Medicare Nation

Latest Episodes:

MN056 Medicare Prescription Drug Plans Are Racking You Over The Coals Sep 02, 2016

Show notes

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

MN055 How to Find a New Prescription Drug Plan Aug 27, 2016

Show notes

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.

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!

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

MN054 You Can Be Diagnosed With Glaucoma At Any Time Aug 19, 2016

Show notes

Welcome Medicare Nation!

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

I was diagnosed with Narrow Angle Glaucoma!

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

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

Open-Angle Glaucoma

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

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

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

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

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

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

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

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

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

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

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

What are some Symptoms of Angle-Closure Glaucoma?

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

Treatment

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

Eye drops

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

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

2 Types of Laser Surgeries Are:

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

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

Laser Peripheral Iridotomy (LPI)

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

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

Conventional Surgery MIGS stands for minimally invasive glaucoma surgery.

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

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

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

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

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

Eye pressure is unique to each person.

Ophthalmoscopy

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

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

Perimetry

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

Gonioscopy

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

Pachymetry

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

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

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

Resources:

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

www.glaucoma.org

www.worldglaucoma.org

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

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

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

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

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

Go to my website www.callsamm.com

And "Click" on the contact tab.

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

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

MN053 Are You Being Admitted to the Hospital or Are You Under Observation Aug 12, 2016

Show notes

The NOTICE ACT

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

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

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

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

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

Medicare Advantage Plans

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

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

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

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

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

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

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

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

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

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

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

Your Primary Doctor is the "Quarterback of your health team!"

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

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

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

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

Find all our shows on the Medicare Nation website –

www.TheMedicareNation.com

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

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

Go to my website www.callsamm.com

And "Click" on the contact tab.

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

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

"I want to be ON Medicare Nation."

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

What Are Advance Beneficiary Notices? Aug 05, 2016

Show notes

Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanks for listening to Medicare Nation!

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

Send me your questions to Support@TheMedicareNation.com

I might read your question on the air!

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Special Election Periods Q and A Jul 29, 2016

Show notes

Welcome Medicare Nation! We have a question today and I know many of you need this information!

MEDICARE SPECIAL ENROLLMENT PERIOD SHOW NOTES

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.

*****You cannot get an SEP because your Doctor left the network********

If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP 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?"

www.callsamm.com - has all of this information available for you. Download the Quick PDF List for Special Election Periods.

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

The Benes Act Explained - Know What You Are Eligible For! Jul 22, 2016

Show notes

Welcome, Medicare Nation! Today I want to explain a brand new bill being introduced in the US House and Senate. It's the BENES Act (Beneficiary Enrollment Notification and Eligibility Simplification Act). This bill impacts people eligible for Medicare, specifically those who are nearing the age 65 enrollment period for Part B. The bill was introduced by Rep. Raul Ruiz (Dem.-CA) and Rep. Patrick Mann (Rep.-PA) in the House and by Sen. Bob Casey (Dem.-PA) and Sen. Chuck Schumer (Dem.-NY) in the Senate. I hope I can clear up any confusion for you!

Let's look at the current PROBLEM, which boils down to a LACK OF INFORMATION:

The current system lets CERTAIN people know when to enroll in Medicare. If you are receiving SSI(disability) or SS benefits, then you will receive a letter as your 65th birthday approaches, advising you of your enrollment period and Medicare effective date. What about those NOT receiving those benefits? THAT is the problem!
If you don't receive current SSI or SS benefits, then the government has no "trigger" to alert you that it's time to enroll as you approach age 65. If you don't enroll during your initial enrollment period (three months prior to, including, and following your BIRTHDAY MONTH—for a total of seven months), then significant late penalties can apply. These can raise the premium you pay by as much as 30%! In 2014, ONE MILLION people paid a late penalty. The average monthly premium is $105 and the average late penalty adds an average of 30% to your monthly premium—EVERY MONTH!
Remember the following:
- If you have worked for 10 years (40 quarters paid into FICA), then you have paid the minimum to qualify for Medicare Part A, premium-free. Part A is the "accommodations" part of Medicare, meaning it covers overnight stays in medical care facilities.
- Part B covers outpatient services, which includes everything you might need in health care, excluding overnight stays.
- Under current law, the government will NOT send you any notification of your approaching enrollment period, and then they will assess you a substantial late penalty if you don't enroll when you should. "It's all about the mighty dollar, folks!"

Let's look at what the BENES Act will do to correct the PROBLEM:

The Act will make it possible for those turning 65 (10,000 Americans EVERY DAY!) to avoid mistakes and will give uniform information about the Part B enrollment process. Each individual will receive a "clear and detailed" notice of Part B enrollment rules that will help them make informed decisions. The government will send a notification when you are 64, letting you know that your initial enrollment period (that 7-month window around your birthday) is approaching. I'm excited about the possibilities of this new law, but it has to get passed first. Congress will reconvene on September 6 after their summer break, and if you want to stay informed about the progress of the BENES Act, then see our resources section.

Here's a listener question from Teresa in Philadelphia:

How do I enroll in Medicare?

Well, Teresa, there are some options. If you are turning 65 and not currently receiving SSI or SS benefits, then you need to visit www.ssa.gov, go under Menu—Benefits—Medicare, and then scroll down to "Apply for Medicare only." Click on "Start a New Application" and follow the directions. It should take about 10 minutes! Do it prior to your 65th birthday. My caution is that your personal information must have been updated with the Social Security Administration or there will be delays. If you have moved to a new address, changed your marital status or name, then you will have to go to the local SS office to enroll. You can call 800-772-1213 to enroll over the phone, but it is a LONG process.

If you are over 65 and still working and are covered by your employer's credible insurance plan, and NOT under Part B---then you will have to go to the local office and have two forms with you: the Employer Attestation Form (to prove there have been no gaps in insurance coverage since your 65th birthday) and the Application to enroll in Part B. Find these forms at www.ssa.gov or email me at support@the medicarenation.com and request copies. Thanks for the question, Teresa, and I hope this helps you!

Resources:

www.medicare.gov and www.callsamm.gov can give you information NOW about Medicare enrollment.

www.congress.gov (Keep up with the BENES Act progress—reference House Bill 5772.)

www.medicarerights.org (For great information and resources!)

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

Diabetes Prevention and an Expanded Pilot Program - Get the Details Here! Jul 15, 2016

Show notes

Welcome, Medicare Nation! Today's topic is Diabetes Prevention, based on the expansion of a pilot program instituted by the CMS (Centers for Medicare/ Medicaid Services). I'll be explaining the program's components and the results. Join me!

What you'll hear in this episode:

Statistics about diabetes:
- There are currently more than 30 million Americans with Type 2 diabetes.
- There are TWO deaths every FIVE minutes from diabetes!
- There are 86 million Americans at a high risk of developing diabetes.
- One out of three adults have "pre-diabetes," which means they have higher than normal (normal is <100) blood glucose levels and are at an increased risk to develop diabetes within the next ten years.
- The sad fact is that most diabetes cases ARE preventable!

Basics of the Diabetes Prevention Program:
- The DPP began in 2011, when the US Department of Health and Human Services provided, through the Affordable Care Act, $11.8 million for the pilot program to be administered by the YMCA.
- The program included weekly meetings with lifestyle coaches for dietary and behavioral changes, and monthly follow-up meetings.
- The target was for each participant to achieve 5% weight loss, which was accomplished. That is enough to substantially reduce the diabetes risk!
- About 80% of the program participants attended at least 4 weekly meetings.

Results of the Diabetes Prevention Program:
- The 5% weight loss goal was reached.
- The estimated healthcare cost savings per participant, when compared to those NOT enrolled in the program, was $2650.
- The Dept. of Health and Human Services wants to invest in programs like this, because of the cost savings and the improved health.
- The program's success is relevant to Medicare, employers, and insurers.
- The pilot program will now be expanded to benefit more people, and be put in place by January, 2018.
- The expansion program will include 16 intensive core group sessions, focusing on nutrition, physical activity, and behavior changes (with follow-up sessions also).

Ideal eligibility factors for participants:
- A BMI (body mass index) of 25 or higher (23 for Asians)
- Hemoglobin ANC-1 level of 5.7-6.4%
- Fasting glucose level of 110-125
- Glucose tolerance test level of 140-199
Visit www.callsamm.com to take the quiz to assess YOUR diabetes risk. Remember, PREVENTION is always the best medicine! If you have questions about Medicare, email me: support@themedicarenation.com. Hey-our ONE YEAR anniversary is coming up next week! Visit our website to help us celebrate and record your message about how the show has helped you. I would love to play those on the show as we celebrate together!

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

Medicare Q and A - Diane Answers Listener Questions Jul 08, 2016

Show notes

Welcome, Medicare Nation!

Today's episode is a Q & A in which I answer questions from two listeners. If you have a question for me about Medicare, then email me: support@themedicarenation.com. Let's jump right in!

From Mike, in Pleasanton, CA: If my doctor drops out of my HMO network, can I change to a Medicare Advantage plan that the doctor currently takes?
- Here's the thing, Mike: when you enroll in Medicare Advantage, you are in a "locked-in" period unless you have a "special election." A special election can occur for a number of reasons: if you moved to a different county with new plans, or if CMS (Center for Medicare Services) decided to terminate a Medicare Advantage policy and you need to find a new one. Another situation for special election would be if you are still working, at age 65 or over, and are covered under your employer's plan and aren't on Part B. If you need to drop your employer's coverage and enroll in Part B, then a special election would exist. Unfortunately, doctors can drop out of an HMO or PPO anytime, although they do have to give 60 days' notice.

Mike, you will have to change doctors unless this occurs between October 15 and December 7, which is the open enrollment period, or unless you have a special election period. Your situation would not be considered for special election. It's unfortunate, but it is very common and happens to many people each year. The doctors do this because of money, but keep in mind that if you follow a doctor to another plan, then the same thing can occur again. I hope this helps. Visit www.callsamm.com or www.medicare.gov for more information.

From Sharon, in Austin, TX: How much will I have to pay to be in the hospital for 7 days?
- Well, Sharon, the answer depends upon your plan. If you have original Medicare, Part A, then you have what I like to call "accommodations insurance." This means overnight stays are covered, with a deductible of $1288 for any stay of 1-60 days. All services and procedures in the hospital would then be covered for you. From days 61-90, you would pay $322/day for the same coverage. Of any stay of more than 90 consecutive days, you can draw on your lifetime reserve of 60 days at a cost of $644/day. Keep in mind, though, that those extra 60 days are a "lifetime piggy bank" of days, and you can't get them back once you use them. The old adage, "You use them - You lose them," applies here.

If you have a Medicare Advantage plan, then they are all different. An HMO will have a smaller network, and your co-pay will range from $0-$250/day. A PPO network is larger, therefore, your co-pay for an inpatient hospital stay will range from $0-$425/day. You would need to contact your Medicare Advantage Carrier to determine the exact amount of what your inpatient hospital co-pay will be. There are also Medicare Supplements (MediGap) plans, such as the F plan, G plan, and N plan. For these plans, you pay your monthly premium, but then have $0 out-of-pocket "medically necessary" inpatient hospital stays. Other Medicare Supplement (MediGap) Plans have a Part A deductible. Again, you need to contact your Medicare Plan customer service representative to determine your exact cost.

Sorry, I can't be more specific since I don't know your plan, Sharon, but I hope this information is helpful for you. Thanks for the question!

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

What Happens When You Can't Speak for Yourself During a Medical Emergency Jul 01, 2016

Show notes

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

Tell us about health care directives and the issues that commonly arise when people come to the ER.
- There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians' Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don't understand these orders, but no one really wants to raise the safety concerns.
What happens when someone comes to the ER with no accompanying family and no papers?
- It's not just an ER situation, but anywhere in the hospital, for any medical procedure. "You, the patient, are asked if you have a Living Will, then you are subjected to whatever their understanding is as to what that means." About 78% of the time, physicians assume that a Living Will equals a DNR, but in 64% of cases, a DNR is strictly an end of life order and does not apply to critical care emergencies. Medical professionals assume if you have any advanced directive that you're an end of life care patient and don't want care. Many don't understand the difference between being critically ill and being in an "end of life" situation.
If you have advanced directive documents, should you bring them with you to any scheduled procedure, like a colonoscopy?
- Most physicians would say YES, but I say NO. Keep your document in a safe place so that it doesn't compromise your care and treatment. Pull it out when you need it, but then you face a retrieval issue. Will the proper medical professional have access to your papers when they need it? We have a process that can insure that those documents are retrieved when needed. Most ER doctors are forced to look at a paper and make an interpretation, based on THEIR understanding, which might not be right for you.
Can you explain the difference in a Living Will and a DNR?
- A Living Will is a legal document, not a medical document. It is for use in situations when someone can't speak for themselves, develops a terminal condition, or is in a persistent vegetative state. A DNR is specifically for when someone is found with no pulse or breathing, and no CPR is desired. There is a common misunderstanding that a DNR means no medical treatment at all, when it most often applies to end of life care. When someone has a Living Will and the medical professional assumes it's a DNR, then it can affect care and treatment of any medical emergency. "It's a coin toss with a 50% chance of being treated or not being treated."
You've developed a solution to help people explain their wishes about receiving treatment. Can you explain?
- At the Institute of Health Care Directives, we have created ID cards containing detailed information to be understood by any medical professional in any hospital. It gives patients a voice to guide their care and treatment. Your ID card has info and directives linked with a QR code that accesses a video recording of your wishes. The recorded video is in a database and can be pulled up on any smart phone for any medical situation you may encounter.
Will this ID card work in any medical office, hospital, or ER?
- Yes, and it's in clear and understandable medical language so that any professional will know what to do.
Can you explain how to find out more and what the service includes?
- Visit our website: www.institutehcd.com or email us: info@institutehcd.com. You can even call us at 814-490-6584. Dr. Mirarchi is offering a 10% discount to the first 100 MN callers on either of the available packages. The Basic package is for healthy, young people, and the VIP package is for those with multiple medical problems. The VIP package gives you access to an on-call doctor 24/7/365. You can ask any question or any medical professional treating you can call for information about your condition. Our solution is a much clearer and simpler process and has received great response from physicians. The goal is to plan for when you are critically ill and (separately) for when you're at the end of life. There is a study coming out in 3-6 months on a 15 state trial, and the preliminary results are amazing. This is truly a game-changer in the health care industry.
  Do you have questions or feedback? I'd love to hear it!
  
  I may answer one of your questions on the air!
  
  email me:
  
  support@themedicarenation.com
  
  Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)
  
  Find out more information about Medicare on Diane Daniel's website!
  
  www.CallSamm.com

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