Medicare Nation

What is the Difference Between a Welcome to Medicare Visit  vs. an Annual Wellness Visit?  A "Welcome to Medicare" preventive visit: Is an introductory visit only within the first 12 months you have Medicare Part B. This visit includes a review of your medical and social history with your Primary Physician, as well as possibly including preventive services, including: Certain screenings, shots, and referrals for other care, if needed Height, weight, and blood pressure measurements A calculation of your body mass index A simple vision test A review of your potential risk for depression and your level of safety An offer to talk with you about creating "Advanced Directives" A written plan letting you know which screenings, shots, and other preventive services you need.  This visit is covered one time. You don’t need to have this visit as a "prerequisite," to be covered for yearly "Wellness" visits. Annual "Wellness" visits: If you've had Part B for longer than 12 months, you can get this visit to develop or up

Hey There Medicare Nation! Today, I'm speaking with a special guest. I'm speaking with my good friend James Van Prooyen. James recently retired from the military, where he spent twenty years in the Air Force. James didn't always want to serve in the Military. At first, James wanted to follow in his grandfather's footsteps and become an electrician. While James was a senior in High School, in Northern Michigan, he was introduced to a recruiting officer. James learned a great deal about being in the Military, and James wanted to serve - for four years!  Shortly approaching his fourth year in the Air Force, James thought about his future. He had a wonderful wife and a new baby. James loved working with his Air Force family, and he decided to enlist again for four more years. Those four years soon turned into twenty, and James found himself retiring and not knowing what to do next.  James kept very busy after retiring from the Air Force by helping his wife with her nutritional business and helping to take care of

Hey Medicare Nation! This week I’m discussing Medical Marijuana! 2017 has issued in with additional States Legalizing Marijuana for Medicinal purposes. I am speaking with Dr. Rachna Patel, The Medical Marijuana Expert this week on Medicare Nation. Dr. Rachna Patel completed her undergraduate studies at Northwestern University in Illinois and her Medical studies at Touro University in Vallejo, CA. Dr. Patel is a licensed practitioner in the State of California and is in impeccable standing with the State of California Medical Board. She has been practicing in the area of Medical Marijuana (cannabis) since 2012, and she has treated countless patients! Dr. Patel is known for her “bedside manner” with her patients and does things differently than other Medical Marijuana doctors. Dr. Patel sees her patients “in person” and not by phone or virtually. Dr. Patel spends a thorough amount of time with patients to ensure she is guiding them step-by-step through the Medical Marijuana process. Dr. Patel may “recommend” me

Hey Medicare Nation! How many of you have just found out your Doctor is leaving the Medicare Advantage Network you're in? I'm certain there are "Thousands of you." That is the #1 complaint I receive from clients, is that their "Doctor" is leaving or has left their Medicare Advantage Plan (MAPD) Network. Medicare has regulations about how a Medicare Advantage Organization (MAO) can "terminate" a Doctor contracted in their network and in reverse, there are regulations on how a Doctor can leave a MAO. There are also regulations on how a MAO publishes it's "Provider Directory" for their network. Chapter 4, Section 110.1.1 of the Medicare Managed Care Manual, titled, Provider Network Standards, lists in part....  "MAO's are required to establish and maintain provider networks that: ...... Are accurately reflected in up-to-date directories. Plans are responsible for verifying and regularly updating their network directories to ensure that providers included in the directories are available to their enrollees (ie, l

Hey Medicare Nation! Medicare has announced the 2017 "5 Star Plans." What are 5 Star Plans? Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing. There are 2 main types of Star Ratings: 1. Overall Star Rating that combines all of the plan's scores. 2. A Summary Star Rating that focuses on a plan's medical or prescription drug services. A few areas Medicare reviews for these Star Ratings include: 1. How plan members rate their plan's services and care. 2. How well a plan's network of doctors detect illnesses and keep members healthy. 3. How well a plan helps it's members use recommended and safe prescription medications. A plan can receive a 1 to 5 Star Rating. 5 Stars is Excellent 4 Stars is above average 3 Stars is average 2. Stars is below average and 1 Star is poor. You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is

Hello Medicare Nation! Happy New Year to everyone. I hope everyone had a wonderful holiday season. The Annual Enrollment Period is over. I hope each of you did your due diligence in deciding which plan will fit you best for 2017. I have many episodes available for you to learn all about Medicare Advantage Plans, Original Medicare and Part D of Medicare. If you determine the Medicare Advantage Plan you are on is not suitable for you or a loved one in 2017, you may have other options available to you. Right now, you are in the Medicare Advantage Disenrollment Period. It started on December 8th and will end on February 14th of 2017. Here is how you "dis-enroll" from a Medicare Advantage Plan during this time period. 1. Call Medicare 800-633-4227 2. Advise the Medicare Representative that you would like to "dis-enroll" from your current Medicare Advantage Plan and go back onto Original Medicare. 3. You can enroll in a stand-alone Part D prescription drug plan. 4. You can also enroll in a Supplement to Original Me

  10 Days left in the Annual Enrollment Period. That's plenty of time to find the plan that fits your needs for 2017, The one change that everyone is talking about is the increase to the Medicare Part B Premium. Last month, Social Security announced a .03% COLA for Social Security beneficiaries in 2017. With the COLA announcement, the hold harmless rule is in effect.                   This means if the social security COLA doesn’t cover the increase to the Medicare Part B base premium, those individuals who already have their Medicare Part B premium taken out of their Social Security benefit check will not see that deduction in their benefit check. The hold harmless individuals, who make up about 70% of all Medicare beneficiaries, won’t even come close to covering the $134.00 base Part B premium in 2017.  The hold harmless protection will squeak out a Medicare Part B premium increase of about $109.00. The hold harmless rule does not protect individuals who: Are enrolling in Medicare Part B for the first time

The Center for Medicare & Medicaid Services, has recently announced the costs for Medicare in 2017.  The one change that everyone is talking about is the increase to the Medicare Part B Premium. Last month, Social Security announced a .03% COLA for Social Security beneficiaries in 2017. With the COLA announcement, the hold harmless rule is in effect.                   This means if the social security COLA doesn’t cover the increase to the Medicare Part B base premium, those individuals who already have their Medicare Part B premium taken out of their Social Security benefit check will not see that deduction in their benefit check. The hold harmless individuals, who make up about 70% of all Medicare beneficiaries, won’t even come close to covering the $134.00 base Part B premium in 2017.  The hold harmless protection will squeak out a Medicare Part B premium increase of about $109.00. The hold harmless rule does not protect individuals who: Are enrolling in Medicare Part B for the first time. Haven’t sta

Welcome, Medicare Nation! I’m excited about our guest and our important topic today. We’re discussing the confusion surrounding advanced directives. Have you ever thought about what would happen if you can’t speak for yourself and are in an emergency health situation? Who will express your wishes, and will the health care professionals understand? Dr. Ferdinando (Fred) Mirarchi is the ER Director of University of Pittsburgh Medical Center-Hamot. He has a solution!  Tell us about health care directives and the issues that commonly arise when people come to the ER. There are three types of directives: living will, DNR (Do Not Resuscitate order), and POLST (Physicians’ Order for Life Sustaining Treatment). All three of these have safety issues surrounding them, and all three bring questions. When are they to be followed? None of us know when an emergency situation may arise, so when do we carry these documents with us? Even medical professionals don’t understand these orders, but no one really wants to raise

Hello Medicare Nation listeners! Today, I’ve put together a few questions from our audience that I’d like to read on the air. Many of you ask the same questions, so I’d like to help out as many of you as I can.   Wendy from King of Prussia, Pennsylvania asks??? HOW DO I GET A REPLACEMENT MEDICARE CARD? If you are on Original Medicare, your Medicare ID card is proof of your Medicare insurance. , If your Medicare card was lost, stolen, destroyed or illegible, you can ask for a replacement card by going online and logging in to your Social Security account at www.ssa.gov If you don’t have an online social security account, you can register one on the www.ssa.gov website. Once you’ve logged into your account, select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.”  Your replacement Medicare card will arrive in the mail in about 30 days, at the address on file with Social Security. If you moved and you did not update Social Security with your new address, you must update your new a

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

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

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 da

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

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.

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 Medicar

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

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

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 o

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