– NEW! Check out our updated Medicare video for 2015
Understand how to qualify for Medicare, Parts A-D, Supplement vs Advantage, Enrollment periods and more, all in 25 min.
Strategic Choices Financial
1445 Huntington Drive, Suite 325
South Pasadena, CA 91030
Thank you so much for the video. As you said I am feeling empowered now.
+Suman Nath Hi Suman, thank you for your comments. You inspired me to
continue paying it forward!
Medicare 202…. Update May 26, 2015… If the “item or service reasonable
or necessary and, therefore, covered by Medicare”…
See Case No. 13-CV-990 Whitcomb v Sylvia Burwell Secretary of Health &
Human Services. Item & service Cannot Be Denied…
A remand sentence-four 42 U.S.C. § 405(g) reverses the Medicare Appeals
Counsel’s decision and is a “victory for the Plaintiff and terminates the
Under Federal Law, a prevailing litigant in a case against the United
States Government is entitled to recover its attorney fees and costs, when
the position asserted by the government was not substantially justified. 28
U.S.C. § 2412. “In the present matter this Court ruling recognizes that the
government’s refusal to cover a medical device for the management of
Whitcomb’s diabetes was not supported in law or fact”.
Not only has a judge in the Medicare Office of Hearings and Appeals found
coverage for CGM was appropriate, but the District Court of Wisconsin has
ruled that claims cannot be denied based on the Article stating CGM is
precautionary and therefore not covered…
On May 26, 2015, the District Court for the Eastern District of Wisconsin
ruled that the Secretary of Health and Human Services cannot deny coverage
of a continuous glucose monitor based on a statement in an Article that
such monitors are “precautionary.” The case reflects the arduous path that
Type 1 diabetic Medicare beneficiaries endure while trying to secure
coverage for a medical device that is considered the standard of care for
Type 1 diabetics with hypoglycemic unawareness – a device widely deemed
necessary to prevent life-threatening hypoglycemic events. The Medicare
beneficiary had sought coverage from United Healthcare’s Secure Horizon’s
Medicare Advantage Plan. Although United Healthcare covers CGM on a limited
basis for non-Medicare beneficiaries, it does not cover CGM for Medicare
Through every phase of the multi-step Medicare administrative appeals
process, the Plaintiff appealed the denial of a CGM that she got in April
2011. Although statutory regulations provide that an administrative law
judge should issue a decision within 90 days of a request for an
administrative hearing, 231 days passed until the Plaintiff received a
favorable administrative law judge decision, i.e., February 2013. United
Healthcare appealed the favorable decision and the Medicare Appeals Council
reversed the decision asserting that the Medicare contractor’s local
coverage determination (“LCD”) incorporated a Medicare Article that deemed
CGM to be “precautionary.” Although Medicare regulations require the
Council to issue a decision within 90 days of a request for review, the
Council took approximately six months to render a decision, i.e., August
The District Court, however, found that the LCD did not incorporate the
Article by reference nor vise versa. Further, the Court noted the
distinction between LCDs (which indicate whether a device is reasonable and
necessary) and Articles (which address non-coverage information such as
coding and payment). The Court reasoned that if a Medicare contractor could
issue a coverage decision in an Article, it would subvert the LCD
development process and would undermine Medicare beneficiaries’ ability to
challenge a non-coverage policy as envisioned by Congress under Section 522
The Court remanded the matter to the Medicare Appeals Council to determine
the Medicare beneficiary’s need for CGM based on her individual medical
condition, i.e., without reference to the Article. The case underscores the
challenges faced by Medicare beneficiaries seeking coverage of a device
that is the standard of care, and the Office of Medicare Hearings and
Appeals’ and Council’s failure to meet statutory deadlines, even for
Very informative and helpful video! Thank you!
Hi Monica, I really appreciate the feedback. I will be updating a
presentation for 2015’s Medicare season and hopefully simplifying it even
more so. Take care!
Excellent! Now to learn more about Part C and Basic Medicare vs Advantage.
Medicare needs the most attention, so we can give back to our elderly.
Very well presented. Thank you for your time and effort.
great presentation thanks
Thank you for the feedback, Johnny. Medicare season starts again in 2
weeks. I am glad the information was helpful. Good luck!
Insurance Medicare advisor
Where is 2015 video? I would love to see that. Can you give the link?
And again thank you for a great job!
Thanks for asking. Here is the link for the new 2015 video with better,
updated information. Medicare 101 Explained – 2015
thanks very very informative,!!
Thanks Oleysa. I have a new version for 2015. It’s very similar but I
think I explain all Medicare better, based on lots of feedback I got.
Olesya, here is the updated version of the video for 2015. Check it out,
let me know what you think and share this video if you like it.
Enjoyed your video, there’s so very much to cover. Wanted to make 2 points.
First, about your 1.2.3. slide on eligibility – suggest you add another
point re spouse (current and former). Second point – your slide on how to
sign up, use SSA (instead of SSN). That’s it, thanks for the overview.
Anna… Wow… that’s right.. Two good points. I will add on my 2015
update soon. Thanks for the feedback!
Not nearly enough information is presented based on the length of the
Great presentation. Thank you
Nicely done video. Excellent overview.
Thanks Scott, glad you enjoyed it. We have a newer Medicare video for 2015.
Check it out – http://youtu.be/Hp-nqjc2QKU