Medicare Nation

Latest Episodes:

Cataract Awareness Month - Know the Signs and Symptoms with Dr. Steven Loomis Jun 24, 2016

Show notes

Welcome, Medicare Nation! My guest today is Dr. Steven Loomis, an optometrist in Littleton, CO. Dr. Loomis is also the president of the American Optometric Association. Did you know that June is Cataract Awareness Month? It's important to know what cataracts are, how they develop, and how to treat them. Dr. Loomis is here to discuss those topics and others related to general eye health. Join us!

Many people don't understand the difference between an optometrist and ophthalmologist. Can you explain?
- Think of an optometrist "like a family doctor for your eyes." These are medical doctors with four years of undergraduate education and four years of specialization. They deal with eye issues such as blurred vision, diabetes, and glaucoma. Optometrists actually diagnosed 240,000 cases of diabetes in 2014! An ophthalmologist is an eye surgeon who works in conjunction with a patient's optometrist.
We know we need comprehensive eye exams, but how often should we get them, and what is included in that exam?
- An annual exam is recommended unless there is a condition that warrants more frequent care. Specific tests are included, such as visual acuity, auto refraction, an image of the inside of the eye, visual field, blood pressure, and a check of the pupils. The doctor will also ask questions about medical family history.
What exactly does "20/20 vision" mean?
- Vision is based on the Snellen Acuity Chart, which was invented by Dr. Snellen over 100 years ago. It is the basic eye chart we are all familiar with that has a series of letters or shapes of certain sizes. The "20 foot" standard has been established, meaning that you see what you should see at a distance of 20 feet. A vision of 20/30 or 20/40 means that you see at 20 ft. what the normal eye sees at 30 or 40 ft. Some people see better than normal, like 20/15. It's interesting how they measure the 20 feet distance, when most exam rooms are not 20 ft. long. The chart might be 12 ft. away from the patient on the wall, and a mirror is placed 8 ft. behind the patient, to make up the 20 ft. distance.
As we age, does 20/20 vision decrease?
- Yes, unfortunately. It's completely normal because our eyes age as do other parts of our bodies. As your lens ages, cataracts may form and the retina and cornea lose some functionality.
What are "floaters," and can they clear up?
- Floaters are very common. They can be seen during an eye exam with dilated eyes. What happens is that the vitreous fluid in the eye, which should be firm, solid, and gelatinous, begins to liquefy as we age. This more liquid substance has fibers in it that appear in our vision as floaters. The good news is that they can clear up; they can shrink, sink, and then we THINK they are gone. If floaters increase or change, then see your optometrist to be checked.
What is glaucoma?
- In short, it occurs when the pressure inside the eye damages the optic nerve. Risk factors include family history, racial characteristics, age, and medications. The first symptom is often vision loss.
If glaucoma is indicated, what is the treatment?
- Medications can control the pressure. Usually eye drops are prescribed once daily and can safely manage the disease.
What are cataracts and how are they treated?
- Cataracts are very, very common and usually show up around age 60. The lens becomes not as clear as it used to be as it loses its clarity and transparency. Exposure to UV rays can cause them, as well as steroids, diabetes, radiation treatments, eye trauma, and eye surgery. The #1 cause? Too many birthdays! There is no treatment needed for early cataracts, but they can worsen to cause hazy vision and nighttime glare. Surgery is the only cure, where the natural lens is removed and an artificial lens is implanted. The good news is that your lens prescription can be incorporated into the artificial lens so your vision is improved on multiple layers. (Tune in to hear a fascinating account of cataract surgery details! Did you know it only takes 5-8 minutes to complete?)
How do Medicare benefits factor into cataract surgery?
- Medicare will pay for a monofocal artificial lens, but the patient can pay for an upgraded lens if desired. Medicare, depending on your plan, will pay a portion of glasses or contacts needed for after surgery.
Final words from Dr. Loomis: Keep up with your annual eye exams and discuss options with your doctor when issues arise. Visit www.aoa.org for more information and for their "doctor locator" tool.
Question from Eileen in PA: Does Medicare cover eyeglasses? The answer is no, except for what is needed after cataract surgery, and then a portion may be covered under your plan.

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

Anyone Can Get Shingles! Know the Signs and Symptoms Jun 18, 2016

Show notes

Welcome Medicare Nation! Today we're talking about Shingles. I recently had shingles and my eyes were opened to how painful it is. It's really a terribly painful illness, so I wanted to give you some facts and tips to help you diagnose your symptoms early.

What is Shingles?

A virus that is a type of herpes zoster virus. You can only get shingles if you've had chicken pox. The virus stays dormant in your spine and attach itself to some of the nerves in your spine. Then something comes along and activates it when you have a lower immune system. If you are on auto-immune suppressing drugs, you are more susceptible to the virus.

Increased stress can also trigger an outbreak of shingles.

What are the symptoms?

A blistery rash that generally starts around your back and wraps around your side. I got a blister on the palm of my hand. About a week before the outbreak, you can begin having pain from the nerve endings being affected.

Patches of blisters will grow and then they are painful. You can have headaches and other pain that goes along with it.

The virus starts coming down your nerve path and it becomes extremely painful. The pain is similar to neuropathy pain.

Treatment?

Because I sought treatment within 48 hours of the onset of symptoms, I was able to take an anti-viral medication. This caused the pain to being to lessen over the next few days.

Anti-Viral medications

Acyclavir
Valacyclavir

Lidocaine can be given to block the pain.

Advil.,Motrin will also be given to lessen pain.

Anybody can get shingles. More likely to occur in older folks because the immune system is naturally weaker.

50% of people over the age of 60 to get shingles.

Shingles is contagious. It is contagious when the blisters are broken open and oozing. Direct contact with open blisters should be avoided.

Shingles Vaccine - given to people 60 and over - Zostavax. There is a 51% chance of not getting the virus when you get the vaccine.

Who should NOT get the vaccine?

-People with allergies to gelatin

If you are allergies to neomycin
If you have a weekend immune system from AIDS or other illness
If you have leukemia or lymphoma
If you are pregnant

Info about Shingles Vaccine:

Medicare Advantage plans will require a co-pay. Find out what it costs with your plan by calling customer service with you plan.

Original Medicare - you will pay 20%

Medigap - you won't pay anything

There is no season for shingles. Anyone can get it at any time.

You can find out more about shingles here.

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

45: Medicare Q & A - Answers to Your Questions About Medicare Jun 10, 2016

Show notes

Welcome, Medicare Nation! I've had a busy two weeks and have just returned from a conference in Miami for the National Osteoporosis Foundation. I have been flooded with emails, so today's episode will be a Q&A session in which I address as many of those questions as possible. Join me!

From Steve in Texas: "I'm turning 65 in July and your program has been helpful to me. Can I change Part D prescription options over time without having to pass insurability determinations?"
- The options can be confusing. You can change Part D plans during the annual enrollment period, from October 15-December 7. You can change plans every year, if needed. You should review your plans yearly, based on your prescription needs and usage.

From Dottie: "I have a Medicare Advantage Plan with Blue Cross. When I get the benefits summary, do the fees reflect those set by Medicare or do the doctors make these up?"
- Every Medicare insurance carrier negotiates with each doctor and facility so they have a contract for how much the doctor gets paid for services. The summary shows what the doctor usually charges, what your plan covers, and what your co-pay amount is. What you see is what the doctor normally charges, but NOT what you will pay. The negotiated rate will be applied by your plan and you pay your co-pay or co-insurance.

From Dottie, the 2nd part of her question: "If I want to change to another Medicare Advantage Plan, can I keep my same doctor even if he isn't in the network?"
- Remember, Medicare Advantage is all about being in a network. It's a "pay as you go" plan because you only pay for what you need. If your doctor is not in network, you have to decide what's more important. Do you have to stay with that doctor or do you value the plan's benefits more? You may need to change plans or pay out of pocket. This depends upon if your plan is an HMO or a PPO. A PPO has an out of network option but you will pay a higher co-pay. An HMO in Medicare Advantage doesn't allow any out of network options.

I hope these questions and answers have been helpful to you. If need be, we'll add another show each week just to cover your questions. So, keep those coming! Email me: support@themedicarenation.com. Remember, you can visit www.medicare.gov for more information.

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

Don't Confuse Aphasia with Dementia - It's Aphasia Awareness Month Jun 03, 2016

Show notes

Welcome, Medicare Nation! Can you believe the month of June is here? The year is rolling right along, and you may not be aware that June is Aphasia Awareness Month. If you're not familiar with aphasia, you should know that it's an acquired disorder that affects a person's ability to speak and to process language, but it does not affect intelligence. Let's learn more about this disorder.

Here are a few basic facts about aphasia:

Often, aphasia is the result of brain injury, brain tumor, neurological disease, or stroke. (25-40% of stroke survivors will have aphasia.)
About 2 million Americans are affected by aphasia, with 180,000 acquiring it yearly.
Aphasia can affect any age, race, ethnicity, and gender. Those over age 60 have the highest aphasia rates, with those over age 40 being the second highest. The rate of occurrence is the same for all other age groups.
Aphasia can't be cured but can be treated and improved with speech and occupational therapy, and these are covered by Medicare, depending on the plan.
Some helpful therapies can be done via an app or on a computer. Many of these costs can be reimbursed, depending on your Medicare plan.
Aphasia is self-diagnosable because the signs are noticeable, and may include social isolation, repeated actions/words, and jumbled/slurred speech.

There are several types of aphasia:

Global aphasia is the most severe form. It leaves the person unable to speak more than a few words and they can't understand spoken words or read.
Broca's aphasia has characteristics of reduced speech output, limited vocabulary, but the person can understand language and read.
Mixed Non-fluent aphasia makes it hard to speak and limits comprehension. The person cannot read or write beyond the elementary school level.
Wernicke's aphasia leaves the person fluent, where they can grasp the overall meaning of a sentence, but may not comprehend individual word meanings.
Primary progressive aphasia is a rare neurological syndrome in which brain tissue degenerates.

To find out more about aphasia, visit the website for the National Aphasia Association: www.aphasia.org. You may contact them via email: naa@aphasia.org or find them on Facebook: Aphasia Recovery Connect.

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

Part 2: Live from the Interdisciplinary Symposium on Osteoporosis by the National Osteoporosis Foundation May 27, 2016

Show notes

Welcome Medicare Nation! Today's episode is Part 2 of our interview series live from the Interdisciplinary Symposium on Osteoporosis held by the National Osteoporosis Foundation in Miami, FL. Today's episode features some of the leading Osteoporosis practitioners in the country, as well as an important summary of Medicare Benefits that relate to the treatment of Osteoporosis.

Today's episode features:

Medicare Benefits for Bone Mass Measurement (Bone Density) Testing

How often is it covered?

Medicare Part B (Medical Insurance) covers this test, which helps to see if you're at risk to broken bones, once every 24 months (more often if medically necessary) for people who meet the criteria below. Medicare only covers this test when it's ordered by a doctor or other qualified provider.

Who's eligible?

All qualified people with Part B who are at risk for osteoporosis and meet one or more of these conditions:

•A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings

•A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures

•A person taking prednisone or steroid-type drugs or is planning to begin this treatment

•A person who has been diagnosed with primary hyperparathyroidism

•A person who is being monitored to see if their osteoporosis drug therapy is working

Your costs in Original Medicare

You pay nothing for this test if the doctor or other qualified health care provider accepts assignment.

Some good times to talk to your Physician about this testing:

During your "new to Medicare" visit to Dr. visit, discuss preventative exams with Dr, they can suggest bone density.

Annual wellness visit to Dr - talk about bone density exam

Listen to this episode to hear interviews from the following professionals:

Dr. Thomas Olinginski - Tom Olenginski, MD, FACP is an associate in Rheumatology at Geisinger Medical Center. A graduate of the Pennsylvania State University and Penn State College of Medicine, he completed both his General Internal Medicine Residency and Rheumatology Fellowship at Geisinger Medical Center. Since 2008, he has been Co-Director of Geisinger's High-Risk Osteoporosis Clinic. He is Chair of Geisinger's Bone Density Committee and is responsible for Geisinger's Osteoporosis Curriculum within its Rheumatology Fellowship. He has also served as a member of the NBHA Secondary Fracture Prevention Committee. His major interests are daily clinical care as a rheumatologist, teaching within Geisinger's Rheumatology Fellowship and Internal Medicine Residency, as well as metabolic bone disease and system-based osteoporosis care, clinically-oriented bone density interpretation, and Geisinger's Fracture Liaison Service.
Sherri Betz - SHERRI BETZ, PT, GCS, CEEAA, PMA®-CPT is a 1991 graduate of the Louisiana State University Medical Center's School of Physical Therapy. Sherri actually began her career as a national gymnastics competitor and as a group fitness instructor and personal trainer for Nautilus Fitness Centers in the 1980's. Inspired by the work of a physical therapist in one of the clubs where she trained, Sherri pursued a degree in physical therapy. Selected to serve on the Foundation for Osteoporosis Research and Education (FORE) Professional Education Committee and the NOF Exercise and Rehabilitation Advisory Council, Sherri is involved in improving awareness about bone health for the lay public, exercise teachers and for healthcare professionals. These committees review the latest updates in research, develop guidelines and design educational programs for physicians and allied health professionals. She has developed the "Do It Right and Prevent Fractures Booklet" for FORE/American Bone Health.
Dr. Steven Harris - Steven Harris, MD is a board-certified internist and endocrinologist with a subspecialty focus on osteoporosis, metabolic bone disease and disorders of mineral metabolism. He received his medical degree from the University of California, San Francisco, and completed a residency and chief residency in Internal Medicine at the same institution. He completed a clinical and research fellowship in Endocrinology and Metabolism at Massachusetts General Hospital in Boston. In 1983, he returned to the University of California, San Francisco, where he is a Clinical Professor of Medicine. Dr. Harris has spent many years working on a variety of clinical research projects to examine the effects of nutrition, calcium supplements, vitamin D, hormone therapy, bisphosphonates, calcitonin, PTH and SERMs upon the prevention and treatment of osteoporosis. Dr. Harris maintains an active consultative practice in metabolic bone disease, but is also engaged in a wide variety of educational initiatives related to osteoporosis.
Dr. Sandesh Nagamani - graduated from the J S S MED COLL, MYSORE UNIV, MYSORE, KARNATAKA, INDIA in 2000. He works in Houston, TX and specializes in Genetics, Medical. Dr. Sreenath Nagamani is affiliated with Methodist Hospital and St Lukes Hospital At The Vintage. He speaks English and Spanish. As an adult clinical geneticist, he provides clinical care for adult patients with a wide variety of heritable conditions. Dr. Nagamani serves as the Director of the Clinic for Metabolic and Genetic disorders of bone that caters to adult subjects with OI, heritable disorders of bone, early-onset osteoporosis, and other common forms of metabolic bone diseases.

Check out the Food4Bones app for iPhone and Android

www.nof.org

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

Live from the Interdisciplinary Symposium on Osteoporosis! May 20, 2016

Show notes

Welcome Medicare Nation! I interviewed clinicians and global experts in the bone health field gathered during the Interdisciplinary Symposium on Osteoporosis held in Miami, Florida from May 12 to 15, 2016. May is the National Osteoporosis Awareness Month. Clinicians and Academicians Joined the National Osteoporosis Foundation to Identify Solutions for Reducing the Two Million Broken Bones Caused by Osteoporosis Each Year.

This conference was sponsored by the National Osteoporosis Foundation (NOF), the organization dedicated to preventing osteoporosis, promoting strong bones, and reducing human suffering through education, advocacy, and research. NOF is committed to promoting bone health among the elderly through healthy diet and safe exercise. Both can help stop the loss of bone mass and help prevent fractures.

Leading medical and scientific experts in the bone health field discussed the latest information on preventing broken bones and lead in-depth educational sessions on the prevention, diagnosis and treatment of osteoporosis.

I met brilliant doctors, nurses, and therapists from all over the world and learned about:

Prevention and treatment of osteoporosis
Education for prevention of people at risk
There are 54 million Americans who suffer from osteoporosis
To address this significant care gap, the ISO 2016 included training on preventive care model that operates under the supervision of a bone health specialist and seeks to prevent repeat fractures.
The Fracture Liaison Service (FLS) Model of Care Training Course is designed to help doctors, nurse practitioners, physician assistants, registered nurses and other healthcare professionals improve the care management of post-fracture patients and navigate the complicated coordination of care process across hospitals, medical offices and multiple medical specialties through the application of best practices.
The FLS model of care is the key to sparing millions of American from breaking bones due to osteoporosis.
This 2016 ISO includes updated FLS training, and the introduction of Bone Health ECHO (Extension for Community Healthcare Outcomes), a strategy of telementoring FLS coordinators and healthcare professionals of all levels, with the aim of reducing the osteoporosis treatment gap said E. Michael Lewiecki, MD, FACP, FACE, New Mexico Clinical Research & Osteoporosis Center, Co-Chair ISO Planning Committee 2016.
If you are over 50 and have hip or back fracture, then you have osteoporosis.
Secondary fractures can occur, too.
Every year, osteoporosis is responsible for two million broken bones, yet fewer than 25 percent of older women and men who suffer from a fracture are tested or treated for osteoporosis.

So many things can happen, secondary fracture, pneumonia,

You can find the best information about osteoporosis from www.nof.org National Osteoporosis Foundation.

Listen to the first part of a 2-part interview. Learn about food for the bones, calcium-enriched diet, safe exercises for the elderly. We are on iTunes, and Google Play. Please tell your friends about medicare nation, and the 3 other shows I have. You shouldn't be breaking your hip or back. If you get fractured, you have osteoporosis.

Susan Randall

Osteoporosis is the condition where the bone is weakened and impaired and more prone to rapture.
Causes of osteoporosis include: aging and decline in estrogen and testosterone
Women and men both have the same hormones. Both lose these key hormones as we age
These hormones influence other bodily functions. As the hormones decline, bone strength and quality are affected
Treatment for breast cancer put on a class of medications that are aromataste inhibitor
Primary and secondary causes of osteoporosis. It's multifactorial

2. Dr. Sanjeev Arora

Dr. Arora, MD, is the Keynote speaker , head of Project ECHO and Improving Health in Underserved Populations through Technology;
He is from the University of New Mexico;
Project ECHO, Extension for Community Health Outcome use the FLS model to improve efficiencies and democratize medical knowledge.
Project ECHO uses video conferencing technology where conference participants can talk via skype about the best treatment in underserved nations. It's a new platform for medicine

Project ECHO is based on the idea that a multidisciplinary team of providers can attract outcome in the internet
The project targets meeting the medical needs of a billion people by 2020. It currently connects 13 countries and hundreds of universities and clinics.
Additional ISO16 Highlights include:

Sessions exploring the controversies in osteoporosis treatment and care;
New tools for assessing fracture risk;
Interactive sessions on safe exercises for people with osteoporosis;
Evidence-based answers to the most common patient questions on osteoporosis and fracture prevention;
Professional development workshops on patient education and new coding and reimbursement for osteoporosis;

3. Karen Kemmis

Karen is a Physical Therapist specializing in safe exercises and movements.
Silver sneakers – use gyms medicare vantage plan
Some exercise and moves could be dangerous for the elderly
Many fitness instructors are not well versed with chronic conditions we have to be careful what is safe for their particular condition
Anything in the upright position is safe for the low-density bone mass
Dangerous moves include forward bending such as toe touches, twisting hard, full rotation, sit-ups
Safe exercise moves include lying on the back; lay grazing, isometric exercise,
To work safely with a fitness instructor tell them about your bone concern, go to www. nof.org, search positive exercises, print those materials and bring to instructor

4. Dr Maria Pesquera

Is a primary physician in Albany, New York and has a lot of patients who have osteoporosis.
Her medical team is having issues with medication used for treating osteoporosis
She favors exercise alternatives such as yoga and pilates.
She promotes a Holistic method of treatment that includes healthy diet

Resources:

National Osteoporosis website: www.nof.org
The best way to contact ECHO and Dr. Arora is via the website: echo.unm.edu

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Lupus Awareness! It's not easy to diagnose; know the symptoms May 13, 2016

Show notes

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

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

How many people in the US have Lupus?

1.5 Million people in the US.

What is LUPUS?

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

Lupus can be difficult to diagnose because:

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

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

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

Lupus primarily affects women in their child-bearing years.

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

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

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

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

Lupus Symptoms:

•Fatigue and fever

•Joint pain, stiffness and swelling

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

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

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

•Shortness of breath

•Chest pain

•Dry eyes

•Headaches, confusion and memory loss

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

Resources:

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

Lupus Foundation of America - www.lupus.org

Lupus Florida - www.lupusflorida.com

Contact Linda Ruescher:

On Twitter: www.twitter.com/chronicillness

On Facebook: www.facebook.com/Linda Ruescher

Email: linda.ruescher@gmail.com

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

Do You Qualify for The Medicare Savings Program? Find out now! May 06, 2016

Show notes

Today's topic is the Medicare Savings Program. It can help you pay part of your Medicare premiums. It's based on certain criteria of your income and resources.

2016 Medicare Savings Programs:

Resources include stock, bonds, 401K, IRA.

It does not include your home, 1 vehicle and other personal items.

4 Levels of Coverage:

QDWI Plan: (Qualified, Disabled, and Working Individual)

Monthly income limit - $4045 (Married $5425)

Resource limit - $4000 (Married $6000)

QI Plan: (Qualifying Individual)

Monthly income limit: $1357 (Married $1823)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

Specified Low Income Medicare Beneficiary Program (SLIM-B)

Monthly income limit: $1208 (Married $1622)

Resource limit: $7280 (Married $10,930)

Pays Part B Premium - $104.90

New to Medicare - $121.80

Qualified Medicare beneficiary (QMB)

Pays Part A, Part B Premium, Deductibles, Co-pays

Monthly income limit: $1010 (Married $1355)

Resources limit: $7280 (Married $10,930)

How to Apply:

Go online to www.ssa.gov. Click "Benefits", then "Extra Help for RX Drugs", look on right side for "Application".
Go to the Social Security office (find locations on ssa.gov) to apply
Go through your state Medicaid Program - Google "medicare" and your state

It may take 4-6 weeks for them to send you an acceptance/rejection letter.

You have to re-qualify annually.

Questions?

Call SSA at 800-772-1212

Email me: support@themedicarenation.com

Call me: 855-855-7266

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

You May Qualify for Extra Prescription Help - A Little Known Government Program Apr 29, 2016

Show notes

Welcome Medicare Nation!

Today, I want to tell you about the federal government program called The Extra Help program, also called Limited Income Subsidy (LIS). If you never heard of this program, you may be missing out on some additional subsidies for your prescription drug purchases. So let's walk through the program to see if you qualify.

Qualifications for the Program:

1. Must be a resident of one of the 50 states in America

2. Your resources (savings, stocks, bonds, 401k etc.) cannot exceed $13,640 (married $27,250)

3. Your annual income cannot be more than $17,820/yr (married $24,030)

4. If you support someone else who resides with you (not your spouse), you may qualify for a higher threshold

How to Apply for Extra Help:

The easiest route is to apply through Social Security

1. Apply online: www.ssa.gov - click benefits and then apply for extra help

2. Call Social Security directly at 800-772-1213

3. Go to your local Social Security office - find locations at www.ssa.gov

Make sure you keep a paper trail of your application.
If you go in person, get them to stamp your application to prove they received it

Automatic qualifications:

On Medicare and Medicaid you are a dual enrollee
If you receive SSI income
If you receive Medicaid

You have to re-qualify every year. Social Security will send you a letter and determine your eligibility for the next year around August.

You can get an overview of the Extra Help program by emailing support@themedicarenation.com and ask for the Extra Help pamphlet.

You can call me with questions at 855-855-7266.

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com

The New CJR Model Explained and What it Means for You Apr 22, 2016

Show notes

Welcome Medicare Nation!

Hot Topic – The Comprehensive Care For Joint Replacement Model (CJR Model)

Hip Replacements & Knee Replacements are the MOST COMMON Inpatient Surgery for Medicare Beneficiaries.
In 2014 over 400K procedures were done, which cost Medicare over 7 Billion $ for the Hospitalization for these procedures ALONE.
Hip & Knee Replacement Surgeries can require long recovery time & long Rehab periods.

I KNOW! I'm not even on Medicare yet, and I've had TWO Arthroscopic Knee Surgeries, and each surgery took me about a good 6 MONTHS to recover.

This is the SCARY PART!

The Quality & Care you receive VARIES from one Hospital to the next!

Complications like –

Infections received at the hospital …….OR
Implant Failures

Can be 3X Higher Performed at Some Hospitals More Than Other Hospitals.

To me……that is just NEGLIGENCE!

When you go into a hospital……you expect to receive the best care, a clean environment and YOU SHOULD NOT CONTRACT ANY INFECTION OR DISEASE from the Hospital you're being treated at! That's what you Expect from a Hospital…..NOTHING LESS. But……it is apparently going on RIGHT NOW Nation!

And it takes a CMS LAW or MODEL PROGAM to prevent it from happening in EVERY Hospital? Aye,,yi,,,yi.

WHY IS THIS HAPPENING TO YOU?

In episode 34 on Medicare Nation, you listened to Melissa's Story.

Melissa's story is about the struggles she had with her mother, who suffered a broken hip and the FRAGMENTED care her mom received while in the hospital and the struggles she had in moving her mom to a skilled care facility and then setting up home care physical therapy for her mom.

That is why all this is happening Nation!

There is a LACK OF COMMUNICATION, between Hospital Staff, other Doctor's, Skilled Nursing Facilities and Home Care Physical Therapy.

NO ONE is talking to anyone else! The LINKS in the CHAIN of Patient Care is BROKEN, and YOU are paying for it!

This FRAGMENTATION of Care is causing LONGER RECOVERY TIMES, HIGHER HOSPITAL RE-ADMISSIONS & HIGHER OUT OF POCKET COSTS FOR YOU & FOR MEDICARE.

The Comp Care Joint Replace Model Addresses the LOW QUaLITY CARE & Higher Costs that come from this FRAGMENTED CARE, by –

PROMOTING CO-ORDINATED PATIENT CENTERED CARE!

Imagine that Nation! Putting the Patient 1st! What a New Concept!

HOW WILL THE CJR MODEL WORK?

Started April 1, 2016

The hospital in which the hip or knee replacement and/or other major

leg procedure takes place, will be accountable for the costs and quality of related care from the time of the surgery through 90 days after hospital discharge—what is called an "episode" of care.

Depending on the hospital's quality and cost performance during the

episode, the hospital will either

Earn a financial reward OR,
beginning with the second performance year, be required to repay Medicare for a portion of the spending.
This payment structure gives hospitals an incentive to work with

physicians,
home health agencies,
skilled nursing facilities,
and other providers to make sure beneficiaries receive the coordinated care they need

The goal is reducing avoidable hospitalizations and complications.

Hospitals in the model will be provided access to additional tools – such as spending and utilization data and sharing of best practices -- to improve the effectiveness of care coordination. The model also gives providers additional flexibilities that are not otherwise available under Medicare so they can better manage the care of patients, including patients who are at home.

By "bundling" payments for an episode of care, hospitals, physicians, and other providers have an incentive to work together to deliver more effective and efficient care.

The CJR model is being tested in 67 geographic areas throughout the country, and nearly ALL hospitals in those geographic areas are required to participate.

The CJR model supports Health & Human Service's efforts to transform the health care system towards one focused on better quality care, smarter spending, and healthier people through care transformation and payment reform.

WHAT AREAS ARE PARTICIPATING IN THE CCJR MODEL

Over 800 Hospitals across the US are participating, in 67 Geographical Locations.

Areas were determined based on statistical population data, with populations of over 50K residents.

Here are a Few selected Areas:

Florida – Broward, Collier County, Gainsville, Hernando, Hillsborough, Indian River County, Lake County, Martin, Miami-Dade, Orange County, Osceola, Palm County, Pensicola area, Pinellas, Pasco, Santa Rosa County, Seminole County and St. Lucia County

California – Alemeda County, Contra Costa County, Los Angeles County, Marin County, Orange County, San Francisco County, San Mateo, Stanislaus County,

The rest are on the CMS.gov site. Search "CJR Model Geographical Areas," To find out if a Hospital or County where you reside is participating.

You can go to my website, www.callsamm.com and I'll put up a PDF of the Counties participating in the CJR Model program for you to request.

You can also download a copy of the Federal Register, which is a daily journal of the US Government. The FINAL Rule for the CCJR Model is there in LONG Form

https://goo.gl/hN44cm

Federal Register/ Vol. 80, No. 226 / Tuesday, November 24, 2015 / Rules and Regulations

www.callsamm.com - has all of this information available for you.

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

I may answer one of your questions on the air!

email me:

support@themedicarenation.com

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

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

www.CallSamm.com