from January 1st through February 14th each year.

During this time, you can "drop" your Medicare Advantage Plan and go back onto Original Medicare.

You do this by contacting MEDICARE by phone     800-633-4227.....and telling the Medicare representative that you would like to "Disenroll from your Medicare Advantage Plan" to go back onto Original Medicare. Medicare may also help you with a Part D prescription Drug Plan if you'd like.

On Original Medicare, you are covered under Part A and Part B of Medicare. 

Under Part A....you are covered for Medicare benefits where you would stay at a location as an "inpatient."

The most common location is .....The Hospital. Another location where you stay overnight as an inpatient is....a Skilled Nursing Facility (SNF).

A SNF is NOT a Nursing Home. An SNF is a location where you are admitted as an inpatient to receive medical care and rehab 24hrs a day.

Also..... if you are diagnosed with a terminal illness, your doctor may suggest you enter Hospice as an inpatient. 

All the services covered in the Hospital, SNF and Hospice are covered under Part A of Medicare.

There is a "Deductible" each time you are admitted to the Hospital. The Deductible cost for being admitted as an inpatient in the hospital is $1,340.00 in 2018. The Deductible is due EACH benefit period you are admitted.

Part B of Medicare is for "Outpatient Services."

Benefits under Medicare for Outpatient Services covered under Part B include, but not limited to:

* Doctor Vists

* MRI's

* Laboratory Blood Draws

* Outpatient Same Day Surgery 

* Oxygen in your home

There is an "Annual Deductible" for Part B of $183.00.

After you pay your $183.00 annual deductible, you will be responsible for the remaining 20% Medicare Allowable Charges for services under Part B.

What does that mean? 

Let's say you already visited your Cardiologist and had bloodwork drawn at Quest or Labcorp.

We'll say your out-of-pocket costs for both cost a total of $183.00.

That takes care of your annual Part B deductible for 2018.

Now....let's say three months later.....you need to have an MRI. We'll say the Medicare allowable cost is $1,500.00.

Medicare Part B covers 80% of the $1,500.00, which is $1,200.00.

You will be responsible for the remaining 20%, which is $300.00.

You will pay 20% of ALL Part B Medicare Allowable Charges. There is NO Cap!

You may also need Prescription Drug Coverage.

Prescription Drugs are NOT covered under Part A or Part B in general. Prescription Drugs will be covered while you are admitted to one of the facilities under Part A. 

If you want Prescription Drug coverage, you WILL need to enroll in a stand-alone-prescription-drug-plan.

You can find which Prescription Drug Plan (PDP) is available in your area, by going onto the Medicare.gov website and "hover" over the FIRST Blue Box named "Sign Up/Change Plans."

A column will appear and go down to where it reads..."Find Health & Drug Plans."

"Click" on that box and it will bring you to the Medicare Plan Finder site.

Type in your zipcode and follow the instructions.

If you are comfortable with the costs associated with Original Medicare Parts A & Part B.....then that's all you need to do.

If you'd like to add additional coverage to protect you against the on-going out-of-pocket costs associated with Original Medicare, you can purchase a Medicare Supplement (a.k.a. Medi-Gap) Plan.

A Medicare Supplement Plan is an Insurance Policy, where you pay the insurance carrier a monthly premium and the plan will pay Medicare out-of-pocket costs that you have pre-determined.

Medicare Supplement Plans "VARY" in coverage and in premiums.

The "Medicare Benefits" they pay for you, are the SAME, no matter where you live in the U.S.

So.....if you chose a Supplement Plan "F," which is the policy which pays ALL your out-of-pocket costs for Medically Necessary services under Medicare, and you live in Seattle, WA.......you will be covered for the EXACT SAME Medicare benefits as a person living in Tampa, FL.

What is different you ask?

The difference is in the PREMIUM you pay.

Insurance Carriers that offer Medicare Supplement Policies charge DIFFERENT  Premiums!

You NEED to know what the difference in Premiums are by EACH Insurance Carrier for the SAME TYPE OF PLAN.

Here's an example:

Mary is turning 65 in March of 2018. Mary has a history of heart problems and would like to remain on Original Medicare and purchase a Medicare Supplement Plan "F" so that she can see ANY Cardiologist that is contracted with Medicare.... in ANY State. 

Mary also wants to have a budget for her out-of-pocket health costs and having a Medicare Supplement "F" plan will allow her to do that.

Mary lives in Miami, FL and calls her Medicare Specialist Diane.

Mary discusses purchasing a Medicare Supplement with Diane and asks for her expertise and guidance.

Diane tells Mary that the 3 lowest premiums in her zipcode have the following montly premiums:

1. $239.00 From Acme Insurance Co.

2. $250.00 From Beta Insurance Co.

and 

3. $275.00 From Delta Insurance Co.

These premiums are for the EXACT same Plan with the SAME benefits!

Why would you pay Delta insurance company $275.00 a month, when you can pay Acme Insurance Company $36.00 a month less....for the SAME benefits!

That's why it's soooo important to speak with a Medicare Specialist or Medicare Consultant like myself.

I speak MEDICARE! I care about YOUR best interests! I have NO loyalties to ANY Insurance Company! 

You can also STAY on the Medicare Advantage Plan you are enrolled in.

Do your Due Dilligenct to ensure you are doing what's best for your health and out of pocket costs for 2018.

I'm hear to help you if you need me!

You can contact me by email at Support@TheMedicareNation.com

You can contact me by phone: 855-855-7266.

I will even answer your question by email if I can answer it in ONE paragraph!

If I have to do any kind of research, you need to hire me as your consultant.

My time is valuable and I want to do what's best for you!

Thanks for listening Nation!

Would love a Review if you would take a minute to do it for me!

Leave me a "Voice" review at www.TheMedicareNation.com

or ...... an iTunes review.

Go to iTunes or Stitcher and in the SEARCH bar type in MEDICARE NATION

MY show comes right up. "Click" on Subscribe and then click on Rating or Review.

Leave me your feedback and if you can.....give us 5 stars!

Thank you and have a Happy, Peaceful & Prosperous Week!

Diane

Jan 19 2018

34mins

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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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