BOOMER'S GUIDE
VOLUME 6 ISSUE 5
MAY 2013
THE BOOMER'S GUIDE TO PLANET
RETIREMENT
DR. MARILYN BRUNO
WWW.GYNOSAPIENS.COM
VOLUME 6 ISSUE 5
MAY 2013
IN THIS ISSUE: Page 1: The Legend of the Stork
Page 4: Strolling In the Park One Day…
Page 5: Government Procurement
Page 5: National Volunteer Week
Page 6: Test Your Brain on Your Smart Phone
Page 7: May is Older Americans Month
Page 7: Very Merry Un-Earth Day
Page 8: Keeping your I.D. Safe in Wi-Fi Zones
Page 9: Medicare Update
QUOTE OF THE MONTH:
Your kids are becoming you......but your grandchildren are perfect! Paul M Frank
The Legend of the Stork
I remember seeing stork nests on top of the churches when I was driving past villages in rural Spain
in the ‘60s. An upscale baby shop in Madrid was named the “Stork from Paris,” because that’s where
little Spanish children were told that babies came from. So, this was not the legend just from
Victorian times!
In honor of Mother’s Day (and also the birth on April 6th of Amanda Jane Burzell, my first grandchild),
here are some reasons behind the bird-baby mythology, courtesy of intranet volunteer info-spreaders
and Wikipedia:
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In many cultures, storks represent fertility, Springtime and good luck.
In Roman times, if a stork built a nest on your roof, it was seen as a blessing and a promise of
never-ending love from Venus. (Aristotle went as far as to make killing storks a crime.)
 Some believed that a stork could cause a woman to become pregnant just by looking at her.
 Storks are considered harbingers of good fortune. In Germany, they are known as “adebar,”
meaning “luck-bringer.”
 In the Netherlands, a stork nesting on one’s roof is viewed as a good omen for the family who
lives there.

Storks have easy access to chimneys — the perfect passageway for both Santa and
babies.
Although they originally nested in trees, storks easily adapted to human activity, and today call
rooftops and chimneys their most common nesting sites.
 When Scandinavian parents needed a convenient explanation for how babies arrived, they
repeated the story of a stork delivering new bundles of joy down the chimney chute. Hans
Christian Anderson wove this folklore into his 1838 fairy tale “The Storks.”

Also like Santa, storks cover a lot of ground.
Storks are migratory, which means they could technically be delivery babies from some far
away, mystical land.
 The souls of unborn children were once believed to live in marshes, wells, springs and ponds
— all areas also coincidentally frequented by storks. The birds were said to fetch the babies’
souls during their migratory flights and deliver them to their expectant parents.

Storks make good parents.
The adult birds are known for their parental dedication; they continue to feed and care for
their offspring well after they can fly.
 This prolonged association led to the belief that it was actually the young birds that were
taking care of their parents and is thought to explain why a law of ancient Greece that
instructs children to look after their elderly parents is called the “pelargonia,” from pelargos,
meaning “stork.”
 It was widely noted in ancient natural history that a stork pair will be consumed with the nest
in a fire, rather than fly and abandon it.

Storks are big birds.
White storks measure 40 to 50 inches tall with a wingspan of 61 to 70 inches and weigh
between 5 and 10 pounds — potentially large enough to at least imagine carrying an infant.
 In Western culture, pictures of a stork carrying a baby in a sling dangling from its bill have
become commonplace. The Vlasic Pickle Company has had a stork as its mascot since the

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1960s, capitalizing on a pregnant woman’s desire for pickles. Walt Disney’s Dumbo was also
delivered by a stork in the animated film by the same name.
Storks are loyal.
Storks typically return to the same nest, adding new material each year so that some nests
have grown as large as 97 inches in diameter, 6.5 feet high, and weigh between 1100 and
1980 pounds.
 The annual return of the mated pair of storks made them a symbol of fidelity, although
research has found that after migration the birds do sometimes change partners every
season.
 For Early Christians the stork became an emblem of a highly respected chaste marriage.

Mythology of storks
-In Greek mythology, Gerana was an Æthiope, the enemy of Hera, who changed her into a stork, a
punishment Hera also inflicted on Antigone, daughter of Laomedon of Troy (Ovid, Metamorphoses
6.93). Stork-Gerana tried to abduct her child, Mopsus. This accounted, for the Greeks, for the mythic
theme of the war between the pygmies and the storks.
-In popular Western culture, there is a common image of a stork bearing an infant wrapped in cloths
held in its beak; the stork, rather than absconding with the child Mopsus, is pictured as delivering the
infant, an image of childbirth.
-An ancient etymology about the Pelasgians, ancient pre-Hellenic inhabitants of Greece, links
pelasgos to pelargos "stork", and postulates that the Pelasgians were migrants like storks, possibly
from Egypt, where they nest.
-Aristophanes deals effectively with this etymology in his comedy the Birds. One of the laws of "the
storks" in the satirical cloud-cuckoo-land (punning on the Athenian belief that they were originally
Pelasgians) is that grown-up storks must support their parents by migrating elsewhere and
conducting warfare.
-In Norse mythology, Hoenir gives to mankind the spirit gift, the óðr that includes will and memory
and makes us human (see Rydberg link). Hoenir's epithets langifótr "long-leg" and aurkonungr "mireking" identify him possibly as a kind of stork. Such a Stork King figures in northern European myths
and fables. However, it is possible that there is confusion here between the White Stork and the
more northerly-breeding Common Crane, which superficially resembles a stork but is completely
unrelated.
-For the Chinese, the stork was able to snatch up a worthy man, like the flute-player Lan Ts'ai Ho,
and carry him to a blissful life.
Storks became the symbol of childbirth.
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-The image of a White stork bearing an infant wrapped in a sling held in its beak is common in
Western popular culture. The small pink or reddish patches often found on a newborn child's eyelids,
between the eyes, on the upper lip, and on the nape of the neck are sometimes still called "stork
bites." In fact they are clusters of developing veins that often soon fade.
-Storks are common in nursery stories in the Netherlands and Northern Germany.
-A baby-bearing stork appeared in a Buster Brown cartoon.
-In Walt Disney's 4th classic Dumbo, the stork (more generally "Mr. Stork") delivers babies to their
animal mothers. At the beginning of the film, he delivers Dumbo to Mrs. Jumbo.
-Several Warner Bros. cartoons — including Stork Naked and Apes of Wrath — cast a stork as a
perpetually drunken employee of a baby-delivery service. Always losing his cargo en route to the
intended recipients, the stork would find a replacement (always the wrong species) and deliver it to
his clients. The stork was a bit player in these shorts, appearing at only the beginning and the end
(where he returns to correct his mistake); the rest of the cartoons played out the interaction between
the parents and the mismatched "child" they attempted to raise.
Strolling Through the Park One Day, In the Merry Merry
Month of May
Turns out that strolling in the park is really beneficial! We already knew that, but the New York
Times felt that this was news that fit its print! The paper reports a new study from Scotland that
confirms that you can ease brain fatigue simply by strolling through a leafy park:
http://well.blogs.nytimes.com/2013/03/27/easing-brain-fatigue-with-a-walk-in-the-park/
Haven’t these researchers been reading bucolic poetry written from time immemorial? Anyway,
researchers at Heriot-Watt University in Edinburgh and the University of Edinburgh attached new,
portable EEG electrodes to the scalps of 12 healthy young adults, connected to a laptops carried in a
backpack for each volunteer, then sent each volunteer out on a short walk of about a mile and half
that wound through three different sections of Edinburgh: a historic shopping district, a busy
commercial district, and a park-like setting. Lo and behold -- they confirmed the idea that green
spaces lessen brain fatigue, are calming, and requiring less of our so-called directed mental attention
than busy, urban streets.
So, time to visit your local park! Or create a green environment one in or near your living space.
Fung shui!
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Government Procurement
It seems like government analysts love to crank out statistics to justify the huge expenditures in
computers and IT (information technology). Here are some numbers that boggle:
2.5 quintillion bytes
Amount of data created each day, per IBM estimates
6 billion
Global cell phone subscriptions beaming location info back to a network
4.5 million
New urls appearing on the Web each month
$200 million
White House investment in data research and development
370,000
Government datasets collected on Data.gov
2 times per day
Number of times NOAA satellites scan the Earth
1.5 million
Shortage of U.S. managers with data analysis skills
200 terabytes
Average amount of stored data/U.S. company with over 1,000 employees
$2.7 billion
Cost of sequencing the first human genome
$8,000
Cost of sequencing an individual human genome in 2012
$1,000
Cost at which genome sequencing will become part of medical diagnosis
2000 terabytes
Space required to store roughly 1,700 human genomes
20 million
Books scanned and put online for Google’s Books Library Project in 2012
25 million gigabytes Amount of data generated annually by the large Hadron Collider at CERN
170
Computer centers across 36 countries needed to analyse data from CERN
39
U.S. buoys beaming back tsunami info from the world’s oceans
P.S. 21ST CENTURY VOCABULARY LESSON:
1 byte (B) = officially, 7 bits. The extended ASCII table has 256 characters, which are each stored in
one byte.
1 gigabyte (GB) = 1000000000 bytes, a billion bytes
1 terabyte (TB) = 1000000000000 bytes, or 1 trillion (short scale) bytes, or 1000 gigabytes
1 exabyte (EB) = 1000000000000000000B = 1 quintillion bytes, = 1000000000gigabytes =
1000000terabytes = 1000petabytes
National Volunteer Week
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I hope you didn’t miss National Volunteer Week April 21-27. Not only is volunteerism very
rewarding, but it also opens worlds of activities and information. For example, these websites offer
some great free resources:
-United States (through Points of Light) 2013 Theme: "Celebrate Service"

http://www.pointsoflight.org/signature-events/national-volunteer-week
-Download the 22-page "National Volunteer Week Resource Guide"
http://www.handsonnetwork.org/files/resources/nvw_resourceguide_2013.pdf
Test your brain on Your Smart Phone
A new study shows that an iOS (Smart Phone, iPhone, iPad, etc.) app yields results on a dichotic
listening test that are as reliable as laboratory tests. The test is based on the assumption by
researchers at the University of Bergen that, when listening to music on a Smart Phone or through
ear buds, each ear is presented with a different syllable at the same time. The test asks the listener
to say which syllable seems clearest. This indicates which side of the brain is most active during
language processing.
The free app for dichotic listening is called iDichotic and was launched on the Apple App Store in
2011. Since then, thousands of people have downloaded the app, and roughly half have sent their
test results to the researchers’ database. The researchers analyzed the first results they received and
compared them with the results of test numbers of individuals in Norway and Australia.
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The results have been published in the open-access journal Frontiers in Psychology, showing that the
tests from the app were as reliable as those of the controlled laboratory tests. This means that
smartphones can be used as a tool for psychological testing, increasing the ability to gather large
volumes of data easily and inexpensively. The developers also created a special version
ofiDichotic for patients with schizophrenia who suffer from auditory hallucinations (hear “voices”).
The app helps in training patients to improve their focus, so that when they hear voices, they are
better able to shut them out.
Test yourself! You can download iDichotic from the App Store. The listening test takes three
minutes and tells you which side of your brain is most active in language processing. Most people
primarily use the left side of the brain, but for a minority (including many left-handed people) the
right side of the brain is more involved in language processing. In addition, the test measures
attention when the task is to focus on one ear at a time. You can send your results to the researchers
anonymously.
For more: The iDichotic website: http://dichoticlistening.com; References: Josef J. Bless et al.,
“Right on all occasions?” –-- On the feasibility of laterality research using a smartphone dichotic
listening application, Frontiers in Psychology, 2013, DOI: 10.3389/fpsyg.2013.00042 (open access)
May is Older Americans Month
Of course, we can debate what constitutes “older”, but each May for the past 50 years, our nation has
celebrated “Older Americans Month.” To help communities get ready for the year celebration, ACL
has updated its Older Americans Month website: http://www.olderamericansmonth.acl.gov/.
Check it out to plan an event in your community. Specifically, the website includes:



Activity Ideas. Get inspiration and ideas about how you can celebrate Older Americans Month
locally by unleashing the power of age through community and creativity.
Social Media Gallery. Get content you can use to promote Older Americans Month through your
social media networks. This page also includes images and content you can post on Facebook,
Twitter, and Pinterest. With the growing use of Pinterest (a social network based on sharing
images), ACL has created its own "Pinboard" about unleashing the power of age where you can pin
your own content.
Activity Ideas. Get inspiration and ideas about how you can celebrate Older Americans Month
locally by unleashing the power of age through community and creativity.
The Department of Health and Human Services (HHS) is calling for nominations of great community
leaders, how to use social media, how to organize a community event, etc.
EARTH DAY/NON-EARTH DAY
Hope you all had a happy one!
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Interestingly, last week scientists reported finding not one but two planets that may have the
necessary conditions to support human life. That's an amazing discovery, but don't start packing for
Kepler 62 just yet: it's 1200 light years away, which means that when we discovered it, we
discovered it as it was in the Earth year 813. And when they look at us (if they happen to exist),
that's what they see too: light reflected off the Earth in the year 813. If they had super high powered
telescopes and could peek at what we're doing here on Earth, we'd be living in the time of the
Vikings.
All of which is to say that space is almost inconceivably vast, and even if there are planets out there
that could support us, it will likely be a very long time before we're able to visit them- if ever. And
this planet right here doesn't have an endless amount of time to try and adapt to 7 billion people
living on it, so we need to do everything we can to make sure this planet can continue as our home,
because it's all we've got for the foreseeable future...
KEEPING YOUR IDENTITY SAFE IN WI-FI ZONES
Instead of staying away from public Wi-Fi, just stay safe. LifeLock provides these 5 simple steps to
help protect your private data from prying eyes in Wi-Fi zones:
Don’t make online purchases or access your bank account.
If you don’t want someone getting ahold of your banking
information or credit card number, it’s best not to access your
accounts when connected to public Wi-Fi.
Double-check the network name.
Sometimes thieves will set up fake Wi-Fi hotspots with
legitimate sounding names. You access the fake network and
they get access to your data. Double-check the network name
with a server, barista or other employee before logging on.
Turn auto-connect off.
Many smartphones have a setting that will allow these devices
to automatically connect to any open Wi-Fi network. Check
your phone’s settings to make sure this feature is turned off
and take control of what networks you access.
Switch up your passwords.
Don’t use the same password for all of your online accounts.
This way if one account is compromised, the rest stay safe.
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Look for the lock.
A locked padlock in the address bar of your web browser
means the information submitted to that particular site is
encrypted. While this provides an extra layer of security when
connected to public Wi-Fi, it’s not fail-safe. Don’t share
information online that you wouldn’t be comfortable sharing
with the person sitting at the table next to you.
MEDICARE UPDATE
--I was not surprised to hear on CNN about David Goldhill’s book, Catastrophic Care: How
American Health Care Killed My Father. Like my Mom in Doctor’s Hospital in Coral Gables, the
very shabby healthcare killed her. Sure, she went in with a broken hip, but that surgery was perfect
and she was on the mend. However, two days later, when she already had developed huge bed
sores, a night nurse installed an oxygen mask in upside down, so all the condensed water drained
into her lungs. As if in a nightmare, she contracted pneumonia. The intake doctor declared that she
had come in with pneumonia and bedsores and, citing that she had signed a Do Not Resuscitate
(DNR) order, he withheld food and water and gave her excessive doses of dilaudid (10x the strength
of morphine) until she entered a stupor that she did not come out of for 2 weeks and died of
starvation. Ghoulish. I was at her side 24/7 and took pictures, was almost kicked out many times,
but could do nothing. The intake doctor told me repeatedly -- in front of witnesses -- that he was
doing me a favor. After Mom’s passing, the police called me (on a tip-off, they said) and asked me if
I wanted to press charges for “foul play.” I was interested until they said that I would have to
authorize an autopsy for Mom. I just couldn’t go through with that. I knew that there would be no
way that the pneumonia alone could be blamed for Mom’s death since, by the end, she had kidney
failure, heart failure, etc. etc. Hadn’t Mom’s pitiful skin and bones been through enough?
But I won’t stop talking about it. When I found out that Medicare will not pay for hospitalacquired infections, I was able to prove that Mom did not have pneumonia when she entered
Doctor’s Hospital (an X-ray was taken before her hip surgery) or bed sores (thanks to date-stamped
photos of her broken hip). So, all I was able to do was to save taxpayers and Mom’s insurance
company many thousands of dollars for that sad mess.
Bottom line: If one of your elderly loved ones goes in to the hospital, get a baseline evaluation of
what he/she is suffering from. Ask for a chest X-ray. Take date-stamped photos of clear skin and
the same skin when the first bed sores appear. Alternatively, if you go into a hospice program, you
have foregone trying to save your loved one’s life and must reconcile yourself that you are arranging
for a quiet, pain-free passage.
-- How to get a Hospital Bed for your home:
These can be necessary if mobility is a problem. Medicare and your healthcare insurance may cover
the rental of a bed for a short period of time. Medicaid beneficiaries have to order the bed through
a Durable Medicare Equipment (DME) Supplier who accepts Medicaid. To find one, check out the
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Medicare website – www.medicare.gov – and look for DME suppliers in your zip code. If the
beneficiary does not have full Medicaid but has “Medically Needy” status, he/she will have to either
show that the cost of the bed is over 80% of their income, or pay his/her share of cost before
Medicaid will pay.
-- Medicare enrollment: Quick Recap for Boomers turning 65:
The time to enroll in Medicare is 3 months before your 65th birthday month. You will automatically
be enrolled in Medicare Parts A & B when you turn 65.
Part A covers hospitalization and skilled nursing care. No monthly premium if you have worked 40
quarters and paid into Medicare. Part A has a $1184 deductible for each benefit period. Part A covers
days 1 - 60 in the hospital. On days 61 - 90, you have a $296 co-payment. On days 91 - 150 have a
co-payment of $592 per day.
Part B covers 80% of doctors, labs, durable medical equipment, oxygen and diabetes supplies. Part
B has a minimum monthly premium of $104.90, which is automatically deducted from your Social
Security benefit check. Part B has an annual deductible of $147.
Most people sign up for either a Medicare Advantage insurance plan (HMO) or buy Medigap
Supplement insurance plan to cover the co-payments and deductibles of Part A & B. You can do a
comparison of the costs and benefits of the different plans by going to the Medicare website:
www.medicare.gov. Or, call your local S.H.I.P. volunteer to help do a comparison.
Part D covers prescription drugs. There is a monthly premium, a co-payment for each drug and
some Part D insurance plans have a deductible. SHINE can assist you in determining what is
available for Part D and what the costs are.
Are you working and have employer provided health insurance that you can still have once you turn
65? Inform the Social Security Administration that you don't want Part B so they don't start charging
you for Part B. People keep their insurance from their employer when it is “creditable” (as good as
Medicare or better). The insurance company will know if they are creditable or not.
There is a penalty for not signing up for Medicare Part B and D when you are initially eligible for it.
Having creditable coverage from an employer is one reason you can delay signing up for Part B and
D and their won't be a penalty later.
There are government programs to help pay the cost of the Part B premium and the Part D
premiums, co-payments and deductibles if your income and assets fall below the eligibility levels.
If you haven't already, go to www.medicare.gov and click on Resources/Publications and order a
Medicare and You 2013 book.
Medicare does not cover long term care, vision unless you have a cataract operation, hearing aids or
dental services. The advantage of joining a Medicare Advantage Plans (HMOs) is that many offer
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these additional services as an incentive for joining their plan. But you have to go to the doctors in
their network.
The advantage of buying Medigap Supplement insurance is that you can go to any doctor in the
United States who accepts Medicare and they will accept the Medigap Supplement. But Medigap
Supplements don't offer vision, dental or hearing.
If you are thinking of getting either a Medicare Advantage Plan (HMO or PPO) ask your current
doctors and preferred hospital which Medicare Advantage Plans they accept and that will narrow
down the field. Then we can look at the benefits and costs of those.
--The Center for Consumer Information and Insurance Oversight (CCIIO), is a new
service of the Centers for Medicare & Medicaid Services (CMS), replacing the Office of Consumer
Information and Insurance Oversight (OCIIO).
www.healthcare.gov.
Check out the new website:
--Insurance Market Reform: CMS is publishing a final rule to implement several key
provisions of the Affordable Care Act to prevent insurance companies from discriminating against
people with pre-existing conditions and protect consumers from the worst insurance company
abuses. Today, as many as 129 million-or 1 in 2-non-elderly Americans have some type of preexisting health condition, ranging from life-threatening illnesses like cancer to chronic conditions
like diabetes, asthma, or heart disease. In most States, these consumers can be denied
individual health insurance coverage, charged significantly higher rates, or have benefits for
medical conditions excluded by insurance companies. In addition, individuals and small
employers often find that they have few protections against premiums increases. To address
these problems starting in 2014, CMS issued a final rule that contains the following:
Guaranteed Availability of Coverage
Health insurance issuers will be prohibited from denying coverage to people because of a pre existing condition or any other health factor. All policies in the individual market will be
guaranteed available and will be offered during open enrollment periods. All policies in the
group market will be available continuously year-round. In addition, individuals will have special
enrollment opportunities in the individual market when they experience certain significant l ife
changes, similar to those in the group market today.
Fair Health Insurance Premiums
Health insurance issuers in the individual and small group markets will no longer be able to use
factors -- such as pre-existing conditions, health status, claims history, duration of coverage,
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gender, occupation, and small employer size and industry - to charge consumers greater
premiums. Health insurance issuers may vary premiums only based on age (within a 3:1 ratio
for adults), tobacco use (within a 1.5:1 ratio for adults and subject to wellness program
requirements in the small group market), family size, and geography.
States can choose to enact stronger consumer protections than these minimum standards. In
addition, starting in 2017, states have the option of allowing health insurance issuers that offer
coverage in the large group market to offer such coverage through the marketplace. For states
that choose this option, these rating rules also will apply to all large group health insurance
coverage. These rules standardize how health insurance issuers can price products, bringing a
new level of transparency and fairness to premium pricing.
Single Risk Pool
The single risk pool provision prevents insurers from segmenting enrollees into separate rating
pools in order to increase premiums at a faster rate for higher-risk individuals more than lowerrisk individuals, as is often the practice today. Health insurance issuers will maintain a single
statewide risk pool for each of their individual and small employer markets, unless a state
chooses to merge the individual and small group pools into one pool. Premiums and annual rate
changes will be based on the health risk of the entire pool.
Guaranteed Renewability of Coverage
The final rule reaffirms existing protections that individuals and employers have with respect to
coverage renewal. For example, these protections will prohibit issuers from refusing to renew
coverage because an individual or employee becomes sick or has a pre-existing condition.
In addition, the final rule includes some additional provisions to protect consumers and increase
choice for small employers.
Catastrophic Plans
The final rule also includes provisions for enrollment in catastrophic plans. Catastrophic plans
generally will have lower premiums, protect against high out-of-pocket costs, and cover
recommended preventive services without cost sharing-providing affordable individual coverage
options for young adults and people for whom coverage would otherwise be unaffordable.
Updating Rate Reviews
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Finally, in preparation for the market changes in 2014 and to streamline data collection for
insurers and states, the rule amends certain provisions of the rate review program. Specifically,
it adds standard for assessing premium increases in Effective Rate Review Programs. And, to
monitor rate increases across the markets, all rate increases must be reported with those that
are 10 percent or higher still subject to review. For the full text of the rule:
http://www.ofr.gov/(S(p4xroye3jgbzidq45niu2hkv))/inspection.aspx?AspxAutoDetectCookieSupport=
--Obama Names Long-Term Care Commission Appointees
President Obama has named three appointees to the Federal Commission on Long-Term Care:
Henry Claypool, executive vice president of the American Association of People with Disabilities,
who helped to create the Administration for Community Living (ACL) and until recently served as
its principal deputy secretary; Julian Harris, director of the Office of Medicaid in Massachusetts;
and Carol Raphael, vice chairwoman of the AARP board of directors.
The commission, created in January as part of the same legislation that repealed the CLASS Act,
is responsible for developing a comprehensive and coordinated plan to ensure long-term
supports and services for people with disabilities. The commission will address the interaction of
a long-term services and support system with existing programs, including Medicare, Medicaid
and private long-term care insurance.
--Medicare Summary Notice (MSN)
MSN is a summary of claims for health care services you recently received from doctor s,
hospitals or other health care providers. Medicare will typically mail you this notice every three
months (i.e., four times a year), if you have Original Medicare, the traditional Medicare program
directly administered by the government. The MSN lists the following:

The health care service you received

Medicare’s decision on whether the service you received is covered

The amount your provider charged Medicare for the health care service you received

The amount Medicare paid your provider for that service

The amount you directly owe to your provider
The MSN is not a bill, even though it may look like one. Instead, it gives you information on the
date charges were made by your provider and the payments made by Medicare. Whenever you
receive a health care service, your provider submits a bill to Medicare for the service you
received. Medicare then pays the provider a set amount for that service, called the
approved amount (usually far less than the anticipated 80% of the billed amount).
After Medicare pays the approved amount, you may be responsible for a portion of the total
health care service cost, which you should pay directly to your provider. The amount you are
responsible for is generally called the coinsurance or copayment.
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If you owe any remaining costs, you will receive a bill from the doctor or health care provider. If
you already paid your provider, make sure you paid the right amount for that service. This is the
amount listed under the “Maximum You May Be Billed” column on your MSN. If you have any
questions about the amount you owe your doctor or health care provider, contact them directly.
Keep in mind that if Medicare refused to pay for the health care service you received, you can
ask Medicare to reconsider by filing an appeal. You will know whether Medicare denied coverage
of a service you received, if you see a “No” under the “Service Approved” column on your MSN.
If you have Original Medicare and you need help understanding your MSN, you can call 800 MEDICARE for assistance or search for answers on the Medicare website: www.medicare.gov.
If you have Original Medicare, call your local S.H.I.P. (SHINE in Florida, HICAP in
California) for assistance in filing an appeal. Find the phone number in your State on the
following website: https://shipnpr.shiptalk.org/shipprofile.aspx.
If you have a Medicare Advantage plan (Medicare private health plan), as opposed to Original
Medicare, you will not receive an MSN. Instead, you will generally receive the plan’s version of
the MSN, called an Explanation of Benefits (EOB). Like the MSN, the EOB is not a bill and just
gives you information on the charges and payments related to the health care service you
received. Your Medicare Advantage plan will typically mail you the EOB, after you receive a
health care service, and inform you if you owe money to your provider for any of the following
reasons:

You owe a copayment or coinsurance to your doctor. Keep in mind that you may have
already paid this when you were leaving the doctor’s office. If you paid more than the
“Member Responsibility” amount listed on your EOB, contact your doctor to discuss.

You have not yet met your deductible, or the amount you must pay out of your own
pocket for health care costs, before your health insurance begins to pay. If you have not
yet reached your plan’s deductible amount, you will generally owe money to your provider
for any health care services you receive. Once you reach your deductible, your plan will
begin paying for part or all of the covered services. Contact your plan, if you are unsure of
what your deductible amount is.

Your Medicare Advantage plan is denying coverage of a health care service or item you
received. If you are denied coverage, you can ask your plan to reconsider coverage of the
service you received. Click here for more information on how to appeal.
Each Medicare Advantage plan is different, so if you have any questions about how to read your
EOB, contact your plan, directly. You can do so by calling the number on the back of your
Medicare Advantage card. Keep in mind that Medicare prescription drug plans (Part D) may also
send EOBs that summarize prescription drug costs to plan members.
If you agree with these charges, you can submit payment to the doctor, hospital or health care
provider that provided you with the service. If you disagree with the amounts that you are
being charged, contact your plan directly.
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If you disagree with the amounts charged and need further assistance, call your local S.H.I.P.
(SHINE in Florida, HICAP in California) for assistance in filing a complaint. Find the
phone number in your State on the following website:
https://shipnpr.shiptalk.org/shipprofile.aspx.
For more info: The Medicare Rights Center sponsors Medicare Interactive, an online resource
that translates complicated Medicare benefits information into “what-does-this-mean-for-me?”
advice for professionals and Web-savvy consumers. The Medicare Rights Center also offers two
hotlines that are staffed by expert counselors. People with Medicare can call (800) 333-4114.
--National Prescription Drug Take-Back Day, April 27
In case you missed it, this day is announced to remind older adults and persons with disabilities
in your community to empty their medicine cabinets of unwanted or expired medications. The
Drug Enforcement Administration (DEA) and its national and community partners are giving the
public a chance to prevent accidental overdose, abuse and theft by ridding their homes of
potentially dangerous expired, unused and unwanted prescription drugs.
In the 3 years since passage of the Affordable Care Act (ACA), more than 6.3 million people with
Medicare have saved more than $6 billion on prescription drugs. In 2013, the health care law
increases the discounts and savings in the prescription drug coverage gap ("donut hole") to 52.5
percent of the cost of covered brand-name drugs and 21 percent of the cost of covered generic
drugs. Access state-by-state donut hole savings:
http://downloads.cms.gov/files/DonutHoleSavingsSummary-March2013.pdf
--CMS’ Navigator Program
I won the national competition to name the State Health Insurance Program (S.H.I.P.)
newsletter the “Navigator” -- so I am very excited that the metaphor is being used more widely
by the CMS.
A new rule was proposed (https://www.federalregister.gov/articles/2013/04/05/201307951/patient-protection-and-affordable-care-act-exchange-functions-standards-for-navigators)
that outlines standards that Navigators (where volunteers like me worked) in federally-facilitated
and State Partnership Marketplaces must meet. Navigators are organizations that will provide
unbiased information to consumers about health insurance, the new Health Insurance
Marketplace, qualified health plans, and public programs including Medicaid and the Children's
Health Insurance Program.
Millions of Americans will be eligible for new coverage opportunities in 2014. For those who are
not familiar with health insurance, have limited English literacy, or are living with disabilities,
Navigators provide information in several languages so that consumers can more easily compare
and shop for coverage plans in the new Marketplace. (Open enrollment in the Marketplace
begins October 1, 2013, with coverage to begin January 1, 2014.)
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In addition to Navigators, consumers will have access to assistance through services such as a
call center, where customer service representatives can provide referrals to the appropriate state
or federal agencies, or other forms of assistance programs including in-person assistance
personnel, certified application counselors and agents and brokers.
--Controlling Medicare Drug and Health Plan Costs
CMS has issued the 2014 rate announcement and final call letter for the Medicare Advantage
(MA) and prescription drug benefit (Part D) programs. The announcements set a path for
improving payment accuracy.
Medicare spending per beneficiary has grown at only 0.4 percent per capita in 2012. For the
first time since inception of the Part D program, the deductible for the defined standard plan will
be lower in 2014 than in previous years. The guidance will give people in Medicare health and
drug plans more value in the care they receive and greater protections against increasing costs.
The rate announcement and final Call Letter may be accessed here. Click on Announcements and
Documents for access to the 2014 files. http://www.cms.gov/Medicare/Health Plans/MedicareAdvtgSpecRateStats/index.html?redirect=/MedicareAdvtgSpecRateStats
Please let me know how topics you would like covered in our next
Newsletters! E-mail:DrBruno@gynosapiens.com.
All previous Newsletters are posted online on the homepage of
www.gynosapiens.com
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