Podcasts about primary doctor

Interview with Upstate hospitalist Timothy Creamer, MD

Content warning: The subject of suicide is briefly discussed in this episode. After years of struggling with digestive issues, weight gain, anxiety, depression and beyond, Jenna Grooms decided to take her health in her own hands and peel back the layers that were sabotaging her from living a life filled with joy by overcoming her own major roadblocks. Jenna, a holistic health coach, lives by the mantra, progress over perfection. She shared this recently with her community, “If our health is dependent on us being perfect 100% of the time, then we're all screwed because it's just not tangible.” Right!? We discuss how pain and stress can affect our physical and mental health, and the importance of taking care of ourselves in a holistic way. Jenna opens up about her personal journey of overcoming pain and suppressing emotions, and how she turned her experience into a path of growth, healing, and helping others. We emphasize the benefits of meal planning and buying organic and provide tips for increasing energy and managing hormonal woes. We include a discussion of menopause and how stress can affect menopausal symptoms. This episode emphasizes the power of asking yourself the right questions and seeking external resources towards healing and designing a life that serves you. Tune in! Highlights of this episode: Suppressing pain and emotions for a long time can lead to a boiling point where action is necessary for healing and growth. Jenna's journey towards holistic health includes deep dive courses into different lenses of health, becoming a certified coach, and incorporating different modalities that have been impactful to her. Progress over perfection is key to our health and well-being, and our journeys are not linear. Stress is a natural response in our bodies, but our stress mechanisms were designed at a time when stress was imperative to our survival. Now, we need to be aware of the negative effects of chronic stress and take steps to reduce it. Nutrition and lifestyle choices play a significant role in managing stress, and Jenna encourages her clients to incorporate mindfulness practices and physical movement in their daily routine. ✨Go to michellefox.com/podcast for SHOW NOTES, TRANSCRIPT, and a link to this YOUTUBE episode.✨ Links mentioned in this episode: Jenna Grooms on Facebook: @coachjennagrooms Jenna Grooms on Instagram: @jennagrooms_ Masterclass: How to Create and Execute Your Weekly Meal Plan in Under 30 Minutes! An organization method that can make (or break) your nutrition goals. Nutrition group coaching with Michelle Connect with Michelle: Free meal planner: michellefox.com/planner Instagram: @michellefoxlove Facebook: @michellefoxlove Website: michellefox.com

This episode we have one of our favorite Seattle Docs to work with. Dr. Wong has always been inspired to be a health care provider because it's a profession that allows her to make a long-lasting impression in a person's life. Dr. Wong diagnoses and treats a wide range of sports-related injuries. Dr. Wong has a special interest in performing ultrasound-guided injections including steroid and PRP injections. She performs osteopathic manipulative treatments on musculoskeletal injuries where applicable. We're pumped for you to hear from her! More from Dr. Wong click here

Dr. Hemkes and Shawn talk about all the best bits about having a direct primary care doctor and why it's important to see your doctor regularly.

What is a primary care provider, why do I need one, and how the hell do I find one?Contacting a primary care provider (PCP) or a primary medical doctor (PMD) is a great first move when you need a new health issue addressed or if you want preventative care and guidance. These are the professionals you want to have a great relationship with. You should not settle for seeing an absolute jerk of a doctor, regardless of how great he or she may be. Getting effective medical care from a professional should not be like a fast-food drive thru or vending machine. You cannot hit a button related to your problem and expect a bag of magic pills, at least most of the time. So why should you invest in your relationship with a PCP? The answer would be continuity! Just like how your social media apps get better at reading your mind based on your activity, your medical care tends to improve when a professional follows you for enough time.So what kinds of primary care providers are out there? Internists usually see patients above 18 y/o and pediatricians below 18 y/o. Family medicine docs see patients of all ages and are the true jack-of-all-trades in the medical field. Ladies can designate a gynecologist as a PCP, but in some cases insurance plans may place restrictions on doing that. Check if your health plan makes you pick an internist or other traditional PCP instead. Older patients with chronic and/or several complex issues may also consider a geriatrician as a PMD.Even though you will hear me say that you need a doc for this and a doc for that, the patients considering themselves to be perfectly healthy may find a better match with a different healthcare professional like an FNP instead where the patient can have various primary needs addressed but can still get referred to a specialist when needed. It is more important to strike a balance: make sure to have a medical provider who has both expertise and professional courtesy.According the Kaiser Family Foundation, there are around 495k active PMDs in the US as of September 2021. In our country of over 330 million people, it should be no surprise that low supply makes it hard to get scheduled with any doctor, let alone a good one. About 25% of those PMDs are in CA, NY, and TX alone.So how can you find a reasonable PMD? Most websites and forums will tell you to seek out friends/family or use your insurance plan's directory. While these sources are nice, not everyone is fortunate to have family in good medical hands already and health plan directories themselves may not be up to date (plug BCBS, UHC, Healthline source here).Let me make this easy: crack open google maps and type ‘internist/pediatrician near me' or write ‘internist/pediatrician in [insert your town here].' Convenience to medical care should matter just as much as how solid a professional's advice may be. Even when your insurance company requires you to designate a PCP, you can seek out whatever prospects are reachable. Go check out the map listings, scroll past the ads, and certainly read some reviews. But don't stop there! If you want another sophisticated tool to complement your impeccable google search, see Medicare's physician comparison site, which is also linked on my Substack's resource page (at rushinagalla.substack.com).Now for the good part: it is better to hear things from the horse's mouth and actually contact the prospective medical offices you see on your computer screen. Good offices want to have nice conversations with new patients and are usually willing to go over all the nuances with you. There is no reason to be shy. Let me give you a few basic questions to ask for improving your screening process.Here's the first thing to open up with: do you take new patients? If you get a ‘yes' then you should follow up with asking what to expect with the first consultation. Given that you are new, there is more history for the PCP to collect. Some physicians give new patients more time for the opening visit or change the overall structure of the appointment. The office's response to describing how new patients are treated should matter in your screening process.The next thing to cover is this: does your physician have experience treating the condition I have? Your expectations here would vary based on your social, personal, and family history, but understanding if a prospective doc has been treating patients with certain conditions for X number of years is a great thing to know regardless. We know already that PCPs treat you for a wide variety of conditions—that being said, we all know what an iPhone does but we still check what the features and specialties are for each new generation. This is why it is helpful to know what kind of tilt a prospective doctor has.Now it would be reasonable to ask another necessary question now rather than later: does your doctor and facility take my insurance? Although you should expect a yes or no answer to this, you should remember that there are a gazillion variations of plans under each insurance network. This is why it is best to have your insurance card handy when you ask that question to clarify what specific health plan you have. You are now making the office staff's job and your screening process easier.The last effective question to ask, which tends to be overlooked, is: Can I get labs and tests performed at the clinic itself? When your new PCP gives you some orders to fill you do not want to realize right then that you need to go to another facility to get additional medical care taken care of. Some primary care facilities are fully equipped to have a test drawn on site but it is easy to know for sure when you ask about their setup over the phone. If all of the aforementioned questions are answered to your satisfaction, it is worth scheduling a visit. Now you have made it through the first major hoop in screening your PMD prospects. It is important to do your research here because you are, ideally, going to see your PCP once a year to stay on top of things. If you wait until a busy season like the end of the year to squeeze in a physical, you will not get to the clinic in a timely manner. Leaving a 6-month calendar reminder on your phone to schedule a visit later makes this part easier.Let's say you make it to the clinic in a reasonable time frame, like within a month or two of your initial phone call, for a regular physical and you are chilling in the waiting room. At this moment you are more likely to check your crypto wallet or social media newsfeed than to think up some questions for your doc. In the next episode, I'll fill you in on simple tips and tricks to get the most of your routine visit even if you're fit as a fiddle.Stay tuned and subscribe to Friendly Neighborhood Patient for more wonderful and practical guidance! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Ever wonder what you can check with your primary doctor to be proactive and preventative? Dr. Lori Gerber shares some of the labs and symptoms you should discuss with your doctor to prevent disease and help with aging. She also discusses supplements & medications that help symptoms and for preventative care to treat adrenal fatigue, leaky gut, hypothyroidism, insulin resistance & diabetes as well as menopause, perimenopause and andropause. Listen it and learn how to take your health into your own hands,

Listen and explore:What originally led Alasdair to seek alternatives to health insuranceAlasdair's recent, glowing health care experience from the desert in New MexicoDon't be afraid to fire your doctorThe four elements of Alasdair's health care strategyAn affordable option to traditional health insurance plansThe value of tela-medicine for full-time travelersA free way to save money on prescriptions (whether you have insurance or not)Covering major downside while maximizing your freedom to choose who you work withJulie-Roxane's experience of French health care and how it compares to the U.S.The only company we use these days for international travel insuranceMentioned on this episode:https://thehealthsharelady.com/ (tell Karen that Alasdair sent you!)SederaMedlion clinicLotus Rain clinic in San DiegoGoodrxSafetywingTwo Years Without Health Insurance (And What I'm Doing Now) - Mr. Money MustacheConnect with us:Website: www.thefarout.lifeEmail us at info@thefarout.lifeOn Instagram: @thefaroutcoupleJulie-Roxane on Instagram: @julieroxaneAlasdair @ www.alasdairplambeck.comSupport this podcast:Become a patron at: https://www.patreon.com/thefaroutcoupleMake one-time donation with PayPal (our account is aplambeck22@gmail.com)Leave a review on iTunes!Share this episode with a friend! :DCredits:Intro music: "Complicate ya" by Otis McDonaldOutro music: "Running with wise fools" written & performed by Krackatoa (www.krackatoa.com)

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!      

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

Tune in as Andrew & Tracey discuss upcoming events, new low dose CT lung screenings, and speak with our guest for this episode, Dr. Eliza Tate, Family Medicine, about her practice, profession, and her approach with patients. Special Guest: Dr. Eliza Tate.

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! 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!                         

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