Medicare Nation

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020! THREE more plan sponsors to discuss! CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00! HUGE Penalty people! According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees. HCSC has the right to Appeal CMS Decision.   NEXT Up..... is Triple-S Management Corporation! CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020. CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of

Hey Medicare Nation! Medicare Nation CMS Imposes a Civil Money Penalty against HUMANA! CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019. Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M. Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees. CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........ $257, 262! Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug.  This allows you time to speak with

Hey Medicare Nation! Medicare Nation Today, I'm informing you about The Centers For Medicare & Medicaid Services Notice, given to Mr. Art Carlos, CEO of Delaware Life Insurance Company. In a notice dated January 31, 2020, CMS notified Mr. Carlos that they were immediately imposing Intermediate "Sanctions" against Delaware Life Insurance Company. CMS determined that Delaware Life Insurance Company is "in substantial violation of Medicare Advantage and Prescription Drug Plan requirements." SIX specific violations were listed in the notice to Carlos. LISTEN to the episode to learn about the violations and what you can do if YOU are a beneficiary under one of Delaware Life Insurance Company's Medicare Advantage Plan or Prescription Drug Plan. www.TheMedicareNation.com Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and

Hey Medicare Nation! www.TheMedicareNation.com Medicare has taken many steps to assist you during the COVID-19 crisis. Coronavirus tests Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called COVID-19). This test is covered when your doctor or other health care provider orders the test. I spoke about testing for COVID-19 in the previous episode, dated April 1, 2020. Listen to episode 101 to learn more about COVID-19 Testing. Your costs in Original Medicare for COVID-19 Testing. You pay nothing for this test. NADA! This includes the newly available COVID-19 “Antibody” test, which determines if you have antibodies in your blood, that were created to recognize the COVID-19 Virus in your body. Hospitalization Medicare covers All medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might have been discharged from the hospital after an inpatient stay, but……. instead you need to stay in the hospital under quarantine.   Your costs i

Hey Medicare Nation! www.TheMedicareNation.com It’s April 1st and over One Million People have been diagnosed with the COVID-19 Virus Worldwide! On this week’s episode….. I provide a time-line of the events of the Pandemic as well as updates on COVID-19 testing and Important phone numbers should you have symptoms or questions about COVID-19. I also have a “list” of phone numbers, for EACH Health Department in All 50 States! You can email me at  Support@TheMedicareNation.com for the list or check the show notes for an attachment. Here is an important phone number for the CDC HOTLINE on COVID-19 800 -232- 4636 - CDC Hotline Advent Health 24hr Hotline -  877 – 847 – 8747 You can also download the Advent Health App on iTunes or Google Play in order to have a “Virtual” visit with an Advent Health Doctor.  Bay Care Virtual Doctor Hotline -  800 – 229 – 2273 You can also go to this website for a “virtual” visit with a Bay Care Doctor – www.BayCareAnywhere.org  The Florida Department of Health Hotline is  866 – 779 –

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

Hey Medicare Nation! www.TheMedicareNation.com It's still January...but February is right around the corner. Spring WILL come. I promise! Let me give you some good news! Medicare is now covering Acupuncture! As of January 21, 2020, The Center for Medicare & Medicaid Services (CMS), will cover acupuncture for "Chronic Low Back Pain." Let's look at the coverage in the Medicare National Coverage Determination Manual. Section 1862(a)(1)(A) of the Social Security Act  Up to "12" visits in 90 days are covered for Medicare Beneficiaries under the following circumstances: a. Chronic Low Back Pain which lasts "12 weeks or longer," b. the Chronic Low Back Pain is "non-specific," in that it has NO identifiable systemic cause (NOT associated with metastatic, inflammatory, infectious, disease). c. the Chronic Low Back Pain is NOT associated with surgery d. the Chronic Low Back Pain is NOT associated with pregnancy. An ADDITIONAL "Eight" (8) sessions WILL be covered for those patients demonstrating an improvement. No m

Hey Medicare Nation! www.TheMedicareNation.com It's 2020!  Love the sound of that! Right now...... the Medicare Advantage Open Enrollment Period is in full swing. If you are on a "Medicare Advantage Plan," you have the opportunity to make a ONE TIME change, between January 1st through March 31st. You can change from one Medicare Advantage Plan to another Medicare Advantage Plan. You can "disenroll" from the Medicare Advantage Plan you're on and go back onto "Original Medicare." With Original Medicare, you can add a stand-alone-prescription drug plan and ..... you can enroll into a Medicare Supplement Plan (aka Medi-gap) to help defray the costs of Original Medicare. Here are options you can do during the Medicare Advantage Open Enrollment Period:  Change from a Medicare Advantage Plan back to Original Medicare. Switch from one Medicare Advantage Plan to another Medicare Advantage Plan. Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug covera

Hey Medicare Nation! CMS just announced the 2020 Medicare Part B Premium increase! CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible. Here's a look at what's changing in 2020: Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act.      SOCIAL SECURITY   Increase:    1.6%  (Avg $24 more a month)   Average Monthly SS Check $1,503.00       2020 - PART A DEDUCTIBLE AND COINSURANCE   Inpatient Hospital Deductible:                       $1408.00 Daily Coinsurance Days 61-90:                    $  352.00 Daily Coinsurance-Lifetime Reserve:           $  704.00 Skilled Nursing Facility-Days 21-100:           $  176.00       2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE   Standard Monthly Premium:                 $ 144.60  ($9.00 More) Annual Deductible:                                $ 198.00   It's a great time to review your plan for 2020. Is it the right plan to fit your unique needs? If so........ keep it! If

Hey Medicare Nation! www.TheMedicareNation.com It's October! That means it's Medicare Time! The Annual Enrollment Period is just around the corner. Did you receive your "Annual Notice of Changes (ANOC)" for your Medicare Advantage Plan or Prescription Drug Plan? If not....contact your plan and request the ANOC. Today......I want to talk with you about Part D Prescription Drug Coverage for 2020! Medicare has set the maximum Part D Deductible for 2020 at $435.00. Medicare Advantage Plans and Stand-Alone Prescription Drug Plans have the option to charge the maximum deductible amount of $435.00...... or....... They can eliminate the Deductible altogether.... or...... They can charge an amount in between. You MUST do your "Due Dilligence" in determining which Prescription Drug Plan will fit your unique needs for 2020. Contact your Medicare Specialist and request their assistance in finding a Prescription Drug Plan for 2020. If you have a question about Medicare or your Prescription Drug Plan.... You can send me an

Hey Medicare Nation! www.TheMedicareNation.com How Do I get treatment & prescriptions during a weather emergency? Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety. What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency? Or…. What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency? Let’s take a look at these questions for you. After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States.  Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian. What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration. For example……. You evacuated your home in Savannah Georgia, to go stay wi

Hey Medicare Nation! www.TheMedicareNation.com If you are turning 65 or still working on  an employer group insurance plan, you may need assistance in finding the Medicare plan that fits YOUR unique needs. You may have a loved one in a nursing home or in an assisted living facility, who is not receiving proper care. Call me! You can hire me as a consultant to assist you with Medicare issues! Call 855-855-7266 or eMail me at Support@TheMedicareNation.com Tell me the situation and I'll personally get back to you! Today, I am speaking to you about Shingles Vaccines! There are two Shingles vaccines licensed in the United States available. The first one is the "Zoster Vaccine Live," also known as "Zostavax." Many of you probably have received this vaccine, which is a "Live" vaccine and the CDC reports it as being 51% effective against Shingles. The second vaccine is the "Recombinant Zoster Vaccine," also known as "Shingrix" has been used since October of 2017. The CDC reports the Shingrix vaccine is about 91% effe

Hey Medicare Nation! www.TheMedicareNation.com Help your PARENTS, Spouses and Friends "SUBSCRIBE" to Medicare Nation! With almost 100 episodes on Medicare and Medicare Resources available, your loved-one will be able to find answers to their Medicare questions! Use the "Purple" colored icon on an Apple phone or .... download Stitcher, Himalaya or Player FM when using Android phones. Search for "Medicare" and "click" on the Medicare Nation logo. You'll see the "subscribe" button on the page. "Click" subscribe and they'll get the NEWEST Medicare Nation episodes delievered to their phone. TODAY.... I'm discussing NEW information released from CMS.   CMS Decision Summary Ambulatory Blood Pressure Monitoring  Devices July 2, 2019…..The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries.  What is hypertension (high blood pressure)? The American Heart Associa

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

Multi Target Stool DNA Test  vs. Fecal Occult Blood Test  Hey Medicare Nation! www.TheMedicareNation.com Have you subscribed to Medicare Nation? Don’t know how? If you have an Apple iPhone……. Click on the “Purple” icon…. With the white microphone. When the page opens….Click on SEARCH. Type in Medicare. Medicare Nation comes right up… WHY……BECAUSE….. it’s a TOP 100 APPLE PODCAST Nation! Click on that Beautiful Flag “Medicare Nation” Logo. When the page opens….Click on the SUBSCRIBE button! That’s it. You’ll get the latest information on Medicare and you can search through the almost 100 episodes on Medicare Information! Are Your Parents subscribed to Medicare Nation? Come On “Sandwich Generation” Show your parents HOW to Subscribe to Medicare Nation! Once they subscribe…. They will STOP asking you questions about Medicare, because they WILL Find the answer by listening to Medicare Nation episodes! Let’s give YOU back some time…. So that YOU can have more time for yourself   Today…..I’m going to be talking to y

Hey Medicare Nation! www.TheMedicareNation.com I'm not an expert on Reverse Mortgages......in fact, I don't know much about them. I have heard about Reverse Mortgages on commercials, in newspapers and on FaceBook feeds. I never had the need to learn about Reverse Mortgages, so...... I never did......until...... a client asked me about them. When a client asks me a question about Medicare..... I know the answer. I'm a Medicare Expert....I'm in the business of knowing as much as I can about Medicare.  Because my clients trust me with their Medicare needs and concerns, they ask me all kinds of questions. When I know the answer.... I tell them. When I don't know the answer..... I get the answer for them! So....when my client asked me about Reverse Mortgages.... I started reading about them. When I was introduced to Michael Banner, President of Professional Mortgage Alliance, LLC, I had many, many questions. Michael Banner was very patient and answered every question I had..... truthfully. An hour and a half later

Hey Medicare Nation! www.TheMedicareNation.com On the Last episode.....I spoke to you about Medicare Supplement Plan "F" and High Deductible Plan F. Today....I'm going to talk about Medicare Supplement Plan "G" and Plan "N" Plan "G" allows you to "purchase" an insurance policy, where you pay a monthly premium to the carrier...... in return...... Medicare Supplement Plan G, will pay ALL your Medically necessary out-of-pocket deductibles, co-insurance and co-pays...... EXCEPT for ..... The Annual Part B Deductible. YOU will be responsible for the Annual Part B deductible each year. Currently.... in 2019, the Annual Part B Deductible is $185.00. So..... when you seek medical care in the beginning of the year.... you will pay out-of-pocket until you hit the $185.00 Part B Deductible. After you pay the $185.00 Part B Deductible....you will NOT be responsible for ANY other deductibles, co-pays or co-insurance under Medicare Supplement Plan G, that are medically necessary under Medicare. Plan "N" allows you to "purc

Hey Medicare Nation! www.TheMedicareNation.com More than 10,000 people a day are turning 65! While qualifying for Medicare Part A and Part B, Medicare Beneficiaries are VERY confused as to what type of plan to enroll in, to "supplement" Original Medicare. By zipcode, a Medicare Beneficiary may have over "100 Plans" to choose from to help supplement their Original Medicare. That's an ENORMOUS amount of research to do!                  If you have the time and enjoy doing all that research.......go for it! If you're like most Medicare Beneficiaries, you are retiring and you want to ENJOY LIFE! You don't want to "waste" time researching Medicare Plans. Call a "Medicare Consultant" or "Medicare Specialist" to assist you in finding the plan that will fit YOUR unique needs. How do you do that?  "Google" "Medicare Consultant" or "Medicare Specialist" and add your city or zipcode to that search. As an example, you would search....Medicare Consultant Tampa FL......or........Medicare Specialist Dallas TX....... Google

Hey Medicare Nation! www.TheMedicareNation.com It's almost Spring time! For many people, this has been a terrible winter. Many Medicare Nation listeners have been emailing me to find out if Medicare covers "Emergencies" while traveling across the U.S. or abroad. That's a great question! Original Medicare and Medicare Advantage Plans Do cover "Emergency Care" AND  Urgent Care ANYWHERE in the United States and it's Territories. An "Emergency" is Life-Threatening. An example would be if you were having chest pain and you believed you were having a heart attack. In this situation.....you would go to the nearest hospital to seek emergency care. Even if it turns out you were diagnosed with "heart burn," Original Medicare AND Medicare Advantage plans will cover the medically necessary treatment for this situation because you believed you were in a "life-threatening" situation.  "Urgent Care" is defined by Medicare as: Care that you get outside of your Medicare health plan's service area for a sudden illness or inj

Hey Medicare Nation! htpps://www.TheMedicareNation.com   Today, I'm going to speak with you about the Medicare Advantage Open Enrollment Period. CMS...Centers For Medicare & Medicaid Services has issued a new regulation that began January 1, 2019. Under 42 CFR 422.62(a)(3)....CMS published the following: During the MA OEP, MA plan enrolles may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP. Who can use the Medicare Advantage Open Enrollment Period? 1. Individuals enrolled in Medicare Advantage plans as of January 1. 2. New Medicare beneficiaries who are enrolled in an Medicare Advantage plan during their Initial enrollment into Medicare       a. The month of entitlement to Part A and Part B up until the last day of the 3rd month...after the month of their entitlement to Part A and Part B. Can Medicare Advantage beneficiaries add or drop their Part D coverage during the Medicare Advantage Open Enrollment Pe