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Medicare Nation

Updated 13 days ago

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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
Cover image of Medicare Nation

Medicare Nation

Updated 13 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

Rank #1: Medicare may not exist for Entrepreneurs Pat Flynn, Sarah Koenig or Tim Ferriss - Episode 000

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This is Medicare Nation. The go-to-resource for your Medicare education.

The problem with Medicare, is there is an overwhelming amount of information and not enough resources to help educate you about Medicare and your benefits.

We solve that problem. Each episode will have a wealth of education about Medicare.

We will take a look at the history of Medicare, the components of Medicare and Medicare benefits. I will also interview guests who are experts in the health and wellness field, who will discuss Medicare related topics on illnesses, nutrition, diseases and injuries. I will update you on changes in Medicare benefits and legislature that is in the news.

Join me as I discuss:

  1. How I solved the Medicare problem
  2. Why I’m so passionate about Medicare

Mentioned Links:

  1. The Medicare Survival Guide –  http://goo.gl/TfLICa
  2. The Official Medicare website – medicare.gov
  3. Senior Advisors For Medicare & Medicaid – callsamm.com

Talk about this episode on Twitter:  @MedicareNation

Visit us on Facebook – www.facebook.com/MedicareNation

Aug 16 2015
11 mins
Play

Rank #2: 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
19 mins
Play

Rank #3: 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
21 mins
Play

Rank #4: How to Save $1,608 or More in Medicare Costs

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Hey Medicare Nation!

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

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

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

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

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

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

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

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

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

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

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

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

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

Medicare Savings Program

2017 Monthly Income Limit:

Single Person

$1,377.00 

Married (living together)

$1,847.00

2017 Total "Resource" Limit:

Single Person

$7,390

Married (living together)

$11,090

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

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

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

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

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

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

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

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

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

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

Extra Help Program

2017 Monthly Income Limit:

Single Person

$1,507.50 

Married (living together)

$2,030.00

2017 Total "Resource" Limit:

Single Person

$13,820.00

Married (living together)

$27,600.00

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

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

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

www.socialsecurity.gov/locator

That's it for today Nation!

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

Diane

Oct 06 2017
33 mins
Play

Rank #5: MN066 Welcome To Medicare Visit vs. Annual Wellness Visit

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

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

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

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

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

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

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

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

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

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

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

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

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

Share Medicare Nation with someone!

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

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

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

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

Feb 17 2017
15 mins
Play

Rank #6: MN075 2018 Prescription Drug changes

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2018 Medicare Part D Prescription Drug Cost Sharing

It's October folks! Medicare season has begun!

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

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

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

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

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

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

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

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

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

That is a Medicare Regulation! 

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

FIND A NEW AGENT!

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

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

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

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

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

Annual Deductible 

The 2018 Maximum PDP Annual Deductible is $405.00.

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

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

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

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

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

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

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

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

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

                                    OR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TrOOP costs are -

1. The drug costs paid by the beneficiary

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

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

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

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

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

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

You will pay either:

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

You will pay whichever amount is greater.

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

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

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

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

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

Support@TheMedicareNation.com

I'll be happy to answer your question.

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

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

www.TheMedicareNation.com

That's it for this week's show!

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

Go to this link and tell me what you think! 

https://goo.gl/sb3JXo

Have a happy, peaceful and prosperous week everyone!

Oct 01 2017
33 mins
Play

Rank #7: Seniors – There’s No Need to Fear, Curtis Bailey is here! MN003:

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Summary:

In this week’s episode of Medicare Nation, Diane Daniels interviews Curtis Bailey, who is a practicing Elder Law attorney in the St. Louis, Missouri area. Curtis is also the co-director of the Senior Scam Action Associates and co-host of the ScammerCast Podcast.During this episode, Diane talks with Curtis about one of her biggest pet peeves: people taking advantage of seniors. If you know someone who has fallen victim to a phone scam, Facebook scam, or had his or her identity stolen, then this episode is a must-listen!

Main Questions Asked:

  • How did you get so involved in helping the elderly with scams?
  • Tell us about Senior Scam Action Associates.
  • What are the most common types of scams?
  • What happens if someone realizes they have been scammed and their personal information has been stolen?
  • What are the credit bureau companies a person can contact?
  • What are signs of a scam?
  • How do we know what is a legitimate email?
  • Tell us about your podcast, ScammerCast.

Key Lessons Learned:

  • Scams come in all forms:
  1. Phone scams
  2. E-mail scams
  3. Facebook friend requests
  4. Physical, “in person” scams
  • Senior Scam Action Associates helps seniors, caregivers, and professionals who work with seniors learn how to recognize and prevent scams and fraud.

Common Types of Medicare Scams

  • Unsolicited telephone call from someone claiming to be a Medicare sales representative.
  • A physical scam whereby an alleged ‘official’ agent knocks on the senior’s door.
  • A true Medicare representative will never show up at your door. They will never ask you for money or personal information.
  • Check Medicare statements each month and look at itemized details for each doctor visit and different types of tests and procedures. If you find a discrepancy, contact your insurance carrier or contact Medicare directly as it could be fraud or abuse.

If A Senior Has Been Scammed

  • Report any scams to the authorities such as local law enforcement and the Federal Trade Commission (FTC).
  • If personal identifying information has been given out, check your credit report immediately.
  • Contact any corresponding banks and financial institutions to report your identity theft.

Credit Bureau Companies

  • The three main credit-checking bureaus are Experian, TransUnion, and Equifax.
  • If a consumer contacts one bureau, the other two must be notified about any possible breeches.
  • Even if you haven’t fallen victim to a scam, it’s a good idea to get a free annual credit report.
  • Curtis recommends requesting a free credit report every 4-months. Ex: Request one free credit report from Equifax in January, then Experian in May and finally Trans Union in September.
  • Credit reports are free, but each company is allowed to charge for additional requests such as a credit score.

Giveaways of a Scam

  1. The contact will always be unsolicited.
  2. There will always be urgency involved, and they prey on fear, greed, and anger.
  3. They will ask for personal identifying information.

Tips to Avoid Scams

  • If you are unsure whether an email is a scam, then make it a rule to not click on a link.
  • If you are getting requests that look official but are unsure, follow up through official avenues such as visiting or calling the bank direct.
  • Be aware of friend requests on Facebook from people you haven’t had contact with for a long time.

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

For more information about Medicare, go to Diane Daniels website    www.callsamm.com

Links to Resources Mentioned

Senior Scam Action Associates

ScammerCast Podcast

Huffman Law Offices

Scammed: 3 Steps to Help Your Elder Parents and Yourself

Annual Credit Report

Medicare Website www.Medicare.gov

Federal Trade Commission www.ftc.gov

Equifax  www.equifax.com

Experian  www.experian.com

Trans Union www.transunion.com

Aug 27 2015
25 mins
Play

Rank #8: MN060 Choose The Medicare Plan That Fits Your Unique Needs

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

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diane Daniels

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

Nov 29 2016
44 mins
Play

Rank #9: MN058 Patient's Are At Risk in ER's Across the U.S.

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Welcome, Medicare Nation!

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

  • Tell us about health care directives and the issues that commonly arise when people come to the ER.
    • There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise the safety concerns.
  • What happens when someone comes to the ER with no accompanying family and no papers?
    • It’s not just an ER situation, but anywhere in the hospital, for any medical procedure. “You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means.” About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you’re an end of life care patient and don’t want care. Many don’t understand the difference between being critically ill and being in an “end of life” situation.
  • If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
    • Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn’t compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
  • Can you explain the difference in a Living Will and a DNR?
    • A Living Will is a legal document, not a medical document. It is for use in situations when someone can’t speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it’s a DNR, then it can affect care and treatment of any medical emergency. “It’s a coin toss with a 50% chance of being treated or not being treated.”
  • You’ve developed a solution to help people explain their wishes about receiving treatment. Can you explain?
    • At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
  • Will this ID card work in any medical office, hospital, or ER?
    • Yes, and it’s in clear and understandable medical language so that any professional will know what to do.
  • Can you explain how to find out more and what the service includes?
    • Visit our website: www.institutehcd.com or email us: info@institutehcd.com. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you’re at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry.
    • Here is the news story video of the 57y.o. man who was mistakenly noted as "DNR" in his hospital file
  •           whistle blower 9 Investigative news
Sep 16 2016
39 mins
Play

Rank #10: 2017 Annual Enrollment is Here. What Plan Will You Be On?

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

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

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

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

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

The hold harmless rule does not protect individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

There are several options available.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Need help with understanding Medicare?

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

Call 855-855-7266 for more information.

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

Nov 11 2016
39 mins
Play

Rank #11: 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
16 mins
Play

Rank #12: MN069 How to Make an Appointment With a Medicare Supplement Plan

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Hey Medicare Nation!

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

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

What I found out didn't surprise me.

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

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

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

Let's take an example.

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

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

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

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

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

Most likely, you don't have another plan.

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

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

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

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

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

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 10 2017
33 mins
Play

Rank #13: MN071 The Special Election Period Medicare Secretly Wont Tell You About

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Hey Medicare Nation!

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

Sound familiar?

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

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

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

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

(1) the number of enrollees affected;

(2) the size of the service area affected;

(3) the timing of the termination;

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

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

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

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

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

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

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

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

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

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

TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD

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

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

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

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

If You Move

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

Losing Coverage:

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

When there are plan changes with Medicare Contracts:

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

Special Circumstances

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

Precautions:

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

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

Need more information on "Special Enrollment Periods?"

See the entire list at www.Medicare.gov

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Apr 07 2017
35 mins
Play

Rank #14: 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
33 mins
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Rank #15: 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
23 mins
Play

Rank #16: Is a Colonoscopy the Only Type of Colo Rectal Preventative Exam Available? MN070

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Hey Medicare Nation!

March is colon cancer awareness month!

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

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

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

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

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

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

www.medicare.gov

How often is it covered?

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

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

Who's eligible?

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

People of any age are eligible for a colonoscopy.

Your costs in Original Medicare

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

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

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

Thank you for listening to Medicare Nation!

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

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

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

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

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

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

Thanks again for listening!

Mar 17 2017
33 mins
Play

Rank #17: 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
23 mins
Play

Rank #18: MN054 You Can Be Diagnosed With Glaucoma At Any Time

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Welcome Medicare Nation!

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

I was diagnosed with Narrow Angle Glaucoma! 

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

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

 

Open-Angle Glaucoma

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

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

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

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

 

The 2nd type of Glaucoma is called - Narrow Angle Glaucoma

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

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

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

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

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

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

What are some Symptoms of Angle-Closure Glaucoma?

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

Treatment

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

Eye drops

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

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

2 Types of Laser Surgeries Are:

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

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

Laser Peripheral Iridotomy (LPI)

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

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

 

Conventional Surgery MIGS  stands for minimally invasive glaucoma surgery.

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

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

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

  Get Your Annual Exam so your Optometrist can detect any issues with your eyes early!   A Comprehensive Glaucoma Exam Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

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

Eye pressure is unique to each person.

Ophthalmoscopy 

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

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

  Perimetry 

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

 

Gonioscopy

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

Pachymetry 

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

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

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

Resources:

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

www.glaucoma.org

www.worldglaucoma.org

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

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

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

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

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

Go to my website www.callsamm.com

And “Click” on the contact tab.

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

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

Aug 19 2016
37 mins
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Rank #19: 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
42 mins
Play

Rank #20: MN065 A Vet Helping Veterans

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Hey There Medicare Nation!

Today, I'm speaking with a special guest.

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

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

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

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

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

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

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

The Veteran's in Business Show was born!

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

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

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

TheMilitaryPodcastNetwork@gmail.com

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

Find the podcast here:

veterans-in-business-show

Contact James Van Prooyen:

@JamesVanProoyen

on Snap Chat - JamesVanProoyen

LinkedIn - James Van Prooyen

James - Thank You for your Service!

Tell a family or friend about Medicare Nation! 

Help someone get on Medicare Nation with a Smart Phone! 

The resources for people 64 and older is so valuable!

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

Help me to help you!

Thanks for listenening!

Feb 10 2017
33 mins
Play

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