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proscan 48 MIPP is for some groups who are either not eligible for -- or who are how to get proscar instead of propecia not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people. Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits. MIPP reimburses them for their Part B how to get proscar instead of propecia premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL). Even if their income is under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid).

Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article how to get proscar instead of propecia. The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no how to get proscar instead of propecia spend down.

Those consumers can qualify for MIPP and have their Part B premiums reimbursed. Here is an example. Sam is age how to get proscar instead of propecia 50 and has Medicare and MBI-WPD. She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies.

$400 - $65 = how to get proscar instead of propecia $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2 how to get proscar instead of propecia. Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries.

Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” how to get proscar instead of propecia Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income how to get proscar instead of propecia is above 120% FPL, then they can enroll in MIPP.

(See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, how to get proscar instead of propecia the transition time can vary based on age. AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02.

The Medicaid case takes about four months to be rebudgeted how to get proscar instead of propecia and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets. 08 how to get proscar instead of propecia OHIP/ADM-4. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd.

4(c). These consumers should how to get proscar instead of propecia receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during hair loss treatment emergency their case may remain with NYSoH for more than 12 months. See here. EXAMPLE how to get proscar instead of propecia.

Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he how to get proscar instead of propecia can keep Medicaid for 12 months beginning June 2020. Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund.

This will continue until the end of how to get proscar instead of propecia his 12 months of continuous MAGI Medicaid eligibility. He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. See GIS 18 MA/001 - 2018 Medicaid Managed Care how to get proscar instead of propecia Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan.

Note. During the hair loss treatment emergency, those who how to get proscar instead of propecia have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments. See GIS 20 MA/04 or this article on hair loss treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child how to get proscar instead of propecia (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they how to get proscar instead of propecia can keep Medicaid eligibility with NO SPEND DOWN. See this article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down.

Therefore, they are eligible for payment of their Part how to get proscar instead of propecia B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher how to get proscar instead of propecia than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11.

Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle how to get proscar instead of propecia &. 1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be how to get proscar instead of propecia used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit.

The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019 how to get proscar instead of propecia. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check.

In contrast, MSP enrollees how to get proscar instead of propecia are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It how to get proscar instead of propecia does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only.

Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because how to get proscar instead of propecia consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment.

Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS.

See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program.

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€œYou are not alone.” These four words is where can i buy proscar over the counter a message to each and every one who has ever been depressed, anxious, had suicidal thoughts or suffer from mental illness. During Suicide Prevention Month, MidMichigan Health professionals remind you that it is okay to talk about suicide and that seeking help is crucial where can i buy proscar over the counter and never a sign of weakness.“According to the National Alliance on Mental Illness, suicide is now the tenth most common cause of death in the United States and the second leading cause of death in those 10 to 34 years old,” said Kathy Dollard, Psy.D., L.P., director of behavioral health at MidMichigan Health. €œPaying attention to warning signs and certain behaviors in individuals can be key to getting them the support and help that they need.”The warning signs before suicide aren’t always clear, nor are they universal. Suicide is often complex and where can i buy proscar over the counter usually not from a single cause. Still, across the board, mental health experts say certain behaviors shouldn’t be ignored.Signals that may indicate someone is in need of help can include both verbal signs and behavioral cues.

Verbal signs may be talking about wanting to die or kill oneself where can i buy proscar over the counter. Declarations of feeling trapped or having nothing to live for. Talking about great guilt or unbearable where can i buy proscar over the counter pain. Insistence of being a burden to others. Speaking of where can i buy proscar over the counter revenge.

Lack of communication or noticeable withdrawal.Behavioral cues that may signal an individual is in trouble can include acting anxious, agitated or restless. Increased use where can i buy proscar over the counter of alcohol or drugs. Sleeping too where can i buy proscar over the counter little or too much. Suggestive actions, such as online searches or obtaining a gun. Giving away where can i buy proscar over the counter possessions or making visits to say goodbye.

Reckless conduct or extreme mood swings.Suicide can become a threat after a loss. It could be the death of a loved one, including where can i buy proscar over the counter a pet, or the loss of a job or relationship.Although the age of onset is usually mid-teens, mental health conditions can also begin to develop in younger children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms in children and teens are behavioral. Symptoms may include changes in school performance, excessive worry where can i buy proscar over the counter or anxiety, fighting to avoid bed or school, hyperactive behavior, frequent nightmares, disobedience or temper tantrums. In addition to the symptoms mentioned, teens might isolate, use substances, and have drastic personality changes.To help address mental health and the wellbeing of middle and high school youth, the ROCK Center for Youth Development was recently awarded a grant from the Midland Area Community Foundation.

The grant will be used to implement the University of Michigan’s Peer to Peer Depression Awareness Program in Midland county high and middle schools.“Middle and high school age is when students first experience depression and anxiety symptoms, so it is important that they are able to recognize it and feel comfortable seeking where can i buy proscar over the counter help early,” explains Dollard, co-chair of a coalition for youth suicide prevention and a board member of the ROCK. €œThe Peer to Peer program includes training for school personal about mental health concerns and suicide prevention, selecting youth who will be trained and mentored as they launch a school-wide awareness campaign and establishing mental health resources for successful and timely referral when a youth is identified as needing care. The program is built where can i buy proscar over the counter on the premise that teens are more likely to listen to their friends than a well-meaning adult. If we can help youth to know what to do when one of their friends is struggling, we can potentially save lives.”MidMichigan Health offers where can i buy proscar over the counter a variety of behavioral health programs, including psychiatric inpatient care, outpatient care and office-based care. Those interested in learning more may visit www.midmichigan.org/mentalhealth.Those concerned about the imminent danger of another taking their life should call 911 immediately.

Those needing assistance or have questions are recommended to where can i buy proscar over the counter call the National Suicide Prevention Lifeline at 1 (800) 273-TALK (8255). In addition, people in crisis can also text HOME to 741741 to connect with a crisis counselor.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Tammy where can i buy proscar over the counter Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Her co-workers, who nominated her for the award, said Terrell is a dedicated and loyal employee who has led the health system through extraordinary challenges this year. Her leadership through the hair loss treatment where can i buy proscar over the counter crisis was calm and steady.

In addition, she remained unruffled as MidMichigan Medical Center – Midland experienced a historical flood, spending both days and nights onsite to ensure patients and employees were safe.“The Lorimer Award is like being selected into our Hall of Fame,” said Greg Rogers, president, MidMichigan Medical Center – Midland, and executive vice president and chief operating officer, MidMichigan Health. €œIt’s a lifetime award for an where can i buy proscar over the counter employee’s commitment to our Medical Center. Tammy is very deserving of this award. She is where can i buy proscar over the counter selfless, kind, wise, intelligent and thoughtful. She is the perfect example of what makes MidMichigan Health excellent.”Terrell has been with MidMichigan Health for 38 years, beginning her career in 1982 as a staff nurse in the Emergency Department (ED) for 14 years and later was the nurse manager for the ED where can i buy proscar over the counter and Perioperative Services Departments at MidMichigan Medical Center – Gratiot.

Then, in February 2006, she was promoted to director of nursing for the Medical Center in Alma. Seven years later she moved over to the director of where can i buy proscar over the counter nursing administration for MidMichigan Medical Center – Midland. In August 2018, Terrell then became the system director of emergency services in Midland and shortly after was promoted to system vice president and chief nursing officer for MidMichigan Health.The Lorimer Award was first given in 1978 and recognizes one employee each year who possesses the characteristics that Bernard E. Lorimer exemplified where can i buy proscar over the counter during his career as president of the Medical Center in Midland. Those qualities include compassion and concern for people, loyalty and dedication to the Medical Center through extended length of service, cooperation, a positive attitude and a willingness to help others.Previous Bernard E.

Lorimer Award recipients include where can i buy proscar over the counter. Carolyn Fraser, Mary Buffa-Tacey, Pete McKnight, Fran Mayhew, Marilyn Haeussler, Lloyd Hoag, Rea Mason, Jan Albar, Harriet Robbins, Barb Dinger, Pauline Fischer, JoAnne Johnston, Sandy Ebright, Becky Dunn, Dave Chapman, Deb Badour, Jan Penney, Dennis Bauer, Karen Calkins, Jan Morrone, Pam Gifford, Carol Campbell, Mary Jane Howe, Norm Adams, Jeanie Hepinstall, Randy Wyse, Bob Valenta, Sally Vajda, Donna Herringshaw, Kathy Squires, Mary Ann Kovacevich, Sue Haley, Andrea Frederick, Peggy Lark, Tonia VanWieren, Rich Weiler, Teresa Wakeman, Susan Janke, Kathleen Ludwig, Sasha Savage, M.D., Cheryl Meyette and Jodi Herman.Terrell attended the University of Phoenix where she received her Bachelor of Science degree in nursing in 2007. She completed where can i buy proscar over the counter her Master of Science degree in nursing at Walden University in June 2013. Terrell is married and resides with her husband of 37 years on their family farm in Gratiot County. She is the where can i buy proscar over the counter mother of four children and has five grandchildren.

Her favorite pastime is being at the lake and spending time with family.Those interested in more information on MidMichigan Health may visit www.midmichigan.org..

€œYou are not alone.” These four words is a message to each and every one who has ever been depressed, anxious, had suicidal browse this site thoughts or suffer from mental illness how to get proscar instead of propecia. During Suicide Prevention Month, MidMichigan Health professionals remind you that it is okay to talk about suicide and that seeking help is crucial and never a sign of weakness.“According to the how to get proscar instead of propecia National Alliance on Mental Illness, suicide is now the tenth most common cause of death in the United States and the second leading cause of death in those 10 to 34 years old,” said Kathy Dollard, Psy.D., L.P., director of behavioral health at MidMichigan Health. €œPaying attention to warning signs and certain behaviors in individuals can be key to getting them the support and help that they need.”The warning signs before suicide aren’t always clear, nor are they universal. Suicide is often complex and how to get proscar instead of propecia usually not from a single cause. Still, across the board, mental health experts say certain behaviors shouldn’t be ignored.Signals that may indicate someone is in need of help can include both verbal signs and behavioral cues.

Verbal signs may be talking about wanting to die or how to get proscar instead of propecia kill oneself. Declarations of feeling trapped or having nothing to live for. Talking about great guilt or unbearable pain how to get proscar instead of propecia. Insistence of being a burden to others. Speaking of revenge how to get proscar instead of propecia.

Lack of communication or noticeable withdrawal.Behavioral cues that may signal an individual is in trouble can include acting anxious, agitated or restless. Increased use of alcohol how to get proscar instead of propecia or drugs. Sleeping too little how to get proscar instead of propecia or too much. Suggestive actions, such as online searches or obtaining a gun. Giving away possessions or making visits to say goodbye how to get proscar instead of propecia.

Reckless conduct or extreme mood swings.Suicide can become a threat after a loss. It could be the death of a how to get proscar instead of propecia loved one, including a pet, or the loss of a job or relationship.Although the age of onset is usually mid-teens, mental health conditions can also begin to develop in younger children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms in children and teens are behavioral. Symptoms may include changes in school performance, excessive worry or anxiety, fighting to avoid bed or school, hyperactive behavior, frequent nightmares, disobedience or temper how to get proscar instead of propecia tantrums. In addition to the symptoms mentioned, teens might isolate, use substances, and have drastic personality changes.To help address mental health and the wellbeing of middle and high school youth, the ROCK Center for Youth Development was recently awarded a grant from the Midland Area Community Foundation.

The grant will be used to implement the University of Michigan’s Peer to Peer Depression Awareness Program in Midland county high and middle schools.“Middle and high school age is when students first experience depression and anxiety symptoms, so it is important that they are able to recognize it and feel comfortable seeking help early,” explains Dollard, co-chair of a coalition how to get proscar instead of propecia for youth suicide prevention and a board member of the ROCK. €œThe Peer to Peer program includes training for school personal about mental health concerns and suicide prevention, selecting youth who will be trained and mentored as they launch a school-wide awareness campaign and establishing mental health resources for successful and timely referral when a youth is identified as needing care. The program is built on how to get proscar instead of propecia the premise that teens are more likely to listen to their friends than a well-meaning adult. If we can help youth to know what to do when one of their friends is struggling, how to get proscar instead of propecia we can potentially save lives.”MidMichigan Health offers a variety of behavioral health programs, including psychiatric inpatient care, outpatient care and office-based care. Those interested in learning more may visit www.midmichigan.org/mentalhealth.Those concerned about the imminent danger of another taking their life should call 911 immediately.

Those needing assistance or have questions are recommended to call how to get proscar instead of propecia the National Suicide Prevention Lifeline at 1 (800) 273-TALK (8255). In addition, people in crisis can also text HOME to 741741 to connect with a crisis counselor.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees how to get proscar instead of propecia in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Her co-workers, who nominated her for the award, said Terrell is a dedicated and loyal employee who has led the health system through extraordinary challenges this year. Her leadership through how to get proscar instead of propecia the hair loss treatment crisis was calm and steady.

In addition, she remained unruffled as MidMichigan Medical Center – Midland experienced a historical flood, spending both days and nights onsite to ensure patients and employees were safe.“The Lorimer Award is like being selected into our Hall of Fame,” said Greg Rogers, president, MidMichigan Medical Center – Midland, and executive vice president and chief operating officer, MidMichigan Health. €œIt’s a lifetime award for an employee’s commitment to our how to get proscar instead of propecia Medical Center. Tammy is very deserving of this award. She is selfless, how to get proscar instead of propecia kind, wise, intelligent and thoughtful. She is the perfect example of what makes MidMichigan Health excellent.”Terrell has been with MidMichigan how to get proscar instead of propecia Health for 38 years, beginning her career in 1982 as a staff nurse in the Emergency Department (ED) for 14 years and later was the nurse manager for the ED and Perioperative Services Departments at MidMichigan Medical Center – Gratiot.

Then, in February 2006, she was promoted to director of nursing for the Medical Center in Alma. Seven years later she moved how to get proscar instead of propecia over to the director of nursing administration for MidMichigan Medical Center – Midland. In August 2018, Terrell then became the system director of emergency services in Midland and shortly after was promoted to system vice president and chief nursing officer for MidMichigan Health.The Lorimer Award was first given in 1978 and recognizes one employee each year who possesses the characteristics that Bernard E. Lorimer exemplified during his career as president of the Medical how to get proscar instead of propecia Center in Midland. Those qualities include compassion and concern for people, loyalty and dedication to the Medical Center through extended length of service, cooperation, a positive attitude and a willingness to help others.Previous Bernard E.

Lorimer Award recipients include how to get proscar instead of propecia. Carolyn Fraser, Mary Buffa-Tacey, Pete McKnight, Fran Mayhew, Marilyn Haeussler, Lloyd Hoag, Rea Mason, Jan Albar, Harriet Robbins, Barb Dinger, Pauline Fischer, JoAnne Johnston, Sandy Ebright, Becky Dunn, Dave Chapman, Deb Badour, Jan Penney, Dennis Bauer, Karen Calkins, Jan Morrone, Pam Gifford, Carol Campbell, Mary Jane Howe, Norm Adams, Jeanie Hepinstall, Randy Wyse, Bob Valenta, Sally Vajda, Donna Herringshaw, Kathy Squires, Mary Ann Kovacevich, Sue Haley, Andrea Frederick, Peggy Lark, Tonia VanWieren, Rich Weiler, Teresa Wakeman, Susan Janke, Kathleen Ludwig, Sasha Savage, M.D., Cheryl Meyette and Jodi Herman.Terrell attended the University of Phoenix where she received her Bachelor of Science degree in nursing in 2007. She completed her Master of Science degree in nursing at how to get proscar instead of propecia Walden University in June 2013. Terrell is married and resides with her husband of 37 years on their family farm in Gratiot County. She is the mother of four how to get proscar instead of propecia children and has five grandchildren.

Her favorite pastime is being at the lake and spending time with family.Those interested in more information on MidMichigan Health may visit www.midmichigan.org..

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Do not donate blood until at least 6 months after your final dose of finasteride. This will prevent giving finasteride to a pregnant female through a blood transfusion.

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Women who are pregnant or may get pregnant must not handle broken or crushed finasteride tablets; the active ingredient could harm the unborn baby. If a pregnant woman comes into contact with broken or crushed finasteride tablets she should check with her prescriber or health care professional. Exposure to whole tablets is not expected to cause harm as long as they are not swallowed.

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Enrolling proscan 42 4k in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" web link 7. What Happens After MSP Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1. NO ASSET LIMIT!. Since April 1, 2008, none of the three MSP proscan 42 4k programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP.

1.A. SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2020) Single Couple Single Couple Single Couple $1,064 $1,437 $1,276 $1,724 $1,436 $1,940 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?. YES, and also Part A premium if proscan 42 4k did not have enough work quarters and meets citizenship requirement. See “Part A Buy-In” YES YES Pays Part A &.

B deductibles &. Co-insurance YES - proscan 42 4k with limitations NO NO Retroactive to Filing of Application?. Yes - Benefits begin the month after the month of the MSP application. 18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year.

(No retro for January application) proscan 42 4k. See GIS 07 MA 027. Can Enroll in MSP and Medicaid at Same Time?. YES YES NO! proscan 42 4k.

Must choose between QI-1 and Medicaid. Cannot have both, not even Medicaid with a spend-down. 2 proscan 42 4k. INCOME LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits.

The income limits are tied to the Federal Poverty Level (FPL). 2019 FPL proscan 42 4k levels were released by NYS DOH in GIS 20 MA/02 - 2020 Federal Poverty Levels -- Attachment II and have been posted by Medicaid.gov and the National Council on Aging and are in the chart below. NOTE. There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented.

During this lag period, local Medicaid offices should continue proscan 42 4k to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment). Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA. See 2019 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples. N.Y proscan 42 4k.

Soc. Serv. L. 367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7.

Gross income is counted, although there are certain types of income that are disregarded. The most common income disregards, also known as deductions, include. (a) The first $20 of your &. Your spouse's monthly income, earned or unearned ($20 per couple max).

(b) SSI EARNED INCOME DISREGARDS. * The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted). * Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc. For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind.

(c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted. You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher. The above chart shows that Households of TWO have a higher income limit than households of ONE.

The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2. See DAB Household Size Chart. Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP.

EXAMPLE. Bob's Social Security is $1300/month. He is age 67 and has Medicare. His wife, Nancy, is age 62 and is not disabled and does not work.

Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit. In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010. This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program.

Under these rules, Bob is now eligible for an MSP. When is One Better than Two?. Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP. In such cases, "spousal refusal" may be used SSL 366.3(a).

(Link is to NYC HRA form, can be adapted for other counties). 3. The Three Medicare Savings Programs - what are they and how are they different?. 1.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance.

QMB coverage is not retroactive. The program’s benefits will begin the month after the month in which your client is found eligible. ** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center). 2.

Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. 3.

Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only. QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. However, QI-1 retroactive coverage can only be provided within the current calendar year.

(GIS 07 MA 027) So if you apply in January, you get no retroactive coverage. Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid. They cannot be in both. It is their choice.

DOH MRG p. 19. In contrast, one may receive Medicaid and either QMB or SLIMB. 4.

Four Special Benefits of MSPs (in addition to NO ASSET TEST). Benefit 1. Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable. They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments.

Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL. However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit. People applying to the Social Security Administration for Extra Help might be rejected for this reason.

Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients. The effective date of the MSP application must be the same date as the Extra Help application. Signatures will not be required from clients.

In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application. The State implementing procedures are in DOH 2010 ADM-03. Also see CMS "Dear State Medicaid Director" letter dated Feb. 18, 2010 Benefit 2.

MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center. If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP). Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July.

Enrollment in an MSP automatically eliminates such penalties... For life.. Even if one later ceases to be eligible for the MSP. AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A.

See Medicare Rights Center flyer. Benefit 3. No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55. Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs.

In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010. The federal government made this change in order to eliminate barriers to enrollment in MSPs. See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses.

Benefit 4. SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP. Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium. Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down.

Here are some protections. Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?. And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?. The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification.

Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification. New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods. Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification. Most elderly and disabled households have 24-month SNAP certification periods.

Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar. A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits. See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website.

Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare. Others need to apply. The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment. See 3rd bullet below.

Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP. See below. WHO IS AUTOMATICALLY ENROLLED IN AN MSP. Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare.

They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid. (NYS DOH 2000-ADM-7 and GIS 05 MA 033). Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &.

Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing. Strategy TIP. Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason. SSA processes these requests quickly, and it will be routed to the State for MSP processing.

Since MSP applications take a while, at least the filing date will be retroactive. Note. The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application. As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1.

Applying for MSP Directly with Local Medicaid Program. Those who do not have Medicaid already must apply for an MSP through their local social services district. (See more in Section D. Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare.

If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev. 8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid. See 10 ADM-04.

Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address. See the application form for other instructions. One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too.

One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1. Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person. Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare Those who, prior to becoming enrolled in Medicare, had Medicaid through Affordable Care Act are eligible to have their Part B premiums paid by Medicaid (or the cost reimbursed) during the time it takes for them to transition to a Medicare Savings Program.

In 2018, DOH clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare ( PDF) provides, "Due to efforts to transition individuals who gain Medicare eligibility and who require LTSS, individuals may not be disenrolled from MMC upon receipt of Medicare. To facilitate the transition and not disadvantage the recipient, the Medicaid program is approving reimbursement of Part B premiums for enrollees in MMC." The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district. The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability.

Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare. IF they obtain Medicare because they turn age 65, they will receive a letter from their local district asking them to "renew" Medicaid through their local district.

See 2014 LCM-02. Now, their Medicaid income limit will be lower than the MAGI limits ($842/ mo reduced from $1387/month) and they now will have an asset test. For this reason, some individuals may lose full Medicaid eligibility when they begin receiving Medicare. People over age 65 who obtain Medicare do NOT keep "Marketplace Medicaid" for 12 months (continuous eligibility) See GIS 15 MA/022 - Continuous Coverage for MAGI Individuals.

Since MSP has NO ASSET limit. Some individuals may be enrolled in the MSP even if they lose Medicaid, or if they now have a Medicaid spend-down. If a Medicare/Medicaid recipient reports income that exceeds the Medicaid level, districts must evaluate the person’s eligibility for MSP. 08 OHIP/ADM-4 ​If you became eligible for Medicare based on disability and you are UNDER AGE 65, you are entitled to keep MAGI Medicaid for 12 months from the month it was last authorized, even if you now have income normally above the MAGI limit, and even though you now have Medicare.

This is called Continuous Eligibility. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2016. He became enrolled in Medicare based on disability in August 2016, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability).

Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2016. Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continues MAGI Medicaid eligibility.

He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP. (Medicaid Reference Guide (MRG) p.

19). Obtaining MSP may increase their spenddown. MIPPA - Outreach by Social Security Administration -- Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply. The letters are.

· Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6. Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium. See Step-by-Step Guide by the Medicare Rights Center). This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium.

See also GIS 04 MA/013. In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as. SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements.

SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program. Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums. In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period. (The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st).

7. What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid. The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check. SSA also refunds any amounts owed to the recipient.

) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS). ​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs. QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application.

18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application. QI-1 - YES up to 3 months but only in the same calendar year. No retroactive eligibility to the previous year. 7.

QMBs -Special Rules on Cost-Sharing. QMB is the only MSP program which pays not only the Part B premium, but also the Medicare co-insurance. However, there are limitations. First, co-insurance will only be paid if the provide accepts Medicaid.

Not all Medicare provides accept Medicaid. Second, under recent changes in New York law, Medicaid will not always pay the Medicare co-insurance, even to a Medicaid provider. But even if the provider does not accept Medicaid, or if Medicaid does not pay the full co-insurance, the provider is banned from "balance billing" the QMB beneficiary for the co-insurance. Click here for an article that explains all of these rules.

This article was authored by the Empire Justice Center.THE PROBLEM. Meet Joe, whose Doctor has Billed him for the Medicare Coinsurance Joe Client is disabled and has SSD, Medicaid and Qualified Medicare Beneficiary (QMB). His health care is covered by Medicare, and Medicaid and the QMB program pick up his Medicare cost-sharing obligations. Under Medicare Part B, his co-insurance is 20% of the Medicare-approved charge for most outpatient services.

He went to the doctor recently and, as with any other Medicare beneficiary, the doctor handed him a bill for his co-pay. Now Joe has a bill that he can’t pay. Read below to find out -- SHORT ANSWER. QMB or Medicaid will pay the Medicare coinsurance only in limited situations.

First, the provider must be a Medicaid provider. Second, even if the provider accepts Medicaid, under recent legislation in New York enacted in 2015 and 2016, QMB or Medicaid may pay only part of the coinsurance, or none at all. This depends in part on whether the beneficiary has Original Medicare or is in a Medicare Advantage plan, and in part on the type of service. However, the bottom line is that the provider is barred from "balance billing" a QMB beneficiary for the Medicare coinsurance.

Unfortunately, this creates tension between an individual and her doctors, pharmacies dispensing Part B medications, and other providers. Providers may not know they are not allowed to bill a QMB beneficiary for Medicare coinsurance, since they bill other Medicare beneficiaries. Even those who know may pressure their patients to pay, or simply decline to serve them. These rights and the ramifications of these QMB rules are explained in this article.

CMS is doing more education about QMB Rights. The Medicare Handbook, since 2017, gives information about QMB Protections. Download the 2020 Medicare Handbook here. See pp.

53, 86. 1. To Which Providers will QMB or Medicaid Pay the Medicare Co-Insurance?. "Providers must enroll as Medicaid providers in order to bill Medicaid for the Medicare coinsurance." CMS Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to Qualified Medicare Beneficiaries (QMBs).

The CMS bulletin states, "If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules." If the provider chooses not to enroll as a Medicaid provider, they still may not "balance bill" the QMB recipient for the coinsurance. 2. How Does a Provider that DOES accept Medicaid Bill for a QMB Beneficiary?. If beneficiary has Original Medicare -- The provider bills Medicaid - even if the QMB Beneficiary does not also have Medicaid.

Medicaid is required to pay the provider for all Medicare Part A and B cost-sharing charges, even if the service is normally not covered by Medicaid (ie, chiropractic, podiatry and clinical social work care). Whatever reimbursement Medicaid pays the provider constitutes by law payment in full, and the provider cannot bill the beneficiary for any difference remaining. 42 U.S.C. § 1396a(n)(3)(A), NYS DOH 2000-ADM-7 If the QMB beneficiary is in a Medicare Advantage plan - The provider bills the Medicare Advantage plan, then bills Medicaid for the balance using a “16” code to get paid.

The provider must include the amount it received from Medicare Advantage plan. 3. For a Provider who accepts Medicaid, How Much of the Medicare Coinsurance will be Paid for a QMB or Medicaid Beneficiary in NYS?. The answer to this question has changed by laws enacted in 2015 and 2016.

In the proposed 2019 State Budget, Gov. Cuomo has proposed to reduce how much Medicaid pays for the Medicare costs even further. The amount Medicaid pays is different depending on whether the individual has Original Medicare or is a Medicare Advantage plan, with better payment for those in Medicare Advantage plans. The answer also differs based on the type of service.

Part A Deductibles and Coinsurance - Medicaid pays the full Part A hospital deductible ($1,408 in 2020) and Skilled Nursing Facility coinsurance ($176/day) for days 20 - 100 of a rehab stay. Full payment is made for QMB beneficiaries and Medicaid recipients who have no spend-down. Payments are reduced if the beneficiary has a Medicaid spend-down. For in-patient hospital deductible, Medicaid will pay only if six times the monthly spend-down has been met.

For example, if Mary has a $200/month spend down which has not been met otherwise, Medicaid will pay only $164 of the hospital deductible (the amount exceeding 6 x $200). See more on spend-down here. Medicare Part B - Deductible - Currently, Medicaid pays the full Medicare approved charges until the beneficiary has met the annual deductible, which is $198 in 2020. For example, Dr.

John charges $500 for a visit, for which the Medicare approved charge is $198. Medicaid pays the entire $198, meeting the deductible. If the beneficiary has a spend-down, then the Medicaid payment would be subject to the spend-down. In the 2019 proposed state budget, Gov.

Cuomo proposed to reduce the amount Medicaid pays toward the deductible to the same amount paid for coinsurance during the year, described below. This proposal was REJECTED by the state legislature. Co-Insurance - The amount medicaid pays in NYS is different for Original Medicare and Medicare Advantage. If individual has Original Medicare, QMB/Medicaid will pay the 20% Part B coinsurance only to the extent the total combined payment the provider receives from Medicare and Medicaid is the lesser of the Medicaid or Medicare rate for the service.

For example, if the Medicare rate for a service is $100, the coinsurance is $20. If the Medicaid rate for the same service is only $80 or less, Medicaid would pay nothing, as it would consider the doctor fully paid = the provider has received the full Medicaid rate, which is lesser than the Medicare rate. Exceptions - Medicaid/QMB wil pay the full coinsurance for the following services, regardless of the Medicaid rate. ambulance and psychologists - The Gov's 2019 proposal to eliminate these exceptions was rejected.

hospital outpatient clinic, certain facilities operating under certificates issued under the Mental Hygiene Law for people with developmental disabilities, psychiatric disability, and chemical dependence (Mental Hygiene Law Articles 16, 31 or 32). SSL 367-a, subd. 1(d)(iii)-(v) , as amended 2015 If individual is in a Medicare Advantage plan, 85% of the copayment will be paid to the provider (must be a Medicaid provider), regardless of how low the Medicaid rate is. This limit was enacted in the 2016 State Budget, and is better than what the Governor proposed - which was the same rule used in Original Medicare -- NONE of the copayment or coinsurance would be paid if the Medicaid rate was lower than the Medicare rate for the service, which is usually the case.

This would have deterred doctors and other providers from being willing to treat them. SSL 367-a, subd. 1(d)(iv), added 2016. EXCEPTIONS.

The Medicare Advantage plan must pay the full coinsurance for the following services, regardless of the Medicaid rate. ambulance ) psychologist ) The Gov's proposal in the 2019 budget to eliminate these exceptions was rejected by the legislature Example to illustrate the current rules. The Medicare rate for Mary's specialist visit is $185. The Medicaid rate for the same service is $120.

Current rules (since 2016). Medicare Advantage -- Medicare Advantage plan pays $135 and Mary is charged a copayment of $50 (amount varies by plan). Medicaid pays the specialist 85% of the $50 copayment, which is $42.50. The doctor is prohibited by federal law from "balance billing" QMB beneficiaries for the balance of that copayment.

Since provider is getting $177.50 of the $185 approved rate, provider will hopefully not be deterred from serving Mary or other QMBs/Medicaid recipients. Original Medicare - The 20% coinsurance is $37. Medicaid pays none of the coinsurance because the Medicaid rate ($120) is lower than the amount the provider already received from Medicare ($148). For both Medicare Advantage and Original Medicare, if the bill was for a ambulance or psychologist, Medicaid would pay the full 20% coinsurance regardless of the Medicaid rate.

The proposal to eliminate this exception was rejected by the legislature in 2019 budget. . 4. May the Provider 'Balance Bill" a QMB Benficiary for the Coinsurance if Provider Does Not Accept Medicaid, or if Neither the Patient or Medicaid/QMB pays any coinsurance?.

No. Balance billing is banned by the Balanced Budget Act of 1997. 42 U.S.C. § 1396a(n)(3)(A).

In an Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to Qualified Medicare Beneficiaries (QMBs)," the federal Medicare agency - CMS - clarified that providers MAY NOT BILL QMB recipients for the Medicare coinsurance. This is true whether or not the provider is registered as a Medicaid provider. If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules. This is a change in policy in implementing Section 1902(n)(3)(B) of the Social Security Act (the Act), as modified by section 4714 of the Balanced Budget Act of 1997, which prohibits Medicare providers from balance-billing QMBs for Medicare cost-sharing.

The CMS letter states, "All Medicare physicians, providers, and suppliers who offer services and supplies to QMBs are prohibited from billing QMBs for Medicare cost-sharing, including deductible, coinsurance, and copayments. This section of the Act is available at. CMCS Informational Bulletin http://www.ssa.gov/OP_Home/ssact/title19/1902.htm. QMBs have no legal obligation to make further payment to a provider or Medicare managed care plan for Part A or Part B cost sharing.

Providers who inappropriately bill QMBs for Medicare cost-sharing are subject to sanctions. Please note that the statute referenced above supersedes CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), which is no longer in effect, but may be causing confusion about QMB billing." The same information was sent to providers in this Medicare Learning Network bulletin, last revised in June 26, 2018. CMS reminded Medicare Advantage plans of the rule against Balance Billing in the 2017 Call Letter for plan renewals. See this excerpt of the 2017 call letter by Justice in Aging - Prohibition on Billing Medicare-Medicaid Enrollees for Medicare Cost Sharing 5.

How do QMB Beneficiaries Show a Provider that they have QMB and cannot be Billed for the Coinsurance?. It can be difficult to show a provider that one is a QMB. It is especially difficult for providers who are not Medicaid providers to identify QMB's, since they do not have access to online Medicaid eligibility systems Consumers can now call 1-800-MEDICARE to verify their QMB Status and report a billing issue. If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer.

See CMS Medicare Learning Network Bulletin effective Dec. 16, 2016. Medicare Summary Notices (MSNs) that Medicare beneficiaries receive every three months state that QMBs have no financial liability for co-insurance for each Medicare-covered service listed on the MSN. The Remittance Advice (RA) that Medicare sends to providers shows the same information.

By spelling out billing protections on a service-by-service basis, the MSNs provide clarity for both the QMB beneficiary and the provider. Justice in Aging has posted samples of what the new MSNs look like here. They have also updated Justice in Aging’s Improper Billing Toolkit to incorporate references to the MSNs in its model letters that you can use to advocate for clients who have been improperly billed for Medicare-covered services. CMS is implementing systems changes that will notify providers when they process a Medicare claim that the patient is QMB and has no cost-sharing liability.

The Medicare Summary Notice sent to the beneficiary will also state that the beneficiary has QMB and no liability. These changes were scheduled to go into effect in October 2017, but have been delayed. Read more about them in this Justice in Aging Issue Brief on New Strategies in Fighting Improper Billing for QMBs (Feb. 2017).

QMBs are issued a Medicaid benefit card (by mail), even if they do not also receive Medicaid. The card is the mechanism for health care providers to bill the QMB program for the Medicare deductibles and co-pays. Unfortunately, the Medicaid card dos not indicate QMB eligibility. Not all people who have Medicaid also have QMB (they may have higher incomes and "spend down" to the Medicaid limits.

Advocates have asked for a special QMB card, or a notation on the Medicaid card to show that the individual has QMB. See this Report - a National Survey on QMB Identification Practices published by Justice in Aging, authored by Peter Travitsky, NYLAG EFLRP staff attorney. The Report, published in March 2017, documents how QMB beneficiaries could be better identified in order to ensure providers do not bill them improperly. 6.

If you are Billed -​ Strategies Consumers can now call 1-800-MEDICARE to report a billing issue. If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer. See CMS Medicare Learning Network Bulletin effective Dec. 16, 2016.

Send a letter to the provider, using the Justice In Aging Model model letters to providers to explain QMB rights.​​​ both for Original Medicare (Letters 1-2) and Medicare Advantage (Letters 3-5) - see Overview of model letters. Include a link to the CMS Medicare Learning Network Notice. Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (revised June 26. 2018) In January 2017, the Consumer Finance Protection Bureau issued this guide to QMB billing.

A consumer who has a problem with debt collection, may also submit a complaint online or call the CFPB at 1-855-411-2372. TTY/TDD users can call 1-855-729-2372. Medicare Advantage members should complain to their Medicare Advantage plan. In its 2017 Call Letter, CMS stressed to Medicare Advantage contractors that federal regulations at 42 C.F.R.

§ 422.504 (g)(1)(iii), require that provider contracts must prohibit collection of deductibles and co-payments from dual eligibles and QMBs. Toolkit to Help Protect QMB Rights ​​In July 2015, CMS issued a report, "Access to Care Issues Among Qualified Medicare Beneficiaries (QMB's)" documenting how pervasive illegal attempts to bill QMBs for the Medicare coinsurance, including those who are members of managed care plans. Justice in Aging, a national advocacy organization, has a project to educate beneficiaries about balance billing and to advocate for stronger protections for QMBs. Links to their webinars and other resources is at this link.

Their information includes. September 4, 2009, updated 6/20/20 by Valerie Bogart, NYLAG Author. Cathy Roberts. Author.

Geoffrey Hale This article was authored by the Empire Justice Center..

FOUR Special how to get proscar instead of propecia Benefits of MSP Programs. Back Door to Extra Help with Part D MSPs Automatically Waive Late Enrollment Penalties for Part B - and allow enrollment in Part B year-round outside of the short Annual Enrollment Period No Medicaid Lien on Estate to Recover Payment of Expenses Paid by MSP Food Stamps/SNAP not reduced by Decreased Medical Expenses when Enroll in MSP - at least temporarily 5. Enrolling in an MSP - Automatic Enrollment &. Applications for People who Have Medicare What is how to get proscar instead of propecia Application Process?.

6. Enrolling in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" 7. What Happens After MSP how to get proscar instead of propecia Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1. NO ASSET LIMIT!.

Since April 1, 2008, none of the three MSP programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP. 1.A how to get proscar instead of propecia. SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2020) Single Couple Single Couple Single Couple $1,064 $1,437 $1,276 $1,724 $1,436 $1,940 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?. YES, and also Part A premium if did not have enough work quarters and meets citizenship requirement.

See “Part A how to get proscar instead of propecia Buy-In” YES YES Pays Part A &. B deductibles &. Co-insurance YES - with limitations NO NO Retroactive to Filing of Application?. Yes - Benefits begin the month after the month how to get proscar instead of propecia of the MSP application.

18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year. (No retro for January application). See GIS 07 how to get proscar instead of propecia MA 027. Can Enroll in MSP and Medicaid at Same Time?.

YES YES NO!. Must choose between QI-1 how to get proscar instead of propecia and Medicaid. Cannot have both, not even Medicaid with a spend-down. 2.

INCOME how to get proscar instead of propecia LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits. The income limits are tied to the Federal Poverty Level (FPL). 2019 FPL levels were released by NYS DOH in GIS 20 MA/02 - 2020 Federal Poverty Levels -- Attachment II and have been posted by Medicaid.gov and the National Council on Aging and are in the chart below. NOTE how to get proscar instead of propecia.

There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented. During this lag period, local Medicaid offices should continue to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment). Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA how to get proscar instead of propecia. See 2019 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples.

367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7. Gross income is counted, although there are certain types of income that are disregarded. The most common income disregards, also known as deductions, include. (a) The first $20 of your &.

Your spouse's monthly income, earned or unearned ($20 per couple max). (b) SSI EARNED INCOME DISREGARDS. * The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted). * Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc.

For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind. (c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted. You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher.

The above chart shows that Households of TWO have a higher income limit than households of ONE. The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2. See DAB Household Size Chart.

Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP. EXAMPLE. Bob's Social Security is $1300/month. He is age 67 and has Medicare.

His wife, Nancy, is age 62 and is not disabled and does not work. Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit. In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010.

This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program. Under these rules, Bob is now eligible for an MSP. When is One Better than Two?. Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP.

In such cases, "spousal refusal" may be used SSL 366.3(a). (Link is to NYC HRA form, can be adapted for other counties). 3. The Three Medicare Savings Programs - what are they and how are they different?.

1. Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations.

Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. QMB coverage is not retroactive. The program’s benefits will begin the month after the month in which your client is found eligible. ** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center).

2. Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months.

3. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only. QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months.

However, QI-1 retroactive coverage can only be provided within the current calendar year. (GIS 07 MA 027) So if you apply in January, you get no retroactive coverage. Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid. They cannot be in both.

It is their choice. DOH MRG p. 19. In contrast, one may receive Medicaid and either QMB or SLIMB.

4. Four Special Benefits of MSPs (in addition to NO ASSET TEST). Benefit 1. Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable.

They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments. Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL. However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit.

People applying to the Social Security Administration for Extra Help might be rejected for this reason. Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients. The effective date of the MSP application must be the same date as the Extra Help application.

Signatures will not be required from clients. In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application. The State implementing procedures are in DOH 2010 ADM-03. Also see CMS "Dear State Medicaid Director" letter dated Feb.

18, 2010 Benefit 2. MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center. If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP).

Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July. Enrollment in an MSP automatically eliminates such penalties... For life.. Even if one later ceases to be eligible for the MSP.

AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A. See Medicare Rights Center flyer. Benefit 3. No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55.

Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs. In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010. The federal government made this change in order to eliminate barriers to enrollment in MSPs.

See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses. Benefit 4. SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP. Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium.

Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down. Here are some protections. Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?. And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?.

The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification. Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification. New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods. Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification.

Most elderly and disabled households have 24-month SNAP certification periods. Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar. A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits.

See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website. Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare. Others need to apply. The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment.

See 3rd bullet below. Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP. See below. WHO IS AUTOMATICALLY ENROLLED IN AN MSP.

Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare. They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid. (NYS DOH 2000-ADM-7 and GIS 05 MA 033).

Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &. Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing. Strategy TIP. Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason.

SSA processes these requests quickly, and it will be routed to the State for MSP processing. Since MSP applications take a while, at least the filing date will be retroactive. Note. The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application.

As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1. Applying for MSP Directly with Local Medicaid Program. Those who do not have Medicaid already must apply for an MSP through their local social services district. (See more in Section D.

Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare. If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev. 8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid.

See 10 ADM-04. Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address. See the application form for other instructions.

One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too. One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1. Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person.

Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare Those who, prior to becoming enrolled in Medicare, had Medicaid through Affordable Care Act are eligible to have their Part B premiums paid by Medicaid (or the cost reimbursed) during the time it takes for them to transition to a Medicare Savings Program. In 2018, DOH clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare ( PDF) provides, "Due to efforts to transition individuals who gain Medicare eligibility and who require LTSS, individuals may not be disenrolled from MMC upon receipt of Medicare. To facilitate the transition and not disadvantage the recipient, the Medicaid program is approving reimbursement of Part B premiums for enrollees in MMC." The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district.

The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability. Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare.

IF they obtain Medicare because they turn age 65, they will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. Now, their Medicaid income limit will be lower than the MAGI limits ($842/ mo reduced from $1387/month) and they now will have an asset test. For this reason, some individuals may lose full Medicaid eligibility when they begin receiving Medicare.

People over age 65 who obtain Medicare do NOT keep "Marketplace Medicaid" for 12 months (continuous eligibility) See GIS 15 MA/022 - Continuous Coverage for MAGI Individuals. Since MSP has NO ASSET limit. Some individuals may be enrolled in the MSP even if they lose Medicaid, or if they now have a Medicaid spend-down. If a Medicare/Medicaid recipient reports income that exceeds the Medicaid level, districts must evaluate the person’s eligibility for MSP.

08 OHIP/ADM-4 ​If you became eligible for Medicare based on disability and you are UNDER AGE 65, you are entitled to keep MAGI Medicaid for 12 months from the month it was last authorized, even if you now have income normally above the MAGI limit, and even though you now have Medicare. This is called Continuous Eligibility. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2016.

He became enrolled in Medicare based on disability in August 2016, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2016. Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund.

This will continue until the end of his 12 months of continues MAGI Medicaid eligibility. He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP.

(Medicaid Reference Guide (MRG) p. 19). Obtaining MSP may increase their spenddown. MIPPA - Outreach by Social Security Administration -- Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply.

The letters are. · Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6. Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium. See Step-by-Step Guide by the Medicare Rights Center).

This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium. See also GIS 04 MA/013. In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as.

SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements. SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program. Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums. In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period.

(The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st). 7. What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid. The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check.

SSA also refunds any amounts owed to the recipient. (Note. This process can take awhile!. !.

!. ) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS). ​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs.

QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application. 18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application. QI-1 - YES up to 3 months but only in the same calendar year. No retroactive eligibility to the previous year.

7. QMBs -Special Rules on Cost-Sharing. QMB is the only MSP program which pays not only the Part B premium, but also the Medicare co-insurance. However, there are limitations.

First, co-insurance will only be paid if the provide accepts Medicaid. Not all Medicare provides accept Medicaid. Second, under recent changes in New York law, Medicaid will not always pay the Medicare co-insurance, even to a Medicaid provider. But even if the provider does not accept Medicaid, or if Medicaid does not pay the full co-insurance, the provider is banned from "balance billing" the QMB beneficiary for the co-insurance.

Click here for an article that explains all of these rules. This article was authored by the Empire Justice Center.THE PROBLEM. Meet Joe, whose Doctor has Billed him for the Medicare Coinsurance Joe Client is disabled and has SSD, Medicaid and Qualified Medicare Beneficiary (QMB). His health care is covered by Medicare, and Medicaid and the QMB program pick up his Medicare cost-sharing obligations.

Under Medicare Part B, his co-insurance is 20% of the Medicare-approved charge for most outpatient services. He went to the doctor recently and, as with any other Medicare beneficiary, the doctor handed him a bill for his co-pay. Now Joe has a bill that he can’t pay. Read below to find out -- SHORT ANSWER.

QMB or Medicaid will pay the Medicare coinsurance only in limited situations. First, the provider must be a Medicaid provider. Second, even if the provider accepts Medicaid, under recent legislation in New York enacted in 2015 and 2016, QMB or Medicaid may pay only part of the coinsurance, or none at all. This depends in part on whether the beneficiary has Original Medicare or is in a Medicare Advantage plan, and in part on the type of service.

However, the bottom line is that the provider is barred from "balance billing" a QMB beneficiary for the Medicare coinsurance. Unfortunately, this creates tension between an individual and her doctors, pharmacies dispensing Part B medications, and other providers. Providers may not know they are not allowed to bill a QMB beneficiary for Medicare coinsurance, since they bill other Medicare beneficiaries. Even those who know may pressure their patients to pay, or simply decline to serve them.

These rights and the ramifications of these QMB rules are explained in this article. CMS is doing more education about QMB Rights. The Medicare Handbook, since 2017, gives information about QMB Protections. Download the 2020 Medicare Handbook here.

See pp. 53, 86. 1. To Which Providers will QMB or Medicaid Pay the Medicare Co-Insurance?.

"Providers must enroll as Medicaid providers in order to bill Medicaid for the Medicare coinsurance." CMS Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to Qualified Medicare Beneficiaries (QMBs). The CMS bulletin states, "If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules." If the provider chooses not to enroll as a Medicaid provider, they still may not "balance bill" the QMB recipient for the coinsurance. 2. How Does a Provider that DOES accept Medicaid Bill for a QMB Beneficiary?.

If beneficiary has Original Medicare -- The provider bills Medicaid - even if the QMB Beneficiary does not also have Medicaid. Medicaid is required to pay the provider for all Medicare Part A and B cost-sharing charges, even if the service is normally not covered by Medicaid (ie, chiropractic, podiatry and clinical social work care). Whatever reimbursement Medicaid pays the provider constitutes by law payment in full, and the provider cannot bill the beneficiary for any difference remaining. 42 U.S.C.

§ 1396a(n)(3)(A), NYS DOH 2000-ADM-7 If the QMB beneficiary is in a Medicare Advantage plan - The provider bills the Medicare Advantage plan, then bills Medicaid for the balance using a “16” code to get paid. The provider must include the amount it received from Medicare Advantage plan. 3. For a Provider who accepts Medicaid, How Much of the Medicare Coinsurance will be Paid for a QMB or Medicaid Beneficiary in NYS?.

The answer to this question has changed by laws enacted in 2015 and 2016. In the proposed 2019 State Budget, Gov. Cuomo has proposed to reduce how much Medicaid pays for the Medicare costs even further. The amount Medicaid pays is different depending on whether the individual has Original Medicare or is a Medicare Advantage plan, with better payment for those in Medicare Advantage plans.

The answer also differs based on the type of service. Part A Deductibles and Coinsurance - Medicaid pays the full Part A hospital deductible ($1,408 in 2020) and Skilled Nursing Facility coinsurance ($176/day) for days 20 - 100 of a rehab stay. Full payment is made for QMB beneficiaries and Medicaid recipients who have no spend-down. Payments are reduced if the beneficiary has a Medicaid spend-down.

For in-patient hospital deductible, Medicaid will pay only if six times the monthly spend-down has been met. For example, if Mary has a $200/month spend down which has not been met otherwise, Medicaid will pay only $164 of the hospital deductible (the amount exceeding 6 x $200). See more on spend-down here. Medicare Part B - Deductible - Currently, Medicaid pays the full Medicare approved charges until the beneficiary has met the annual deductible, which is $198 in 2020.

For example, Dr. John charges $500 for a visit, for which the Medicare approved charge is $198. Medicaid pays the entire $198, meeting the deductible. If the beneficiary has a spend-down, then the Medicaid payment would be subject to the spend-down.

In the 2019 proposed state budget, Gov. Cuomo proposed to reduce the amount Medicaid pays toward the deductible to the same amount paid for coinsurance during the year, described below. This proposal was REJECTED by the state legislature. Co-Insurance - The amount medicaid pays in NYS is different for Original Medicare and Medicare Advantage.

If individual has Original Medicare, QMB/Medicaid will pay the 20% Part B coinsurance only to the extent the total combined payment the provider receives from Medicare and Medicaid is the lesser of the Medicaid or Medicare rate for the service. For example, if the Medicare rate for a service is $100, the coinsurance is $20. If the Medicaid rate for the same service is only $80 or less, Medicaid would pay nothing, as it would consider the doctor fully paid = the provider has received the full Medicaid rate, which is lesser than the Medicare rate. Exceptions - Medicaid/QMB wil pay the full coinsurance for the following services, regardless of the Medicaid rate.

ambulance and psychologists - The Gov's 2019 proposal to eliminate these exceptions was rejected. hospital outpatient clinic, certain facilities operating under certificates issued under the Mental Hygiene Law for people with developmental disabilities, psychiatric disability, and chemical dependence (Mental Hygiene Law Articles 16, 31 or 32). SSL 367-a, subd. 1(d)(iii)-(v) , as amended 2015 If individual is in a Medicare Advantage plan, 85% of the copayment will be paid to the provider (must be a Medicaid provider), regardless of how low the Medicaid rate is.

This limit was enacted in the 2016 State Budget, and is better than what the Governor proposed - which was the same rule used in Original Medicare -- NONE of the copayment or coinsurance would be paid if the Medicaid rate was lower than the Medicare rate for the service, which is usually the case. This would have deterred doctors and other providers from being willing to treat them. SSL 367-a, subd. 1(d)(iv), added 2016.

EXCEPTIONS. The Medicare Advantage plan must pay the full coinsurance for the following services, regardless of the Medicaid rate. ambulance ) psychologist ) The Gov's proposal in the 2019 budget to eliminate these exceptions was rejected by the legislature Example to illustrate the current rules. The Medicare rate for Mary's specialist visit is $185.

The Medicaid rate for the same service is $120. Current rules (since 2016). Medicare Advantage -- Medicare Advantage plan pays $135 and Mary is charged a copayment of $50 (amount varies by plan). Medicaid pays the specialist 85% of the $50 copayment, which is $42.50.

The doctor is prohibited by federal law from "balance billing" QMB beneficiaries for the balance of that copayment. Since provider is getting $177.50 of the $185 approved rate, provider will hopefully not be deterred from serving Mary or other QMBs/Medicaid recipients. Original Medicare - The 20% coinsurance is $37. Medicaid pays none of the coinsurance because the Medicaid rate ($120) is lower than the amount the provider already received from Medicare ($148).

For both Medicare Advantage and Original Medicare, if the bill was for a ambulance or psychologist, Medicaid would pay the full 20% coinsurance regardless of the Medicaid rate. The proposal to eliminate this exception was rejected by the legislature in 2019 budget. . 4.

May the Provider 'Balance Bill" a QMB Benficiary for the Coinsurance if Provider Does Not Accept Medicaid, or if Neither the Patient or Medicaid/QMB pays any coinsurance?. No. Balance billing is banned by the Balanced Budget Act of 1997. 42 U.S.C.

§ 1396a(n)(3)(A). In an Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to Qualified Medicare Beneficiaries (QMBs)," the federal Medicare agency - CMS - clarified that providers MAY NOT BILL QMB recipients for the Medicare coinsurance. This is true whether or not the provider is registered as a Medicaid provider. If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules.

This is a change in policy in implementing Section 1902(n)(3)(B) of the Social Security Act (the Act), as modified by section 4714 of the Balanced Budget Act of 1997, which prohibits Medicare providers from balance-billing QMBs for Medicare cost-sharing. The CMS letter states, "All Medicare physicians, providers, and suppliers who offer services and supplies to QMBs are prohibited from billing QMBs for Medicare cost-sharing, including deductible, coinsurance, and copayments. This section of the Act is available at. CMCS Informational Bulletin http://www.ssa.gov/OP_Home/ssact/title19/1902.htm.

QMBs have no legal obligation to make further payment to a provider or Medicare managed care plan for Part A or Part B cost sharing. Providers who inappropriately bill QMBs for Medicare cost-sharing are subject to sanctions. Please note that the statute referenced above supersedes CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), which is no longer in effect, but may be causing confusion about QMB billing." The same information was sent to providers in this Medicare Learning Network bulletin, last revised in June 26, 2018. CMS reminded Medicare Advantage plans of the rule against Balance Billing in the 2017 Call Letter for plan renewals.

See this excerpt of the 2017 call letter by Justice in Aging - Prohibition on Billing Medicare-Medicaid Enrollees for Medicare Cost Sharing 5. How do QMB Beneficiaries Show a Provider that they have QMB and cannot be Billed for the Coinsurance?. It can be difficult to show a provider that one is a QMB. It is especially difficult for providers who are not Medicaid providers to identify QMB's, since they do not have access to online Medicaid eligibility systems Consumers can now call 1-800-MEDICARE to verify their QMB Status and report a billing issue.

If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer. See CMS Medicare Learning Network Bulletin effective Dec. 16, 2016. Medicare Summary Notices (MSNs) that Medicare beneficiaries receive every three months state that QMBs have no financial liability for co-insurance for each Medicare-covered service listed on the MSN.

The Remittance Advice (RA) that Medicare sends to providers shows the same information. By spelling out billing protections on a service-by-service basis, the MSNs provide clarity for both the QMB beneficiary and the provider. Justice in Aging has posted samples of what the new MSNs look like here. They have also updated Justice in Aging’s Improper Billing Toolkit to incorporate references to the MSNs in its model letters that you can use to advocate for clients who have been improperly billed for Medicare-covered services.

CMS is implementing systems changes that will notify providers when they process a Medicare claim that the patient is QMB and has no cost-sharing liability. The Medicare Summary Notice sent to the beneficiary will also state that the beneficiary has QMB and no liability. These changes were scheduled to go into effect in October 2017, but have been delayed. Read more about them in this Justice in Aging Issue Brief on New Strategies in Fighting Improper Billing for QMBs (Feb.

2017). QMBs are issued a Medicaid benefit card (by mail), even if they do not also receive Medicaid. The card is the mechanism for health care providers to bill the QMB program for the Medicare deductibles and co-pays. Unfortunately, the Medicaid card dos not indicate QMB eligibility.

Not all people who have Medicaid also have QMB (they may have higher incomes and "spend down" to the Medicaid limits. Advocates have asked for a special QMB card, or a notation on the Medicaid card to show that the individual has QMB. See this Report - a National Survey on QMB Identification Practices published by Justice in Aging, authored by Peter Travitsky, NYLAG EFLRP staff attorney. The Report, published in March 2017, documents how QMB beneficiaries could be better identified in order to ensure providers do not bill them improperly.

6. If you are Billed -​ Strategies Consumers can now call 1-800-MEDICARE to report a billing issue. If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer. See CMS Medicare Learning Network Bulletin effective Dec.

16, 2016. Send a letter to the provider, using the Justice In Aging Model model letters to providers to explain QMB rights.​​​ both for Original Medicare (Letters 1-2) and Medicare Advantage (Letters 3-5) - see Overview of model letters. Include a link to the CMS Medicare Learning Network Notice. Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (revised June 26.

2018) In January 2017, the Consumer Finance Protection Bureau issued this guide to QMB billing. A consumer who has a problem with debt collection, may also submit a complaint online or call the CFPB at 1-855-411-2372. TTY/TDD users can call 1-855-729-2372. Medicare Advantage members should complain to their Medicare Advantage plan.

In its 2017 Call Letter, CMS stressed to Medicare Advantage contractors that federal regulations at 42 C.F.R. § 422.504 (g)(1)(iii), require that provider contracts must prohibit collection of deductibles and co-payments from dual eligibles and QMBs. Toolkit to Help Protect QMB Rights ​​In July 2015, CMS issued a report, "Access to Care Issues Among Qualified Medicare Beneficiaries (QMB's)" documenting how pervasive illegal attempts to bill QMBs for the Medicare coinsurance, including those who are members of managed care plans. Justice in Aging, a national advocacy organization, has a project to educate beneficiaries about balance billing and to advocate for stronger protections for QMBs.

Links to their webinars and other resources is at this link.

Proscan power supply

The following essay is proscan power supply reprinted with permission from The http://marthamukaiwa.com/viagra-discount/ Conversation, an online publication covering the latest research. The eruption of Mount Semeru in Indonesia on Saturday tragically claimed the lives of 22 people, with another 22 still missing and 56 injured. More than 5,000 people have been affected by proscan power supply the eruption, and more than 2,000 people have taken refuge at 19 evacuation points. Saturday’s eruption produced an ash plume that reached 15km into the atmosphere, along with hot pyroclastic flows—dense, fast-moving clouds of solidified lava, ash and gas. Volcanic mudflows called lahars also tumbled down the volcano’s steep slopes.

Heavy ash blanketed nearby villages and plunged some areas into proscan power supply temporary darkness. Several villages have been buried in up to 4 metres of volcanic material and debris, more than 3,000 buildings have been damaged, and Gladak Perak Bridge, which connected Lumajang with the nearby city of Malang, has collapsed. Jembatan Gladak Perak penghubungKab Malang ke Kab Lumajang dan sebaliknya putus, imbas lahar dingin erupsi Gunung Semeru hari ini, Sabtu (4/12/2021).pic.twitter.com/oxyrze6MYL— Asumsi (@asumsico) December 4, 2021 The Volcano Observatory Notice for Aviation (VONA) has since reported further pyroclastic flows travelling down the the volcano’s slopes, and ash plumes reaching 4.5km above its summit. There are also reports of lava flows proscan power supply at the summit crater. Mt Semeru is one of the most active volcanoes in Java, with activity taking place in 74 of the past 80 years.

The volcano’s current eruptive phase began in 2014, with frequent emissions of ash plumes to hundreds of metres proscan power supply above the crater, pyroclastic flows and glowing lava avalanches. Unexpected larger-scale eruption But Saturday’s eruption was, unexpectedly, much larger than the ongoing background of activity. The Head of the Geological Agency of the Ministry of Energy and Mineral Resources, Eko Budi Lelono, said a thunderstorm and persistent rain had eroded part of the volcano’s lava dome—a “plug” of solidified lava at the summit. This caused the dome to collapse, triggering proscan power supply the eruption. Lava dome collapse is a common trigger of volcanic eruptions, and has been behind some of the deadliest eruptions in history.

Collapse of the unstable dome of solidified lava is rather like taking the top off a fizzy drink bottle, depressurising the system and triggering an eruption proscan power supply. Lava domes sometimes collapse under their own weight as they grow, or they can be weakened by external weather conditions, as was evidently the case at Mt Semeru. The fact that Saturday’s eruption was triggered by an external factor, rather than conditions inside the volcano, would have made this event harder to forecast. Volcano monitoring typically relies on proscan power supply signs of increased unrest inside a volcano. Increased earthquake activity can be a sign that magma is moving around beneath the ground.

Another warning sign is a change in the temperature or type of gases emitted. Sometimes, small changes in the shape of the volcano or lava dome can be detected on the ground proscan power supply or from satellites. Another fatal, hard-to-predict explosive eruption happened in 2019 at Whakaari (White Island) in New Zealand. That event was thought to have been driven by an explosion of pressurised steam rather than by magma, which made it challenging to predict. Living with active volcanoes As the world’s population grows, more and more people proscan power supply are living close to active volcanoes.

According to one estimate, more than a billion people (14% of people on the planet) live within 100km of an active volcano. In Indonesia, more than 70% of the proscan power supply population live within 100km of one or more of the country’s 130 active volcanoes – that’s a staggering 175 million people. More than 8.6 million Indonesians live within 10km of an active volcano – well within range of deadly pyroclastic flows. The fertile soils typically found near volcanoes mean these communities need to balance their livelihoods with the risks. Keeping an eye on dozens of active volcanoes poses a continuous proscan power supply challenge to Indonesia’s volcano monitoring and disaster management authorities.

This article was originally published on The Conversation. Read the original article..

The following how to get proscar instead of propecia essay is reprinted with permission from The Conversation, an online publication covering the latest research. The eruption of Mount Semeru in Indonesia on Saturday tragically claimed the lives of 22 people, with another 22 still missing and 56 injured. More than 5,000 people have been how to get proscar instead of propecia affected by the eruption, and more than 2,000 people have taken refuge at 19 evacuation points.

Saturday’s eruption produced an ash plume that reached 15km into the atmosphere, along with hot pyroclastic flows—dense, fast-moving clouds of solidified lava, ash and gas. Volcanic mudflows called lahars also tumbled down the volcano’s steep slopes. Heavy ash blanketed nearby villages and plunged some areas how to get proscar instead of propecia into temporary darkness.

Several villages have been buried in up to 4 metres of volcanic material and debris, more than 3,000 buildings have been damaged, and Gladak Perak Bridge, which connected Lumajang with the nearby city of Malang, has collapsed. Jembatan Gladak Perak penghubungKab Malang ke Kab Lumajang dan sebaliknya putus, imbas lahar dingin erupsi Gunung Semeru hari ini, Sabtu (4/12/2021).pic.twitter.com/oxyrze6MYL— Asumsi (@asumsico) December 4, 2021 The Volcano Observatory Notice for Aviation (VONA) has since reported further pyroclastic flows travelling down the the volcano’s slopes, and ash plumes reaching 4.5km above its summit. There are also how to get proscar instead of propecia reports of lava flows at the summit crater.

Mt Semeru is one of the most active volcanoes in Java, with activity taking place in 74 of the past 80 years. The volcano’s current eruptive phase began in 2014, with frequent emissions how to get proscar instead of propecia of ash plumes to hundreds of metres above the crater, pyroclastic flows and glowing lava avalanches. Unexpected larger-scale eruption But Saturday’s eruption was, unexpectedly, much larger than the ongoing background of activity.

The Head of the Geological Agency of the Ministry of Energy and Mineral Resources, Eko Budi Lelono, said a thunderstorm and persistent rain had eroded part of the volcano’s lava dome—a “plug” of solidified lava at the summit. This caused how to get proscar instead of propecia the dome to collapse, triggering the eruption. Lava dome collapse is a common trigger of volcanic eruptions, and has been behind some of the deadliest eruptions in history.

Collapse of the how to get proscar instead of propecia unstable dome of solidified lava is rather like taking the top off a fizzy drink bottle, depressurising the system and triggering an eruption. Lava domes sometimes collapse under their own weight as they grow, or they can be weakened by external weather conditions, as was evidently the case at Mt Semeru. The fact that Saturday’s eruption was triggered by an external factor, rather than conditions inside the volcano, would have made this event harder to forecast.

Volcano monitoring typically relies on how to get proscar instead of propecia signs of increased unrest inside a volcano. Increased earthquake activity can be a sign that magma is moving around beneath the ground. Another warning sign is a change in the temperature or type of gases emitted.

Sometimes, small changes in the shape of the volcano or lava dome can be detected on the ground or from satellites how to get proscar instead of propecia. Another fatal, hard-to-predict explosive eruption happened in 2019 at Whakaari (White Island) in New Zealand. That event was thought to have been driven by an explosion of pressurised steam rather than by magma, which made it challenging to predict.

Living with how to get proscar instead of propecia active volcanoes As the world’s population grows, more and more people are living close to active volcanoes. According to one estimate, more than a billion people (14% of people on the planet) live within 100km of an active volcano. In Indonesia, more than 70% of the population live within 100km of one or more of the country’s 130 active volcanoes how to get proscar instead of propecia – that’s a staggering 175 million people.

More than 8.6 million Indonesians live within 10km of an active volcano – well within range of deadly pyroclastic flows. The fertile soils typically found near volcanoes mean these communities need to balance their livelihoods with the risks. Keeping an eye on dozens of active volcanoes poses a continuous challenge to Indonesia’s volcano monitoring and how to get proscar instead of propecia disaster management authorities.

This article was originally published on The Conversation. Read the original article..

Is proscan a good brand tv

Latest Pregnancy News By Steven Reinberg is proscan a good brand tv HealthDay ReporterTHURSDAY, Where is better to buy antabuse Nov. 19, 2020 (HealthDay News)Pregnant women with hair loss treatment have little risk of developing severe symptoms, as do their newborns, a new study finds.In fact, 95% of these women have good outcomes, and just 3% of their babies test positive for hair loss treatment, researchers say."For 5% of hair loss treatment-positive pregnant women, however -- those who get very sick -- the risks to both mother and baby are significant," is proscan a good brand tv said study lead author Dr. Emily Adhikari, medical director of perinatal infectious diseases at Parkland Hospital in Dallas.Pregnancy itself, however, does not appear to increase the odds for hair loss treatment complications, she said."Most women with asymptomatic or mild will be relieved to know that their babies are unlikely to be affected by the proscar," Adhikari said."When studying all pregnant women with hair loss treatment , both those needing and not needing hospitalization, we are able to identify that the risks to the mothers are similar to those of the general population," she added.At the start of the proscar, the U.S. Centers for Disease Control and Prevention thought the risk for pregnant women is proscan a good brand tv was greater than for others. But the new findings should reassure pregnant women that their risk is in line with other groups, researchers said."The initial reports from the CDC were very frightening, but it may not be as bad as it seemed to be initially," said Dr.

Jennifer Wu, is proscan a good brand tv an ob-gyn at Lenox Hill Hospital in New York City. She was not part of the study, but reviewed the findings.But more data is needed to know the risk to mother and baby of hair loss transmission, Wu is proscan a good brand tv said. Babies of infected mothers should be tested for hair loss treatment, she added.For the study, Adhikari and her colleagues followed nearly 3,400 expectant women, 252 of whom had hair loss treatment.Among those who tested positive, 95% had no or mild symptoms. Six women, however, developed severe or critical hair loss treatment pneumonia.Comparing women with and without hair loss treatment during pregnancy, researchers found it did not increase the risk of adverse outcomes — including preterm birth, preeclampsia, or cesarean is proscan a good brand tv delivery for abnormal fetal heart rate, Adhikari said.Preterm birth was higher among women who had severe or critical illness, but it's hard to predict which patients will. Researchers said diabetes may boost the odds."Of the 252 infected women, the rate of hospitalization for hair loss treatment was 6%, which is similar to the rate in the general population and lower than previous reports," Adhikari said.

"Earlier studies had suggested that almost 20% of pregnant women with hair loss treatment might require hospitalization."The study found that being pregnant does not appear to increase the risk of severe illness for the majority of women, she added.Even so, Wu said pregnant women -- like everyone else -- should wear masks and practice social distancing to minimize the odds of getting the proscar."We do think that pregnant women have more risks with hair loss treatment s, so all precautions should be taken to avoid is proscan a good brand tv getting infected," Wu said.The findings were published online Nov. 19 in the is proscan a good brand tv journal JAMA Network Open.More informationFor more on hair loss treatment, visit the U.S. Centers for Disease Control and Prevention.SOURCES. Emily Adhikari, MD, medical is proscan a good brand tv director, perinatal infectious diseases, Parkland Hospital, Dallas, and assistant professor, obstetrics and gynecology, UT Southwestern Medical Center, Dallas. Jennifer Wu, MD, obstetrician-gynecologist, Lenox Hill Hospital, New York City.

JAMA Network Open, is proscan a good brand tv online, Nov. 19, 2020Copyright © 2020 HealthDay is proscan a good brand tv. All rights reserved. SLIDESHOW Conception is proscan a good brand tv. The Amazing Journey from Egg to Embryo See SlideshowLatest High Blood Pressure News THURSDAY, Nov.

19, 2020 (American Heart Association News)Jessica Grib noticed being a lot more tired with her second pregnancy is proscan a good brand tv. She felt is proscan a good brand tv winded easily and couldn't catch her breath when lying down. Near her delivery date, she started having issues with high blood pressure. At 36 weeks, her blood pressure remained high is proscan a good brand tv enough – even with medicine – that doctors ordered her on bed rest.Her daughter, Amelia, was born a week later. It almost cost Jessica her life.Because Amelia was breech, not in the head-down position, doctors ordered a caesarean section.

Everything was OK until Jessica reached the recovery room."Her oxygen levels plummeted, and her heart rate was all over the is proscan a good brand tv place. They couldn't is proscan a good brand tv stabilize it," said her husband, Kevin. "That's really the first indication that something was really going wrong."Jessica was taken to intensive care and "essentially the bat signal went out to all the cardiologists in the building" to get to the ICU, Kevin said. Eventually, doctors sent Jessica to the is proscan a good brand tv cardiac catheterization lab so they could get a good look at her heart.Along the way, Jessica stopped breathing. It took six people and 10 minutes to resuscitate her.Doctors determined her heart's blood flow could not meet the demand of her body's organs for oxygen.

The condition is called peripartum cardiomyopathy, an uncommon form of heart failure that happens during the last month of pregnancy or up is proscan a good brand tv to five months after giving birth. Doctors put Jessica on a ventilator and implanted a device in her heart to keep her is proscan a good brand tv blood pumping. She was stabilized and transferred to another hospital with specialized equipment to keep her alive.The doctor told Kevin that basically Jessica's heart had to start working on its own within two weeks."He really laid out that this was going to be an incredible uphill battle, and even if we got her back, there was a small chance we would get her back in a fully functioning state," Kevin said.Lots of people showed up at the hospital to make sure they could see Jessica, who was 30 at the time.After a couple of days, family members noticed an occasional blip on her heart monitor. Eventually, the blips is proscan a good brand tv turned into more regular beating."My heart was recovering itself, which is pretty amazing," Jessica said.Doctors were able to wean Jessica from the life support machine after about five days, but her vital signs were still troubling. Jessica's blood pressure was still high, and her heart rate was all over the place.

After about two weeks, her vital signs stabilized and she awoke from the heavy sedation to be reunited is proscan a good brand tv with Amelia and her toddler, Noah.Jessica pushed herself in physical and occupational therapy. It paid is proscan a good brand tv off. Three weeks after the roller-coaster journey began, Jessica went back to her home in St. Louis.Recovery took is proscan a good brand tv time. At first, she couldn't walk long distances or hold Amelia's pacifier because of difficulty with fine motor skills.

On top of that, she had is proscan a good brand tv excruciating headaches. Jessica wasn't sure what her life was going to be like.During a is proscan a good brand tv post-op hospital visit, Jessica bumped into her cardiologist. The doctor was puzzled why Jessica wasn't getting better and suggested testing her for a rare tumor.Sure enough, a tumor was found next to her adrenal gland. While scary, the doctor assured her is proscan a good brand tv this could be the answer to everything. Removing it could get her life back."It was extremely dangerous, high-risk, because the tumor secreted all this adrenaline into my body and made my heart stop the first time," Jessica said.The surgery was a success.

Six weeks later, Jessica's life indeed returned to normal.Since is proscan a good brand tv then, she has worked to spread awareness about peripartum cardiomyopathy. The signs are often dismissed as ordinary pregnancy or postpartum symptoms is proscan a good brand tv. They include fatigue, a rapid heartbeat or palpitations, increased nighttime urination, shortness of breath with activity and when lying flat, swelling of the ankles, swollen neck veins, and low blood pressure or blood pressure that drops when standing. SLIDESHOW is proscan a good brand tv Conception. The Amazing Journey from Egg to Embryo See Slideshow "I had a baby in America in a hospital in 2016, so I had no idea that I would have been fighting for my life," said Jessica, who was otherwise healthy and exercised into her third trimester.

"I had never heard is proscan a good brand tv of this before with either of my pregnancies."American Heart Association News covers heart and brain health. Not all views expressed in this story reflect is proscan a good brand tv the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you is proscan a good brand tv have questions or comments about this story, please email [email protected]By Stefani KopenecAmerican Heart Association NewsCopyright © 2020 HealthDay. All rights reserved.

From is proscan a good brand tv Women's Health Resources Featured Centers Health Solutions From Our SponsorsLatest Nutrition, Food &. Recipes News THURSDAY, Nov is proscan a good brand tv. 19, 2020 (American Heart Association News)The football teams taking the field on Thanksgiving will bring shrewd strategies and meticulous game plans to make sure they finish the day healthy and successful.As we tackle one of the year's biggest feasts, should we do the same?. On the one hand, it's just one day."If you spend the majority of your time is proscan a good brand tv eating well and exercising, my general opinion on Thanksgiving is give yourself a break," said Krista Varady, professor of nutrition at the University of Illinois, Chicago. "Don't be crazy, but everybody deserves a day off."On the other hand, Thanksgiving kicks off the holiday eating season, which can have significant ramifications on body weight – and health – for the entire year."Between Thanksgiving and January 1, it's not uncommon to see a 10-pound weight gain if an individual is not careful," said registered dietitian Linda Van Horn, a professor of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

"We need to recognize is proscan a good brand tv the risks and be thoughtful."The Calorie Control Council, a food and beverage industry group, calculates one Thanksgiving meal can total 4,500 calories. That's more than twice the recommended number is proscan a good brand tv of 1,600 to 2,400 calories per day for a woman.A 2016 study in the New England Journal of Medicine reported that the average American gains 1.3 pounds during the holiday season, while a 2000 study in Nutrition Reviews concluded that what's packed on during the holidays accounts for half of weight gain for the year."Even if the average weight gain is only a kilogram (2.2 pounds) each year, over a lifetime it adds up," said Surabhi Bhutani, assistant professor in the School of Exercise and Nutritional Sciences at San Diego State University, who studies holiday eating habits.This year may not be typical, as the hair loss proscar disrupts the usual stream of holiday gatherings and office parties. But the lessons for curbing the dietary impact of Thanksgiving dinner remain the same. Here are some is proscan a good brand tv tips:Prepare. "In the weeks leading up to the holidays, be a bit more vigilant about your food intake," Varady said.

"Maybe lose a couple pounds is proscan a good brand tv so you'll wind up with a net zero after the holidays."Tweak recipes. "You can treat yourself is proscan a good brand tv to special foods but also have control over how they're made," Van Horn said. Search the internet for a healthier version of a favorite recipe or a substitute for an unhealthy ingredient.There's no quick fix for overeating. You can't exercise your way is proscan a good brand tv out of gorging at the holiday table, Varady said. "Exercise is great, but it's really more about eating less food.

It's calories is proscan a good brand tv in, calories out."Don't come hungry. Have a is proscan a good brand tv healthy breakfast or lunch, Bhutani said. "Some people try to avoid weight gain by eating very little before the big feast or a party, but that ends up backfiring because they're so hungry they're not able to control themselves."It's not just about eating. Alcohol has calories too, Van Horn said is proscan a good brand tv. "And the more you drink, the less you care – not just about the alcohol but the rest of the meal as well."Pace yourself.

"It takes time is proscan a good brand tv for the brain to realize you're getting full," Bhutani said. "Eating slowly and waiting a few minutes before you go for seconds or thirds can is proscan a good brand tv be very helpful."Beware of leftovers. The holiday table may be full of the most calorically dense foods people eat all year, Van Horn said. "If there's more left over, you may be the one suffering the is proscan a good brand tv consequences. Sooner or later, those pumpkin pies do get eaten."As sound as the advice may be, Bhutani said, the culinary temptations this time of year are hard to resist."Holiday season can be the time when people just let go," she said.

"When there are so many food cues and so much exposure is proscan a good brand tv to high-caloric foods, it's very difficult unless people are really determined and given some support. But we have to try."American Heart Association News covers heart and brain is proscan a good brand tv health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., is proscan a good brand tv and all rights are reserved. If you have questions or comments about this story, please email [email protected]By Michael PreckerAmerican Heart Association NewsCopyright © 2020 HealthDay.

All rights is proscan a good brand tv reserved. SLIDESHOW Stress-Free Holiday Travel Tips is proscan a good brand tv See SlideshowLatest Arthritis News By Amy Norton HealthDay ReporterTHURSDAY, Nov. 19, 2020 (HealthDay News)A procedure that "stuns" pain-sensing nerves might offer relief to people with severe arthritis of the hip or shoulder, a small, preliminary study suggests.The procedure is a form of radiofrequency ablation, where doctors use needles to send a low-grade electrical current to nerves that are transmitting pain signals from the arthritic joint to the brain. The current heats and damages the nerve fibers, rendering them unable to deliver those is proscan a good brand tv pain messages.In the United States, a number of ablation devices are cleared for treating low back pain and knee osteoarthritis.At this point, the procedure is slowly becoming a more established treatment, said Dr. Felix Gonzalez, a radiologist at Emory University School of Medicine in Atlanta.But whether ablation can help patients with severe hip or shoulder arthritis is unclear.To find out, Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections -- two standard treatments -- were no longer helping.Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average.

Among hip arthritis patients, pain declined by an average of 70%.Gonzalez called the results "promising" and said, in his experience, there have been no major complications from the procedure, such as bleeding or s -- though those is proscan a good brand tv are potential risks.And before the ablation is done, Gonzalez explained, patients go through what is basically a trial run. They are given an injection of numbing medication near the nerves believed to be generating the is proscan a good brand tv pain signals. If the pain abates, that means targeting the same nerves with ablation will likely work, too -- longer term.It's too soon, however, to judge the effectiveness of the approach for shoulder and hip pain, according to Dr. Rajat Bhatt, a rheumatologist who was not involved in the study.None of the study patients received a placebo (inactive treatment) to serve as a comparison, is proscan a good brand tv said Bhatt, of Prime Rheumatology in Katy, Texas. So it's possible at least some of the pain relief came from the fact that patients received a novel therapy."With pain, there's generally a large placebo effect," Bhatt pointed out.Larger studies, with a comparison group, are still needed, he said.Gonzalez is scheduled to present the findings at the annual meeting of the Radiological Society of North America, being held online Nov.

29 to is proscan a good brand tv Dec. 5. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention.The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion.People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks.

Prolonged use is linked to increased risks of heart disease and kidney damage.Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time, Bhatt said, and there are long-term safety issues, including a risk of cartilage damage. SLIDESHOW What Is Rheumatoid Arthritis (RA)?. Symptoms, Treatment, Diagnosis See Slideshow Beyond that, Gonzalez said, there are essentially two options for more severe pain. Joint replacement surgery or opioid painkillers."But not everyone is a candidate for surgery, because of health reasons," Gonzalez said.

"And some patients don't want it."Opioids, meanwhile, carry their own well-documented problems, including the potential for addiction."So we need something to fill the gap," Gonzalez said.Ablation stands as an additional therapy, he said, but it's not a "cure." For one, it addresses pain -- not the underlying joint damage of arthritis. And the pain is not banished forever. The nerve fibers eventually grow back.When ablation is used for knee osteoarthritis, Gonzalez said, the pain relief typically lasts 6 months or more -- and up to two years in some patients. The procedure can be repeated.In this early study, patients were only followed for three months. So it's not clear how long the pain relief will last, Gonzalez said.And while ablation is coming into wider use for certain pain conditions, people may not be able to find it locally.

Gonzalez said some of his patients come from hours away to get the treatment.More informationThe Arthritis Foundation has more on osteoarthritis.SOURCES. Felix Gonzalez, MD, assistant professor, department of radiology and imaging sciences, Emory University School of Medicine, Atlanta. Rajat Bhatt, MD, Prime Rheumatology, Katy, Texas. Presentation, Radiological Society of North America virtual annual meeting, Nov. 29 to Dec.

5, 2020Copyright © 2020 HealthDay. All rights reserved. From Arthritis Resources Featured Centers Health Solutions From Our SponsorsLatest Prevention &. Wellness News By Dennis Thompson HealthDay ReporterTHURSDAY, Nov. 19, 2020 (HealthDay News)Americans should stay home and avoid big Thanksgiving gatherings, leading public health agencies and medical societies warn as hair loss treatment surges and proscar deaths in the United States pass 250,000.At a press conference held Thursday, officials at the U.S.

Centers for Disease Control and Prevention advised people to limit celebrations to only those who've been living in the household for the previous two weeks.Groups representing the nation's doctors, nurses and hospitals also issued a joint recommendation to curb travel and mingling this holiday season."With Thanksgiving approaching, our hearts and minds turn to seeing family and friends, as part of one of our nation's great traditions, and we all need to consider the safest way to celebrate this holiday," said Dr. Henry Walke, the CDC's hair loss treatment incident manager. "Amidst this critical phase of the hair loss treatment proscar, CDC is recommending against travel during the Thanksgiving period."The CDC took this step based on the "exponential increase" in hair loss treatment cases, hospitalizations and deaths that has occurred this month, said Walke and Erin Sauber-Schatz, lead for the CDC's Community Intervention and Critical Population Task Force."The reason we made the update is the fact that over the last week, we've seen over a million new cases in the country," Sauber-Schatz said.Over 250,000 Americans have now died from hair loss treatment.Three of the nation's leading medical societies lent their voices to the same message Thursday in an open letter asking Americans to pare down their holiday plans."We -- the physicians, nurses, hospital and health system leaders and public health professionals on the front lines of this proscar -- strongly urge everyone throughout our country to celebrate responsibly, in a scaled-back fashion that limits the proscar's spread, to help reduce the risk of infecting friends, family and others you love," reads the letter co-signed by the American Medical Association, American Hospital Association and American Nurses Association.The letter noted that throughout the proscar, hair loss treatment spread has followed a similar pattern around holidays and mass gatherings."Positive cases spiked after Memorial Day, after the Fourth of July, after Labor Day, and now two weeks after Halloween," the letter said. "The record-shattering surge underway is resulting in uncontrolled community spread and that has already overburdened health systems in some areas and will ultimately consume capacity of our health care system and may reduce the availability of care in many places in our country."Aside from the strong recommendation against travel and gatherings, the CDC's updated guidance also provided clarification about who should be considered part of a household for control purposes."We received lots of questions from Americans about college students or people coming home for the holidays," Sauber-Schatz said. "The safest way to celebrate Thanksgiving this year is at home with the people in your household.

If people have not been actively living with you for the 14 days before you're celebrating, they are not considered a member of your household."If college students do go home for Thanksgiving, everyone in the household should wear a mask and stringently follow control measures, Walke said. These include sustaining good ventilation throughout the house, practicing hand hygiene and maintaining social distancing."What's at stake is the increased chance of one of your loved ones becoming sick and then being hospitalized and dying," Walke said. "Around these holidays, we tend to get people together from multiple generations -- grandparents, parents, nieces and nephews all come together in this celebration."People who are older or who have chronic health problems are at increased risk of a potentially fatal hair loss treatment , health officials said.There's also the risk of further spread if a person travels to a big family gathering, becomes infected, and then returns to their own community to pass the proscar along there, Walke said.The CDC asks that before people travel to a Thanksgiving gathering, they consider:Whether someone at the gathering is at increased risk from hair loss treatment.If hair loss treatment is spiking in either their own community or their destination.Whether hospitals are becoming overwhelmed by hair loss treatment cases.If restrictions for travelers are in place, either in their state or the locale they plan to visit.Whether during the 14 days before travel, either you or those you are visiting have had close contact with people outside your households.Whether travel plans involve cramped conditions in a bus, train or airplane.CDC officials are even concerned about s occurring at transportation hubs like bus stations or airports, Walke said."When people are in lines or waiting to get on the bus or the plane, people tend to crowd together and can't maintain their distance," he said. SLIDESHOW Stress-Free Holiday Travel Tips See Slideshow "If the answer to any of these questions is 'yes,' you should consider making other plans, such as hosting a virtual gathering or delaying your travel," the CDC guidance says. "It's important to talk with the people you live with and your family and friends about the risks of traveling."If attending or hosting a gathering that includes people not in your household, the CDC recommends that you:Bring your own food, drinks, plates, cups and utensils.Wear a mask, removing it only to eat or drink.Limit the number of people in food-preparation areas.Have a small outdoor meal with a limited number of guests.Have one person serve the food if a meal is being shared, using disposable items like paper plates and plastic utensils.In their open letter, the medical associations acknowledged that people have grown weary with proscar-related restrictions and urged Americans to celebrate responsibly."Given the serious risks, we underscore how important it is to wear masks, maintain physical distancing and wash your hands," the letter said.

"Following these science-based, common-sense measures is the best way to prevent our health care systems and dedicated health care professionals from being overwhelmed by critically ill patients."More informationThe U.S. Centers for Disease Control and Prevention has tips for celebrating Thanksgiving during the proscar.SOURCES. Henry Walke, MD, MPH, hair loss treatment Incident Manager, U.S. Centers for Disease Control and Prevention. Erin Sauber-Schatz, PhD, MPH, lead, CDC Community Intervention and Critical Population Task Force.

Open letter signed by the American Medical Association, American Hospital Association, American Nurses AssociationCopyright © 2020 HealthDay. All rights reserved..

Latest Pregnancy News By how to get proscar instead of propecia browse around this website Steven Reinberg HealthDay ReporterTHURSDAY, Nov. 19, 2020 (HealthDay News)Pregnant women with hair loss treatment have little risk of developing severe symptoms, as do their newborns, a new study finds.In fact, 95% of these women have good outcomes, and how to get proscar instead of propecia just 3% of their babies test positive for hair loss treatment, researchers say."For 5% of hair loss treatment-positive pregnant women, however -- those who get very sick -- the risks to both mother and baby are significant," said study lead author Dr. Emily Adhikari, medical director of perinatal infectious diseases at Parkland Hospital in Dallas.Pregnancy itself, however, does not appear to increase the odds for hair loss treatment complications, she said."Most women with asymptomatic or mild will be relieved to know that their babies are unlikely to be affected by the proscar," Adhikari said."When studying all pregnant women with hair loss treatment , both those needing and not needing hospitalization, we are able to identify that the risks to the mothers are similar to those of the general population," she added.At the start of the proscar, the U.S. Centers for Disease Control and Prevention thought the risk how to get proscar instead of propecia for pregnant women was greater than for others.

But the new findings should reassure pregnant women that their risk is in line with other groups, researchers said."The initial reports from the CDC were very frightening, but it may not be as bad as it seemed to be initially," said Dr. Jennifer Wu, an ob-gyn how to get proscar instead of propecia at Lenox Hill Hospital in New York City. She was not part of the study, but reviewed the findings.But more data is needed to know the risk to mother and baby of hair loss transmission, Wu said how to get proscar instead of propecia. Babies of infected mothers should be tested for hair loss treatment, she added.For the study, Adhikari and her colleagues followed nearly 3,400 expectant women, 252 of whom had hair loss treatment.Among those who tested positive, 95% had no or mild symptoms.

Six women, however, developed severe or critical hair loss treatment pneumonia.Comparing women with and without hair loss treatment during pregnancy, researchers found it did not increase the risk of adverse outcomes — including preterm birth, preeclampsia, or cesarean delivery for abnormal fetal heart rate, Adhikari said.Preterm birth how to get proscar instead of propecia was higher among women who had severe or critical illness, but it's hard to predict which patients will. Researchers said diabetes may boost the odds."Of the 252 infected women, the rate of hospitalization for hair loss treatment was 6%, which is similar to the rate in the general population and lower than previous reports," Adhikari said. "Earlier studies had suggested that almost 20% of pregnant women with hair loss treatment might require hospitalization."The study found that being pregnant does not appear to increase the risk of severe illness for the majority of women, she added.Even so, Wu said pregnant women -- like everyone else how to get proscar instead of propecia -- should wear masks and practice social distancing to minimize the odds of getting the proscar."We do think that pregnant women have more risks with hair loss treatment s, so all precautions should be taken to avoid getting infected," Wu said.The findings were published online Nov. 19 in the journal JAMA Network Open.More informationFor more on how to get proscar instead of propecia hair loss treatment, visit the U.S.

Centers for Disease Control and Prevention.SOURCES. Emily Adhikari, MD, medical director, perinatal infectious diseases, Parkland Hospital, how to get proscar instead of propecia Dallas, and assistant professor, obstetrics and gynecology, UT Southwestern Medical Center, Dallas. Jennifer Wu, MD, obstetrician-gynecologist, Lenox Hill Hospital, New York City. JAMA Network how to get proscar instead of propecia Open, online, Nov.

19, 2020Copyright © 2020 how to get proscar instead of propecia HealthDay. All rights reserved. SLIDESHOW Conception how to get proscar instead of propecia. The Amazing Journey from Egg to Embryo See SlideshowLatest High Blood Pressure News THURSDAY, Nov.

19, 2020 (American Heart Association News)Jessica Grib noticed being a lot more tired with her how to get proscar instead of propecia second pregnancy. She felt winded how to get proscar instead of propecia easily and couldn't catch her breath when lying down. Near her delivery date, she started having issues with high blood pressure. At 36 weeks, her blood pressure remained high enough – even with medicine – that doctors how to get proscar instead of propecia ordered her on bed rest.Her daughter, Amelia, was born a week later.

It almost cost Jessica her life.Because Amelia was breech, not in the head-down position, doctors ordered a caesarean section. Everything was OK until Jessica reached the recovery room."Her oxygen levels plummeted, and her heart rate was all how to get proscar instead of propecia over the place. They couldn't stabilize how to get proscar instead of propecia it," said her husband, Kevin. "That's really the first indication that something was really going wrong."Jessica was taken to intensive care and "essentially the bat signal went out to all the cardiologists in the building" to get to the ICU, Kevin said.

Eventually, doctors sent Jessica to the cardiac catheterization lab so they could get a good look at how to get proscar instead of propecia her heart.Along the way, Jessica stopped breathing. It took six people and 10 minutes to resuscitate her.Doctors determined her heart's blood flow could not meet the demand of her body's organs for oxygen. The condition is called peripartum cardiomyopathy, an uncommon form of heart failure that happens during the last month of pregnancy or up to five months how to get proscar instead of propecia after giving birth. Doctors put Jessica on a ventilator and implanted a device in her heart to keep her how to get proscar instead of propecia blood pumping.

She was stabilized and transferred to another hospital with specialized equipment to keep her alive.The doctor told Kevin that basically Jessica's heart had to start working on its own within two weeks."He really laid out that this was going to be an incredible uphill battle, and even if we got her back, there was a small chance we would get her back in a fully functioning state," Kevin said.Lots of people showed up at the hospital to make sure they could see Jessica, who was 30 at the time.After a couple of days, family members noticed an occasional blip on her heart monitor. Eventually, the how to get proscar instead of propecia blips turned into more regular beating."My heart was recovering itself, which is pretty amazing," Jessica said.Doctors were able to wean Jessica from the life support machine after about five days, but her vital signs were still troubling. Jessica's blood pressure was still high, and her heart rate was all over the place. After about two weeks, her vital signs stabilized and she awoke from the heavy sedation to how to get proscar instead of propecia be reunited with Amelia and her toddler, Noah.Jessica pushed herself in physical and occupational therapy.

It paid how to get proscar instead of propecia off. Three weeks after the roller-coaster journey began, Jessica went back to her home in St. Louis.Recovery took how to get proscar instead of propecia time. At first, she couldn't walk long distances or hold Amelia's pacifier because of difficulty with fine motor skills.

On top of that, she had excruciating headaches how to get proscar instead of propecia. Jessica wasn't sure what her life was going to be like.During a post-op hospital how to get proscar instead of propecia visit, Jessica bumped into her cardiologist. The doctor was puzzled why Jessica wasn't getting better and suggested testing her for a rare tumor.Sure enough, a tumor was found next to her adrenal gland. While scary, the doctor assured her this how to get proscar instead of propecia could be the answer to everything.

Removing it could get her life back."It was extremely dangerous, high-risk, because the tumor secreted all this adrenaline into my body and made my heart stop the first time," Jessica said.The surgery was a success. Six weeks later, Jessica's life indeed returned to normal.Since then, she has worked to spread awareness how to get proscar instead of propecia about peripartum cardiomyopathy. The signs are often dismissed how to get proscar instead of propecia as ordinary pregnancy or postpartum symptoms. They include fatigue, a rapid heartbeat or palpitations, increased nighttime urination, shortness of breath with activity and when lying flat, swelling of the ankles, swollen neck veins, and low blood pressure or blood pressure that drops when standing.

SLIDESHOW Conception how to get proscar instead of propecia. The Amazing Journey from Egg to Embryo See Slideshow "I had a baby in America in a hospital in 2016, so I had no idea that I would have been fighting for my life," said Jessica, who was otherwise healthy and exercised into her third trimester. "I had never heard of this before with either of my pregnancies."American Heart Association News covers how to get proscar instead of propecia heart and brain health. Not all views expressed how to get proscar instead of propecia in this story reflect the official position of the American Heart Association.

Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email [email how to get proscar instead of propecia protected]By Stefani KopenecAmerican Heart Association NewsCopyright © 2020 HealthDay. All rights reserved. From Women's Health Resources Featured Centers Health Solutions From Our SponsorsLatest Nutrition, Food how to get proscar instead of propecia &.

Recipes News THURSDAY, Nov how to get proscar instead of propecia. 19, 2020 (American Heart Association News)The football teams taking the field on Thanksgiving will bring shrewd strategies and meticulous game plans to make sure they finish the day healthy and successful.As we tackle one of the year's biggest feasts, should we do the same?. On the one hand, it's just one day."If you spend the majority of your time eating well and exercising, my general opinion on Thanksgiving is give yourself a break," said Krista Varady, professor of nutrition at how to get proscar instead of propecia the University of Illinois, Chicago. "Don't be crazy, but everybody deserves a day off."On the other hand, Thanksgiving kicks off the holiday eating season, which can have significant ramifications on body weight – and health – for the entire year."Between Thanksgiving and January 1, it's not uncommon to see a 10-pound weight gain if an individual is not careful," said registered dietitian Linda Van Horn, a professor of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

"We need to recognize the risks and be thoughtful."The Calorie Control Council, a food and beverage how to get proscar instead of propecia industry group, calculates one Thanksgiving meal can total 4,500 calories. That's more than twice the recommended number of 1,600 to 2,400 calories per day for a woman.A 2016 study in the New England Journal of Medicine reported that the average American gains 1.3 pounds during the holiday season, while a 2000 study in Nutrition Reviews concluded that what's packed on during the holidays accounts for half of weight gain for the year."Even if the average weight gain is only a kilogram (2.2 pounds) each year, over a lifetime it adds up," said how to get proscar instead of propecia Surabhi Bhutani, assistant professor in the School of Exercise and Nutritional Sciences at San Diego State University, who studies holiday eating habits.This year may not be typical, as the hair loss proscar disrupts the usual stream of holiday gatherings and office parties. But the lessons for curbing the dietary impact of Thanksgiving dinner remain the same. Here are some how to get proscar instead of propecia tips:Prepare.

"In the weeks leading up to the holidays, be a bit more vigilant about your food intake," Varady said. "Maybe lose a couple pounds so how to get proscar instead of propecia you'll wind up with a net zero after the holidays."Tweak recipes. "You can treat yourself to special foods but also have how to get proscar instead of propecia control over how they're made," Van Horn said. Search the internet for a healthier version of a favorite recipe or a substitute for an unhealthy ingredient.There's no quick fix for overeating.

You can't how to get proscar instead of propecia exercise your way out of gorging at the holiday table, Varady said. "Exercise is great, but it's really more about eating less food. It's calories in, calories how to get proscar instead of propecia out."Don't come hungry. Have a healthy breakfast how to get proscar instead of propecia or lunch, Bhutani said.

"Some people try to avoid weight gain by eating very little before the big feast or a party, but that ends up backfiring because they're so hungry they're not able to control themselves."It's not just about eating. Alcohol has calories too, Van Horn said how to get proscar instead of propecia. "And the more you drink, the less you care – not just about the alcohol but the rest of the meal as well."Pace yourself. "It takes time for the brain to realize you're how to get proscar instead of propecia getting full," Bhutani said.

"Eating slowly and waiting a few minutes before you how to get proscar instead of propecia go for seconds or thirds can be very helpful."Beware of leftovers. The holiday table may be full of the most calorically dense foods people eat all year, Van Horn said. "If there's more left over, you may be the one suffering how to get proscar instead of propecia the consequences. Sooner or later, those pumpkin pies do get eaten."As sound as the advice may be, Bhutani said, the culinary temptations this time of year are hard to resist."Holiday season can be the time when people just let go," she said.

"When there are so how to get proscar instead of propecia many food cues and so much exposure to high-caloric foods, it's very difficult unless people are really determined and given some support. But we have to try."American Heart Association News covers heart and brain how to get proscar instead of propecia health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held how to get proscar instead of propecia by the American Heart Association, Inc., and all rights are reserved.

If you have questions or comments about this story, please email [email protected]By Michael PreckerAmerican Heart Association NewsCopyright © 2020 HealthDay. All rights reserved how to get proscar instead of propecia. SLIDESHOW Stress-Free Holiday Travel Tips See SlideshowLatest Arthritis News By Amy Norton how to get proscar instead of propecia HealthDay ReporterTHURSDAY, Nov. 19, 2020 (HealthDay News)A procedure that "stuns" pain-sensing nerves might offer relief to people with severe arthritis of the hip or shoulder, a small, preliminary study suggests.The procedure is a form of radiofrequency ablation, where doctors use needles to send a low-grade electrical current to nerves that are transmitting pain signals from the arthritic joint to the brain.

The current heats and damages the nerve fibers, rendering them unable to deliver those pain messages.In the United States, a number of ablation devices are cleared for treating low back pain and knee osteoarthritis.At this point, the procedure is slowly becoming a more established treatment, said how to get proscar instead of propecia Dr. Felix Gonzalez, a radiologist at Emory University School of Medicine in Atlanta.But whether ablation can help patients with severe hip or shoulder arthritis is unclear.To find out, Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections -- two standard treatments -- were no longer helping.Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%.Gonzalez called the results "promising" and said, in how to get proscar instead of propecia his experience, there have been no major complications from the procedure, such as bleeding or s -- though those are potential risks.And before the ablation is done, Gonzalez explained, patients go through what is basically a trial run. They are given an injection of numbing medication near the nerves believed how to get proscar instead of propecia to be generating the pain signals.

If the pain abates, that means targeting the same nerves with ablation will likely work, too -- longer term.It's too soon, however, to judge the effectiveness of the approach for shoulder and hip pain, according to Dr. Rajat Bhatt, a rheumatologist who was not involved in the study.None of the how to get proscar instead of propecia study patients received a placebo (inactive treatment) to serve as a comparison, said Bhatt, of Prime Rheumatology in Katy, Texas. So it's possible at least some of the pain relief came from the fact that patients received a novel therapy."With pain, there's generally a large placebo effect," Bhatt pointed out.Larger studies, with a comparison group, are still needed, he said.Gonzalez is scheduled to present the findings at the annual meeting of the Radiological Society of North America, being held online Nov. 29 to how to get proscar instead of propecia Dec.

5. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention.The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion.People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks.

Prolonged use is linked to increased risks of heart disease and kidney damage.Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time, Bhatt said, and there are long-term safety issues, including a risk of cartilage damage. SLIDESHOW What Is Rheumatoid Arthritis (RA)?. Symptoms, Treatment, Diagnosis See Slideshow Beyond that, Gonzalez said, there are essentially two options for more severe pain.

Joint replacement surgery or opioid painkillers."But not everyone is a candidate for surgery, because of health reasons," Gonzalez said. "And some patients don't want it."Opioids, meanwhile, carry their own well-documented problems, including the potential for addiction."So we need something to fill the gap," Gonzalez said.Ablation stands as an additional therapy, he said, but it's not a "cure." For one, it addresses pain -- not the underlying joint damage of arthritis. And the pain is not banished forever. The nerve fibers eventually grow back.When ablation is used for knee osteoarthritis, Gonzalez said, the pain relief typically lasts 6 months or more -- and up to two years in some patients.

The procedure can be repeated.In this early study, patients were only followed for three months. So it's not clear how long the pain relief will last, Gonzalez said.And while ablation is coming into wider use for certain pain conditions, people may not be able to find it locally. Gonzalez said some of his patients come from hours away to get the treatment.More informationThe Arthritis Foundation has more on osteoarthritis.SOURCES. Felix Gonzalez, MD, assistant professor, department of radiology and imaging sciences, Emory University School of Medicine, Atlanta.

Rajat Bhatt, MD, Prime Rheumatology, Katy, Texas. Presentation, Radiological Society of North America virtual annual meeting, Nov. 29 to Dec. 5, 2020Copyright © 2020 HealthDay.

All rights reserved. From Arthritis Resources Featured Centers Health Solutions From Our SponsorsLatest Prevention &. Wellness News By Dennis Thompson HealthDay ReporterTHURSDAY, Nov. 19, 2020 (HealthDay News)Americans should stay home and avoid big Thanksgiving gatherings, leading public health agencies and medical societies warn as hair loss treatment surges and proscar deaths in the United States pass 250,000.At a press conference held Thursday, officials at the U.S.

Centers for Disease Control and Prevention advised people to limit celebrations to only those who've been living in the household for the previous two weeks.Groups representing the nation's doctors, nurses and hospitals also issued a joint recommendation to curb travel and mingling this holiday season."With Thanksgiving approaching, our hearts and minds turn to seeing family and friends, as part of one of our nation's great traditions, and we all need to consider the safest way to celebrate this holiday," said Dr. Henry Walke, the CDC's hair loss treatment incident manager. "Amidst this critical phase of the hair loss treatment proscar, CDC is recommending against travel during the Thanksgiving period."The CDC took this step based on the "exponential increase" in hair loss treatment cases, hospitalizations and deaths that has occurred this month, said Walke and Erin Sauber-Schatz, lead for the CDC's Community Intervention and Critical Population Task Force."The reason we made the update is the fact that over the last week, we've seen over a million new cases in the country," Sauber-Schatz said.Over 250,000 Americans have now died from hair loss treatment.Three of the nation's leading medical societies lent their voices to the same message Thursday in an open letter asking Americans to pare down their holiday plans."We -- the physicians, nurses, hospital and health system leaders and public health professionals on the front lines of this proscar -- strongly urge everyone throughout our country to celebrate responsibly, in a scaled-back fashion that limits the proscar's spread, to help reduce the risk of infecting friends, family and others you love," reads the letter co-signed by the American Medical Association, American Hospital Association and American Nurses Association.The letter noted that throughout the proscar, hair loss treatment spread has followed a similar pattern around holidays and mass gatherings."Positive cases spiked after Memorial Day, after the Fourth of July, after Labor Day, and now two weeks after Halloween," the letter said. "The record-shattering surge underway is resulting in uncontrolled community spread and that has already overburdened health systems in some areas and will ultimately consume capacity of our health care system and may reduce the availability of care in many places in our country."Aside from the strong recommendation against travel and gatherings, the CDC's updated guidance also provided clarification about who should be considered part of a household for control purposes."We received lots of questions from Americans about college students or people coming home for the holidays," Sauber-Schatz said.

"The safest way to celebrate Thanksgiving this year is at home with the people in your household. If people have not been actively living with you for the 14 days before you're celebrating, they are not considered a member of your household."If college students do go home for Thanksgiving, everyone in the household should wear a mask and stringently follow control measures, Walke said. These include sustaining good ventilation throughout the house, practicing hand hygiene and maintaining social distancing."What's at stake is the increased chance of one of your loved ones becoming sick and then being hospitalized and dying," Walke said. "Around these holidays, we tend to get people together from multiple generations -- grandparents, parents, nieces and nephews all come together in this celebration."People who are older or who have chronic health problems are at increased risk of a potentially fatal hair loss treatment , health officials said.There's also the risk of further spread if a person travels to a big family gathering, becomes infected, and then returns to their own community to pass the proscar along there, Walke said.The CDC asks that before people travel to a Thanksgiving gathering, they consider:Whether someone at the gathering is at increased risk from hair loss treatment.If hair loss treatment is spiking in either their own community or their destination.Whether hospitals are becoming overwhelmed by hair loss treatment cases.If restrictions for travelers are in place, either in their state or the locale they plan to visit.Whether during the 14 days before travel, either you or those you are visiting have had close contact with people outside your households.Whether travel plans involve cramped conditions in a bus, train or airplane.CDC officials are even concerned about s occurring at transportation hubs like bus stations or airports, Walke said."When people are in lines or waiting to get on the bus or the plane, people tend to crowd together and can't maintain their distance," he said.

SLIDESHOW Stress-Free Holiday Travel Tips See Slideshow "If the answer to any of these questions is 'yes,' you should consider making other plans, such as hosting a virtual gathering or delaying your travel," the CDC guidance says. "It's important to talk with the people you live with and your family and friends about the risks of traveling."If attending or hosting a gathering that includes people not in your household, the CDC recommends that you:Bring your own food, drinks, plates, cups and utensils.Wear a mask, removing it only to eat or drink.Limit the number of people in food-preparation areas.Have a small outdoor meal with a limited number of guests.Have one person serve the food if a meal is being shared, using disposable items like paper plates and plastic utensils.In their open letter, the medical associations acknowledged that people have grown weary with proscar-related restrictions and urged Americans to celebrate responsibly."Given the serious risks, we underscore how important it is to wear masks, maintain physical distancing and wash your hands," the letter said. "Following these science-based, common-sense measures is the best way to prevent our health care systems and dedicated health care professionals from being overwhelmed by critically ill patients."More informationThe U.S. Centers for Disease Control and Prevention has tips for celebrating Thanksgiving during the proscar.SOURCES.

Henry Walke, MD, MPH, hair loss treatment Incident Manager, U.S. Centers for Disease Control and Prevention. Erin Sauber-Schatz, PhD, MPH, lead, CDC Community Intervention and Critical Population Task Force. Open letter signed by the American Medical Association, American Hospital Association, American Nurses AssociationCopyright © 2020 HealthDay.