Staying healthy with preventive care

Transcription

1 Fall 2013 Staying healthy with preventive care (Good news: It s free!) The benefits of Priority Health Medicare Advantage plans Priority Health nurse case managers: Helping you get the care you need Choose your 2014 Medicare plan by Dec. 7 Learn more on page 6

2 Chat with a nurse case manager I like helping members understand their health conditions. And with phone calls and s, I can offer continued support and education to help them be their healthiest. Christine Adams, RN, BSN, CDE Nurse Case Manager Free help for all chronic conditions Priority Health has an in-house team of more than 70 nurses, doctors, pharmacists and certified case managers to make sure you get the care you need, especially when you have a chronic disease or condition like diabetes, asthma, heart failure or depression. Call Customer Service to learn more. Contact Customer Service Medicare members: days a week, 8 a.m. 8 p.m. TTY users should call: 711 We have free interpreter services to answer any questions you may have about your health or drug plan. No English? No hable inglés? Comunicarse a el y pedir un traductor. Q. My mother had diabetes, and now I ve been diagnosed with diabetes, too. I m getting overwhelmed with all the information, facts and numbers I need to know. Can Priority Health help? A. Yes, we can help. If you have diabetes, taking care of yourself can make a world of difference in how you feel. With our free diabetes case management program, a nurse case manager will help you manage your diabetes, set health goals and understand your coverage. To learn more about the program or to talk to a case manager, please call Customer Service. Remember, with diabetes, it s important to ask your doctor about: Checking for kidney disease. An annual urine test and blood test can help measure your kidney function and reduce your chances of kidney failure. Controlling cholesterol. A cholesterol blood test once a year allows you to monitor your progress. Aim for LDL cholesterol of less than 100 mg/dl. Monitoring your A1c. Check it at least every six months and try to keep your A1c level at less than 7%. Keeping blood pressure in check. The goal is to stay below 140/80. Getting a foot exam. Have your doctor do a foot exam at every visit. Search keyword: diabetes You can also send a secure anytime by visiting priorityhealth.com and clicking on Contact us, found in the upper right corner of the page. 2 Health Journal Fall 2013

3 Listening to you We ve established a new Member Advisory Council to help us improve the ways we interact with our members and create better experiences for you. The council, which includes Priority Health members from many walks of life, meets once a month to provide feedback and ideas to help us evaluate what we do well and how we can improve. The Member Advisory Council at their monthly meeting If you re interested in participating in the Member Advisory Council, please Cheryl Osentoski at cheryl.osentoski@priorityhealth.com or call Inside Medicare: We ve got you covered We ve added new and useful information online for people shopping for Medicare. Our "Inside Medicare" page has helpful articles like Medicare options at a glance and Signing up for Medicare Parts A and B. Find it at priorityhealth.com/blogs/inside-medicare Medicare Explained videos and more online It s easy to learn about your coverage options at prioritymedicare.com, where you ll find videos, quizzes, in-depth articles and the opportunity to enroll. Search keyword: Medicare explained priorityhealth.com/member 3

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5 Answers to your questions about Original Medicare Our members ask a lot of good questions and we have the answers. Does Original Medicare give me all the coverage I need? Original Medicare is the hospitalization (Part A) and medical services (Part B) coverage you can get through the federal government. It covers many health care services like preventive screenings and wellness exams, but there are some health care services it doesn t cover. For example, Original Medicare does not include prescription drug coverage, but you can get this coverage under a Medicare Part D plan. And with Original Medicare, you ll have to pay out of your own pocket for deductibles before Original Medicare covers hospitalization and medical services. You also pay a monthly Part B premium and some health care you need may not be covered. As you consider your options, you may want to think about a plan that combines your Medicare Parts A, B and D benefits and also offers additional health care benefits. Can I get a plan that covers more than Original Medicare? Yes, you can choose a Medicare Advantage (MA) or a Medicare Advantage with prescription drug coverage (MAPD) plan that will give you more coverage than you get with Original Medicare. Medicare Advantage plans, also known as Part C Medicare, are an alternative way for you to get your Medicare Parts A and B benefits. So, you get all your Original Medicare benefits with an MA or MAPD plan. Plus you get more, such as: Predictable copayments Comprehensive physicals Unlimited hospital days Prescription drug coverage (with MAPD) No deductibles Dental coverage Free gym memberships And you just use one Priority Health Medicare card each time you receive health care services or prescriptions. What s a supplement plan and can I add it to my Original Medicare? Yes, you can buy supplement plans to enhance your Original Medicare coverage. Priority Health offers Medigap (Medicare Supplement) plans that help cover costs like copayments, coinsurance and deductibles that Original Medicare doesn t cover. Medigap plans do not cover prescription drugs, but you can buy a separate plan for that coverage. Keep in mind that you can t enroll in a Medigap plan if you have a Medicare Advantage plan. priorityhealth.com/member 5

6 Choose your 2014 Priority Health Medicare plan by Dec. 7 DECEMBER Everywhere we go, Priority Health Medicare 1 members are quick to share how satisfied they are with their Medicare Advantage (MAPD) plans. But they wonder whether they can keep the same plan again next year. Good news! If you re happy with your current plan, you can have the same plan again. 2 For 2014, we have four MAPD plans: PriorityMedicare Value SM (HMO-POS), PriorityMedicare SM (HMO-POS), PriorityMedicare Merit SM (PPO) and PriorityMedicare Select SM (PPO). 3 All of our plans have: No deductibles when you receive care in our network Doctor visits and hospital coverage Emergency and urgent care coverage Coverage throughout the U.S. and around the world Prescription drug coverage without paying a deductible Fitness membership and home fitness kits* *Not currently available for employer-sponsored plans Three easy ways to learn more Looking for more information about our plans and your Medicare options? We can help. Call Priority Health or visit us online at prioritymedicare.com. Call (TTY users call 711) 7 days a week from 8 a.m. to 8 p.m. to talk with a Priority Health Medicare expert. Get face-to-face information. Priority Health offers free Medicare meetings where you can learn the basics about Medicare, compare benefits and more. Just call us or visit prioritymedicare.com to sign up for a meeting in your area. 4 Check out your local Medicare Medicaid Assistance Program (MMAP). This state program offers free, local health insurance counseling to people with Medicare. Call to be linked to a counselor in your community. 1 Priority Health has HMO-POS and PPO plans with a Medicare contract. 2 The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact us. Limitations, copayments and restrictions apply. Benefits, formulary, pharmacy network, premium and/or copayments and coinsurance may change on January 1 of each year. 3 You must continue to pay your Medicare Part B premium. 4 A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call (TTY users should call 711) 24 hours a day, seven days a week. 6 Health Journal Fall 2013

7 Medigap (Medicare Supplement) plans We offer four Medigap plans 5 A, D, F and N Our plans start at less than $100 a month 6. Helps keep your out-of-pocket costs lower than with just Original Medicare. Plans are offered statewide. See any doctor that participates with Medicare. There s coverage for doctor visits and hospital care. You must have Part A and Part B to purchase a Medigap plan. 5 Neither Priority Health Medigap plans nor agents authorized to sell Priority Health Medigap plans are connected with or endorsed by the United States government or the federal Medicare program. 6 Certain factors may affect your monthly premium cost: county of residence, age, gender, health status and use of tobacco products. Our Medicare Advantage plans have received the highest accreditation status of Excellent from the National Committee for Quality Assurance (NCQA). Medicare coverage throughout Michigan You can enroll in our Priority Health Medicare Advantage plans with prescription drug coverage if you live in one of the counties below. Plan availability varies by county. Medigap plans are available throughout all of Michigan. Alcona*, Allegan, Alpena*, Antrim, Arenac, Barry, Bay, Benzie, Berrien*, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron*, Ingham, Ionia, Iosco*, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer*, Leelanau, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency*, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda*, Otsego, Ottawa, Presque Isle*, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren*, Washtenaw, Wayne and Wexford *New for Note: Be sure to read your Annual Notice of Change thoroughly to learn about the changes to your plan for The Annual Notice of Change is a document that also includes the Evidence of Coverage that is delivered to our Medicare members before October 1. priorityhealth.com/member 7

8 Get healthy, stay healthy Your free medication review could save your life Have you ever wondered if you re taking too many types of medicine, if you re taking them properly or if they re working together? As a Priority Health Medicare member, you re eligible for a free, 30-minute medication review. Specially trained Medication Therapy Management (MTM) pharmacists will help you get the best results from your medication while keeping your out-of-pocket costs down. Your pharmacist will provide: Comprehensive medication review: Looks at all your medications to identify duplications and conflicts and organize your medication schedule. Doctor consult: Works with your doctor(s) to resolve any problems found with your medications. Priority Health Medicare members are eligible for free preventive services to stay healthy. This includes all Medicare preventive health screenings, including certain labs, a yearly physical, Medicare wellness exams and Medicare-covered immunizations. You ll find the details in your Evidence of Coverage. Search keyword: preventive Get your flu shot for free Be sure to show your Priority Health Medicare Advantage ID card (not your Original Medicare card) when you get your flu vaccine this fall. You won t pay a dime whether you get your flu vaccine at your doctor s office or a vaccine pharmacy. You ll find a complete list of vaccine pharmacies at priorityhealth.com. Search keyword: Medicare pharmacy Non-prescription consult: Helps you figure out which over-the-counter drugs to use to treat minor ailments easily and inexpensively. Drug information: Explains the purpose and correct use of new medications and follows up with you to make sure everything is right. To get your free medication review: Call your pharmacist and ask to schedule an appointment for a medication review Or contact Priority Health Customer Service to find pharmacies near you that offer medication reviews Search keyword: medication management To learn more about your prescription coverage and pharmacy management procedures, go to priorityhealth.com and search keyword prescriptions. 8 Health Journal Fall 2013

9 Stay up-to-date with colon cancer screenings Cancer of the colon and rectum often has few or no symptoms, yet it s one of the leading causes of cancer deaths in the United States. If found and removed early, however, the chances of full recovery are very good. If you have not been screened by any of the following, call your doctor today: A colonoscopy every 10 years, or every two years if you re at high risk (this is the best test doctors have for finding and removing colorectal polyps) An annual fecal occult blood test you can do at home and send back to your doctor A flexible sigmoidoscopy every four years or every 10 years after having a screening colonoscopy Search keyword: colorectal What our members are saying Nancy G. of Grand Rapids said: I was having severe back pain and needed surgery. I was sinking into a depression, and I don t think I could have hung on if I didn t have Priority Health. Priority Health connected me with a nurse case manager to meet my needs when I wasn t able to think clearly. They listened to me and even executed paperwork on my behalf. Most insurance companies are quick to criticize. Priority Health was quick to help with the personalized care I needed. Y0056_4000_4030_75 File and use

10 Protecting your privacy We re committed to protecting your privacy. Our Notice of Privacy Practices describes how your medical information may be used and disclosed and how you can get access to this information. A new federal regulation called the HIPAA Omnibus Final Rule was published earlier this year. It requires a few minor changes to the way we use and disclose your medical information. Our Notice of Privacy Practices is updated to include the changes. To get the notice online, visit priorityhealth.com and search keyword privacy. For a print copy, call Customer Service at Health Journal Fall 2013

11 Why choose a Priority Health Medicare Advantage plan? More individuals pick Priority Health Medicare Advantage plans over any other plan in Michigan.* And our plans were awarded 4.5 stars or 4 stars in 2013.** Stars for quality A plan can get ratings between one and five stars, as determined by the Centers for Medicare and Medicaid Services (CMS). = Excellent = Above average = Average = Below average = Poor Less money out of your pocket See any doctor in our network without paying a deductible Fill your prescriptions without paying a deductible Get dental and hearing coverage Coverage in the United States and around the world Fewer hassles and more benefits Excellent customer service available 7 days a week Care management to help you feel your best Fitness membership and wellness tools (not currently available for employersponsored plans) *According to January August 2013 monthly enrollment reports from the Centers for Medicare and Medicaid Services. ** Medicare evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next. PriorityMedicare Value SM (HMO-POS) and PriorityMedicare SM (HMO-POS) plans were awarded 4.5 stars (out of 5) by the Centers for Medicare and Medicaid Services in their 2013 Medicare plan ratings. PriorityMedicare Select SM (PPO) plan was awarded 4 stars (out of 5). PriorityMedicare Merit SM (PPO) is new in 2013 so is not yet rated. priorityhealth.com/member 11

12 Spread the word! We have affordable health plans for every stage of life. You already know more individuals choose our Medicare Advantage plan over any other plan in Michigan.* But did you know our MyPriority SM health insurance for individual buyers is the fastest-growing individual plan in the state? Even better, we were selected by Michigan as the "benchmark" plan all other carriers must model their individual health insurance on. So, if you know someone who buys their own health insurance, spread the word that Priority Health has them covered! Just like with Medicare, individual buyers now have an annual Open Enrollment Period. Starting Oct. 1, anyone who needs individual insurance will be able to conveniently shop for our plans on our new, easy-to-use website. If their income is low enough to qualify for federal assistance, they can shop for one of our plans on the federal Health Insurance Marketplace. MyPriority SM is a Qualified Health Plan in the Health Insurance Marketplace. *According to January August 2013 monthly enrollment reports from the Centers for Medicare and Medicaid Services. 12 Health Journal Fall 2013

13 Do you have uninsured family or friends who think they can't afford to buy their own health insurance? Here s a good example of why they can t afford NOT to: The typical emergency room visit now costs more than an average month s rent*. We offer: Traditional HMO and PPO plans that are comprehensive and affordable High deductible plans that work with a health saving account (HSA) Temporary coverage Special coverage for people under 30 To learn more: Call us toll-free at 855.MyPriority ( ) Visit mypriority.com for a free instant quote Contact a Priority Health licensed agent Global emergency travel assistance with every plan Discounts at local businesses Did you know? The cost of the average American hospital stay was $33,079 in 2010*. You can't afford to go without coverage. *Source: FacetheFactsUSA.org (a project of The George Washington University) *Source: 2013 journal article in Public Library of Science (PLOS) priorityhealth.com/member 13

14 2013 Senior Impact Awards top ten Priority Health will honor four senior volunteers with its Senior Impact Award this year. The annual program recognizes volunteers 63 years and older who devote their time and energy toward improving their communities. The winners' organizations each receive a $1,000 donation. Get information via We re working hard to give you more ways to receive information from us. By having your address on file, you can be the first to know when you re able to sign up to get information, like this Health Journal, via . To provide your address, just log in to your account at priorityhealth.com and at the top of the page click My Profile. This year's winners were selected from nearly 100 nominees. To see who won, visit priorityhealth.com and search keyword senior impact. This year's top ten finalists were: Dan Eagles, Habitat for Humanity of Montcalm County Judy Kinkle, Hospital Hospitality House of Saginaw Luella Jahsan, St. Vincent and Sara Fisher Center Warren Jackson, VFW - Dr. George Washington Carver Post 3791 Celeste Lombardo, Catholic Service of Macomb George Morency, Ronald McDonald House of Western Michigan Dr. James O'Conner, DD, St. Luke's Clinic Judy Peterson, American Red Cross Millie Pike, VA Medical Center Dr. Patricia Quattrin, Benton Harbor Girls Association Stop getting duplicate documents Is there more than one person in your household with the same Priority Health Medicare plan? If so, you can help save paper by requesting that we only mail one copy of identical materials, like your Evidence of Coverage, to your home. To receive only one copy, call Customer Service at We need the other member in your home to agree to this, so make sure they can talk to us when you call. If you ever need extra copies of your documents, or if you change your mind and want to get two copies mailed to your home, you can always contact Customer Service. 14 Health Journal Fall 2013

15 Save big with member discounts As a Priority Health member, you can get big discounts on products and services throughout Michigan and across the country. From health clubs and fitness gear to sporting goods and even computers, Priority Health member discounts save you money wherever you work, play or travel. Just show your Priority Health ID card to get the discounts. For a list of all the member discounts and special deals, visit priorityhealth.com and search keywords: member discounts. Up to $65 off initiation fee. Memberships from $34 per month. Membership is free for our Medicare members with Silver&Fit. Coupon is subject to the participation of the vendor. 10% off monthly dues and 50% off new standard enrollment. Membership is free for our Medicare members with Silver&Fit. Coupon is subject to the participation of the vendor. 10% off non-sale items. Coupon is subject to the participation of the vendor. 10% off most non-sale sporting goods. Coupon is subject to the participation of the vendor. Up to 30% of list prices for select configurations in addition to any web discounts or special promotions. Coupon is subject to the participation of the vendor. 10% off all footwear. Not to be combined with other coupons or discounts. Coupon is subject to the participation of the vendor. priorityhealth.com/member 15

16 1231 East Beltline Ave. NE Grand Rapids, MI Get the latest news, tips and information. Just like us on Facebook or on Twitter. Health or wellness or prevention information HealthJournal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI All rights reserved. HealthJournal and its graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material. HealthJournal is an information newsletter for the customers of Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician. Always consult your physician for individualized care. If you have any questions, please call the number on your identification card. Priority Health encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage. Upgraded ID card app We've updated our mobile ID card for iphone and Android smartphones. Now you can use your smartphone to: See copayment information Fax your ID card to your doctor's office Find your doctor's contact information, office hours and location map Contact Customer Service with the touch of a button See your plan balances (deductible and out-of-pocket) See both of your Priority Health ID cards if you have dual coverage Getting started is easy. Just download the app from the iphone app store or Google Play. Search keyword: mobile Y0056_4000_4009_30 CMS-approved Priority Health priorityhealth.com 7680B 08/13