Advantage. The. Looking Forward to a Healthy Autumn! M a r t i n s P o i n t G e n e r at i o n s A d v a n ta g e. What s Inside?

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1 The Advantage ISSUE A NEWSLETTER FOR MEMBERS OF M a r t i n s P o i n t G e n e r at i o n s A d v a n ta g e Looking Forward to a Healthy Autumn! Dear Neighbors, As autumn approaches, it s a good time to make a plan to take full advantage of your health plan s preventive care benefits to ensure your best health. An ounce of prevention Inside you ll find reminders to get your free flu vaccine (it s not too early!) and breast cancer screenings. There s also information about a local program that promotes good balance to prevent falls. And, if you haven t already done so, it s time to make appointments with your PCP for your $0 Medicare Wellness Visit and Annual Physical Exam. To learn more, go to medicare.martinspoint.org/member-toolkit. An Rx for your best health Along with good preventive care, it s important to follow your doctor s orders for taking your prescription drugs. Inside, you ll find helpful articles about statin medications, the importance of taking the right medications after a hospital stay, and support if you take medications for several chronic conditions. Staying active throughout the year With cooler weather ahead, this may be a great time to buy indoor exercise equipment or become a member at your local gym. Look inside for a fact-filled FAQ about your Wellness Wallet benefit that can help cover those costs. Looking for a new doctor? Get your care AND coverage from Martin s Point! Martin s Point Health Care Centers are accepting new patients at all locations. Learn more at MartinsPoint.org/Locations What s Inside? PCP Visits after Hospital Stays A Matter of Balance Program Wellness Wallet FAQs Time for Your Flu Shot Medication Therapy Management Out-of-Country Coverage Tips Busting Statin Myths NEW Online EOCs for 2019 As always, if you have questions about information in this newsletter or your plan benefits, don t hesitate to call our Member Services team. We re here for you! Thank you for choosing Martin s Point Health Care and best wishes for a healthy and happy autumn! Dan Hounchell Vice President, Health Plan Products Martin s Point Health Care Y0044_2018_328 Accepted: 8/31/2018

2 Make Sure to See Your PCP Soon After a Hospital Stay A hospital stay is a major event in a person s life. The first month after coming home can be hard physically, mentally, and emotionally. Studies show that almost half of discharged patients will have at least one issue that will lead to a readmission within that first month. It is very important to see your primary care provider (PCP) within 2 7 days of any hospital discharge. This important follow-up care can lower your risk of a hospital readmission. Be sure to bring ALL your medications with you to this PCP visit. At this follow-up visit, your doctor will check to see if you are healing well. They will also make sure of the following: You understand what warning signs to look for Your medications are correct You understand what your medications are for and how to take them You have all the resources you need to remain out of the hospital In addition, if you have any questions once you get home, you can call the toll-free Generations Advantage Nurse Line. They are available 24 hours a day, every day, at Generations Advantage Contact Information Member Services (for current members) (TTY: 711) We are available 8 am 8 pm, seven days a week from October 1 to March 31; and Monday through Friday the rest of the year. Interested in becoming a member? Please call (TTY: 711) Generations Advantage Website MartinsPoint.org/Medicare 2 Martin s Point Generations Advantage is a health plan with a Medicare contract offering HMO, HMO- POS, HMO SNP, and PPO products. Enrollment in a Martin s Point Generations Advantage plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, copayments, and coinsurance may change on January 1 of each year. Material presented in this newsletter is not intended to replace your health care provider s medical advice. If any information in The Advantage newsletter conflicts with provisions of your health plan s Evidence of Coverage (your contract), the provisions of your contract prevail. Martin s Point Health Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: Si vous parlez français, des services d aide linguistique vous sont proposés gratuitement. Appelez le (ATS :711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711).

3 Chair yoga classes at the Martin s Point Scarborough Community Center have become very popular. This fall the Community Center will host A Matter of Balance in partnership with Southern Maine Agency on Aging. A Matter of Balance A program to help you stay on your feet! A Matter of Balance is an awardwinning, nationally recognized program designed by researchers at Boston University to reduce the fear of falling and encourage physical activity. The eight-week workshop combines classroom instruction with exercises to do at home. It is designed to improve balance and confidence and can help you: View falls and fear of falling as controllable Set realistic goals for increasing activity Change your environment to reduce fall risk factors Promote exercise to increase strength and balance A Matter of Balance Program Offered in Maine and New Hampshire! Several Area Agencies on Aging are conducting the A Matter of Balance workshop this fall. The Martin s Point Community Center in Scarborough is hosting Southern Maine Agency on Aging s A Matter of Balance, provided through MaineHealth s Partnership for Healthy Aging. For more information on A Matter of Balance, contact Southern Maine Agency on Aging or your local Area Agency on Aging. Area Agencies on Aging Southern Maine Agency on Aging 136 US Route One, Scarborough, ME or Aroostook Area Agency on Aging One Edgemont Dr., Suite 2, Presque Isle, ME or Eastern Area Agency on Aging 450 Essex St., Bangor, ME or SeniorsPlus 8 Falcon Rd., Lewiston, ME or Spectrum Generations One Weston Court, Suite 109 Augusta, ME ServiceLink of Strafford County 25 Old Dover Rd., Rochester, NH ServiceLink of Hillsborough County (Manchester Region) 555 Auburn St., Manchester, NH (Nashua Region) 70 Temple St., Nashua, NH

4 4 THE ADVANTAGE MEMBER NEWSLETTER ISSUE

5 Wellness Wallet FAQs To help you stay healthy and active, every Generations Advantage plan offers Wellness Wallet a benefit that reimburses your costs for qualifying fitness/wellness goods and services. Below are answers to some frequently asked questions to guide you in using your Wellness Wallet benefit. Q: How do I get reimbursed for covered services under the Wellness Wallet benefit? A: Send a completed Wellness Wallet Reimbursement form, itemized receipt, and proof of payment to the following address: Martin s Point Generations Advantage Claims Department PO Box Portland, ME Q. How do I get a reimbursement form? A. You can download a reimbursement form by selecting the Member Resources tab on our website at Medicare.MartinsPoint.org. You can also call Member Services to ask to have a reimbursement form mailed to you. Q: How long will it take for me to receive my reimbursement check? A: If additional information is not needed, you should receive payment within 4 to 6 weeks. Q: When is the deadline to submit my reimbursement request for services I receive in 2018? A: To be eligible for payment, you must submit your claim by March 1, Note: The date of service or purchase must be in Q: Where can I purchase fitness equipment? A: You can purchase equipment from any licensed retail establishment. We will not approve reimbursement for fitness equipment that has been purchased from a nonretail source (example: yard sale or Craigslist). For your safety we want to ensure there is no risk of injury from noncertified equipment. If members want to save on costs or prefer to purchase second-hand equipment, there are a number of retailers such as Play-it-Again Sports (Portland) that offer used equipment that has been checked for proper function and safety. Q: Is my sports club membership (tennis, golf, squash, etc.) eligible for reimbursement? A: No, sports club memberships are not eligible for reimbursement. While sports clubs do keep members physically active and engaged in their communities, Medicare guidelines do not allow reimbursement because they fall under the recreation category. Q: Will the Wellness Wallet cover Silver Sneakers reimbursement? A: Wellness Wallet does not reimburse for Silver Sneakers costs. Wellness Wallet is a fitness reimbursement program offered by Generations Advantage. Silver Sneakers is a national fitness network program offered by businesses and health plans and is not available to individuals through Generations Advantage plans. Q: Will any nutritional/dietary program be eligible for reimbursement? (Focus DC plan only) A: Any individual or group education and counseling is eligible for reimbursement, as long as the services are provided by licensed or certified practitioners furnishing services within the scope of their license or certificate. Q: Will the Wellness Wallet cover NutriSystem or other meal programs? (Focus DC plan only) A: Per Medicare guidelines, only weight management programs that include weekly structured lessons with regular feedback and monitoring tailored to individual goals qualify. We cannot cover any food for reimbursement. If you are not sure if your expense is eligible for reimbursement, please call Martin s Point Generations Advantage Member Services at

6 It s Time for Your Flu Shot Your Generations Advantage plan has you covered this flu season. Members have two ways to get a yearly flu shot at no cost: 1. Vaccine Pharmacy Network Show your Generations Advantage member ID card at one of these participating pharmacies and you won t have to pay for the shot: Hannaford Pharmacies CVS (including former Target pharmacies) Walgreens/Rite Aid Shaw s/osco Walmart Other pharmacies also participate in the network, including several independent pharmacies. If you do not see your pharmacy listed above, please call Member Services. If your pharmacist has any trouble submitting your claim, he or she should call our Medicare Part D Pharmacy Help Desk at Primary Care Provider Office Visit If you get your yearly flu vaccine at your doctor s office, you may be charged for the office visit, but you will not be charged for the vaccine itself. IMPORTANT NOTE FOR Value Plan Members! Your flu shot benefit works differently. If you go to your doctor s office there is no cost for the vaccine, but you may be charged for the office visit. If you go to ANY pharmacy, you ll have to pay for the vaccine up front and submit a reimbursement form to us. Forms are available on our website or by calling Member Services. 6

7 Why Fight the Flu? The flu is caused by viruses that can spread from person to person. It can make some people very sick, causing hospitalization and even death. Most people who end up in the hospital due to flu are 65 years old or older. It is especially important for older people to get a flu shot each year because they are at a higher risk for serious complications from flu, including pneumonia. Flu can also worsen conditions like congestive heart failure, asthma, COPD, or diabetes. Getting a flu shot each year is the best way to prevent the flu. It can take two weeks to develop immune protection after your flu shot, so getting it in early fall is best. Be sure to get your flu shot this season and protect yourself and your loved ones from flu! 7

8 Four Fast Facts: Medication Therapy Management What is Medication Therapy 1 Management (MTM)? Medication Therapy Management (MTM) is a plan benefit for certain members where a pharmacist works directly with you to help you understand your medications and take them effectively. A key part of MTM is the Comprehensive Medication Review (CMR). This is a conversation that you can have with a pharmacist to review all of your prescription and over-the-counter medications. You can have this conversation over the phone or in person. For people who qualify, a CMR should be done each year. What does the pharmacist do 3 during a CMR? During a CMR, your pharmacist will answer your questions about your medications. They will also assist you with the correct dosage and timing of your medications and make sure your current drug therapy is appropriate, safe, and cost-effective for you. 4 How can a comprehensive medication review help me? After a CMR conversation you ll understand your medications better and you may save money on your medications. You ll also have a complete list of your medications to share with all of your health care providers. 2 Who qualifies for MTM? MTM is available to members who: are on a plan that includes Medicare prescription drug coverage (Part D) have certain health conditions take a number of medications spend a certain amount on their drugs To see if you qualify, please visit our website at MartinsPoint.org/Prescriptions- and-pharmacies/medication- Therapy-Management 8

9 Understanding Your Coverage During Foreign Travel Planning a trip outside the US? Here are a few important tips for you to know before you go! When you are outside of the country, your Generations Advantage plan only covers services that are required to stabilize your condition. Coverage applies to the following services for health emergencies only: Ambulance services for transportation to emergency care Emergency room services Physician services occurring during an ER visit/ inpatient stay/or observation stay Services rendered on board a ship Inpatient stays required for stabilization Foreign hospitals/providers may require you to pay out-of-pocket at the time of service. Keep your receipts with conversion to US dollar amounts, if applicable! Your Generations Advantage plan will reimburse what you paid for emergency care while abroad, minus any applicable copays. We recommend that you look into travel insurance to cover other unexpected things that may happen while traveling. Some policies cover medical emergency flights and other potentially costly services. ¹The Health of America Report, Blue Cross Blue Shield; 9

10 Busting Myths about Statin Medications Statin medications can be an important tool in treating high cholesterol a condition that can lead to heart attacks, strokes, and death. Unfortunately, there are some ideas about statins that are untrue and may be preventing people from taking advantage of this effective medication. The Truth About Statins Statin therapy reduces heart attack, stroke, and death. A recent study showed reduced cholesterol levels with statin therapy. The risk of heart attacks and stroke is reduced by ~20-25%, and mortality is reduced by 10%. 1 Statin therapy carries a low risk of muscle injury that, in most cases, is reversible. Muscle injury occurs in 1 in 10,000 patients per year. The risk of muscle breakdown (rhabdomyolysis) is 2 3 in 100,000 patients per year. 2 If you are not able to tolerate statins, there are options that may reduce or eliminate this side effect and allow you to continue to receive the benefits of statin therapy. 3 DID YOU KNOW? Cardiovascular (CV) disease commonly known as heart disease is the world s leading cause of death based on data from the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). 4,5 More than 15 million Americans have heart disease, and about one third of people who have a CV event die as a result. 5 10

11 Statins Have Proven Benefits to Your Heart that Outweigh the Risk of Serious Adverse Effects! SOME MYTHS ABOUT STATINS: Don t fall for them! 6 Myth Statins cause diabetes. It s okay to have high cholesterol. Statins don t prevent vascular diseases. Statins are expensive. Explanation There have been some studies that showed an increase in blood sugar with statin therapy; however, the results were inconsistent. There s not enough data to support this. High cholesterol builds up in the arteries leading to cardiovascular disease, which can put patients at a higher risk for heart attack or stroke. Statins prevent more plaques from forming and they reduce inflammation which decreases the risk for vascular diseases.. Some statins may be expensive; however, many are offered at a very low cost ask your doctor about them. References: 1. Stone NJ, Robinson JG, Lichtenstein AH, et al ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63: Cholesterol Treatment Trialists C, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380: Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716): Centers for Disease Control and Prevention (CDC). Leading Causes of Death. 2015; World Health Organization (WHO). The top 10 causes of death. 2014; Society for Vascular Surgery. Don t fall for These Myths about Statins. Available at: Accessed July 18th,

12 The Advantage ISSUE A NEWSLETTER FOR MEMBERS OF M a r t i n s P o i n t G e n e r at i o n s A d v a n ta g e Health and Wellness or Prevention Information PO Box 9746 Portland, Maine NONPROFIT ORG US POSTAGE PAID PERMIT #186 PORTLAND, ME DID YOU KNOW? $0 Annual Breast Cancer Screenings All Generations Advantage plans cover an in-network screening mammogram each year at no cost and no PCP referrals are needed for this screening. Talk to your PCP about how frequently you should have this screening and take advantage of a benefit that could save your life. New Online EOCs for 2019 Plans Beginning October 1, Evidence of Coverage (EOC) documents for 2019 Generations Advantage plans will be available online to be viewed and/or printed electronically. To view or print your plan s 2019 EOC, provider directory, formulary tools, and other plan documents, go to Member Resources on our website at Please be aware that we will not be automatically mailing 2019 EOC documents to plan members. If you would like to request a printed version of your plan s 2019 EOC, please call Member Services. 12