Medicare Nation

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020! THREE more plan sponsors to discuss! CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00! HUGE Penalty people! According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees. HCSC has the right to Appeal CMS Decision.   NEXT Up..... is Triple-S Management Corporation! CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020. CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00! CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration. Triple-S has the right to Appeal CMS decision. Last up..... is Tufts Health Plan, Inc.  CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00. CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations. Tufts has the right to Appeal CMS' decision. If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call. You can request a "Special Election Period," based on your experience with any of these companies. Call Medicare at  800 - 633 - 4227  24hrs a day, 7 days a week. www.TheMedicareNation.com   Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!  

Hey Medicare Nation! Medicare Nation CMS Imposes a Civil Money Penalty against HUMANA! CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019. Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M. Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees. CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........ $257, 262! Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug.  This allows you time to speak with your doctor to see if there is an alternative prescription drug on the new plan ...... or...... you can request a "Formulary Exception." This means your doctor is requiring you to take this medication, because it is the one that is stablizing or correcting your condition, and that you need to continue to take it. If the drug is NOT on the new plan's formulary and they Approve the formulary exception, you WILL be charged a higher amount for taking a drug that is not on their formulary. Humana has the right to appeal the decision by requesting a hearing. The notice is signed by John Scott, Acting Director of the Medicare Parts C and D Oversight and Enforcement Group. Medicare Nation NEXT CMS Penalty is given notice to......... SOLIS Health Plans out of Miami, Florida On December 4, 2019, CMS gave notice to Mr. Daniel Hernandez - CEO of Solis Health Plans. CMS imposed a CIVIL MONEY PENALTY of $41,552.00! CMS stated in their summary that Agents employed by SOLIS engaged in an aggressive marketing campaign that was conducted by a contractor provider clinic. Solis Agents conducted a marketing presentation in a secluded area and enroll patients upon conclusion of the presentation. CMS determined that Solis violated the communication and marketing requirements, which had the substantial likelihood of adversely affecting its enrollees. Solis Failed to oversee and manage the marketing process to ensure its agents and brokers did not engage in inappropriate marketing practices including "misleading" beneficiaries. Solis may request a hearing to appeal CMS's determination. Both notices are signed by John Scott, acting director of the Medicare parts C and D Oversight and Enforcement Group. Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels    

Hey Medicare Nation! Medicare Nation Today, I'm informing you about The Centers For Medicare & Medicaid Services Notice, given to Mr. Art Carlos, CEO of Delaware Life Insurance Company. In a notice dated January 31, 2020, CMS notified Mr. Carlos that they were immediately imposing Intermediate "Sanctions" against Delaware Life Insurance Company. CMS determined that Delaware Life Insurance Company is "in substantial violation of Medicare Advantage and Prescription Drug Plan requirements." SIX specific violations were listed in the notice to Carlos. LISTEN to the episode to learn about the violations and what you can do if YOU are a beneficiary under one of Delaware Life Insurance Company's Medicare Advantage Plan or Prescription Drug Plan. www.TheMedicareNation.com Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels Medicare Consultant

Hey Medicare Nation! www.TheMedicareNation.com Medicare has taken many steps to assist you during the COVID-19 crisis. Coronavirus tests Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called COVID-19). This test is covered when your doctor or other health care provider orders the test. I spoke about testing for COVID-19 in the previous episode, dated April 1, 2020. Listen to episode 101 to learn more about COVID-19 Testing. Your costs in Original Medicare for COVID-19 Testing. You pay nothing for this test. NADA! This includes the newly available COVID-19 “Antibody” test, which determines if you have antibodies in your blood, that were created to recognize the COVID-19 Virus in your body. Hospitalization Medicare covers All medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might have been discharged from the hospital after an inpatient stay, but……. instead you need to stay in the hospital under quarantine.   Your costs in Original Medicare ZERO!   3     VACCINE FOR COVID-19 At this time, there's no vaccine for COVID-19.  However, If and when one becomes available, it will be covered by all  MEDICARE Prescription Drug plans -  Which is Part D of Medicare.   TELEHEALTH  SERVICES During the National Emergency for COVID-19, you will be able to receive a specific set of services through telehealth These services include: Evaluation and management visits (common office visits), mental health counseling and preventive health screenings  without a copayment if you have Original Medicare.  Your costs in Original Medicare  $0  Co-Pay if you have Original Medicare. You can use your smart phone or computer to access Telehealth services. 5.    Virtual check-ins virtual check-ins (also called “brief communication technology-based services”) with your doctors and certain other practitioners. What is it ? Virtual check-ins allow you to talk to your doctor or certain other practitioners, like nurse practitioners or physician assistants, using a device like your phone, integrated audio/video system on your laptop or computer, or captured video image without going to the doctor’s office. Your doctor or other practitioner can respond to you using: Phone Audio/visit Secure text messages Email Use of a patient portal   Virtual Check-Ins can be used for treatment for the Coronavirus from ANYWHERE……including places of residences….HOMES. Nursing Homes, AND Assisted Living Facilities.       Things to know You must talk to your doctor or other practitioner to start these types of visits. The communication must not be related to a medical visit within the past 7 days and must not lead to the medical visit within the next 24 hours (or the soonest appointment available). You must verbally consent to the virtual check-in, and your consent must be documented in your medical record. Since January 1, 2020 your doctor may obtain a single consent for a year’s worth of these services.        Your costs in Original Medicare      Normally, you would pay for “Virtual Visits” under Part B of Medicare.      During the National Emergency, your co-insurance and deductible will be waived, and you will have “No Co-insurance, or deductible” for Virtual Visits for COVID-19 services.   Certain Skilled Nursing Facility Care requirements have been waived during the National Emergency for COVID-19. During the COVID-19 Pandemic, some people may be able to get renewed SNF coverage without first having to start a new benefit period.  Original Medicare covers up to “100 consecutive days” in a Skilled Nursing Facility.” For each benefit stay. During the National Emergency for COVID-19, your Doctor may request an extension of days for your benefit period.   If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get SNF care without a qualifying hospital stay.   if you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described above and many plans have waived Hospital co-pays during the pandemic. Check with your plan about your coverage and costs for ALL services covered for COVID-19. Review your Summary of Benefit Booklet for 2020 from your Medicare Advantage Plan Carrier. Don’t have one……… Go to the plan’s website to download a digital copy. OR…… Call the Customer Service number on the back of your Identification card and ask them to mail you a “Formulary” for your Specific plan.     Preparing for healthcare needs   Be sure you have over-the-counter medicines and medical supplies like tissues….cough drops…. Tylenol…etc.  to treat fever and other symptoms.   Most people will be able to recover from COVID-19 at home.   Have enough household items and groceries on hand…..Soup, Macaroni and Cheese, Bread for Toast…. Whatever it is you will eat & drink when you’re sick….so that you'll be prepared to stay at home for a period of time.   Check out the following websites for updates on COVID-19   Centers for Disease and Control - CDC.gov …..  has the latest public health and safety information from the CDC and for the medical and health provider community on COVID-19.   USA.gov -  has the latest information about what the U.S. Government is doing in response to COVID-19.   CoronaVirus.gov - is the source for the latest information about COVID-19 prevention, symptoms, and answers to frequent questions.   Visit your State Department of Health for local COVID-19 Information about YOUR State.   You can search on Google for your State’s Health Dept. by typing in ……… NY State Health Depart……… CA State Health Dept……..Florida State Health Depart……    Visit my website for a LIST of EVERY State Health Department’s Phone Number…… By going to www.TheMedicareNation.com/COVID19     Many of you are turning 65 and have no idea what to do to enroll in Medicare or what Plan to enroll in. I invite you to contact me….. so that I can assist you with all this. Send me your question to Support@TheMedicareNation.com   I answer ALL emails myself! No Assistants, NO Virtual Assistants….. I do! I will answer your question in one paragraph. If I cannot, I will let you know how to contact me if you wish to reach out to me for a consultation. Until next time……. Practice Social Distancing…..Do things to Make you Happy……. AND Stay Healthy!! Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!   The information on this podcast and/or website is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional, which neither I nor anyone else associated with Medicare Nation LLC is not! Please consult with your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. If you think you may have a medical emergency, call your physician and/or 911 immediately. Medicare Nation LLC reserves the right to add, remove or edit content on this page at its’ sole discretion.

Hey Medicare Nation! www.TheMedicareNation.com It’s April 1st and over One Million People have been diagnosed with the COVID-19 Virus Worldwide! On this week’s episode….. I provide a time-line of the events of the Pandemic as well as updates on COVID-19 testing and Important phone numbers should you have symptoms or questions about COVID-19. I also have a “list” of phone numbers, for EACH Health Department in All 50 States! You can email me at  Support@TheMedicareNation.com for the list or check the show notes for an attachment. Here is an important phone number for the CDC HOTLINE on COVID-19 800 -232- 4636 - CDC Hotline Advent Health 24hr Hotline -  877 – 847 – 8747 You can also download the Advent Health App on iTunes or Google Play in order to have a “Virtual” visit with an Advent Health Doctor.  Bay Care Virtual Doctor Hotline -  800 – 229 – 2273 You can also go to this website for a “virtual” visit with a Bay Care Doctor – www.BayCareAnywhere.org  The Florida Department of Health Hotline is  866 – 779 – 6121   State Health Department List of Phone Numbers   Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Contact Me! Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!

Hey Medicare Nation! We're smack in the middle of a Corona Virus Pandemic! The Medicare Nation I wanted to give you an episode that is full of USEFULL information. I know you've been hammered by the news, internet and newspapers about the Corona Virus. Let's start with a very important fact: Human coronaviruses were first identified in the mid-1960s. The 1960's people! the coronavirus gets its name from a distinctive corona or in a scientists world…a “Crown of Sugary Proteins,” that projects from the surface of the virus. There are four main types of Human Corona Viruses Alphacoronavirus,  Betacoronavirus,  Gammacoronavirus, and  Deltacoronavirus. The first two only infect mammals, including bats, pigs, cats, and humans.   Gammacoronavirus mostly infects birds such as poultry (chickens) and Deltacoronavirus can infect both birds and mammals. Do you recognize the Virus named SARS? Severe acute respiratory syndrome abbreviated as …. (SARS-CoV) SARS-CoV (the beta coronavirus.  Guess what it causes?  It causes severe… acute…..respiratory syndrome, SARS was first recognized as a distinct strain of coronavirus in 2002. The source of the virus has never been clear, though the first human infections can be traced back to the Chinese province of Guangdong in November of 2002. The virus then became a pandemic, causing more than 8,000 infections of an influenza-like disease in 26 countries with close to 800 deaths. In the United States, only eight persons were laboratory-confirmed as SARS cases. There were NO  SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring. By July of 2003….. the World Health Organization declared the outbreak over. On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is….SARS-COV-2 aka coronavirus disease 2019, abbreviated as COVID-19.  ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. The Medicare Nation COVID-19 is a new disease, caused by a novel (or new) “coronavirus” or strain of “Corona Virus” that has not previously been seen in humans. What are the Symptoms of COVID-19?  The CDC (Centers of Disease Control) have listed these as the most common symptoms of COVID-19: Fever Cough Shortness of breath Symptoms may appear 2-14 days after exposure. Reported illnesses have ranged from mild symptoms….like a dry cough…. to severe illness, with high fever and shortness of breath, requiring hospitalization and there have been deaths reported for confirmed coronavirus disease 2019 (COVID-19) cases.   Currently……according to the WHO… as of March 13th….there are over 132, 758 reported cases of    COVID-19 …. Worldwide. Of those cases….. there are 4,955 Deaths worldwide. Over 80% of the reported cases are recovering. In the U.S…… there are currently 1,629 reported cases…… in 47 of the 50 States. No reported cases yet….in Idaho, Alabama and West Virginia. There have been 41 Deaths reported in the U.S. ….. with 37 Deaths coming from the State of Washington. The deaths mainly being reported from a nursing facility, with those being elderly and having underlying medical conditions prior to contracting the CoronaVirus. What do we mean by Underlying medical conditions????  If you have a blood disorder.... like sickle cell disease... or ... you have chronic kidney disease.... you're currently receiving chemotherapy or radiation. You may have congestive heart failure or coronary artery disease. You may have chronic asthma or chronic obstructive pulmonary disease or you may need oxygen at home. All of these conditions..... as well as many more..... may raise your risk of contracting COVID-19. You may NOT contract the virus. Just be more cognizant of your surroundings and who you are in contact with. What do you do if you believe you have symptoms of the COVID-19? NUMBER 1…. Call your Primary Doctor. Speak with the Nurse or Physician’s Assistant. Tell them your symptoms and they will advise you of what to do.  IF You CANT get Through to your Doctor……. If you have a Medicare Advantage Plan…… the Plan most likely has a 24 hr. Nurse’s Line.  CALL THEM!!  Tell the nurse  your symptoms. They will advise you. Call your STATE Health Department for Advise. Each State has an information line dedicated to the COVID-19 Crisis and will be able to assist you with answering question. If you have any severe symptoms….. as in Difficulty Breathing, fluid in your lungs, High fever of over 104 degrees…. CALL 911!   If you do have symptoms, and your doctor wants you to have the test to confirm COVID-19…. Where do you go?? According to the FDA….. here is the current list of laboratories across the U.S. that will be offering testing for the COVID-19 very soon  Advent Health Laboratories  Lab Corp Quest Laboratories As well as many other public health, university and private labs will be available on the FDA list of laboratories to test for the COVID-19. Medicare IS Covering the Test for COVID-19 as a Preventative Diagnostic Test….and therefore ….. you will have NO COPAY when you take the test. There are currently  TWO Testing Codes for the COVID-19 Test Is for having the Test at a Public Health Lab ( your local community Health Department) which is U0001 The 2nd is for having the test at a commercial or private lab (like Lab Corp) which is U0002.   If you are diagnosed with COVID-19, self-quarantine yourself in your home, away from your family members and pets, until you have tested negative. We ALL need to SELF-Police ourselves and HELP STOP the Spread of COVID-19….. so we can curtail the spread and help stop the pandemic.  Remember to Drink lots of fluids….. eat plenty of chicken soup and crackers ….. and get lots of REST!! The Medicare Nation You can go to the Center for Disease Control website for daily updates on the Corona Virus 19 situation ….. go to….. www.CDC.gov   You can also go to the World Health Organization website…. Go to …. www.who.int   AND…. PLEASE go to your STATE”S Health Department website for local information by “Googling” your State.  That’s all for today Nation. Call your Parents….. Make sure they’re ok and help them subscribe to Medicare Nation…. So they can hear this episode as well as over 100 other episodes about Medicare and it’s Resources. Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!      

Hey Medicare Nation! www.TheMedicareNation.com It's still January...but February is right around the corner. Spring WILL come. I promise! Let me give you some good news! Medicare is now covering Acupuncture! As of January 21, 2020, The Center for Medicare & Medicaid Services (CMS), will cover acupuncture for "Chronic Low Back Pain." Let's look at the coverage in the Medicare National Coverage Determination Manual. Section 1862(a)(1)(A) of the Social Security Act  Up to "12" visits in 90 days are covered for Medicare Beneficiaries under the following circumstances: a. Chronic Low Back Pain which lasts "12 weeks or longer," b. the Chronic Low Back Pain is "non-specific," in that it has NO identifiable systemic cause (NOT associated with metastatic, inflammatory, infectious, disease). c. the Chronic Low Back Pain is NOT associated with surgery d. the Chronic Low Back Pain is NOT associated with pregnancy. An ADDITIONAL "Eight" (8) sessions WILL be covered for those patients demonstrating an improvement. No more than "20" acupuncture treatments may be administered annually. Treatment MUST be discontinued if the patient is NOT improving or is regressing. The Acupuncture must be Administered under the supervision of a doctor of medicine or osteopathy. Need more information?  Check out our website www.TheMedicareNation.com What plans cover Acupuncture? Acupuncture for Chronic Low Back Pain, will be covered under ORIGINAL Medicare.  If you present your Medicare ID Card to providers as your Health Insurance..... You may start utilizing this treatment now. If you present your Medicare ID Card, as well as a Medi-Gap (Medicare Supplement) Plan..... You may start utilizing this treatment now. If you have a Medicare Advantage Plan, you need to check your Summary of Benefits Book under your plan, to see if they cover Acupuncture. If you can't find it.... call the customer service number on the back of your ID Card and ask the representative. Acupuncture is NOT covered under Medicare Part D. Part D is ONLY for Prescription Drug Coverage. If you have any questions.... send them to Support@TheMedicareNation.com   Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels                                                                            Medicare Consultant Support@TheMedicareNation.com    

Hey Medicare Nation! www.TheMedicareNation.com It's 2020!  Love the sound of that! Right now...... the Medicare Advantage Open Enrollment Period is in full swing. If you are on a "Medicare Advantage Plan," you have the opportunity to make a ONE TIME change, between January 1st through March 31st. You can change from one Medicare Advantage Plan to another Medicare Advantage Plan. You can "disenroll" from the Medicare Advantage Plan you're on and go back onto "Original Medicare." With Original Medicare, you can add a stand-alone-prescription drug plan and ..... you can enroll into a Medicare Supplement Plan (aka Medi-gap) to help defray the costs of Original Medicare. Here are options you can do during the Medicare Advantage Open Enrollment Period:  Change from a Medicare Advantage Plan back to Original Medicare. Switch from one Medicare Advantage Plan to another Medicare Advantage Plan. Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage. Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage. Join a Medicare Prescription Drug Plan. Switch from one Medicare drug plan to another Medicare drug plan. Drop your Medicare prescription drug coverage completely   I'm adding the EXACT language from the Medicare Managed Manual, regarding the Medicare Advantage Open Enrollment Period. 30.5 – Medicare Advantage Open Enrollment Period (MA OEP) 42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019) During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP. This chart outlines who can use the MA OEP and when: Who can use the MA OEP: MA OEP occurs: Individuals enrolled in MA plans as of January 1 – March 31 New Medicare beneficiaries who are enrolled in an MA plan during their ICEP The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to: • MA-PD • MA-only • Original Medicare (with or without a stand-alone Part D plan) The effective date for an MA OEP election is the first of the month following receipt of the enrollment request. NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE). You may also go onto Medicare.gov to view information on the Medicare Advantage Open Enrollment Period. If you decide to make a change during the MA OEP, you will be "locked-in" to the new plan, until the next enrollment period.... which is....the Annual Enrollment Period, from October 15th through December 7th. You may also make a change to your plan if you have a "special circumstance." These are listed under the "Special Election Periods" for Medicare on Medicare.gov You can also LISTEN to my previous show on Special Election Periods..... Episode 051, which was published on July 29, 2016. The episode is titled..... "Special Election Period Q & A" I go into detail about the Special Elections available. www.TheMedicareNation.com Remember Medicare Nation listeners........ an "Insurance Agent," is NOT allowed to "solicit" you during the Medicare Advantage Open Enrollment Period.  There are strict Medicare regulations regarding this. YOU must make the first move in contacting or telling your "Agent" or Medicare Specialist, that you are unhappy with your current plan. No one should be calling you, texting you, emailing you ..... or worse...... knocking on your door, telling you about the Open Enrollment Period. If someone does...... tell them to "Take a Hike!" You don't need a dishonest person like that helping you with your Medicare needs! If you need help finding a new plan during the OEP, contact you're Medicare Advisor. If you are all set with your Medicare Advantage Plan for 2020, You don't need to do anything! Just enjoy your family, friends and activities!    Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Contact me on my website - www.TheMedicareNation.com Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels                                                                          Medicare Consultant                                                                  Medicare Nation LLC.

Hey Medicare Nation! CMS just announced the 2020 Medicare Part B Premium increase! CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible. Here's a look at what's changing in 2020: Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act.      SOCIAL SECURITY   Increase:    1.6%  (Avg $24 more a month)   Average Monthly SS Check $1,503.00       2020 - PART A DEDUCTIBLE AND COINSURANCE   Inpatient Hospital Deductible:                       $1408.00 Daily Coinsurance Days 61-90:                    $  352.00 Daily Coinsurance-Lifetime Reserve:           $  704.00 Skilled Nursing Facility-Days 21-100:           $  176.00       2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE   Standard Monthly Premium:                 $ 144.60  ($9.00 More) Annual Deductible:                                $ 198.00   It's a great time to review your plan for 2020. Is it the right plan to fit your unique needs? If so........ keep it! If not....... change it! I am available to assist you with your Medicare Plan choices for 2020. If I can answer your email in one paragraph or less, I WILL answer your question for you! If the answer to your question requires any research or my response is longer than one paragraph..... I will let you know that you will need to hire me to answer that question. If you live outside of Florida, you can hire me as your consultant at a rate of $200.00 an hour ( The hourly rate is going up to $250.00 an hour, starting January 1 2020). If you are a Florida resident, I can assist you in enrolling into the plan that fit's your unique needs at no additional charge. I will receive a commission from the insurance carrier once you are enrolled. The commission is regulated by Medicare. The Annual Enrollment Period ends December 7th, so make sure you do your "due dilligence" and find the plan that works for you! Until next time..... Have a Happy, peaceful & prosperous week! Diane Daniels Medicare Consultant 855-855-7266

Hey Medicare Nation! www.TheMedicareNation.com It's October! That means it's Medicare Time! The Annual Enrollment Period is just around the corner. Did you receive your "Annual Notice of Changes (ANOC)" for your Medicare Advantage Plan or Prescription Drug Plan? If not....contact your plan and request the ANOC. Today......I want to talk with you about Part D Prescription Drug Coverage for 2020! Medicare has set the maximum Part D Deductible for 2020 at $435.00. Medicare Advantage Plans and Stand-Alone Prescription Drug Plans have the option to charge the maximum deductible amount of $435.00...... or....... They can eliminate the Deductible altogether.... or...... They can charge an amount in between. You MUST do your "Due Dilligence" in determining which Prescription Drug Plan will fit your unique needs for 2020. Contact your Medicare Specialist and request their assistance in finding a Prescription Drug Plan for 2020. If you have a question about Medicare or your Prescription Drug Plan.... You can send me an email to Support@TheMedicareNation.com If I can answer your question in ONE Paragraph, I will answer your question! If I cannot ...... I will request you hire me as your consultant. I currently charge $199.00 an hour for my consultation services.  I always do my best to answer your questions in ONE paragraph. The "initial coverage period (ICP)" for Part D, has a threshold of $4,020.00 When you hand in a prescription, the total amount of the prescription is applied towards the ICP. If you have a Deductible, that is applied towards the ICP too. When the total amount of your prescriptions reaches $4,020.00..... you will now enter a new phase called the "coverage gap." In this stage.... you will now pay 25% of generic drugs.... and you will pay 25% of brand name drugs. If you reach $5,018.75 you will enter the next stage, which is called.... The "Catastrophic Stage." In the Catastrophic Stage, you will now pay a 5% co-insurance or $3.60 for Generic Drugs..... or.... $8.95 for Brand or non-preferred Drugs.... which ever is a greater amount. You will remain in the Catastrophic Stage until your out-of-pocket spending reaches $6,350 or..... when the ball drops on New Year's Eve! I know prescription drugs can be very expensive! There are programs available for those of you with lower incomes. The program is called "Extra Help," or "Low Income Subsidy." To apply for Extra Help, go to the social security website - www.socialsecurity.gov/extrahelp If your individual income is less than $1,562 a month, you would qualify for the LIS program. If your income is more than $1,562 a month, but is less than $1,900 a month....APPLY! You have nothing to lose! All they can say is No! You can also appy for the "Medicare Savings Program" If you qualify, CMS will pay for your Medicare Part B Premium. Depending on your qualifications, CMS may pay your premium, deductible and co-insurance. Apply for the Medicare Savings Program here: https://www.medicare.gov/Contacts/#resources/msps Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels  

Hey Medicare Nation! www.TheMedicareNation.com How Do I get treatment & prescriptions during a weather emergency? Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety. What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency? Or…. What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency? Let’s take a look at these questions for you. After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States.  Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian. What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration. For example……. You evacuated your home in Savannah Georgia, to go stay with your relatives in Michigan. Prior to evacuating your home, you were receiving home health care for physical therapy…due to a sprained ankle. If you are on Original Medicare, you can contact “Any” home health agency that accepts Medicare to re-start your physical therapy at your relative’s home. They should be able to contact Medicare to get copies of the orders you had for the Physical Therapy. If you’re on a Medicare Advantage Plan, you will need to contact your Plan carrier…… advise them you evacuated from a Public Health Emergency area and that you need to “Resume” physical therapy at home ASAP. The plan should contact a home health care vendor in the area you’re temporarily staying in, to resume your physical therapy. If you have a Medicare Specialist, call them! You WILL need their help in expediting the process. Remember…… MILLIONS of people have evacuated coastal areas! Don’t Delay!!! If you need to use your Medicare benefits…. CALL as soon as possible. For Prescription Medications……let’s say in the stress of having to “evacuate,” you forgot all your prescriptions at home. under a Medicare Advantage Plan, call your carrier & tell them what happened. You should be able to get a “Refill” under the “Emergency Waiver,”  for most prescriptions. If you need an Extension for 60 – 90 days for your prescription, due to being out of the area, call your plan and ask them if they “offer” extended day prescriptions. If you’re on an “opioid” prescription……… call your plan & advise them of your situation. Hopefully, you can get a refill…. for at least a day…. or two…… under the waiver, until you can be seen by a doctor in the area you’re temporarily staying at. Your carrier will tell you which Pharmacy is “IN” network…. Where you’re staying.  If there is NO pharmacy “In” Network where you’re staying, ask the carrier if they will “reimburse” you for the cost of the prescriptions. You will need a receipt with the Pharmacy name,  prescription name, and the price you paid for the prescription on the receipt to submit to your Medicare Advantage Carrier for reimbursement. If you had Durable Medical Equipment …… Orthotics, Prosthetics,  or Oxygen Supplies for example….. that was lost, destroyed, “irreparably damaged” ….. or otherwise rendered unusable…… you should be able to replace it from a vendor in the area you’re staying….. with the “flexibility” to WAIVE the replacement requirements that are normally in place. If you are on a Medicare Advantage Plan, contact your carrier for assistance in getting a replacement…. And advise them the “Blanket Waiver” is in place. They will assist you in finding a local vendor to “Replace” your equipment.    For those of you needing to stay at a “Skilled Nursing Facility,”Under “Normal” Circumstances…… if you or a loved one needed to enter a “Skilled Nursing Facility,” you would be required to have a “ 3 Day Prior Hospitalization” … prior to entering the Skilled Nursing Facility. Under the “Blanket Waiver,” the 3 Day prior hospitalization is “waived,” so that you can enter the Skilled Nursing Facility without further delay. This rule would be in effect “temporarily,” for those who are …… “ evacuated, transferred, or otherwise…. “dislocated” as a result of the emergency. So….. if you “evacuated” your home in Puerto Rico, Florida, Georgia or South Carolina, due to Hurricane Dorian….. and let’s say you’re temporarily staying with relatives in Pennsylvania………and you need to enter a Skilled Nursing Facility……you would be able to enter the facility without the 3 day prior hospitalization. If you are on a Medicare Advantage Plan, you must contact your carrier to assist you in determining which “Skilled Nursing Facilities” has room for you to be admitted into.   These are examples of how Medicare “requirements” are more flexible during a Public Health Emergency WITH a “Blanket Waiver.”   How long does the Blanket Waiver Last? Until Secretary AZAR signs an order stating the Public Health Emergency is over. NOW….. let’s take a look at how FEMA affects enrollment into Medicare.   FEMA… which stands for the Federal Emergency Management Agency, also declared emergencies in Puerto Rico, Florida, Georgia, South Carolina AND the Virgin Islands (which are St. Croix, St. John, St. Thomas AND Water Island) ….., which creates a “Special Election Period” for Medicare Beneficiaries, who needed to enroll in a Medicare Plan during that time, but were unable to ….. due to the effects of Hurricane Dorian. This means if you needed to enroll in Medicare, or into a Medicare Advantage Plan for September 1st…….. you will be given a Special Election Period to do so…. Under the Emergency “Weather Event.” So….if you need to enroll into a Medicare Advantage Plan…..OR…. a Stand-Alone Prescription Drug Plan…. you can do so, most likely through the end of October…… or even November in South Carolina & Georgia, under the FEMA Emergency. You can call Medicare at  800 – 633 – 4227 or your Medicare Specialist for more information.   If you feel you are overly “stressed” with all the information on TV & social media, about Hurricane Dorian…… #1 ….. STOP watching the news continuously!  Listen to some music…. Read a book….. play a board game. Go out for a walk. Continuously Watching the news about the weather is the worst thing you could do! If you need to speak with someone, you can call the “Disaster Distress Helpline.” Call  800 – 985  - 5990 to connect with a trained counselor, who can assist you with your distress. You can even “TEXT” ….. TALKWITHUS   type the letters all together and send it to…. 66746. You can also go online to get more Public Health & Safety info by going to https://www.phe.gov/Dorian Finally….. if you would like to help those affected by Hurricane Dorian in the Bahamas….OR ….any of the other impacted States….. Call your local TV Station or go onto their websites to find information on how to volunteer or donate supplies. If you’d like to “donate” money to a cause….. For Animals. Go to the Humane Society of the United States website… HumaneSociety.org/Disaster-Relief The Humane Society is evacuating animals form Animal Shelters across Florida and the other States. They have already helped transport almost 100 animals here in Florida, that they will place in “safe shelters,” with the hope of being put up for adoption. If you’d like to contribute to a Humanitarian Charity….. or one that is specifically helping those in the Bahamas…… go to the Charity Navigator website & they have a list of highly ranked charities that are providing relief. Go to   http://charities.foundation/dorian To donate to one of these funds. That’s all for this special show and I wish everyone out there, in the path of Dorian…… that you & your loved ones are safe. Till next time.... Have a Safe & Peaceful week! Diane 

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!    

Hey Medicare Nation! www.TheMedicareNation.com Help your PARENTS, Spouses and Friends "SUBSCRIBE" to Medicare Nation! With almost 100 episodes on Medicare and Medicare Resources available, your loved-one will be able to find answers to their Medicare questions! Use the "Purple" colored icon on an Apple phone or .... download Stitcher, Himalaya or Player FM when using Android phones. Search for "Medicare" and "click" on the Medicare Nation logo. You'll see the "subscribe" button on the page. "Click" subscribe and they'll get the NEWEST Medicare Nation episodes delievered to their phone. TODAY.... I'm discussing NEW information released from CMS.   CMS Decision Summary Ambulatory Blood Pressure Monitoring  Devices July 2, 2019…..The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries.  What is hypertension (high blood pressure)? The American Heart Association (AHA) defines blood pressure as…. a force that pushes blood through a network of arteries, veins and capillaries. The blood pressure reading is the result of two forces: the systolic pressure occurs as blood pumps out of the heart and into the arteries; diastolic pressure is created as the heart rests between heart beats (American Heart Association, 2018). Elevated blood pressure, or hypertension, leads to harm by causing tiny tears in the interior lining of the arteries and coronary vessels…..stimulating a local immune response in the endothelial cells within the atrial walls.  In these regions, the arterial intima retains apolipoprotein B, which attracts lipid-rich macrophages (foam cells).   These preatherotic lesions develop into atherosclerotic plaques which become increasingly fibrotic and can form fissures, hematomas, thrombi, and calcifications (Swirski and Nahrendorf, 2013). The end result is stiff, thickened arteries that narrow the flow of blood to organs and limbs….which both increases pressure on target organs and limits oxygenation of them. There is also the risk of atherosclerotic plaque rupture, resulting in distal vascular obstruction and ischemia and infarction of end organs, such as stroke in the brain (U.S. Department of Health & Human Services, 2018). CMS is lowering the blood pressure threshold for hypertension… from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria.  This will allow more patients to use ABPM and receive appropriate treatment if needed. General Ambulatory blood pressure monitoring (ABPM) is a diagnostic test… that allows for the identification of various types of high blood pressure. ABPM devises are small… portable machines that are connected to a blood pressure cuff worn by patients…. that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities..including sleep. The recording is interpreted by a physician or non-physician practitioner….and appropriate action is taken based on the findings. Diagnosis and treatment of high blood pressure is important for the management of various conditions…. including cardiovascular disease and kidney disease.   Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries is covered under the following circumstances: For beneficiaries with suspected “white coat hypertension,” which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm … but less than 160 mm … or diastolic blood pressure greater than 80… but less than 100… on two separate clinic/office visits …..with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are 140/90 on at least three separate clinic/office visits with two separate measurements made at each visit; At least two documented blood pressure measurements taken outside the office which are

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200! CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.  From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information. In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing. Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services. Enrollees were affected in the following area: Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY. Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs. CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage. Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost. In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0,  you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.  Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you. If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation. If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240. You can also make a complaint to Medicare directly by calling 800-633-4227. If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240. If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can : 1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan  or 2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/ when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads - Find Your Local SHIP "Click" on that ORANGE buton and a list will come up of all 50 States. "Click" on the State where you reside, to contact your local SHIP center. If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either: Support@TheMedicareNation.com or  call me at 855-855-7266 If I can answer your question in ONE paragraph in an email, I will directly answer your question! If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.  I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country! Please SUBSCRIBE to Medicare Nation so that you will receive EVERY NEW episode that is published! Give Medicare Nation a ***** 5-Star Review on iTunes! The more reviews we get, the more people can find the show! Go to www.itunes.com and type MEDICARE NATION in the search bar. When the page opens, "Click" on the Review tab and leave your review! Thanks so much for listening! If you'd like to hear about a specific topic on the show or you'd like a specific guest on the show...... send me an email to Support@TheMedicareNation.com I appreciate your Support! Diane Daniels  

Multi Target Stool DNA Test  vs. Fecal Occult Blood Test  Hey Medicare Nation! www.TheMedicareNation.com Have you subscribed to Medicare Nation? Don’t know how? If you have an Apple iPhone……. Click on the “Purple” icon…. With the white microphone. When the page opens….Click on SEARCH. Type in Medicare. Medicare Nation comes right up… WHY……BECAUSE….. it’s a TOP 100 APPLE PODCAST Nation! Click on that Beautiful Flag “Medicare Nation” Logo. When the page opens….Click on the SUBSCRIBE button! That’s it. You’ll get the latest information on Medicare and you can search through the almost 100 episodes on Medicare Information! Are Your Parents subscribed to Medicare Nation? Come On “Sandwich Generation” Show your parents HOW to Subscribe to Medicare Nation! Once they subscribe…. They will STOP asking you questions about Medicare, because they WILL Find the answer by listening to Medicare Nation episodes! Let’s give YOU back some time…. So that YOU can have more time for yourself   Today…..I’m going to be talking to you about the Differences Between Multi Target Stool DNA Test  vs. Fecal Occult Blood Test Medicare offers these Preventative Tests to determine if you have blood in your stool and/or suspected cancerous characteristics. ColoRectal  cancer (CRC) is the second most frequent cause of cancer DEATH in the United States.  The Most Frequent Cause of Cancer Death is…… Lung Cancer. This year, an estimated 145,600 adults in the United States will be diagnosed with colorectal cancer. According to Cancer.net…… an estimated 51,020 of the 145,600 adults will die this year…..due to ColoRectal Cancer. When colorectal cancer is found early, it can often be cured. CURED Nation! This is due to improvements in treatment and increased screening….. which finds colorectal changes before they turn cancerous and cancer at earlier stages. Medicare Part B offers TWO Preventative Screening Tests The First…. Is a Fecal Occult Blood Test “Fecal Occult” Blood Test is just a scary way of saying….. “ Looking for Blood in your Poop.”  The test ONLY detects the “presence” or “absence” of blood in your stool. The test does not indicate potential sources of bleeding and it does not “Diagnos” disease. “Fecal” means……“Stool” or “Poop”….and…. “Occult Blood” means you can’t see the blood in your stool with the “naked eye,” so….. the specimen is sent to the lab for a closer look. Blood in the stool may indicate polyps…. or it may indicate cancer in the intestine or rectum….though not all cancers or polyps bleed. If blood is detected through the “Fecal Occult Blood Test,” additional tests may be needed to determine the source of bleeding as well as “diagnosing” an ailment or disease. Blood in the stool could also mean Hemorrhoids….which are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin….. that the veins bulge and get irritated, especially when you poop! Straining while pooping is a major factor in Hemorrhoids.  EAT more Fiber Nation! Eat More Vegetables….try Metamucil or Miralax. Straining to poop is not good. Drink more water! You should try to drink at least 96 oz. a day. I use a 24oz bottle I fill 4 x a day….. to get my 96 oz of water. You can do it. It’s important. Hemorrhoids can cause itching & pain.  Hemorrhoids can also bleed. There are several types of Fecal Occult Blood Tests, I’m going to discuss the “newer version,” which is called a “ Immunochemical Fecal Occult Blood Test,” (aka iFOBT or FIT) The IFOBT or FIT test is less of a mess and easy to administer. Typically, you have a “spoon-like” device to collect the sample of stool and you place the device into a collection container then seal it. You either return the collection container to your doctor’s office, or you mail it. There are no dietary restriction with the iFOB-IT and the test can be performed on any random sample of your stool. Your Doctor will review the results and there are just two options: Negative Result, which means no blood was detected in the stool sample you provided. OR…….. Positive Result, which means blood WAS detected in the stool sample you provided.   This type of test ISN’T ALWAYS accurate. Your fecal occult blood test could show a negative test result when cancer is present (false-negative result) if your cancer or polyps don't bleed. If you had the test to screen for colon cancer and you're at average risk — you have no colon cancer risk factors other than age — your doctor may recommend waiting one year and then repeating the test.  If you have a “positive result,” You may need additional testing — such as a colonoscopy — to locate the source of the bleeding. Under Medicare…… The Fecal Occult Blood Test…. can be given ONCE every 12 months if you’re 50 or older, at ZERO Cost to you.        Now….. let’s take a look at Mult-Target Stool DNA Tests. You will know the “Multi-Target Stool DNA Test” more commonly known as “ColoGuard.” ColoGuard …….   addresses several barriers to colorectal screening. Patient concerns with colonoscopy. Include…having to schedule a separate and lengthy appointment at the testing facility. The need to undergo a “Stay Close to my Bathroom” bowel preparation the exposure to sedation or anesthesia……and the discomfort associated with an invasive imaging process…. Of sticking either the “colono-scope” during a colonoscopy or a flexible sigmoud device up your butt.   By comparison, the “Multi Target Stool DNA” screening test is a noninvasive, “multi-marker”, stool-based ColoRectal Cancer screening test….. that detects altered De-oxyribo-nucleic Acid (DNA), , as well as a fecal immunochemical test (FIT)… for blood released from cancer and precancerous lesions of the colon. The presence of fecal hemoglobin….. even in the absence of elevated DNA markers…..can lead to a positive result given the weighted nature of the Multi Target Stool DNA algorithm. Patients may collect and mail stool specimens from their homes with no bowel preparations and no dietary or medication restrictions.   Medicare covers this at-home multi-target stool DNA lab test…. once every 3 years…if you meet ALL of these conditions:   You’re  between the age of  50-85. You show NO CURRENT symptoms of colorectal disease including, but not limited to one of these: Lower gastrointestinal pain Blood in stool Positive Guaiac fecal occult blood test….which is an older version of the Immunochemical Test… where you “smear” stool onto a TEST Card with a wooden applicator or brush. The Guaiac test has dietary restrictions and you are required to collect “TWO” or more samples from the same Stool Sample for the test. Much Messier than the Immunochemical Fecal Blood Occult Test. OR…… A Positive Result from a Fecal Blood Occult Test ALSO    YOU NEED TO BE….. at average risk for developing colorectal cancer, meaning: You have no personal history of  (adenomateous ) polyps”  which are …..  a common type of polyp. They are gland-like growths that develop on the mucous membrane that lines the large intestine. They are also called adenomas: You have no personal history of  … colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis. OR…… You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.   If you meet the above criteria….. You pay nothing for this test if your doctor…. or other qualified health care provider accepts Medicare.   So that’s the difference between Multi Target Stool DNA Tests vs. Fecal Occult Blood Test.   If you haven’t had one of these preventative tests, speak to your primary doctor and get one. It could very well SAVE YOUR LIFE!   If you have any questions about Medicare…. Send me an email to – Support@TheMedicareNation.com   I answer ALL my emails. As long as I can answer your question in a paragraph, I’ll answer your question. If my response involves any research or it will take more than one paragraph to answer you….. I’ll send you a suggestion to hire me as your Medicare Consultant.   I charge $199.00 an hour. I’m one of the TOP Medicare Experts in the Country Nation…… I could easily command $400 or $500 an hour, but I CARE about each and every one of you! My time is extremely valuable and I want to help as many of you as I can with your Medicare problems and Medicare Plan Comparisons.   Also…..if you’d like to have me speak about Medicare … go to the website…  www.TheMedicareNation.com and click on the Contact tab and send me your information. I’ve already started booking speaking engagements for the Annual Enrollment Period…. Starting in October…so contact me now to schedule me for your corporation or event.   Thanks for listening to Medicare Nation! I appreciate your loyalty and referrals. Until next time…. I want YOU to have a Peaceful, Happy & Prosperous Week!   Diane            

Hey Medicare Nation! www.TheMedicareNation.com I'm not an expert on Reverse Mortgages......in fact, I don't know much about them. I have heard about Reverse Mortgages on commercials, in newspapers and on FaceBook feeds. I never had the need to learn about Reverse Mortgages, so...... I never did......until...... a client asked me about them. When a client asks me a question about Medicare..... I know the answer. I'm a Medicare Expert....I'm in the business of knowing as much as I can about Medicare.  Because my clients trust me with their Medicare needs and concerns, they ask me all kinds of questions. When I know the answer.... I tell them. When I don't know the answer..... I get the answer for them! So....when my client asked me about Reverse Mortgages.... I started reading about them. When I was introduced to Michael Banner, President of Professional Mortgage Alliance, LLC, I had many, many questions. Michael Banner was very patient and answered every question I had..... truthfully. An hour and a half later..... I had a much better idea about reverse mortgages, and I invited Michael Banner to come onto The Medicare Nation Podcast to share his knowledge with our Medicare Beneficiaries and Sandwich Generation! Here are the highlights of my interview with Michael Banner: * What is a Reverse Mortgage? *  Do I pay a higher intersest rate with a Reverse Mortgage? *  If I "Will" my home to my children.... what happens to the      Reverse Mortgage? *  What is a Non-Recourse Loan? * What does it mean if the value of my house is "upside              down?" *  What is No-Debt Service? *  Is a Reverse Mortgage Safe? *  If a person leaves the home to live in an assisted living          facility, what happens to the Reverse Mortgage? *  Can a person "out live" a Reverse Mortgage? * What are the "5 Ways" payments are made with a Reverse     Mortgage? Want to learn more about Reverse Mortgages? Reach out to Michael Banner at : MBanner@PMAnow.com Website for Professional Mortgage Alliance, LLC Professional Mortgage Alliance Michael Banner's Phone Number -  (727) 224 - 3859 Where to purchase Michael Banner's Book - MBanner@PMAnow.com   The 62 Who Knew Show www.WeBeamTV.com   Have Questions About Medicare? Send me an email to - Support@TheMedicareNation.com If you'd like to hire me as a Medicare Consultant, starting  June 1, 2019.... my rate is $199.00 an hour.  Contact me by either email at .... Support@TheMedicareNation.com or ... call me ..... 855 - 855 - 7266. Thanks for listening to Medicare Nation! SUBSCRIBE to Medicare Nation and get the latest episodes delivered to you! Give us a Rating & Review on iTunes! This helps others find Medicare Nation so that they can have their Medicare questions answered too! www.TheMedicareNation.com Until next time.... have a happy, peaceful & prosperous week! Diane Daniels

Hey Medicare Nation! www.TheMedicareNation.com On the Last episode.....I spoke to you about Medicare Supplement Plan "F" and High Deductible Plan F. Today....I'm going to talk about Medicare Supplement Plan "G" and Plan "N" Plan "G" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier...... in return...... Medicare Supplement Plan G, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for ..... The Annual Part B Deductible. YOU will be responsible for the Annual Part B deductible each year. Currently.... in 2019, the Annual Part B Deductible is $185.00. So..... when you seek medical care in the beginning of the year.... you will pay out-of-pocket until you hit the $185.00 Part B Deductible. After you pay the $185.00 Part B Deductible....you will NOT be responsible for ANY other deductibles, co-pays or co-insurance under Medicare Supplement Plan G, that are medically necessary under Medicare. Plan "N" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier...... in return...... Medicare Supplement Plan N, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for ..... 1. The Annual Part B Deductible ($185.00 in 2019) 2. A co-pay of up to $20.00 for each doctor visit. 3. A co-pay of $50.00 if you go to the Emergency Room and you are "Discharged" from the Emergency Room. If you are "admitted" to the hospital from the ER... you will NOT incur a $50.00 co-pay. If you have paid all of your Part B Deductible, you will have NO other out-of-pocket costs while you are an inpatient in the hospital. 4. If you seek treatment, testing or diagnostic testing from a physician or facility that does NOT accept Medicare, you WILL be responsible for 100% of the cost of that service. The provider or facility can legally charge you 15% above and beyond the Medicare Allowable charge. It is vital that you always ask prior to receiving care, a test or doctor visit....if the physician or facility "accepts Medicare."  If they do.....your charges are outlined above. If they do not accept Medicare..... you may be responsible for ALL of the charges, up to 15% of the Medicare Allowable charge. ASK BEFORE YOU SEE A DR or RECEIVE TREATMENT! Prices for Medicare Supplements VARY by zipcode! Get quotes from MANY different insurance carriers prior to enrolling in a plan. You could save hundreds....sometimes over a thousand dollars a year! HAVE a Question for ME? Send it to me at  Support@TheMedicareNation.com I will answer ALL emails I receive.... personally! If the answer to your question will take me more than 1 paragraph to answer... or .... it is necessary to do some research for you in order to answer the question.... I will respond and advise you to hire me as your consultant. Many of your questions may be answered on the official Medicare website - www.Medicare.gov Always do YOUR Due Dilligence before you enroll in a Medicare Plan! Consider leaving a review & rating on the Medicare Nation Podcast page in iTunes.  http://nation.reviews/medicare8   Thanks for listening to Medicare Nation! Show your Parents how to "Subscribe" to Medicare Nation. With over 100 episodes... most of their questions will be answered by listening to my episodes. This way... your parents are NOT bothering YOU for information about Medicare! Enjoy time for yourself and your family! Teach people how to "subscribe" to Medicare Nation! YOU will be responsible for the Annual Part B deductible each year.

Hey Medicare Nation! www.TheMedicareNation.com More than 10,000 people a day are turning 65! While qualifying for Medicare Part A and Part B, Medicare Beneficiaries are VERY confused as to what type of plan to enroll in, to "supplement" Original Medicare. By zipcode, a Medicare Beneficiary may have over "100 Plans" to choose from to help supplement their Original Medicare. That's an ENORMOUS amount of research to do!                  If you have the time and enjoy doing all that research.......go for it! If you're like most Medicare Beneficiaries, you are retiring and you want to ENJOY LIFE! You don't want to "waste" time researching Medicare Plans. Call a "Medicare Consultant" or "Medicare Specialist" to assist you in finding the plan that will fit YOUR unique needs. How do you do that?  "Google" "Medicare Consultant" or "Medicare Specialist" and add your city or zipcode to that search. As an example, you would search....Medicare Consultant Tampa FL......or........Medicare Specialist Dallas TX....... Google will then populate the "Ads" first. Businesses PAY to be on the top of the 1st page of Google. SCROLL down past the "ADS." Just because a business "Pays" for an ad DOES NOT mean they are the best option for you. You will start seeing local businesses and names of Medicare Specilaists.  You should be checking out these "Brokers" and "Medicare Specialists" or "Medicare Consultants." I'm speaking specifically about Medi-Gap Plan F and the High Deductible F Plan. The Supplement F Plan to Medicare, is an Insurance Policy you take out on yourself. Medi-gap Plans are NOT part of Medicare. Medi-Gap Plans are an insurance policy that an Insurance Carrier sells to you. You are "purchasing" a policy, where you pay a monthly premium to the Insurance Carrier to protect some or all of  your out-of-pocket costs associated with Medicare. Medi-Gap "F" Plan pays the out-of-pocket costs YOU are responsible for. The "F" Plan will pay your "medically necessary" out-of-pocket costs. Plan F pays for your Part A In-Patient Hospital Deductible. Plan F pays your co-pay for being in a Skilled Nursing Facility. Plan F pays your Annual Part B deductible and Plan F pays your 20% co-insurance under Part B. Plan F pays for all of this, for one monthly premium. ALL Medicare Plan F Plans have EXACTLY the same benefits. It doesn't matter if you live in Tampa, FL......San Francisco, CA.....or Salt Lake City, Utah.....The BENEFITS under Plan F are the SAME! What IS different..is the MONTHLY PREMIUM! In YOUR ZipCode.......there may be up to 50 DIFFERENT Insurance Carriers that offer Plan F....EACH one of those Insurance Carriers offer a DIFFERENT Premium for the SAME Plan F Plan. You should find the LOWEST Monthly Premium from the Insurance Carrier that has an "A" Financial Rating. An "A" financial rating means the company WILL pay your claims. That's the Insurance Carrier your looking for. Plan F is the "Peace of Mind" Medi-Gap Plan. There is NO Network of Doctors and Facilities....because......Plan F is NOT part of Medicare.  Original Medicare has NO Network.....Original Medicare allows you to see ANY Doctor....or go to ANY Medical Facility in the U.S. that ACCEPTS Medicare! YOUR Health Insurance IS......Original Medicare.....NOT your Plan F! So.....if you're looking for a Medicare Supplement Plan that will cover ALL your Medicare Necessary out-of-pocket costs...Then Plan F is for you. Now.....let's take a look at the High Deductile F Plan. The High Deductible F Plan.....has a DEDUCTIBLE! For 2019.....the annual deductible is $2,300.00 That means......you WILL pay-out-of-pocket until......you reach the $2,300 DEDUCTIBLE. When you reach the $2,300 deductible, the plan will then pay all your "medically necessary" out-of-pocket costs that you are responsible for under Medicare, for the remainder of the calendar year. You will NOT pay the "Cash" price......you will be paying the Medicare Allowable price....BIG difference. If you go to a cardiologist, and the visit under Medicare, costs a total of $150, Medicare will pay 80% of that amount.... which is $120. you would pay the remaining 20%, which $30. You would continue to pay out-of-pocket until you reach $2,300. If you don't see many doctors or have any diagnostic tests, you will ONLY pay for the services you use. For a healthy person, this could be a very viable option. If you are a person with a chronic illness, let's say for example...Diabetes......Asthma.....or high cholesterol with high blood pressure.....this plan may NOT be a good choice for you. It's important for you to take into consideration your own health history, what medications you take, your financial status and what doctors you see, before enrolling in a Medicare Plan. Next time, I will go over the differences between Plan G and PLan N. If you are turning 65....or.....you are getting ready to come off of your employer plan and you need to figure out what Medicare Plan will suit your needs best..... Contact Me! Reach out to me by email - Support@TheMedicareNation.com or..... by phone....... (855) 855 - 7266. I will help you find the plan that fits YOUR unique needs. Go to my website..... www.TheMedicareNation.com for more information. Until next time.....have a very happy, a very healthy and Prosperous week!   Diane Daniels  

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    

Hey Medicare Nation! htpps://www.TheMedicareNation.com   Today, I'm going to speak with you about the Medicare Advantage Open Enrollment Period. CMS...Centers For Medicare & Medicaid Services has issued a new regulation that began January 1, 2019. Under 42 CFR 422.62(a)(3)....CMS published the following: During the MA OEP, MA plan enrolles may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP. Who can use the Medicare Advantage Open Enrollment Period? 1. Individuals enrolled in Medicare Advantage plans as of January 1. 2. New Medicare beneficiaries who are enrolled in an Medicare Advantage plan during their Initial enrollment into Medicare       a. The month of entitlement to Part A and Part B up until the last day of the 3rd month...after the month of their entitlement to Part A and Part B. Can Medicare Advantage beneficiaries add or drop their Part D coverage during the Medicare Advantage Open Enrollment Period? Yes. Individuals who are already enrolled in a Medicare Advantage Plan with Prescription Drug Coverage can switch to: a. Another Medicare Advantage Prescription Drug Plan b. A Medicare Advantage Plan ONLY (with NO prescription drug coverage) c. Go back to "Original Medicare" and add a stand-alone prescription drug plan or don't add one. d. Go back to "Original Medicare" and add a Supplement to Original Medicare Plan.     How long is the Medicare Advantage Open Enrollment Period? It runs from January 1st through March 31st each year.   How many times may a Medicare Beneficiary change Medicare Advantage Plans during the MA OEP? A Medicare Beneficiary may make only ONE change during the MA OEP.   If you have ANY questions regarding the MA OEP.... and you would like me to answer it in ONE paragraph, send me an email to  Support@TheMedicareNation.com I ALWAYS answer emails if I can answer them in ONE paragraph. If I can not answer your question in one paragraph, you may hire me and I charge $150.00 hr. I can answer ANY question about Medicare and I can solve ANY problem you have with Medicare. Looking for more information on Medicare? Go to www.TheMedicareNation.com  website. Looking for a SPEAKER at your conference or event? Just click on the "Contact" tab on the website.   Thank you so much for listening to Medicare Nation. I appreciate it very much! If you feel I'm delivering important content, I would love it if you would leave a rating & review on the Apple Podcasts review page (formerly iTunes). Until next time Nation.....I want each of you to have a Happy, Peaceful and Prosperous week! Diane Daniels

Hey Medicare Nation! You are getting ready for Thanksgiving and you haven't even looked at Prescription Drug Plans for 2019. Don't panic!  I have your back :) There are Prescription Drug Plan changes for 2019.  Listen to this episode to learn about the NEW changes and make a confident decision to enroll in the Medicare Prescription Drug Plan that fits your unique needs. Here is the link to the Medicare.gov website as an additional resoure: www.medicare.gov Have a question about Prescription Drug Plans for 2019? Ask me! If I can answer your question in ONE PARAGRAPH, I will! If I need to do "any" type of research or the answer to your question is longer than ONE paragraph, you may have to hire me as a consultant. I answer ALL emails personally. I'm the expert and I make sure you receive my expertise in answering your questions. Send your questions to - Support@TheMedicareNation.com   I look forward to hearing from you! Happy Thanksgiving everyone! Diane

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

Hey Medicare Nation! I have a special show for you today. The FDA has issued a "Voluntary Recall" on Westminster Pharmaceuticals of all lots of their Levothyroxine and Liothyronine (Thyroid Tablets). Westminster Pharmaceuticals, LLC, which has its Corporate HQ in Tampa, Florida, is voluntarily recalling all lots, within the expiration date, of Levo-thyroxine and Lio-thyronine (Thyroid Tablets) dosages of 15 mg, 30 mg, 60 mg, 90 mg, & 120 mg up to the wholesale level. These products are being recalled by Westminster Pharmaceuticals as a precaution, because they were manufactured using active pharmaceutical ingredients that were sourced, prior to the FDA’s “Import Alert”  of Sichuan Friendly Pharmaceutical Co., Ltd., which is out of China.   The Recall comes as a result of a 2017 inspection where deficiencies were found with “Current Good Manufacturing Practices” (cGMP). Substandard cGMP practices…..could represent……the possibility of risk….. being introduced into the manufacturing process. To date, Westminster Pharmaceuticals has not received any reports of adverse events related to this product. Levothyroxine and Liothyronine (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands. Thyroid tablets contain both tetra-io-do-thyronine sodium (T4 levothyroxine) and lio-thy-ronine sodium (T3 liothyronine). Levothyroxine and Liothyronine tablets (thyroid tablets, USP) are indicated as replacement or  supplemental therapy in patients with hypothyroidism. Because these products may be used in the treatment of serious medical conditions, patients taking the recalled medicines should continue taking their medicine until they have a replacement product. According to the U.S. Food & Drug Administration Report..... [8/17/2018] FDA is alerting active pharmaceutical ingredient (API) repackagers and distributors, finished drug manufacturers, and compounders that Sichuan Friendly Pharmaceutical Co. Limited, China, is recalling certain lots of porcine thyroid API due to inconsistent quality of the API. FDA recommends that manufacturers and compounders not use Sichuan Friendly’s porcine thyroid API received since August 2015. This thyroid API comes from porcine (pig) thyroid glands and is used to make a non-FDA approved  drug product, composed of levothyroxine and liothyronine, to treat hypothyroidism (underactive thyroid). FDA laboratory testing confirmed the Sichuan Friendly API has inconsistent levels of the active ingredients – levothyroxine and liothyronine – and should not be used to manufacture or compound drugs for patient use. Risks associated with over or under treatment of hypothyroidism could result in permanent or life-threatening adverse health consequences. These lots were distributed nationwide in the USA to Westminster’s direct accounts. These lots were distributed nationwide in the USA  NDC Product Lot Expiration 69367-159-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15mg X 100ct 15918VP03 2/29/2020 15918VP02 2/29/2020 15918VP01 2/29/2020 15918007 3/31/2020 15918006 3/31/2020 15918005 2/29/2020 15918004 12/31/2019 15918003 12/31/2019 15918002 12/31/2019 15918001 12/31/2019 15917VP03 10/31/2019 15917VP02 10/31/2019 15917VP01 10/31/2019 69367-155-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 30mg X 100ct 15517VP01 8/31/2019 15517VP02 8/31/2019 15517VP03 8/31/2019 15518001 12/31/2019 15518002 3/31/2020 69367-156-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 60mg X 100ct 15618011 3/31/2020 15618009 2/29/2020 15618008 2/29/2020 15618004 12/31/2019 15618002 12/31/2019 15617VP06 11/30/2019 15617VP05 11/30/2019 15617VP04 12/31/2019 15617VP03 7/31/2019 15617VP01 7/31/2019 15617VP-02 7/31/2019 69367-157-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 90mg X 100ct 15717VP-01 7/31/2019 15717VP-02 7/31/2019 15717VP-03 7/31/2019 15718004 3/31/2020 15717002 12/31/2019 69367-158-04 Levothyroxine and Liothyronine (Thyroid Tablets, USP) 120mg X 100ct 15817VP-01 9/30/2019 15817VP-02 9/30/2019 15817VP-03 9/30/2019 15818001 3/31/2020 Westminster is notifying its direct accounts by email and by phone to immediately discontinue distribution of the product being recalled. The FDA Advises Consumers who have the recalled products, should not discontinue use before contacting their physician for further guidance. There are several manufacturers who make “generic” Levothyroxine and Liothyronine (thyroid tablets) that your doctor can give you a new prescription for.  Call the Pharmacy where you receive your Levothyroxine or Liothyronine, and ask the pharmacist who the manufacturer of their supply is. They should be able to easily tell you that. Customers and patients with medical-related questions, information about an adverse event or other questions about the Westminster’s product’s being recalled……. should contact Westminster’s Regulatory Affairs department by phone at: 888-354-9939 ….. Live calls are received Monday-Friday, 9:00AM - 5:00PM EST with voicemail available 24 hours/day, 7 days/week or you can send an email to  recalls@wprx.com. Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online…..by regular mail……or by fax. To Complete and submit the report Online…....just “click” on the link & it will take you directly to the FDA MedWatch Page. FDA Med Watch Page   If you’d like to report Adverse Reactions or quality problems by Mail or Fax: Download form www.fda.gov/MedWatch/getforms.htm  Med Watch Reporting Form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form……or…….submit by Fax to 1-800-FDA- 0178   It’s almost the Annual Enrollment Period! Beginning Monday, October 15th through Friday, December 7th, many of you will be able to switch Medicare Advantage Plans, Switch Medicare Prescription Drug Plans or return to Original Medicare, with the majority of you having NEW effective dates of January 1, 2019. There are MANY Changes coming to Medicare for 2019, so I will be busy Posting Changes for you Starting the Week of October 1st. Medicare Nation, will be going back to a “weekly” episode during the Annual Enrollment Period, so that I can bring to you the most up-to-date information I can. Remember, I am here to answer ANY Medicare question you have, as long as I can answer your question in ONE paragraph. If I need to “research” anything or…..if it takes me more than one paragraph to answer your question, I will advise you that you can contact me to help you with your Medicare needs by hiring me to “consult” with you about your Medicare needs. Many of you contacted me last Medicare Annual Enrollment Period for consultations and I am here again to assist you or your parent’s Medicare Questions or concerns. Need help choosing a Medicare Advantage Plan or Prescription Drug Plan where you live? I can help you with that. Need help comparing your employer insurance plan benefits to a Medicare plan? I can help you with that too. Contact me by email at Support@TheMedicareNation.com or call the toll free number 855-855-7266 and tell me how I can help you with your Medicare Needs.   If you like Medicare Nation, I’d love for you to give Medicare Nation an honest Rating and Review on Apple Podcasts.   How to leave an iTunes rating or review for a podcast from your iPhone or iPad Launch Apple's Podcast Tap the Search Enter Medicare Nation in the search field. Tap the blue Searchkey at the bottom right. Tap the album art for Medicare Nation. Tap the Reviews Tap Write a Reviewat the bottom. Enter your iTunes passwordto login. Tap the Starsto leave a rating. Enter title text and content to leave a review. Tap Send.   If you have an ANDROID phone…..open up your “Stitcher” App or Download the Stitcher App from your Google Play App. OR……just go to ……. subscribe on Android.com When the page opens, just type in Medicare Nation into the field. Hit enter and voila! Click on the Medicare Nation Full LOGO and “click” Subscribe on Android. That’s it! Folks You now will receive my up to date Medicare Weekly episode to get you through the AEP   Thanks for listening to Medicare Nation! I appreciate it. Until next time….I want each of you to have a …..Happy, Healthy and Prosperous Week!      

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!  

Hey Medicare Nation! Millions of people are diagnosed with "Foot Drop." Some people also call it......"Drop Foot." Help A Child or Adult Walk Again! Either way, Foot Drop is a serious matter! Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot, necessary for walking. Foot Drop causes a person to drag the foot and toes, or engage in a high-stepping walk called a steppage gait. Foot Drop Increases the risk of falling.   Who Can Be Diagnosed With Foot Drop? Men or Women, at any age. What are some causes of Foot Drop? Multiple Sclerosis, Cerebral Paulsy, Stroke, Traumatic Brain Injurey, Spinal Cord Injuries, and other injuries to the Peroneal Nerve in the leg.  Viruses can cause Foot Drop as well as other infections. Injuries to the leg and/or the lower back can also cause Foot Drop. What is a WalkAide? A WalkAide is a Functional Electrical Stimulation Device, when wore on the calf, sends electric impulses to the affected foot causing the foot and leg to lift.  Where Can I get information on WalkAides? Go to the Hanger Clinic website: https://goo.gl/9UuX7Y Are Other Types of FES Devices Available? Yes. The Bioness L300 is also available. Go to the Bioness Website for more information. https://goo.gl/FMXr5i Who are the Freedom to Walk Foundation? The Freedom to Walk Foundation is a 5019c)3 non-profit, dedicated to assisting with funds for the purchases of WalkAides for children AND Adults diagnosed with Foot Drop due to: * Multiple Sclerosis *Cerebral Palsy * Stroke * Incomplete Spinal Cord Injury * Traumatic Brain Injury If you want more information about the Freedom to Walk Foundation, go to their website: FreedomToWalkFoundation.org Go To 6th Annual Freedom to Walk Foundation GALA

Hey Medicare Nation! Do you know what "Drop Foot" is? Foot Drop is a weakness or paralysis of the muscles involved in lifting the front part of the foot necessary for walking. It causes a person to drag the foot and toes, or engage in a high-stepping walk called a "steppage gait." This increases the risk of falling for individuals.  There are about 70,000 people diagnosed with Food Drop in the State of Florida alone! I have teamed up with the Freedom to Walk Foundation, to assist them in raising funds for the purchase of WalkAides. WalkAides are electronic stimulating devices when worn on the calf, sends electric impulses to the affected foot, causing the muscles to contract and lift the foot and leg. Children and adults are WALKING agian with the help of WalkAides! The one major problem, is that most medical insurance companies don't cover WalkAides. Medicare will only cover WalkAides for those diagnosed with "Incomplete Spinal Cord Injury." Those diagnosed with Multiple Sclerosis, Cerebal Palsy, stroke, traumatic brain injuries and complete spinal cord injuries, are not covered by most insurance companies. How can you help? A WalkAide costs $5,000 to purchase. A $5.00 or more donation to the Freedom to Walk Foundation will help children and adults purchase WalkAides. Please be considerate and donate with your heart! www.FreedomtoWalkFoundation.org/donate Thank You! NEW MEDICARE CARDS are being mailed now. Your New Medicare Cards…….which are now called “Medicare Beneficiary Identifier” or MBI……have started mailing! People who are enrolling in Medicare for the first time will be among the first in the country to receive the new cards. Your new card will automatically come to you. You don't need to do anything as long as your address is up to date. If you need to update your address, visit ssa.gov and sign up for MySocialSecurity Account. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away. Current States Receiving New Medicare Cards  Delaware Pennsylvania Virginia Washington D.C.   AND….. West Virginia Want to know when YOUR card has been mailed? Go to Medicare.gov/NewCard Enter your email to receive an email when your new Medicare Card is mailed to you. What do the New Medicare Cards Look Like? Across the top of the New Medicare Card will read…..Medicare Health Insurance….in “white” letters inside a blue border. There is also an image of an Eagle in white outline. Your Name will appear on the next line. The next line will be the NEW set of Characters. The New Card will have  “11 Characters – both numbers and letters of the alphabet. All Letters will be Capitalized and spot # 2, 5, 8 & 9 on your card, will ALWAYS be a Letter of the alphabet.   Finally, you’ll see Your effective date of your Part A of Medicare…….. And you’ll see Your effective date of Part B if you enrolled in Medicare Part B. Here are things to know about your new Medicare card Your new card will automatically be mailed to you. You don’t have to do anything as long as your address is up to date. If you need to update your address, go to www.ssa.org  and enroll in a My Social Security Account.  Your Medicare coverage and benefits will stay the same. Your card may arrive at a different time than your friend’s or neighbor’s. Medicare is mailing over 60 million New Cards. CMS says they will have completed the mailing by April of 2019. We’ll see if that’s true! Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away. If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare—Use your Medicare Advantage Plan ID Card whenever you need care. And, if you have a separate Medicare precrption drug plan, be sure to keep that ID card as well.   Doctors, other health care providers and facilities know it’s coming and will ask for your new Medicare card when you need care, so carry it with you. Only give your new Medicare Number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online. And….until January 2020, health care providers may use your New Medicare Card or your Social Security number to process claims. FINALLY….. Be Careful! Scammers are out there  trying to steal your identity! Medicare will NEVER call you and ask for Personal Information! The Government can’t even process Medicare Advantage Plan Changes timely…….they certainly don’t have the staff or the time to call Medicare Beneficiaries. So DON”T trust ANYONE who calls and says they are calling you from Medicare. Your Insurance Agent, Medicare Advisor or a representative from your Medicare Advantage Plan or Medicare Prescription Drug Plan will call you …..WITH YOUR PERMISSION!   If someone calls and says they are calling about your New Medicare card….. HANG UP THE PHONE ON THEM!             If someone calls and says they are from your Medicare Advantage Plan…. Ask them a few questions to make sure they are legit. Ask them these questions:   How much is my current premium for my Medicare Plan? If they are from your Medicare Insurance Plan….they should know the answer!   Ask them who your Primary Doctor is. Again……they should have that information documented.   Finally……if you are still unsure of who you are talking to…..HANG UP! Call the customer service number on the back of your Medicare Insurance Plan card and when a representative answers……ask them if they just contacted you. RESOURCES: ssa.org www.medicare.gov/newcard  

Hey Medicare Nation! www.TheMedicareNation.com Special Election Period Extended through March 31, 2018 for Medicare Beneficiaries Affected by California Wildfires. The Centers for Medicare & Medicaid Services (CMS) has extended the Special Election Period (SEP) for Medicare Beneficiaries affected by the California Wildfires to March 31, 2018. Any Medicaer Beneficiary who resides in, or resided in an area for which the Federal Emergency Management Agency (FEMA) declared a disaster area is eligible for the SEP......if......the beneficiary was unable to enroll in a Medicare Advantage Plan or stand-alone-prescription drug plan, during the annual enrollment period (AEP) or other qualifying election period. Also....if you don't live in the affected counties of California, but you receive assistance from someone living in one of the affected areas that was declared a disaster area, you are eligible for the SEP. You can call Medicare at 800-633-4227, or you can contact a Medicare Advisor or Medicare Consultant to assist you in finding a plan that will suit your unique needs. How do you find a Medicare Advisor or Medicare Consultant like me? Google it! Type in ......Medicare Consultant Los Angeles California....or Medicare Advisor San Francisco California. After you get beyond the "ADS" by all the paid advertisers.....you will start seeing results for what you asked for. So here are the COUNTIES  in California affected by the WildFires, which have a SEP: Butte Lake Los Angeles Mendocino Napa Nevada Orange Riverside San Diego Santa Barbara Solano Sonoma Ventura and Yuba. You can also go to the FEMA website and read more infomation at: www.fema.gov/disasters Any questions? Have a special guest you'd like to hear on Medicare Nation? Send Diane an email to -  Support@TheMedicareNation.com Need help with Medicare......Contact Diane and she will schedule a call with you to determine your needs. Send your request to Support@TheMedicareNation.com Have a Happy, Peaceful and Prosperous Week! www.TheMedicareNation.com  

Hey Medicare Nation! It's January 2018! I hope everyone made informed decisions regarding your Medicare Advantage Plans for 2018. If you missed the last episode, go back and listen to it! I discussed the Medicare Premiums, co-pays and co-insurance for 2018. Many of you have sent me emails "asking me" if you can change your Medicare Advantage Plan in January. The answer is......yes....with specific guidelines. Currently, it is the Medicare Advantage Plan "Disenrollment Period." The current Disenrollment Period runs from January 1st through February 14th each year. During this time, you can "drop" your Medicare Advantage Plan and go back onto Original Medicare. You do this by contacting MEDICARE by phone     800-633-4227.....and telling the Medicare representative that you would like to "Disenroll from your Medicare Advantage Plan" to go back onto Original Medicare. Medicare may also help you with a Part D prescription Drug Plan if you'd like. On Original Medicare, you are covered under Part A and Part B of Medicare.  Under Part A....you are covered for Medicare benefits where you would stay at a location as an "inpatient." The most common location is .....The Hospital. Another location where you stay overnight as an inpatient is....a Skilled Nursing Facility (SNF). A SNF is NOT a Nursing Home. An SNF is a location where you are admitted as an inpatient to receive medical care and rehab 24hrs a day. Also..... if you are diagnosed with a terminal illness, your doctor may suggest you enter Hospice as an inpatient.  All the services covered in the Hospital, SNF and Hospice are covered under Part A of Medicare. There is a "Deductible" each time you are admitted to the Hospital. The Deductible cost for being admitted as an inpatient in the hospital is $1,340.00 in 2018. The Deductible is due EACH benefit period you are admitted. Part B of Medicare is for "Outpatient Services." Benefits under Medicare for Outpatient Services covered under Part B include, but not limited to: * Doctor Vists * MRI's * Laboratory Blood Draws * Outpatient Same Day Surgery  * Oxygen in your home There is an "Annual Deductible" for Part B of $183.00. After you pay your $183.00 annual deductible, you will be responsible for the remaining 20% Medicare Allowable Charges for services under Part B. What does that mean?  Let's say you already visited your Cardiologist and had bloodwork drawn at Quest or Labcorp. We'll say your out-of-pocket costs for both cost a total of $183.00. That takes care of your annual Part B deductible for 2018. Now....let's say three months later.....you need to have an MRI. We'll say the Medicare allowable cost is $1,500.00. Medicare Part B covers 80% of the $1,500.00, which is $1,200.00. You will be responsible for the remaining 20%, which is $300.00. You will pay 20% of ALL Part B Medicare Allowable Charges. There is NO Cap! You may also need Prescription Drug Coverage. Prescription Drugs are NOT covered under Part A or Part B in general. Prescription Drugs will be covered while you are admitted to one of the facilities under Part A.  If you want Prescription Drug coverage, you WILL need to enroll in a stand-alone-prescription-drug-plan. You can find which Prescription Drug Plan (PDP) is available in your area, by going onto the Medicare.gov website and "hover" over the FIRST Blue Box named "Sign Up/Change Plans." A column will appear and go down to where it reads..."Find Health & Drug Plans." "Click" on that box and it will bring you to the Medicare Plan Finder site. Type in your zipcode and follow the instructions.   If you are comfortable with the costs associated with Original Medicare Parts A & Part B.....then that's all you need to do. If you'd like to add additional coverage to protect you against the on-going out-of-pocket costs associated with Original Medicare, you can purchase a Medicare Supplement (a.k.a. Medi-Gap) Plan. A Medicare Supplement Plan is an Insurance Policy, where you pay the insurance carrier a monthly premium and the plan will pay Medicare out-of-pocket costs that you have pre-determined. Medicare Supplement Plans "VARY" in coverage and in premiums. The "Medicare Benefits" they pay for you, are the SAME, no matter where you live in the U.S. So.....if you chose a Supplement Plan "F," which is the policy which pays ALL your out-of-pocket costs for Medically Necessary services under Medicare, and you live in Seattle, WA.......you will be covered for the EXACT SAME Medicare benefits as a person living in Tampa, FL. What is different you ask? The difference is in the PREMIUM you pay. Insurance Carriers that offer Medicare Supplement Policies charge DIFFERENT  Premiums! You NEED to know what the difference in Premiums are by EACH Insurance Carrier for the SAME TYPE OF PLAN. Here's an example: Mary is turning 65 in March of 2018. Mary has a history of heart problems and would like to remain on Original Medicare and purchase a Medicare Supplement Plan "F" so that she can see ANY Cardiologist that is contracted with Medicare.... in ANY State.  Mary also wants to have a budget for her out-of-pocket health costs and having a Medicare Supplement "F" plan will allow her to do that. Mary lives in Miami, FL and calls her Medicare Specialist Diane. Mary discusses purchasing a Medicare Supplement with Diane and asks for her expertise and guidance. Diane tells Mary that the 3 lowest premiums in her zipcode have the following montly premiums: 1. $239.00 From Acme Insurance Co. 2. $250.00 From Beta Insurance Co. and  3. $275.00 From Delta Insurance Co. These premiums are for the EXACT same Plan with the SAME benefits! Why would you pay Delta insurance company $275.00 a month, when you can pay Acme Insurance Company $36.00 a month less....for the SAME benefits! That's why it's soooo important to speak with a Medicare Specialist or Medicare Consultant like myself. I speak MEDICARE! I care about YOUR best interests! I have NO loyalties to ANY Insurance Company!  You can also STAY on the Medicare Advantage Plan you are enrolled in. Do your Due Dilligenct to ensure you are doing what's best for your health and out of pocket costs for 2018.   I'm hear to help you if you need me! You can contact me by email at Support@TheMedicareNation.com You can contact me by phone: 855-855-7266. I will even answer your question by email if I can answer it in ONE paragraph! If I have to do any kind of research, you need to hire me as your consultant. My time is valuable and I want to do what's best for you! Thanks for listening Nation! Would love a Review if you would take a minute to do it for me! Leave me a "Voice" review at www.TheMedicareNation.com or ...... an iTunes review. Go to iTunes or Stitcher and in the SEARCH bar type in MEDICARE NATION MY show comes right up. "Click" on Subscribe and then click on Rating or Review. Leave me your feedback and if you can.....give us 5 stars! Thank you and have a Happy, Peaceful & Prosperous Week! Diane

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 Enrollment   If 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  

Hey Medicare Nation! It's Medicare Annual Enrollment Time! The Medicare Annual Enrollment Period runs from October 15th through December 7th, each year. Many of you are looking at different Medicare Advantage Plans and Prescription Drug Plans for 2018. Some of you are staying with the Medicare Advantage Plan you're already on. What many of you don't know.......is that the Center for Medicare & Medicaid Services (CMS) has added a Special Election Period for individuals affected by weather related disaster's since September. Anyone that resides in Alabama, Florida, Georgia, Puerto Rico, South Carolina or the U.S. Virgin Islands, may qualify for this special election period, due to hurricane Irma. Anyone residing in Louisiana and Mississippi may qualify for the Special Election Period, due to Tropical Storm Nate. Residents of Texas may qualify due to Hurricane Harvey. To determine if you qualify for this special election period, CMS has deferred the locations affected by Weather Disaster's to FEMA. Go to the FEMA website - www.fema.gov/disasters and click on the weather related emergency, to see if your location was declared an emergency by FEMA. If your county or State has been declared an emergency due to the unique weather event, you will be granted an SEP by CMS, to change your Medicare Advantage Plan or stand alone Prescription Drug Plan.  In addition, the weather related special election period is available to..... those individuals who don't live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. Go to www.fema.gov and click on the link for the weather related disaster in your State, to see if you qualify for this special election period. You can call Medicare if you have questions regarding the "weather event" special election period. Call 800-633-4227. The "weather event" special election period runs till December 31, 2017.  

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

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!  

Hey Medicare Nation! Here I am bringing you yet another Medicare Advantage Plan Sponsor, being slapped by CMS, for failing to comply with Medicare requirements related to Part C (Medicare Choice) and Part D (Medicare Prescription Drug Plans). Today, I will be discussing the CMS Civil Money Penalty (CMP) that was imposed on Fallon Community Health Plan. On June 29, 2017, a letter was issued to Mr. Richard Burke, the President and CEO of Fallon Community Health Plan, from Vikki Ahern, Director of the Medicare Parts C and D Oversight and Enforcement Group. The letter was written relating to a "Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Numbers: H2411, H2470 and H9001. Summary of Noncomplliance CMS conducted an audit of Fallon's Medicare operations from February 16, 2016 through February 26, 2016. In the audit report issued on July 20, 2016, CMS auditors reported that Fallon failed to comply with Medicare requirements related to...."Part C and Part D organization/coverage determinations, appeals and grievances in violation of 42 CFR" (Code of Federal Regulations).  The audit report lists the exact subsections of 42 CFR that were violated The letter goes on to state....Fallon's failures in these areas were systemic and resulted in enrollees inappropriately experiencing delayed or denied access to benefits and/or increased out-of-pocket costs. CMS made a determination to impose a civil money penalty (CMP) for Fallon's failure to comply, in the amount of $344,100.00. That's a BIG fine!  Fallon Comunity Health Plan was founded in 1977. They have a product portfolio of group and individual health plan options. Fallon also has a Senior Care Services Division, oversees all products, programs and solutions which focus on the senior population. If you are a member of a Fallon Medicare Advantage Plan and you have questions regarding your plan, I would call the Senior Care Services Division. The number is - 800-868-5200. If you are a current member of a Fallon Medicare Advantage Prescription Drug Plan, your benefits are intact and working for you.  The $300,100 CMP was issued due to the incorrect classifications of "grievances", "organization determinations" for Part C complaints or "coverage determinations" for Part D complaints by members. These incorrect classifications resulted in members not receiving the required level of review, and/or experiencing delayed access to medically necessary or life-sustaining treatments. How does something like this happen, you may ask?  Insufficient training of Fallon customer representatives and agents. Employers like Fallon, need to ensure their employees are properly trained in CMS Medicare Advantage Plan and Medicare Part D regulations as well as Fallon's Medicare Health Plans and benefits. Train your employees Fallon!  Fallon needs to ensure their employees are competent and complying with Medicare rules & regulations relating to Medicare Advantage Part C and Medicare Part D.  What Should You Do if You or Your Parent(s) are on a Fallon Medicare Advantage Prescription Drug Plan? Pay attention to your MONTHLY Explanation of Benefits (EOB) letter. Look the document over and ensure all the prescriptions you filled that month are correct! Look and make sure the provider(s) listed on your EOB are doctors or facilities you visited. Ensure any treatments or diagnostic tests were ones you actually did! If you find a discrepancy, call Fallon customer service to notify them of it. A Fallon customer service rep should be able to assist you with this issue. If Fallon customer service is unable to assist you or if they refuse to assist you, you have two good options: 1. Call your Medicare Agent or Medicare Advisor. They enrolled you in the Fallon Medicare plan and should be a liaison between you and Fallon. 2. Call Senior Medicare Patrol.      Senior Medicare Patrol (SMP) is an awesome resource that is available to you for free!      SMP Volunteer's are seniors and understand what you're going through. They are trained to investigate or notify the agency who can investigate, suspicious or fraudulent charges on your EOB statement.      Go to the SMP website to find an SMP location near you:       www.SMPresource.org If you believe you were denied coverage or delayed in receiving your benefits, you have a right to appea Ask your Medicare Agent or Medicare Advisor to assist you and explain your options. Your coverage and benefits are intact and not in danger at Fallon Health Plan. Fallon has the right to appeal the CMS CMP by August 29, 2017.  We'll see what happens. In the meantime, due your due-dilligence and monitor your EOB statements no matter which Medicare Advantage or Medicare Prescription Drug Plan you are on. Report any discrepancies or suspicions right away. I am available for consultations if you feel you have been denied a claim or your benefits were delayed due to an incorrect classification. I also can initiate a reconsideration appeal for Part C claims or a redetermination appeal for Part D claims. Contact me at Support@TheMedicareNation if you'd like me to consult with you. Thank you for listening to Medicare Nation! I appreciate you taking the time to learn more about Medicare and Medicare Plans. Help your parents and grandparents learn about Medicare, by showing them how to gain access to the Medicare Nation Podcast! Questions about Medicare or your Medicare Plan you need answered? Send me an email to Support@TheMedicareNation.com or go to my website www.callsamm.com Have a very happy, peaceful and prosperous week everyone! Diane Daniels  

Hey Medicare Nation! I'm so happy to be here and tell you the latest, regarding Cigna-HealthSpring (Cigna) Medicare Advantage Prescription Drug Plans (MAPD) and Prescription Drug Plans (PDP). In January of 2016, CMS suspended Cigna from enrolling NEW Medicare Beneficiaries into their Medicare Advantage and stand-alone Prescription Drug Plans. The following States were affected by the suspension: Alabama, Arizona, Florida, Georgia, North Carolina, Pennsylvania, South Carolina and Tennesse. ON June 16, 2017, CMS released the suspension of marketing and enrollment sanctions on Cigna.....with a big BUT. On March 17, 2017, CMS received an attestation from Cigna, stating Cigna had corrected all  the violations that were listed in the CMS sanction notice. Quoted from the letter CMS sent to Cigna interim CEO & COO Mr. Shawn Moore - "CMS required Cigna to hire an independent auditor to conduct a validation audit provide CMS with the results of the audit. CMS used the information in the audit report to determine whether Cigna corrected the deficiencies that formed the basis for the sanction." Based on the results of the audit report, CMS determined that......"Cigna's deficiencies have been sufficiently corrected." Therefore, effective June 16, 2017, CMS is lifting the intermediate sanctions for Cigna's contracts and Cigna will return to normal marketing and enrollment status." Further down in the CMS document, on page 2, paragraph 1, line 3, it states...."In addition, during the independent validation audit, several findings were indentified, none of which prevent CMS from releasing Cigna from sanctions, but some of which merit additional monitoring and reporting. .......For up to one year, CMS will also conduct targeted monitoring in certain areas to ensure that Cigna continues to improve its operations.  What does that mean if you are currently a Medicare beneficiary on a Cigna-HealthSpring MAPD or PDP Plan? First of all, you are completely covered. Your benefits are intact and current. What you need to do now is become more "diligent" in reviewing your "explanation of benefits" (EOB) statement. Your EOB statement will contain information regarding prescription drugs, medical visits, diagnostics etc.  You should be ensuring the prescriptions listed on your EOB are the ones you received and that each doctor, diagnostic tests & procedures, hospitalizations etc. were actually done! Mistakes happen more than you know. Human errors and computer errors happen frequently. When you look at your EOB Statement every month you help eliminate these errors.  It is soooo important to review your EOB statement each month. If you find an error on your EOB statement, you have several options to rectify it. #1. Call Cigna Customer Support (800-668-3813)        Explain to customer support the "discrepency" you          found on your EOB statement. That may easily              correct the issue you found.  #2. Call your Medicare Consultant, Medicare                  Advisor or Agent.        Your Medicare Agent, who "sold" you this             policy, should be available to assist you with questions  or issues with your Cigna plan. #3. Contact Senior Medicare Patrol        Go to the Senior Medicare Patrol website to look up resources in your area.         Senior Medicare Patrol #4.  Contact your State Dept. of Aging          Every State has a Department of Aging or Department of Elder Affairs, which will assist you with many types of issues.          The "Healthy Aging" website has a list of each State's contact information for their Department of Aging or Elder Affairs.            Here's the link:           Healthy Aging List of State Agencies #5.   Contact Medicare          As a last resort, call Medicare directly. Government "downsizing" has caused delays in telephone correspondence, but it is still a reliable source.          Expect to be on hold from ten minutes to an hour, depending on the day and season.   Expect to see Cigna hit the airwaves and your mailboxes with advertisements regarding their Medicare Advantage and Prescription Drug plans. If you are not sure if you should remain on a Cigna Medicare Advantage Plan for 2018 and you have no one to speak to for assistance, call me! I am available for consulting and I do so on an hourly basis. I charge $150.00 an hour and I assure you, I am very honest in my time. If you have an interest in contacting me for consulting, send me an email to: Support@TheMedicareNation.com You can also visit my website for more information. www.CallSamm.com   I thank each of you for listening to Medicare Nation and I look forward to hearing from you with any questions you have regarding Medicare.   Until next time, have a happy, peaceful and prosperous week! Diane              

Hey Medicare Nation! Learn More About Medicare Here I receive many questions from clients and listeners about Medicare.  A question that is quite common is: "What vaccinations are covered under Medicare?" That's what this week's episode is all about.... vaccinations! There are currently three vaccinations that are covered under preventative and screening services under Medicare: 1. Flu Shot 2. Hepatitis Shot 3. Pneumococcal Vaccine   Flu Shot If you are enrolled in Medicare Part B, you can receive a Flu Shot from your doctor or other qualified health provider, who accepts Medicare assignment for administering the flu shot.  The cost for the Flu Shot under this scenario is $0 out-of-pocket for you. If your doctor or other healthcare provider does not accept Medicare assignment, your out-of-pocket cost be up to 100% of the cost of the Flu shot. Ensure your doctor or healthcare physician is contracted with Medicare before receiving treatment. For more information on the Flu, I'm sending you to this website: www.Flu.gov   Hepatitis B The Hepatitis B shot is available to individuals who are enrolled in Medicare Part B, have a doctor or other qualified health provider, who accepts Medicare assignment and you are at a "Medium" or "High" Risk to contract Hepatitis B. What indicates a Medium or High Risk? Well....there are many answers, but if you have certain diseases like hemophilia, ESRD (End Stage Renal Failure), Diabetes or other conditions that lower your resistance to infection are some good examples. If you have any questions regarding your eligibility for the Hepatitis B shot, ask your doctor. Since the Hepatitis B shot is covered under the Preventative and Screening Services of Medicare, there is $0 out-of-pocket cost to you. To learn more about Hepatitis B, I'm giving you the link to the Center for Disease Control and Prevention (CDC). Learn More About Hepatitis B   Pneumococcal Shot You are entitled to a Pneumococcal Shot if your doctor believes you need one, he or she is a qualified health provider, who accepts Medicare assignment and you are enrolled in Medicare Part B. There is also a second, different Pneumococcal shot that is administered one year after the first shot is given. Medicare Part B will cover this additional shot if your doctor says you need the two shots. You should always discuss your options and your concerns with your primary doctor. Here is the link to the CDC website on additional information about pneumococcal vaccinations: Learn More About Pneumococcal Vaccinations   Additional Vaccinations and Shots Available Other commercially administered vaccinations are available under Medicare Part "D" Tetanus, Diptheria and Pertussis (Whooping Cough) are examples of Part D coverage. A "Booster" shot, given to adults, adolescents and children is available as Tdap. Depending on what type of Prescription Drug Plan you are on, will depend on your out-of-pocket cost. You should contact your Medicare Insurance Carrier customer service department to request such information.   Shingles The Shingles Vaccine (Herpes Zoster) is also available under Part "D" of Medicare. The Shingles Vaccine out-of-pocket costs will vary by plan. You must contact your Medicare Plan Carrier's customer service department to determine your out-of-pocket cost for the Shingles Vaccine.  If you are not enrolled in Medicare Part D, you may have to pay up to 100% of the cost for the Shingles Vaccine. Here is the link to the CDC website for information on Shingles. Learn More about Shingles I also did an ENTIRE EPISODE ON SHINGLES! Go to Apple Podcasts and search in the Medicare Nation "Feed" directory. You'll see the episode is number 46, and was published on June 17, 2016. Listen to that episode! It is EXTREMELY educational. As the Medicare season has slowed down, I will be taking a break from the weekly publishing for the next few months. I'll post a new episode about every 3-4 weeks until September, when I'll pick right up and publish weekly shows again. Thank you soooo much for being a loyal Medicare Nation listener!  If you are enjoying Medicare Nation, give us a 5 Star Review on Apple Podcasts! The more people we can reach, the more people will learn more about Medicare. It' as simple as that! Thank you for listening to Medicare Nation! I'm so happy you are here! Share Medicare Nation with your family and friends, so they can learn more about Medicare and their benefits. Have a peaceful and prosperous week! Diane      

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. During the Annual Enrollment Period which is between October 15th through Dec 7th every year. 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. 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 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. 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. 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. 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. 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: If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc. 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. If you leave a PACE (Program All-Inclusive Care for the Elderly) Program. If you had Medicaid and lost eligibility because of income requirements.   When there are plan changes with Medicare Contracts: 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. If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.   Special Circumstances You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like! 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. 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. 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. 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. 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  

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!  

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!

Hey Medicare Nation! Many of you carry your Medicare ID card in your wallet or purse. If you are a Medicare Advantage beneficiary, you have a “separate” medical ID card from the insurance carrier. It is not necessary to carry your Medicare ID card, If you have a Medicare Advantage ID card. Who should carry their Medicare ID Card? If the official Medicare program is your “primary” insurance, you should be carrying your Medicare ID card. Now….. let me discuss with you how you can carry your Medicare ID card in a safer way. Currently, your Medicare ID Card has your Social Security number on it, with a letter at the end of your Social Security number.  If you have your social security number memorized, take these steps to help prevent “identity theft.” Make a copy of your Medicare ID Card Place your original Medicare ID Card in a safe place. Take a Black Permanent Marker and “black out” all of the numbers of your social security number( except the last four numbers and the letter), on the copy. Laminate the copy Put this copy of your Medicare ID card in your wallet or purse.   If you are on a Medicare Advantage Plan or a Supplement to Medicare Plan, you should be carrying the Medical ID card the insurance carrier provided you. If you have a stand-alone prescription drug plan, you will also have a separate card for your prescriptions. You will need to carry this card in your wallet or purse also.   How Do I Replace My Medicare ID Card if I Lost it or it Was Stolen? If you made a copy of your Medicare ID Card like I described above, you won’t have a problem. You can retrieve your Medicare ID Card from it’s safe place and make a new copy of the card. If you didn’t make a copy of your Medicare ID Card, you will need to ask the Social Security Administration for a replacement card. Follow these steps: You can ask for a Medicare Replacement Card : Online By phone At a local Social Security office location                                                            A.Online Go to ssa.gov You’ll see pretty pictures on the home page. On the left side is a picture, with the caption… “Learn What You Can Do Online.” “Click” on the that photo. When the next page opens, look down to about the 7th It will read….”If you get Social Security benefits or have Medicare you can….” “Click” on that line. Sign in or Register for a “My Social Security Account.” 5th line down should read….. “Get a Replacement Medicare Card” Select – “Replacement Documents” tab. Fill out the required information. If the site “accepts” your information, you are all set! You should receive your replacement Medicare Card in 30 – 60 days. If the site shows any kind of “error” or “red flags,” you will need to physically go down to a local Social Security location.             B. By Phone                      1. Call 800 - 633 - 4227                     C. Social Security Office                       1. Click on the "Social Security Location" tab and put in your                          zip code to find the nearest location to you.   Thanks so much for listening to Medicare Nation! I appreciate the time you took to listen. If you have a parent or grandparent, who is approaching Medicare age (65) or is already receiving Medicare benefits, help them “Subscribe” to Medicare Nation. Buy them a Smartphone! If you buy them an Apple phone…show them the “purple” podcast icon on the phone and how they access Medicare Nation. Once the Medicare Nation page loads….. click on “subscribe.” All current shows will load automatically once a week for them! If you buy them an Android phone, just go to Google Play and “Search” for the app – “Stitcher.” Download the Stitcher App. When you open Stitcher, they will need to sign up with an email address and password. Once the home page opens, show them how to “swipe” to the left, until they reach the “last page.” This is the “Search” page. In the “search” bar…. Type in “Medicare Nation.” Medicare Nation comes right up! “Click” on the Subscribe button…… they are set! Help your parents “search” for other types of podcasts they would have an interest in. You will be opening up a brand new world for them and they WILL thank you for it!

Hey Medicare Nation! I hope everyone is having an awesome week! Say goodbye to February! I know all of you Northerners are thrilled to see it go! Bring it on March! You know, I see many, many clients and one of the top questions I am asked is, "What does the letter on my Medicare ID card mean?" It happens so often, I figured I better dedicate an episode to just that! The Social Security Administration (SSA) assigns a letter and a number, (if you fit into a sub-group) when you apply for Social Security Benefits and/or Medicare. The letter (and number if it applies) is found on your Medicare ID Card, right after your social security number. As an example, if you have worked and contributed to FICA (Federal Insurance Contribution Act), and started receiving your Social Security benefits at age 64, and you enrolled in Medicare at age 65, the letter "A" will be designated to you. The "claim" number would look like this on your Medicare ID Card: 123-45-6789A Just as "Different Strokes for different Folks," the Social Security Administration assigns "claim" numbers for different situations. "Where Do I find the full list of Social Security claim letters?" You can go to the following locations to see a full list of claim letters: 1. www.ssa.gov 2. Title XVIII of the Social Security Act 3. For a Free List of the Codes Listed by the Social Security Administration on their website, go to my website - www.callsamm.com   Thanks for listening to Medicare Nation! Please SHOW someone how to "subscribe" to Medicare Nation, so they can learn about their Medicare benefits and what type of Medicare Plan they should be on!  

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!   

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!      

Hey Medicare Nation! This week I’m discussing Medical Marijuana! 2017 has issued in with additional States Legalizing Marijuana for Medicinal purposes. I am speaking with Dr. Rachna Patel, The Medical Marijuana Expert this week on Medicare Nation. Dr. Rachna Patel completed her undergraduate studies at Northwestern University in Illinois and her Medical studies at Touro University in Vallejo, CA. Dr. Patel is a licensed practitioner in the State of California and is in impeccable standing with the State of California Medical Board. She has been practicing in the area of Medical Marijuana (cannabis) since 2012, and she has treated countless patients! Dr. Patel is known for her “bedside manner” with her patients and does things differently than other Medical Marijuana doctors. Dr. Patel sees her patients “in person” and not by phone or virtually. Dr. Patel spends a thorough amount of time with patients to ensure she is guiding them step-by-step through the Medical Marijuana process. Dr. Patel may “recommend” medical marijuana for conditions and diagnoses such as, but not limited to: Chronic Pain (nerve, muscular) Auto-Immune Conditions Anxiety Insomnia Cancer Dr. Patel may “not” recommend medical marijuana for conditions and diagnoses such as, but not limited to: Spinal Stenosis Severe “Shingles” Case Bi-Polar Disorder History of Heart Attack/Stroke   Medical Marijuana is “Googled” daily by tens-of-thousands of people. According to ProCon.org , Colorado residents show the most interest in “searching” information on Medical Marijuana.  This may be due to the fact that Colorado was the first State to legalize “recreational use” of marijuana, and has set a "standard" for other States to follow. According to the website ProCon.org, as of March of 2016, there are over 1,250,000.00 people using marijuana medicinally. As more States legalize the use of Medical Marijuana, those numbers will steadily rise. The following 21 States have passed legislation for the use of Medicinal Marijuana: Montana, North Dakota, Minnesota, Michigan, Ohio, Pennsylvania, New York, Vermont, New Hampshire, Rhode Island, Connecticut, New Jersey, Delaware, Hawaii. The following Nine States have passed legislation for the recreational use of marijuana: Washington, Oregon, California, Nevada, Alaska, Colorado, Maine, Massachusetts, D.C.  That’s 30 States Total that have legalized Medicinal Marijuana. Here are a few links to learn more about Medical Marijuana: www.weedmaps.com http://medicalmarijuana.procon.org/ Would you like to contact Dr. Rachna Patel to learn more about Medical Marijuana and/or her practice? Here are links for Dr. Patel. Website – www.Dr.RachnaPatel.com Facebook page: www.facebook.com/DoctorRachnaPatel YouTube                                                                                                       https://www.youtube.com/channel/UCNtN7JXpNKHAYA7ZdWzpi1A     How to Choose a Medical Marijuana Doctor that You Can Trust 28 Legal Medical Marijuana States and DC: Laws, Fees, and Possession Limits   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!    

Hey Medicare Nation! How many of you have just found out your Doctor is leaving the Medicare Advantage Network you're in? I'm certain there are "Thousands of you." That is the #1 complaint I receive from clients, is that their "Doctor" is leaving or has left their Medicare Advantage Plan (MAPD) Network. Medicare has regulations about how a Medicare Advantage Organization (MAO) can "terminate" a Doctor contracted in their network and in reverse, there are regulations on how a Doctor can leave a MAO. There are also regulations on how a MAO publishes it's "Provider Directory" for their network. Chapter 4, Section 110.1.1 of the Medicare Managed Care Manual, titled, Provider Network Standards, lists in part....  "MAO's are required to establish and maintain provider networks that: ...... Are accurately reflected in up-to-date directories. Plans are responsible for verifying and regularly updating their network directories to ensure that providers included in the directories are available to their enrollees (ie, listed providers accept new patients who are enrolled in the plan).   In section 110.2.2 labeled Provider Directory Updates, it states in part: ....MAO's must include information regarding all contracted network providers in directories at the time of enrollment. Directories must include information about the number, mix, and distribution of all network providers. MAO's may have separate directories for each geographic area they serve (e.g. metropolitan areas, surrounding county areas), provided that all directories together cover the entire service area. Provider Directories must be updated anytime the MAO becomes aware of changes. They have 30 days to update the changes or be non-compliant. When there is a change to the provider network (a provider is terminated or the provider is leaving the network), The MAO "must make a good faith effort to provide a written notice of a termination of a contracted provider at least 30 calendar days before the termination effective date to all enrollees who are patients seen on a regular basis by the provider whose contract is terminating." In regards to termination of "Primary Care Physicians," all enrollees who are patients of that primary care professional must be notified."   So.....what's being done about all the inaccuracies to provider directories?   CMS conducted it's first review of 54 Medicare Advantage Organizations (MAO's) online provider directories, between February and August of 2016. The finding......45% of provider directory locations listed in these online directories were inaccurate! About one-third of all MAO's with 5,832 providers were reviewed in total. Twenty-One MAO's received warning letters from CMS around January 6th, and they have 30 days to fix the errors or face possible fines or sanctions, which could include suspending marketing and enrollment of medicare beneficiaries. Here are the Medicare Advantage Plans that received warning letters from CMS to immediately fix the errors in their provider directories. Blue Cross & Blue Shield of Rhode Island - RI Rhode IslandBlue Cross Blue Shield of Michigan - FL MI, MO WI Catholic Health Partners - IA,KY, MI, OH CIGNA  - IL, IA Community Health Plan of Washington - WA Emblem Health Inc. - CT, NY, RI Fallon Community Health - MA Gateway Health Plan, LP - OH, PA, WV Health Partners Plans, Inc. - PA Highmark Health - PA Humana Inc. - WI Indiana University Health - IA Magellan Health Inc. - NY Moda, Inc. AK, ID, MT, NM, OR, WA Molina Healthcare, Inc. - UT Piedmont Community Health Plan - VA Premera - WA Samaritan Health Services - OR SCAN Health Plan - CA UnitedHealth Group, Inc. - CO Wellcare Health Plans - IL   Now.... if you are a member of one of these MAO plans that received a "warning letter," you may qualify for a "Special Enrollment Period," from Medicare. What should you do?........ 1. Call Medicare - 800-633-4227 2. Tell the Medicare employee that you are a member of the ________ Medicare Advantage Plan, that received a "Warning Letter" from CMS for non-compliance of their provider directory. 3. State (if it's true!) that you were not notified by your physician or the MAO of the termination of your doctor, and your directory wasn't updated. 4. VERY IMPORTANT  TO STATE.....     Tell the Medicare employee you RELY on the directory to locate an in-network provider, and by the Medicare Advantage Plan & the Doctor NOT informing you that he/she was LEAVING the network, it caused a SIGNIFICANT access to care barrier for you!  Because now...... You can't see your doctor who has taken such good care of you..... due to the error. 5. Ask for a Special Election Period, so that you can choose a Medicare Advantage Plan where your Doctor is in-network. 6. If they grant you the Special Election Period, tell the Medicare employee which Medicare Advantage Plan you want to be on. 7. If they say "NO,"  Thank the Medicare Representative for their help and say goodbye.   What do you do now???? See if you qualify for a different Special Election Period. Listen to my earlier episode on SEP's. Listen to Last Friday's episode on 5 STAR Plans. Listen to the episode on the Medicare Advantage Disenrollment Period. It also includes information on Special Need Plans. If NONE of these ideas offer you the opportunity to change your Medicare Advantage Plan to a better option, than you will have to remain on the Medicare Advantage Plan you are on until the Annual Enrollment Period to change plans. Do your Due Dilligence Nation! Don't enroll in another Medicare Advantage Plan.... just because the doctor who is leaving the network is on that one! Make sure the plan will fit your Medical, financial and prescription needs for 2017! Share Medicare Nation with someone! Teach your parents, your grandparents how to access this podcast! Buy them a smartphone. The more they know, the less they will ask you for help. It's not easy being the "Sandwich Generation." So...... do yourself and your parents a favor and help them listen to Medicare Nation!   

Hey Medicare Nation! Medicare has announced the 2017 "5 Star Plans." What are 5 Star Plans? Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing. There are 2 main types of Star Ratings: 1. Overall Star Rating that combines all of the plan's scores. 2. A Summary Star Rating that focuses on a plan's medical or prescription drug services. A few areas Medicare reviews for these Star Ratings include: 1. How plan members rate their plan's services and care. 2. How well a plan's network of doctors detect illnesses and keep members healthy. 3. How well a plan helps it's members use recommended and safe prescription medications. A plan can receive a 1 to 5 Star Rating. 5 Stars is Excellent 4 Stars is above average 3 Stars is average 2. Stars is below average and 1 Star is poor. You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is available in your area. You can only switch to a 5 Star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once from December 8th to November 30th of the next year. Once you use your election to enroll in a 5 Star Plan, you cannot use it again. If a Medicare Advantage Plan or a Stand-Alone Prescription Drug Plan has received a 5 Star Rating from Medicare, it doesnot mean you automatically go out and enroll in the 5 Star Plan. That 5 Star Plan may not fit your unique needs! The option is available..... if you need it! Some people enroll in a Medicare Advantage Plan during the Annual Enrollment Period, and only switched plans because they received an incentive from the new plan. Ex: Your neighbor "Phil" tells you he is on the greatest Medicare Advantage Plan. He receives $30 in "Bandaids" from his plan every month. He tells you to "switch" plans so you can get $30 worth of over-the-counter supplies every month. Phil hands you his "Agent's" card. You call Phil's "Agent," who gladly comes out and enrolls you into the same exact plan that Phil has. The plan goes into effect January 1st. You call your Primary Doctor on February 6th for an appointment because you think you have the flu.  The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network? Sorry......you should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th.  Maybe you were better off on the plan you originally were on. In this example, you may have another option! You find out in January, that XYZ Medicare Advantage Plan has a 5 Star Rating in your area. You can look up the XYZ Plans and determine if one of their plans accepts your Primary Doctor in their network. Check the co-pays, co-insurance and deductibles on the new plan. Check that all your prescription drugs are in the new 5 Star Plan's formulary. If you like what you found out about the 5 Star Rating Plan that is available in your area, you are allowed to "switch" one time from the Medicare Advantage Plan you are stuck on, to the 5 Star Rating Plan available in your area.  Once you make the election to switch to the 5 Star Plan, you cannot enroll into another plan - whether it has 5 Stars or not.  Only a criteria that fits a Special Election Period will be allowed. Look on the www.Medicare.gov website for the list of Special Election Period examples. The 14 Medicare advantage Plans that received "5 Star Ratings" for 2017 are:      Company Name                           Service Area 1. KS Plan Administrators, LLC -     4 Counties TX 2. Kaiser Found. HP, INC                 31 Counties CA 3. Kaiser Found. HP of CO               17 Counties CO 4. Kaiser Found. of the Mid-            D.C. &         Atlantic States                              11 Counties MD                                                             9 Counties VA 5. Tufts Assoc. HMO                       10 Counties MA 6. BCBS of MA HMO Blue                11 Counties MA 7. Group Health Plan (MN)            87 Counties MN                                                           8 Counties WI 8. Aultcare Health Ins. Corp          12 Counties OH 9. Physicians Health Choice TX     19 Counties TX 10. Gundersen Health Plan            1 County IA,                                                                 8 Counties WI 11. Optimum Healthcare Inc.        25 Counties FL 12. Kaiser Found. HP of NW          9 Counties OR                                                            4 Counties WA 13. Sierra Health & Life Ins.         1 County CO,                   1 County KS, 2 Counties MA, 3 Counties MD.             1 County MI, 2 Counties NJ, 2 Counties PA,               2 Counties TX, 1 County in VA   If you live in the service area of the above 5 Star Rated Plans, you should go onto the Medicare.gov website and compare the 5 Star Plan to the Plan you are currently on. Make sure your doctors are in the network. Make sure ALL your prescription drugs are covered in the formulary. Look at the co-pays, co-insurance and any deductibles. Make sure the "5 Star Plan," is worth "switching" too! Just because it was given a 5 Star Rating from Medicare, doesn't mean the plan will automatically be the best choice for your unique needs. Do your Due Diligence!  You can check the Medicare.gov site for any 5 Star Prescription Drug Plans in your service area and Medicare Advantage Plans that are health plans only and do not offer prescription drug coverage on that particular plan. You can also listen to episode MN061. I give you information on the Medicare Advantage Disenrollment period and information on Special Need Plans. You don't have to be "stuck" on a Medicare Advantage Plan that doesnot suit your needs. This is the time of year to make changes. Make sure you switch to a better plan this time! Questions?? Send them to Support@TheMedicareNation.com Thanks for listening to Medicare Nation. If you like the information that is provided, give us a 5 Star Review on iTunes! The more reviews we get, the more exposure iTunes will give Medicare Nation, and that means more people will be able to find the show. https://itunes.apple.com/us/podcast/medicare-nation/id1031060767?mt=2 Have a happy, peaceful & prosperous week!                         

Hello Medicare Nation! Happy New Year to everyone. I hope everyone had a wonderful holiday season. The Annual Enrollment Period is over. I hope each of you did your due diligence in deciding which plan will fit you best for 2017. I have many episodes available for you to learn all about Medicare Advantage Plans, Original Medicare and Part D of Medicare. If you determine the Medicare Advantage Plan you are on is not suitable for you or a loved one in 2017, you may have other options available to you. Right now, you are in the Medicare Advantage Disenrollment Period. It started on December 8th and will end on February 14th of 2017. Here is how you "dis-enroll" from a Medicare Advantage Plan during this time period. 1. Call Medicare 800-633-4227 2. Advise the Medicare Representative that you would like to "dis-enroll" from your current Medicare Advantage Plan and go back onto Original Medicare. 3. You can enroll in a stand-alone Part D prescription drug plan. 4. You can also enroll in a Supplement to Original Medicare plan, that will assist you in paying your out of pocket costs for Part A & Part B.  Each Supplement to Original Medicare Plan (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan J, Plan K, Plan L and Plan N.) cover different out of pocket Medicare costs. Research each one prior to enrolling in the Supplement plan to determine the plan that will fit your health & financial needs for 2017. If you find it difficult to figure out if Original Medicare and enrolling in a Part D and/or a Supplement to Original Medicare Plan is right for you, contact me at either -  Support@TheMedicareNation.com OR Go to my website..... www.CallSamm.com and tell me in the "Contact Me" how I can assist you.   SPECIAL NEED PLANS Are you a Diabetic? Do you have COPD? Do you have Cardiovascular Disease? If you answered "yes" to any of these questions, you may be eligible to enroll in a special needs plan. A special needs plan is a Medicare Advantage Plan. If you are diagnosed with any of the conditions I listed above, you may use a special election to change to a special needs plan one time during the year. How do you determine if you have Special Need Plans in your area? Go to www.medicare.gov and click on the "find health and drug plans." The database will take you through several screens and you should select "special needs plan," when you advise Medicare what type of plan you are on. The database will provide you with the special need plans in your area. You can also look under special election periods, to determine if you have a qualified reason to change. If you like Medicare Nation, please give us a 5 Star Review on iTunes! https://goo.gl/uAhvLe When you leave us a great review, iTunes gives Medicare Nation more exposure. More exposure means individuals who need advise about Medicare will find the show! I appreciate you listening to Medicare Nation! Have a happy, healthy & prosperous week!    

  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: Are enrolling in Medicare Part B for the first time. Haven’t started receiving their Social Security Benefits and are enrolled in Medicare Part B. Are directly billed for their Medicare Part B premium Make an annual income of $85,000.00 or more Are enrolled in the Medicare Savings Program (States pay the new Medicare Premium increase). 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: Switch from one Medicare Advantage Plan to another Medicare Advantage Plan. Drop their Medicare Advantage Plan and go back to Original Medicare. Switch from a Stand-alone Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan and vice versa. Go from Original Medicare onto a Medicare Advantage Plan. Stay with the Medicare Advantage Plan they currently have. Switch from a Medicare Supplement Plan to a Medicare Advantage Plan. 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. 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.  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.   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

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: Are enrolling in Medicare Part B for the first time. Haven’t started receiving their Social Security Benefits and are enrolled in Medicare Part B. Are directly billed for their Medicare Part B premium Make an annual income of $85,000.00 or more Are enrolled in the Medicare Savings Program (States pay the new Medicare Premium increase). 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: Switch from one Medicare Advantage Plan to another Medicare Advantage Plan. Drop their Medicare Advantage Plan and go back to Original Medicare. Switch from a Stand-alone Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan and vice versa. Go from Original Medicare onto a Medicare Advantage Plan. Stay with the Medicare Advantage Plan they currently have. Switch from a Medicare Supplement Plan to a Medicare Advantage Plan. 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. 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.  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.   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  

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 http://www.wsoctv.com/news/9-investigates/whistleblower-9/whistleblower-9-do-not-resuscitate-bracelet-mistakenly-put-on-hospitalized-mans-wrist/446014450    Here is a Parody Video on "Advanced Directives" https://youtu.be/S6XKv7MOuts Good Practice (A parody of Green Day's " Good Riddance") By Michael Barton 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            

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

How to Find a New Prescription Drug Plan Welcome Medicare Nation! Many clients have been contacting me the last several weeks to tell me their Medicare plan has dropped one or several of their prescription drugs from the plan’s formulary. MAPD plans and Stand Alone Prescription Drug Plans (PDP) may change their formularies during the calendar year. Two examples of when they can do this, is if a prescription drug is found to be unsafe by the FDA. If a prescription drug may cause serious injury or death, they will remove the drug from the market. All Medicare plans would be forced to remove that drug from their formulary. Another reason a drug may be removed or added is when a generic of the brand drug comes out. This year Crestor, a brand drug for high cholesterol, became generic. With generic drugs available, the cost of the drug to the Medicare plan goes down. The plan adds the generic to their formulary and either keeps Crestor in addition to the generic, or removes Crestor from the formulary and keeps the generic versions. If you are on a Medicare Advantage Prescription Drug Plan (MAPD), you are locked in the plan, until the open enrollment period which begins on October 15th this year, or you have a special enrollment period. You can go to www.Medicare.gov to look up special election periods, or you can listen to episode #36 published on April 15, 2016. Stand Alone Prescription Drug Plans and MAPD plans, which have prescription drugs included, will be announcing their 2017 plans and formularies by October 1, 2016. Several Medicare Advantage Plans or Stand Alone Prescription Drug Plans may be available in your area. How do you compare plans to find the right one for you or your loved one? Use the official Medicare Website Plan Finder’s database. Go to www.Medicare.gov You’ll see a Dark Blue Bar under Medicare.gov Hover your cursor over the tab that reads “Drug Coverage.” Click on the last item in the column labeled “Find Health & Drug Plans.” Add your zip code & click on “Find Plans.” Check the box that pertains to you. Original Medicare? Health Plan (MAPD)? Check the box that pertains to you in regards to assistance. Do you receive extra help? I Don’t Know? Click “Continue.” Now enter your drugs. All of them. When you enter a brand drug, a box will come up asking you if you’d prefer to check the “generic.” If you take the brand, keep the brand drug. If you use the generic – choose the generic. If you don’t know…..choose the generic for now. You can ask your pharmacist or doctor later. Select “My Drug List is Complete.” You’ll see on the right side a grayish box that has a Prescription ID# Copy that number and the Password Date. You will be able to come back and edit the drug list in the future, without having to add all the previous drugs again. What a timesaver! Now select a pharmacy you use. Then select “Continue to plan results” On this page, you’ll see a summary of your search. Select the box that pertains to your plan.    Either Prescription Drug Plan with Original Medicare or    Health Plan with Prescription Drug Plan (MAPD).       All the drug plans in your geographical area available to you will be displayed.       Now you can look at each plan to determine which plans have all your prescription drugs and which ones do not.       You can enroll directly from the Medicare.gov portal, call Medicare directly or call your insurance agent or better yet – your Medicare Advisor.       You have several options.       With your Prescription ID# and the Password Date,  you will be able to come back at a later date and edit your list.       Start getting your list together, so it will be easier for you to check out 2017 plans!  Here's the link to read the guidelines your Primary Doctor uses in prescribing you scheduled drugs. www.cdc.gov/drugoverdose/prescribing/guideline Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com        Go to the Contact page and send me an email or “click” on the “Speak” button and talk to me! No other equipment is needed! Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com