CareMore s HOW TO Guide HOW2SBSCSTANCVPSNP14 Y0017_14_111305A CHP CMS Accepted (11062013)
WELCOME TO CareMore This How To Guide was created as a quick reference to help you make the most of your membership in CareMore Health Plan. In this book, you will find answers to frequently asked questions, as well as important telephone numbers that we think will be the most relevant to you as a new CareMore member. We recommend that you hang onto this How To Guide as it may be useful in the months to come. Please refer to your Evidence of Coverage or call Member Services if you cannot find the answer you re looking for in this guide.
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health Plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. This information is available for free in other languages. Please contact our Member Services number at 1-800-499-2793, TDD/TTY users call 711. 8 a.m. - 8 p.m., seven days a week (October 1 through February 14, except Thanksgiving and Christmas) and Monday through Friday (except holidays) from February 15 through September 30. Esta información esta disponible gratis en otros idiomas. Por favor comuníquese con el servicios para los miembros al 1-800- 499-2793, TDD/TTY deben llamar al 711, de 8 a.m. a 8 p.m., los 7 días de la semana desde el 1 de octubre hasta el 14 de febrero (excepto el Día de Acción de Gracias y Navidad), y de lunes a viernes (excepto los días feriados) desde el 15 de febrero hasta el 30 de septiembre. CareMore Diabetes (HMO SNP) is a Special Needs Plan available to anyone who has chronic Diabetes Mellitus. CareMore Reliance (HMO SNP) is a Special Needs Plan available to anyone who has chronic Diabetes Mellitus. CareMore Breathe (HMO SNP) is a Special Needs Plan available to those who have been diagnosed with a Chronic Lung Disease. CareMore Heart (HMO SNP) is a Special Needs Plan available to anyone who has been diagnosed with cardiovascular disease or chronic heart failure. CareMore ESRD (HMO SNP) is a Special Needs Plan available to anyone who has been diagnosed with End-Stage Renal Disease requiring dialysis.
TABLE OF CONTENTS Now that I m a Member... Health Services Does enrolling with CareMore mean I m losing my Medicare coverage?...2 Will I get a CareMore membership card?...2 What do I do with my red, white and blue Medicare card?...2 If I m not using the Medicare card, do I have to keep paying the Part B premium?...2 Who will tell my previous Medicare plan and/or Primary Care Provider (PCP) that I have switched to CareMore?...3 If I choose a new PCP, how will my medical records be transferred to my new PCP?...3 How do I know if I qualify for a Low-Income Subsidy (LIS)?...4 How can CareMore help me find other assistance programs I might qualify for?...4 How can I change the payment processing option for my Health Plan or Optional Dental plan premiums?...5 What is Healthy Start?...5 CareMore Care Centers How do I change my PCP?...12 What if I move?...12 What if my PCP leaves the Plan?...13 What are Referrals and when are they required?...13 What services can I get without a Referral (or Prior Authorization)?...14 How can I get a second opinion?...15 Where do I go for X-rays or lab services?...15 What should I do in an emergency?...16 What happens when I need urgent care?...16 What urgent care facilities or emergency rooms can I use?...17 How can I make sure I keep my durable medical equipment (DME), like my bed, oxygen and wheelchair, as long as I need it?...17 How do I use my Exercise and Strength Training Benefit?...18 How do I use my Vision Benefit?...19 How Can I Get Dental Coverage?...20 What is a CareMore Care Center (CCC)?...8 How do I find out about special events at the CCCs?...8 What services are available at the CCC?...9 How do I make a CCC appointment?...10
TABLE OF CONTENTS Other Benefits of Membership What Are CareMore s Caring Extras?...24 Can CareMore Help Me Get To My Appointments?...25 Medication and Supplies Plan Documents Where can I go for copies of my Evidence of Coverage, Formulary and Directory?...34 How may I request materials in alternate formats?...34 How do I download my Evidence of Coverage, Formulary and Directory?...34 How do I find out what drugs are covered?...28 What is a pharmacy network?...28 What is a preferred network pharmacy?...28 How do I use CareMore s mail-order pharmacy?...29 How do I request a formulary exception?...30 What is the difference between brand and generic drugs?...30 What do my drugs cost?...31 Am I covered for prescription drugs in the coverage gap ( donut hole )?...31 How do I get my diabetic monitors and supplies?...31 What programs can help me manage my medications?...32 Where to Call I want to refer a friend to CareMore. Who should they call?...36 What if my questions have not been answered in this guide, or if I need additional help?...36 Important Phone Numbers...37 Where is my closest CCC?...38 Additional Information Nifty after Fifty...43 CareMore s Caring Extras...47 Fraud, Waste & Abuse...59
NOW THAT I M A MEMBER...
2 Now that I m a Member... Does enrolling with CareMore mean I am losing my Medicare coverage? No, it doesn t. You are enrolling in a Medicare Advantage health plan, but you are still in the Medicare program, as you must have Medicare Part A and Part B to enroll with CareMore. Our members receive all of the benefits Original Medicare offers, in addition to many more. Will I get a CareMore membership card? Yes. You may have already received your CareMore member ID card or, you will get it soon. Keep this card with you at all times. You will need to present your CareMore membership card at all of your medical appointments and pharmacies. The card has information that your provider will need to bill us after you get care. It also has our Member Services number if you need to call us. If you misplace your membership card, please call Member Services to request a new card. What do I do with my red, white and blue Medicare card? As long as you are a member of CareMore, you must not use your red, white, and blue Medicare card to get covered medical services (with the exception of routine clinical research studies and hospice services). Keep your red, white, and blue Medicare card in a safe place in case you need it later. If I m not using the Medicare card, do I have to keep paying the Part B premium? Yes, you do. Medicare requires you to continue paying your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party, such as a former employer. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premiums may be covered in full. In order to be eligible for our plan, you must maintain your eligibility for Medicare Parts A and B. Your Part B premium is in addition to paying any applicable CareMore plan premiums. CareMore s How To Guide CareMore Health Plan
Now that I m a Member... 3 Who will tell my previous Medicare plan and/or Primary Care Provider (PCP) that I have switched to CareMore? 1 If you were already enrolled in a Medicare Advantage plan, Medicare will notify your previous health plan that you are disenrolling from their plan upon your enrollment with CareMore. No action whatsoever is required on your part. However, if you were enrolled in a Medicare Supplement Plan, you will need to inform your previous plan that you re switching to CareMore and want to disenroll. If you are also switching to a new CareMore PCP, there is no need to contact your previous doctor. Simply present your new CareMore membership card to your new PCP at your next office visit. If I choose a new PCP, how will my medical records be transferred to my new PCP? 1 When you enrolled, you may have signed the Authorization for Use or Disclosure of Protected Health Information form. If not, you can request the transfer of your medical records by signing the Authorization for Use or Disclosure of Protected Health Information at your new PCP s office. They will then work to transfer your records. If you prefer, you may instead bring the records with you to your new PCP s office. You may also contact Member Services to request that a copy of the Authorization for Use or Disclosure of Protected Health Information form be mailed to you. 1 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
4 Now that I m a Member... How do I know if I qualify for a Low-Income Subsidy (LIS)? Medicare provides Extra Help to pay prescription costs for people that have limited income or resources. If you qualify, you ll get help paying for any Medicare drug plan monthly premium, yearly deductible and prescription copayments. Extra Help also counts toward your out-of-pocket costs. Some people automatically qualify for Extra Help and don t need to apply. Medicare mails a letter to people who automatically qualify. Currently, only about 30% of those who qualify take advantage of this program. To see if you qualify for Extra Help, call one of the phone numbers listed below. CareMore has contracted with My Advocate to help our members determine if they qualify for Extra Help. My Advocate: 1-866-242-1285 (9 a.m. to 6 p.m. EST, Monday Friday); or Medicare: 1-800-MEDICARE (1-800-633-4227); TDD/TTY users should call 1-877-486-2048 (24 hours a day, 7 days a week); or Social Security: 1-800-772-1213; TDD/TTY users should call 1-800-325-0778 (7 a.m. to 7 p.m., Monday Friday); or Your state Medicaid office How can CareMore help me find other assistance programs for which I might qualify? You may qualify for additional federal, state and local social programs that you are unaware of. For guidance on eligibility, call: My Advocate: 1-866-242-1285 (9 a.m. to 6 p.m. EST, Monday Friday) CareMore s How To Guide CareMore Health Plan
Now that I m a Member... 5 How can I change the payment processing option for my Health Plan or Optional Dental plan premiums? Some plans have a monthly premium that can be: Automatically deducted from your Social Security check. Automatically drafted from your bank account. Automatically charged to your credit card. You can receive a monthly billing statement. You chose your payment option when you signed up for your CareMore plan. If you wish to change your premium payment method, please contact Member Services / Premium Billing & Member Eligibility at 1-888-250-5800, (TTY users should call: 711). 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30). If you decide to change your premium payment method, it may take up to three months for your new payment method to take effect. Please be aware that while we are processing your request for a new payment method, you are still responsible for making sure that your Plan premium is paid on time. What is Healthy Start? 1 Once you re enrolled, we ll schedule you for a Healthy Start appointment. A Healthy Start appointment is how CareMore learns everything we need to know about your health. It s how we assess your personal needs and plan for your individual care. Our goal: to build a healthy relationship with you through our benefits and unique health programs. Your Healthy Start appointment begins at your local CareMore Care Center (CCC) with a head-to-toe comprehensive personalized assessment of your medical and psychosocial needs. We detect chronic conditions, evaluate your medications, conduct lab tests and provide on-site lab results. We ll ask questions regarding your health history to find out which areas of your health and lifestyle are satisfactory to you and which areas you want to improve. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
6 Now that I m a Member... Through Healthy Start, our clinical team will be able to make specific recommendations about your care and tailor a plan to meet your individual needs. At the end of your Healthy Start assessment, you ll receive a personalized care plan that summarizes your overall health status. This plan offers preventive and proactive recommendations for your follow-up care. And we ll forward it to your PCP so that everyone involved in your care knows exactly what you need. To best understand your health, we need you to bring the following (if applicable) with you to your Healthy Start appointment at the CCC: CareMore membership ID card. Any prescription and over-the-counter medications. Please bring the actual bottles. Your prescription eyeglasses. An ESRD report card from the dialysis center. Your glucometer. Any questions you may have regarding your care. 1 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. CareMore s How To Guide CareMore Health Plan
CAREMORE CARE CENTERS
8 CareMore Care Centers What is a CareMore Care Center (CCC)? CareMore Care Centers are much more than just a doctor s office or clinic. Owned and operated by CareMore, the CareMore Care Centers offer comprehensive personalized health care as well as an array of programs that combine medical supervision with nutrition, exercise and social activities to enhance your overall wellness. At the CCC, we take our time with you, and offer access to a highly qualified and specially trained staff of providers who understand proactive, integrated care. Our goal is your total health, so we aim to prevent and detect disease when it s more curable and easier to treat. Some of our specialized programs include a Healthy Start health assessment, diabetes education and a foot care center 1. CareMore Care Centers are also meeting places where you may see old friends and make new ones. Visit a smoking cessation clinic. Join a class to learn more about your chronic condition or Healthy Living. There s a lot going on at the CCC! How do I find out about special events at the CCCs? The best way to find out about events at your local CCC is to call them using the numbers listed on pages 38-40 of this How To Guide. As a CareMore member, you will also receive a subscription to CareMore Chronicles, our newsletter, with information about CareMore activities and events, as well as staying healthy. 1 Not available at all CareMore Care Centers. 2 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. 3 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. CareMore s How To Guide CareMore Health Plan
CareMore Care Centers 9 1, 2, 3 What services are available at the CCC? The following services do not require a Referral or Prior Authorization, but may require advanced scheduling, so call your local CCC to make an appointment. Not all services are available at every CCC so check your local center to see what is offered. Phone numbers are listed on pages 38-40 of this How To Guide. Chronic Obstructive Pulmonary Disease (COPD) Program Education, information and self-management techniques to improve well-being. Congestive Heart Failure (CHF) Program Education, nutritional training, medication management, physical activity, blood pressure monitoring, limiting sodium intake. Close collaboration with your plan cardiologist. DiabeatIT (CareMore s Diabetes Management Program) Nutritional education and counseling, including blood sugar control; diabetes support groups, exercise classes and a toll-free helpline. Educational Classes Series of classes on healthy living and chronic disease management. Exercise & Strength Training Strength training coupled with a balancetraining program to increase muscle strength. Fall Prevention Program Comprehensive assessment, education and evaluation for people with a history of or who are at risk for falls. Healthy Start Comprehensive physical and psychosocial evaluation performed by a specially trained Nurse Practitioner with recommendations and choices for treatment and follow-up care. Healthy Journey Annual head-to-toe assessment (physical exam, medication evaluation, pain assessment, onsite labs) for members of CareMore s Special Needs Plans, including Heart, Breathe, Diabetes, Reliance, Connect and ESRD. Nutritional Consultation Education, self-management, clinical and dietary management and maintenance of appropriate weight levels and physical activity. Foot Care Center Medical podiatry care, regular foot examinations, routine toenail trimming and callus removal. Smoking Cessation Program Education and encouragement on most effective ways to stop smoking; medication treatment and management may be part of personalized program. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
10 CareMore Care Centers Wound Care Program Wound evaluation, medical history review, individualized wound care treatment and supplies. The following services may require a Referral or Prior Authorization: Anti-Coagulation Clinic 1 Education and training about medication side effects, food-drug interactions, safety, dosing instructions; counseling, on-site testing and immediate reporting. Chronic Kidney Disease (CKD) Care Program 1 Health evaluations and risk assessment to support your complex needs; close collaboration with a plan-approved nephrologist. Hypertension (HTN) Program 1 Daily home electronic monitoring of member s blood pressure; educational classes, support groups and periodic wellness checkups. Pre-Op Surgery Evaluation Clinical assessment of members scheduled for surgery, to avoid potential medical complications. Post Hospitalization Exam Clinical assessment of health status following hospitalization. How do I make a CCC appointment? Call your nearest CareMore Care Center (CCC) to schedule an appointment for programs and services that do not require a Referral or Prior Authorization. You can log onto www.caremore.com or refer to pages 38-40 of this How To Guide for a listing of local CCC phone numbers. For more information about referrals and prior authorization, please see pages 13-14 in this guide. Not all services/programs are available in every CCC. Exercise and strength training classes may be offered at the CCC or at a separate vendor facility, depending on your location. Your Provider/Pharmacy Directory identifies what programs and services are available at your local CCC. Or, you can call your local CCC to find out what programs and services are available (the numbers are listed on pages 38-40). 1 Not available at all CareMore Care Centers. CareMore s How To Guide CareMore Health Plan
HEALTH SERVICES
12 Health Services How do I change my PCP? 1 You may change your PCP to another PCP within CareMore s network for any reason (for example, if you become unhappy with your current PCP). Check your Provider/Pharmacy Directory for options, and when you find a provider that you d like to sign up with, call Member Services to find out if the PCP you have selected is accepting new patients. Member Services will change your membership records to reflect the name of your new PCP, and will tell you exactly when the change to your new PCP is expected to take effect. They will also send you a new membership card that reflects the name and phone number of your new PCP. Any change of PCP made before the last business day of the month will become effective the first day of the following month. Please note that business days do not include weekends or holidays. What if I move? If you plan on moving your place of residence, please be sure to call Member Services. They can help you to determine what this move means to your current coverage. If you are moving within your coverage area, we will update your membership record so we know how best to contact you. If you are moving into another CareMore coverage area, Member Services will discuss any change that may take place regarding your coverage. However, if you are permanently moving out of a CareMore coverage area, you must do the following: Call Member Services to notify them that you are leaving the plan. When you are disenrolled, you will become eligible to enroll in a new plan in your new area. Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY users should call 1-877-486-2048) to request a Special Election Period, followed by a call to Social Security Administration at 1-800-772-1213 (TTY users should call: 1-800-325-0778), 7 a.m. 7 p.m., Monday Friday to notify them of your address change. CareMore s How To Guide CareMore Health Plan
Health Services 13 What if my PCP leaves the plan? 1 This does happen from time to time, and you will have to switch to a new PCP. CareMore will automatically assign you to a new PCP; however, you have the option to change to another PCP, if you like. Simply call Member Services to select another PCP. If your specialist leaves the plan, we will also direct you to another specialist. You can also find a list of PCPs and specialists in your Provider/Pharmacy Directory or visit www.caremore.com for options. We ll make sure that the PCP or Specialist you have selected is accepting new patients. If he/she is, our Member Services Representative will change your membership records and send you a new membership card with updated contact information. Member Services will also advise you when this change will take effect. What are Referrals and when are they required? 1 You will receive your routine or basic care from your PCP. To get specialty services or to see a CareMore contracted specialist, you must get approval in advance from your PCP, a CareMore Extensivist or Nurse Practitioner, or another specialist (this is called getting a referral ). Your PCP, CareMore Extensivist or Nurse Practitioner, or specialist will then coordinate to obtain approval in advance from CareMore (this is called getting prior authorization ). An extensivist is a physician who generally splits his time between the hospital, where he rounds on a small group of members each day, and an outpatient clinic, where he sees recently discharged and other members at high risk of admission. Sometimes depending on your medical and social needs your PCP will refer you to specialists and programs at your local CCC to provide you with additional resources to meet your health care needs. Our CCCs have a variety of disease management programs and many specialists on staff such as a podiatrist, nutritionist, pulmonologist, cardiologist, dermatologist and more. If our CCC does not offer the services you need, you may be referred to a CareMore network specialist who can provide these services. 1 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
14 Health Services It s very important to obtain proper approval from your PCP or CareMore before you see a contracted specialist or receive specialty services. If you do not have a Referral or Prior Authorization before you receive services, you may have to pay for these services yourself. Please remember that when you select your PCP, you are also choosing the hospitals and specialty networks associated with your PCP. CareMore organizes its provider network into neighborhoods to help promote a community based approach to health care. When you choose a PCP, you will be referred to the specialists, hospitals and other providers associated with your PCP and neighborhood. If there is a particular plan specialist or hospital that you want to use, check first to be sure that specialist or that hospital is in the same neighborhood as your PCP. What services can I get without a Referral (or Prior Authorization)? 1, 2 For most of your routine healthcare needs, you will usually see your PCP first. However, there are a few types of covered services you may get on your own. These are known as self-referrals. You may receive the following services without getting approval in advance from your PCP, as long as you get them from a network provider: Flu shots Hearing exams Men s prostate cancer screening exams Routine eye exams Annual wellness exams Nutritional consultations (at the CareMore Care Center) Routine women s health care, including breast exams, screening mammograms (X-rays of the breast), Pap tests and pelvic exams Urgently needed care Of course, emergency services are available (without a Referral or Prior Authorization) from either network or out-of-network providers. You may also self-refer to other services such as: CareMore s How To Guide CareMore Health Plan
Health Services 15 Kidney dialysis (when network providers are temporarily unavailable or inaccessible). If you re planning to travel, call Member Services to arrange for maintenance dialysis while you re away. Exercise and strength training programs (at plan-approved locations) Healthy Start appointments (at the CCC) It s always a good idea to refer to your Evidence of Coverage to find out the specific rules for Referrals & Prior Authorizations. See Chapters 3 and 4 for more information. How can I get a second opinion? 1 You are entitled to a second opinion by another physician within our network. You may contact your PCP to have them submit an authorization request or contact Member Services for assistance. Where do I go for X-rays or lab services? 1, 2 For X-rays and lab services, you will need to obtain a request form from your treating provider. Call Member Services or visit www.caremore.com to get the address of the contracted facility nearest to you. Your provider can also refer you to a contracted radiology facility or laboratory. 1 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. 2 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
16 Health Services What should I do in an emergency? 1 Medical emergency = When you believe that your health is in serious danger. A medical emergency can include severe pain, a bad injury, a sudden illness or a medical condition that is quickly getting much worse. In a medical emergency, you should: Get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Tell CareMore about your emergency as soon as possible. We need to follow up on your emergency care. You re covered for emergencies anywhere in the United States or its territories. CareMore offers limited supplemental emergency coverage when you re out of the country. Check your Evidence of Coverage, Chapter 4, for more details. What happens when I need urgent care? Urgently Needed Care = When you need medical care right away, but your health is not in serious danger. Urgent care may be required for an illness, injury or condition that you did not expect or anticipate, but your health is not in serious danger. How you get urgent care services depends on where you are. In most situations, if you are in the plan s service area, we will cover urgently needed care only if you get care from network providers. If you are inside the service area, call your PCP. If your PCP office is closed, you may go to any Urgent Care Center located in our service area. Before you need urgent care, it is a good idea to check your Provider/Pharmacy Directory or call Member Services to locate an Urgent Care Center near you. If you are outside the service area, CareMore will cover urgently needed care that you get from any provider. You re covered for urgent care anywhere in the United States or its territories. CareMore also offers limited supplemental urgently needed medical care coverage for occasions when you are outside of the United States. Please refer to your Evidence of Coverage, Chapter 4, for more information. CareMore s How To Guide CareMore Health Plan
Health Services 17 What urgent care facilities or emergency rooms can I use? 2 You can find a listing of CareMore s contracted urgent care facilities and hospitals in your Provider/Pharmacy Directory or by visiting www.caremore.com. If your situation is life threatening, you should go to the nearest emergency room. How can I make sure I keep my durable medical equipment (DME), like my bed, oxygen and wheelchair, as long as I need it? 1 When you signed up with CareMore, your sales representative should have assisted you in filling out the forms necessary to begin care with us. One of the forms that must be completed is a Continuity of Care form. This form ensures that we have the information necessary to properly transition your existing DME services to CareMore. If you did not complete a form or you have obtained new DME since enrolling but prior to your effective date, you may call Member Services for assistance. You can also learn more about your DME benefit by referring to your Evidence of Coverage, Chapter 4. If you need new DME, please contact your PCP so he or she can submit a service request based upon your needs. 1 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. 2 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
18 Health Services How do I use my exercise and strength training benefit? 1, 2 Staying active is key to good health. That s why we encourage our members to keep moving! CareMore members can access several facilities that provide specialized fitness and training programs. If you re already exercising, you ll enjoy the fun, friendly atmosphere and special programs to keep you strong and healthy, as well as enhance your flexibility, strength and cardio endurance. If you re just starting an exercise routine or you have some physical limitations we ve got medicallysupervised programs to improve and increase muscle strength, balance, mobility, flexibility and overall fitness. Just remember to check with your doctor before starting any exercise program. Nifty after Fifty Created by a doctor, Nifty after Fifty helps you keep or regain strength, flexibility, balance and mental sharpness. It is another program available to members of all CareMore plans, except CareMore Touch (HMO SNP). No ordinary gym, it s a unique approach to wellness with personally supervised physical and mental fitness programs that help you maintain your independence and increase your zest for life. For more details, please see our Nifty after Fifty brochure on page 43. Among the program features: Exercise classes specifically designed for our members. First visit orientation and training to learn how to use the exercise equipment. Supervision by physical therapists or fitness coaches who develop a personalized plan for each member. Just call Member Services to find a location near you. CareMore s How To Guide CareMore Health Plan
Health Services 19 How do I use my vision benefit? 1, 2 It s important to take care of your eyes and CareMore s vision benefit helps you do that. You can self-refer for routine eye exams performed by network optometrists and you re covered for eyewear. Check your Evidence of Coverage, Chapter 4, for detailed information about your vision and eyewear benefits. Routine vision services are offered by the following vision providers: California: UniView Vision Insight Arizona: Block Vision / Eye Specialists Nevada: Nevada EyePA Other vision services, such as those covered by Medicare, require Prior Authorization from your PCP. These include services to diagnose and treat conditions of the eye or visits to an ophthalmologist. You may self-refer to any vision provider that participates in your vision plan for routine eye exams and eyeglasses. Check your Provider/Pharmacy Directory for a listing of participating providers in your area. 1 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. 2 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
20 Health Services How can I get dental coverage? 1, 2 Healthy teeth keep you smiling and are important to both your physical and mental health! Optional Dental Premium $9.00 per month That s why CareMore offers optional dental coverage. The 2014 Optional Dental Plan Enrollment Form is in your Welcome Kit. With minimal monthly premiums, the Optional Dental plan offers many preventive services at $0 copay including teeth cleaning (up to two cleanings per calendar year), oral exams, bitewing X-rays and amalgam restorations. Even better, you have no deductible and no annual dollar maximum. You can join the Optional Dental plan up to 60 days after you become a CareMore member. Simply complete and return the 2014 Optional Dental Plan Enrollment Form or call Member Services. You select a general dentist when you join the Optional Dental plan. If you wish to change your dentist at any time after joining the plan, just refer to the Provider/ Pharmacy Directory to select a new dentist and call Member Services for assistance in making the change. Once you have joined the Optional Dental plan, you must have all of your dental services performed by an Optional Dental plan provider. With the Optional Dental plan, you will enjoy savings on many dental procedures. 3 For example: CareMore s How To Guide CareMore Health Plan
Health Services 21 ADA Code Procedure D0120 Periodic Oral Evaluation $0 D1110 Prophylaxis (cleaning) 2 per year $0 D0180 Comprehensive Periodontal Evaluation new or established patient D0330 Panoramic Film $0 D2140 Amalgam, 1 surface, primary or permanent $0 D2330 Resin based composite one surface, anterior $0 Optional Dental Copay D2740 Crown porcelain/ceramic substrate $245 D2790 Crown full cast high noble metal $225 D3310 Endodontic therapy, anterior tooth (excluding final restoration) D4341 Periodontal scaling and root planning four or more teeth per quadrant D5110 Complete denture maxillary $260 D5410 Adjust complete denture maxillary $10 D7220 Removal of impacted tooth soft tissue $30 $0 $60 $55 1 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. 2 You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs. 3 This is only a sampling of Optional Dental copays. For a complete listing of Optional Dental copayments, please contact Member Services to request the Optional Dental Handbook. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
22 Health Services CareMore s How To Guide CareMore Health Plan
OTHER BENEFITS OF MEMBERSHIP
24 Other Benefits of Membership What are CareMore s Caring Extras? CareMore s Caring Extras are value-added items and services that help you save money. We understand that getting your health care through CareMore solves many of your health care issues. But getting all the health-related services you need at a reasonable cost can be difficult. CareMore wants you to stay healthy. We have carefully selected our Caring Extras partners to give you confidence in the services they provide. That s why we offer our members extra discounts on hearing, vision, fitness, dental, weight management and much more. For more details about our Caring Extras programs and partners, please see our CareMore s Caring Extras Value-Added Items & Services listing on pages 47 through 58. CareMore s How To Guide CareMore Health Plan
Other Benefits of Membership 25 Can CareMore help me get to my appointments? Yes. At CareMore, we make it easy for you to see your doctors and other health care providers. That s why we offer a routine transportation benefit. Check your Evidence of Coverage to understand what your specific plan covers. Typically, transportation services are available during regular business hours 9:00 a.m. to 4:00 p.m. Monday through Friday (excluding holidays). If you are scheduled for dialysis treatment, transportation services are available seven days a week (including holidays). You must be able to use a standard mode of transportation bus, van or taxicab. And, you must be able to ride with other people. You can bring one escort (who is at least 17 years of age). If you bring an escort, you must let the Transportation Department know at least 24 hours in advance. How to schedule or cancel a trip? Call the CareMore Transportation Unit: 1-877-211-6687, 7:00 a.m. to 6:00 p.m., Monday through Friday (excluding holidays) Transportation tips to remember? You must schedule transportation no less than 24 business hours prior to your medical appointment. If you need to cancel, you must notify CareMore at least 24 business hours prior to your scheduled ride. If your scheduled ride is not cancelled, it may count towards your trip limit. (if you plan has a trip limit). If you need to cancel a Monday appointment, please call on Friday to make sure the trip does not count towards your trip limit. (if your plan has a trip limit)] When you schedule your appointment, you need to confirm that: You can see the transportation vehicle from the building. You can get from the building and into the transportation vehicle unassisted. Your scheduled ride allows time for you to be transported to and from your appointment during the regular transportation business hours: 9:00 a.m. to 4:00 p.m. Monday through Friday (excluding holidays). CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
26 Other Benefits of Membership What happens when you ve used up your transportation benefit? If you have other transportation needs not covered under the plan, additional local transportation resources may be available to assist you with your travel needs. These community-based services are not affiliated or contracted with CareMore. They usually charge a nominal fee and have specific eligibility requirements. Please refer to the Community-Based Transportation Services insert in this Welcome Kit for more information. CareMore s How To Guide CareMore Health Plan
MEDICATION AND SUPPLIES
28 Medication and Supplies How do I find out what drugs are covered? 1 To find out what drugs are covered, you can look at CareMore s 2014 Formulary (List of Covered Drugs) included in this Welcome Kit. A drug formulary is a list of drugs covered. It also includes such information as quantity limits. CareMore does not cover all brand or generic prescription drugs. If the drug is not listed in the formulary, it is not covered. In some cases, the law does not allow any Medicare plan to cover certain types of drugs. In other cases, we have decided to not include a particular drug on the formulary. Please check the online formulary at www.caremore.com for the most up-to-date list. To get a copy of the CareMore s 2014 Formulary, call Member Services or visit www.caremore.com. What is a pharmacy network? A pharmacy network is a group of pharmacies that are contracted to provide prescription medications to our members. Your formulary prescription drugs are covered at these pharmacies. As a member of CareMore, you have access to more than 69,000 network pharmacies across the country. What is a preferred network pharmacy? In addition to our existing network pharmacy partners, you now can choose from more than 11,000 preferred network pharmacies that offer our members lower copays on most drugs. Our preferred network pharmacies* where you can save include: Kroger Pharmacies Rite Aid Pharmacies Walmart Pharmacies Kroger Co. participating pharmacies include Kroger, FredMeyer, King Soopers, City Market, Fry s, Smith s, Dillons, Ralphs, QFC, Baker s, Scott s, Owen s, Pay Less, Gerbes, JayC. Walmart participating pharmacies include Walmart, Neighborhood Market and Sam s Club. CareMore s How To Guide CareMore Health Plan
Medication and Supplies 29 Preferred network pharmacies: We contract with these pharmacies to offer you lower copays on most drugs. Please see the box for a listing of these preferred network pharmacies. Network pharmacies: You can continue to use network pharmacies, such as Walgreens, CVS and other local pharmacies but the cost may be higher than at a preferred network pharmacy. A full list of our preferred and network pharmacies can be found in our 2014 Provider/Pharmacy Directory. Information is also available at www.caremore.com or call Member Services. How do I use CareMore s mail-order pharmacy? 1 CareMore s mail-order pharmacy is provided through Walgreens. In order to be eligible for mail-order services, you must order at least a 90-day supply, (30-day supply for Tier 5 Specialty Drugs). You can sign up with Walgreens mail service over the phone, online or by mail. The phone number is: 1-800-RX-REFILL (1-800-797-3345). To receive order forms and information regarding filling your prescriptions by mail, please call Member Services or visit www.caremore.com to download them. How to download mail-order forms: Visit www.caremore.com Click the Current Members tab Click the Drug Formulary and Pharmacy tab Click Walgreens Prescription Order Form Select either the by mail or by fax order form the contact information you need is located on the forms. You must send the Walgreens mail service form and your prescription (you may mail them your prescription yourself, or request to have your prescribing provider phone in or fax in the prescription on your behalf). *Other pharmacies are available in our network. 1 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
30 Medication and Supplies This year, each time you get an automatic refill, the mail order pharmacy will contact you first to ensure that you want to continue receiving this specific medication. Usually, a mail-order pharmacy order will arrive in 14 days. However, your mail order may sometimes be delayed. If your mail-order prescription is delayed for some reason, you may still obtain your medication from your local pharmacy. Your local pharmacy will simply contact CareMore to get permission to temporarily fill up to a 30-day supply of your prescription. Your normal copay will apply. NOTE: If you use a mail-order pharmacy other than Walgreens, your prescription will not be covered. How do I request a formulary exception? If you are currently taking a drug that is not on the formulary, you (or your representative, your PCP or other prescriber) can request a formulary exception. This means you are asking for us to cover your drug, even though it is not on the formulary. First, speak with your doctor or other prescriber about covered alternatives. If there are no alternative medications and your doctor or other prescriber believes that you have medical reasons that justify an exception, you, your representative, your doctor or other prescriber should contact Member Services. What is the difference between brand and generic drugs? 1 A generic drug is a prescription drug that has the same active ingredients as the brand name drug. The generic drug works just as well as the corresponding brand name drug but costs less. There are generic drug substitutes available for many brand name drugs. If you are currently taking a brand name drug and would like to switch to a generic version, ask your doctor if a generic option of your brand name drug is available and right for your care. 1 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. CareMore s How To Guide CareMore Health Plan
Medication and Supplies 31 What do my drugs cost? The formulary includes both brand name and generic drugs. Every drug on the formulary belongs to one of six cost-sharing tiers. In general, the higher the costsharing tier, the higher the cost for your drug. Generic drugs are in the lowest tiers and are the least expensive drugs for you. Brand drugs are more expensive and are in the higher tiers. However, Select Care drugs (Tier 6) have a low-cost copayment. If you go to a preferred network pharmacy, your costs may be lower for most of the cost-sharing tiers. Please refer to your Evidence of Coverage, Chapter 6, for your specific drug costs. Am I covered for prescription drugs in the coverage gap ( donut hole )? Most CareMore plans offer coverage in the coverage gap. Please check your Evidence of Coverage, Chapter 6, for detailed information about your Plan s coverage in the gap. In addition, CareMore members can enjoy the savings from the Medicare Coverage Gap Discount Program while in the coverage gap. Refer to your Evidence of Coverage for details. You can expect additional savings on your brand name and generic drugs in the coverage gap over the next six years until the coverage gap is closed in 2020.* How do I get my diabetic monitors and supplies? 1 If needed for your condition, you may receive your diabetic supplies at the time of your Healthy Start appointment, if available. Otherwise, you will receive a prescription that can be taken to a local pharmacy for your glucometer, lancets and test strips. Your PCP can give you a prescription to be filled at the pharmacy. CareMore covers the following diabetic monitors and their corresponding test strips: FreeStyle Lite FreeStyle Freedom Lite FreeStyle InsuLink *Reference: www.medicare.gov CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
32 Medication and Supplies With these monitors, Caremore can track your insulin count and share this information with your PCP. CareMore and your PCP will use this information to help you best manage your diabetes. What programs can help me manage my medications? We have programs that can help you with special situations if you have several complex medical conditions, take many drugs at the same time or have very high drug costs. Voluntary and free to you, these programs were developed by a team of pharmacists and doctors. Their goal: to make sure you are using the drugs that work best to treat your medical conditions and help us identify possible medication errors. One program is called a Medication Therapy Management (MTM) program. If you take several medications for different medical conditions, you may qualify. If you qualify for this program, CareMore will notify you by mail and then follow-up with a phone call by a pharmacist. In the MTM program, a pharmacist gives you a comprehensive review of all your medications. You can talk about how best to take your medications, your costs or any problems you re having. You ll get a written summary of this discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions. You ll also get a personal medication list that will include all the medications you re taking and why you take them. We hope that you to accept this offer to review your medications. If we have a program that fits your needs, we will automatically enroll you in the program and send you information. If you decide not to participate, please notify us and we will withdraw you from the program. If you have any questions about these programs, please contact Member Services. 1 Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. CareMore s How To Guide CareMore Health Plan
PLAN DOCUMENTS
34 Plan Documents Where can I go for copies of my Evidence of Coverage, Formulary and Directory? Copies of your Evidence of Coverage, Formulary and Directory are included in this Welcome Kit. If you need additional copies, you may obtain them online at www.caremore.com. You may also contact Member Services to request any of these materials to be mailed to you. How may I request materials in alternate formats? What alternate formats are available? You may contact Member Services to request materials in alternate formats. We can provide certain materials (usually the Evidence of Coverage, Formulary and Provider/Pharmacy Directory) in large print, braille or languages other than English. You may also log onto the Plan s website www.caremore.com to obtain both English and Spanish language materials. How do I download my Evidence of Coverage, Formulary and Directory? 1 STEP ONE Visit www.caremore.com 2 STEP TWO Select Current Member tab 3 STEP THREE Click Member Materials Tab 4 STEP FOUR Select Plan Materials 5 STEP FIVE Indicate your specific county and Plan 6 STEP SIX Click button for items needed NOTE: For Spanish, go to the blue bar at the top right corner of the page and select [change] and then choose Español. CareMore s How To Guide CareMore Health Plan
WHERE TO CALL
36 Where to Call I want to refer a friend to CareMore. Who should they call? Your friend, or any other referral you may have, can call your sales representative (if you have his or her phone number) or a CareMore Enrollment Specialist at 1-877-211-6614 (TTY users should call: 711). 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30) for assistance. What if my questions have not been answered in this guide, or if I need additional help? Our Member Services representatives are ready and willing to help. Just call us for further assistance. Or, you can refer to your Evidence of Coverage for more detailed information. CareMore s How To Guide CareMore Health Plan
Where to Call 37 Important Phone Numbers CareMore Main Number 1-800-499-2793; TTY: 711 Plan-Specific Member Services Numbers CareMore Breathe 1-888-357-4166 CareMore Connect 1-800-589-3146 CareMore Diabetes 1-888-357-4187 CareMore ESRD 1-888-357-4177 CareMore Heart 1-888-494-8280 CareMore Reliance 1-800-589-3145 CareMore Touch 1-800-589-3147 CareMore Value Plus 1-800-822-6991 CareMore StartSmart Plus 1-800-822-8720 CareMore Healthy Start Appointments 1-888-291-1387 Care Center Appointments: See pages 38 through 40 CareMore Premium Billing 1-888-250-5800 (Option 5 / Member Eligibility) CareMore Medical Assistance Numbers* 24-Hour Hypertension (HTN) Medical Assistance 1-888-458-1428 24-Hour Congestive Heart Failure (CHF) Medical Assistance 1-877-874-8515 24-Hour Diabetes, Chronic Obstructive Pulmonary Disease (COPD), End-Stage Renal Disease (ESRD) and Connect Medical Assistance 1-800-589-3148 Other Important Phone Numbers Medicare 1-800-633-4227; TDD/TTY users should call 1-877-486-2048 (24 hours a day, 7 days a week) Understanding Eligibility for Low-Income Subsidy through My Advocate 1-866-242-1285 (9 a.m. to 6 p.m. EST, Monday - Friday) Social Security Administration 1-800-772-1213; TDD/TTY users should call 1-800-325-0778 (7 a.m. to 7 p.m., Monday Friday) *8 a.m.- 5 p.m. answered by live person; 5 p.m.- 8 a.m. answered by exchange and connected to clinician on call. CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
38 Where to Call Where is my closest CCC?* ARIZONA Maricopa County 750 E. Thunderbird Rd. Phoenix, AZ 85022 1-602-866-1220 2330 N. 75th Ave. Phoenix, AZ 85035 1-480-257-7500 5225 N. Scottsdale Rd. Scottsdale, AZ 85250 1-480-429-3400 Pima County 191 W. Esperanza Ave. Green Valley, AZ 85614 1-520-791-7300 7091 E. Speedway Blvd. Tucson, AZ 85710 1-520-721-5777 315 W. Irvington Rd., #101 Tucson, AZ 85706 1-520-294-1740 4821 N. Stone Tucson, AZ 85704 1-520-314-3300 * Addresses and phone numbers are correct as of January 1, 2014. For the latest listing of CareMore Care Centers in your community, please call Member Services (see number below). CareMore s How To Guide CareMore Health Plan
Where to Call 39 CALIFORNIA Los Angeles County 10000 Lakewood Blvd. Downey, CA 90240 1-562-862-3684 406 E. Colorado Street Glendale, CA 91205 1-818-844-2778 15034 Imperial Hwy. La Mirada, CA 90638 1-562-902-4929 4540 E. 7th St. Long Beach, CA 90804 1-562-344-1150 3513 E. 1st St. Los Angeles, CA 90063 1-323-859-2660 303 S. Union Ave. Los Angeles, CA 90017 1-213-355-2600 2444 W. Beverly Blvd. Montebello, CA 90640 1-323-201-4130 301 N. Azusa Blvd. West Covina, CA 91791 1-626-214-2600 14350 Whittier Blvd., #100 Whittier, CA 90605 1-562-696-1104 Orange County 1182 N. Euclid St. Anaheim, CA 92801 1-714-399-9222 340 W. Central Ave., #110 Brea, CA 92821 1-714-529-3971 1325 N. Rose Dr., #102 Placentia, CA 92870 1-714-203-1767 1945 E. 17th St., #101 Santa Ana, CA 92705 1-714-888-8900 15230 Hawthorne Blvd. Lawndale, CA 90260 1-424-269-3600 CareMore Member Services 1-800-499-2793 (TTY users should call: 711) 8 a.m. - 8 p.m., 7 days a week (October 1 February 14) and Monday Friday (February 15 September 30)
40 Where to Call CALIFORNIA San Bernardino County 19059 Bear Valley Rd., #1 Apple Valley, CA 92308 1-760-515-5000 17083-17085 Main St. Hesperia, CA 92345 1-760-981-1284 141 W. Foothill Blvd. Upland, CA 91786 1-909-296-8800 Santa Clara County 255 N. White Rd., #200 San Jose, CA 95127 1-408-503-7600 4855 Atherton Ave., #101 San Jose, CA 95130 1-408-963-2400 7888 Wren Avenue #C-131 Gilroy, CA 95020 1-408-665-4400 Stanislaus County 1234 McHenry Ave. Modesto, CA 95350 1-209-544-2554 1000 Delbon Ave., #5 Turlock, CA 95382 1-209-664-7700 NEVADA Clark County 3085 E. Flamingo Rd., Ste. A Las Vegas, NV 89121 1-702-436-0835 100 N. Green Valley Pkwy., #235 Henderson, NV 89014 1-702-754-2200 2601 N. Tenaya Way Las Vegas, NV 89128 1-702-233-4950 CareMore s How To Guide CareMore Health Plan
ADDITIONAL INFORMATION
42 ADDITIONAL INFORMATION CareMore s How To Guide CareMore Health Plan
43 CareMore and Nifty after Fifty Passionate About Health You have many different health needs during your lifetime, which is why CareMore (HMO and HMO SNP) focuses so closely on personal service. It s also why we include Nifty after Fifty* with our CareMore Medicare Advantage plans. The New You. www.niftyafterfifty.com *Nifty after Fifty is not a covered program for CareMore Touch plans. NAFFLY14 Y0017_14_101310A CHP CMS Accepted (10072013)
44See Positive Changes in Your Health 44 Created by a doctor, Nifty after Fifty helps you keep or regain strength, flexibility, and balance. It s no ordinary gym, it s a unique approach to wellness with personally supervised fitness programs that help you maintain your independence and increase your zest for life. During your first visit to a Nifty after Fifty Center, your fitness level is assessed by one of our qualified fitness coaches, who all have degrees in Kinesiology (the study of muscle function). Our coaches have special training in the needs of mature adults and work closely with you to build your strength, balance and flexibility. State of the Art yet simple Nifty after Fifty uses a special Fitness Key for our Clinically Supervised Full-Body Fitness program. Your key fits each exercise machine showing your personal goals while recording sets and repetitions. And through the Fitness Key, your results and progress are monitored and adjusted. Nifty after Fifty uses specialized equipment that can exercise every major muscle group without creating joint damage. Unlike a gym, all of our methods and exercises are designed to significantly improve your range of capabilities and overall state of health. Nifty After Fifty services include: Supervised Full-body Fitness customized specifically for you Prescribed FitnessTM Programs addressing specific chronic conditions Unique Muscle Training that boosts every workout Fall Free to enhance balance, flexibility, and mobility Nifty People : Social Connections
45 45 Nifty after Fifty fitness offers safe coaching support while building your strength, improving your balance and increasing your endurance. Interested in more info? Call 1-877-211-6614 Current CareMore members can call 1-800-499-2793. (TTY users call 711) 8 AM - 8 PM 7 days a week, October 1 through February 14, (except Thanksgiving and Christmas) and Monday through Friday, February 15 through September 30 (except holidays). Nifty after Fifty is no charge The New You. www.niftyafterfifty.com to members of CareMore Medicare Advantage plans.
46 The New You. www.niftyafterfifty.com www.caremore.com CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health Plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. This information is available for free in other languages. Please contact our customer service number at 1-800-499-2793, TDD/TTY users call 711. 8 a.m. - 8 p.m., seven days a week (October 1 through February 14, except Thanksgiving and Christmas) and Monday through Friday (except holidays) from February 15 through September 30. Esta información esta disponible gratis enotros idiomas. Por favor comuníquese con el departamento de servicios al cliente al 1-800- 499-2793, TDD/TTY deben llamar al 711, de 8 a.m. a 8 p.m., los 7 días de la semana desde el 1 de octubre hasta el 14 de febrero (excepto el Día de Acción de Gracias y Navidad), y de lunes a viernes (excepto los días feriados) desde el 15 de febrero hasta el 30 de septiembre.
47 47 CareMore s Caring Extras Value-Added Items & Services Additional health services that save you money VAISBRO14_POST_EN CHP Int.101306A (10/13)
48 Valuable discounts on health related services Getting Medicare through CareMore (HMO and HMO SNP) helps you solve many of your healthcare issues. But getting all of the health related services you need, at a reasonable cost, can be difficult. CareMore wants you to stay healthy. We have carefully selected our Caring Extras partners to give you confidence in the services they provide. That s why CareMore provides its members valuable discounts on dental, hearing,vision, fitness services and much more! The products and services described are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the CareMore grievance process.
49 49 CALL TODAY to learn more about all the special items & services available through CareMore 1-800-499-2793 (TTY users call 711) 8:00 a.m to 8:00 p.m., 7 days a week www.caremore.com
50 FAMILY & HOME 1-866-797-2333 http://slc.seniorlinkcare.com/partner/ panthem.html Seniorlink Care is dedicated to assisting caregivers to access the information needed in order to understand service options, establish a plan for the care of an elder, and receive expert advice from eldercare professionals. CareAdvisory service at a 15% discount: $33.00 for 3 months or $84.00 for one year Personal Emergency Response System discount: $30/month and an initial $50 enrollment fee Coupon code: Discount15 www.benefitscheckup.org/caremore.com BenefitsCheckUp helps you enroll online in public and private benefits programs. Sponsored by the independent National Council on Aging (NCOA), you can find local, state and federal programs to help with expenses such as prescription drugs, rent, heating bills, meals and more. Completing a BenefitsCheckUp questionnaire is free and your answers are kept private. If you don t have a computer, visit the local library or a senior center or ask a friend, relative or family member to help. 1-800-800-0517 Medical Alarm is a personal emergency response system unit that can allow you to live more independently. This device provides round-the-clock monitoring. In the event of an emergency, you simply press a button located on a pendant that is worn around your neck or wrist. A dedicated Medical Alert team is available to aid CareMore members in both emergency and nonemergency situations, 24 hours a day. CareMore members will receive a discount on the monthly monitoring agreement. CareMore members will pay $24.95 per month for the following benefits: State-of-the-art, plug-and-go approved medical alarm unit Help at a push of a button Two-way voice communication specifically designed to assist the hearing impaired Lifetime Warranty No service or repair costs incurred by the customer Power supply with battery backup Telephone connection cord Waterproof emergency neck pendant NO activation fee NO long-term contract
51 1-866-413-8669 www.greatcall.com GreatCall starts you out with the Jitterbug Plus, a high-quality, durable phone with large, backlit buttons, bigger numbers, and effortless navigation combined with friendly, U.S.- based customer support. GreatCall then helps you stay healthy with LiveNurse (24/7 unlimited access to registered nurses) and Medication Reminders (a free prescription reminder service). Call now to receive: $20 off the price of the Jitterbug Plus FREE shipping FREE LiveNurse Advice Line FREE Medication and Prescription Reminder Service FREE Car changer 1-866-242-1285 https://myadvocatehelps.com You may be eligible for free financial assistance toward your healthcare costs through My Advocate (formerly Social Service Coordinators). Each year, My Advocate helps Medicare Advantage members with enrollment into Medicare Savings Programs (MSPs). Medicare Savings Programs (MSP) Provides education and assistance free of charge to CareMore members for applying and enrolling into MSPs, which may pay your Medicare Part B premium. Medicare Part D Extra Help Provides assistance to CareMore members with applying and enrolling into Medicare Part D s Low-Income Subsidy (LIS) also known as Extra Help. MSP Recertification Offers services to help CareMore members enroll into an MSP, whether or not they used My Advocate to help them enroll previously. My Advocate helps members complete the annual process of re-applying through the state Medi-Cal/Medicaid administration the Department of Health Care Services to maintain their MSP. MyAdvocateHelps.com Helps CareMore members learn about the numerous money-saving and community assistance programs that are specifically available for them that assist with: Utilities (phone, heat and electricity) Transportation Nutrition and food assistance Prescriptions And much more Visit MyAdvocateHelps.com today to see how My Advocate might help you with these programs.
52 FITNESS & HEALTH 1-800-432-5378 www.medicalert.org/caremore Identify yourself as a CareMore Member to receive the discounts. An international charity, MedicAlert Foundation was established in 1956 and pioneered the use of medical identification and information services for medical emergencies. We protect the health and well-being of more than 4 million members worldwide through our trusted 24/7 emergency support network. We educate emergency responders and health professionals about the services we provide during emergencies. And, we communicate your health information, your wishes, and your directives to ensure you receive the best care possible. MedicAlert members include the following services and benefits for CareMore Members: Live 24/7 Emergency Response Service Comprehensive Emergency Medical Information Record (EMIR) Free Emergency Wallet Card Ongoing training of Emergency Responders and Health Professionals Advance Directives/DNR/Document Storage Medic Alert Alzheimer s Association Safe Return $55 per year Medic Alert Advantage $50 per year (A premium offering) MedicAlert Essential TM $30 for 3 years (An online platform) https://www.choosehealthy.com/ default.aspx?hp=wellpnt ChooseHealthy is your online partner for wellness and health. We re committed to providing you with the very best online information, products and resources to support your health goals. Save on Fitness Facility memberships, health and wellness products, visits to massage therapists, acupuncturists and more. Fitness Facility Memberships Health & Wellness products Massage therapists Acupuncturists The ChooseHealthy programs is a product of American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy and the ChooseHealthy logo are registered trademarks of ASH. 1-800-294-1500 www.globalfit.com/caremore For more than 20 years, GlobalFit has been committed to improving health through physical activity. Save on fitness and gyms nationwide. Join your choice of OVER 10,000 fitness centers nationwide including Curves, Bally s, Gold s, Anytime Fitness, and many more all at the lowest available rate!
53 1-877-Jenny70 www.jennycraig.com/orgcode=caremore Get healthy with Jenny Craig and CareMore Jenny Craig clients lose three times more weight than dieting on their own.* Your consultant will help you find the program that fits your life. Plus, they ll work with you to create a menu of delicious, nutritionally-balanced meals to help you keep feeling full and satisfied every step of the way! * Rock CL, Flatt SW, Karanja N, et al. JAMA. 2010;304(16): 1803-1811. Clients following our program, on average, lose 1-2 lbs per week. As a CareMore member, you can choose one of these discounted offers: Jenny As You Go! $39/month-to-month. FREE 30-Day Program** or Jenny All Access Membership** $19.99/month-to-month (after 12 months, monthly dues drops to $14.99). 30% discount off a one time initial fee. Visit www.jennycraig.com/orgcode=caremore to register and unlock your discounts. ** Plus the cost of food. Plus the cost of shipping, if applicable. Valid at participating centres. No cash value. One offer per person. Not valid with any other program offers or discounts. Restrictions apply. 1-800-651-6000 http://www.weightwatchers.com/cs/index. aspx?path=cs/anthem Weight Watchers works. And it can work for you! For over 50 years, we ve helped millions of people lose weight. Why does Weight Watchers work for such wonderfully diverse people? Easy: real food, combined with a realistic (and entirely liveable) approach, means anyone can lose weight. $10 off a 3 month subscription to Weight Watchers Online Weight Watchers Online for only $55 (less than $5 per week) 1-888-686-8723 http://www.murad.com/special-offershealthplan-members Murad s transforming skincare products are at the heart of a comprehensive approach that Dr. Murad calls Inclusive Health. Transform your skin and save! $25 off plus FREE gift with any purchase of $100 or more Use promo code MuradSpecial to receive a special offer
54 1-800-645-1030 http://www.puritan.com/sports-nutrition- 043?scid=19299&cm_mmc=Empire-_- FitnessandHealth_-September-_-20PFS It s Puritan s Pride mission to make the finest quality nutritional supplements available at the best value. You ll find variety and value in the pages of the Puritan s Pride catalog. Join our six million customers and see how Puritan s Pride is the #1 way to shop at home for vitamin products and herbal supplements. 20% on your order Free Shipping on orders of $25 or more DENTAL 1-855-887-7699 www.careington.com/co/caremore Savings on dental care made easy! Are you looking for savings on dental care? Try the Careington Dental Plan. This non-insurance plan allows members to save 5% to 60% on most dental procedures including exams, X-rays, cleaning and major work such as dentures, braces, root canals and crowns. Plus, you ll have access to over 200,000 dental access points which means more dentists for you to choose from! Do you want even better news? Anyone can join the plan, there s no waiting and it s free to try for 30 days! Simply join the plan, visit a participating dentist in the Careington dental network and receive the discount off the regular priced fee. It is that easy! Plan starting at $6.75 a month or $67.95 for the year*. * Plus a one-time, $5.00 non-refundable processing fee. THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN.* The plan provides discounts at certain health care providers for medical services. The range of discounts will vary depending on the type of provider and service. The plan does not make payments directly to the providers of medical services. Plan members are obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount medical plan organization. You may access a list of participating health care providers at www.careington.com/co/caremore. Upon request the plan will make available a written list of participating health care providers. You have the right to cancel within the first 30 days after receipt of membership materials and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN resident will be refunded processing fee). Discount Medical Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380. This plan is not available in Montana and Vermont. This plan is not currently available in Washington. *Medicare statement applies to MD residents when pharmacy discounts are part of plan.
1-800-373-5400 http://luminahealthcare.com 55 Lumina HealthCare is proud to be chosen by CareMore as a value-added service offered to all CareMore Touch members, providing convenient, on-site dental care, right in the comfort of your own home or place of residence. We provide complete mobile onsite dental services to members residing in Skilled Nursing Facilities and Assisted Living Communities, board and care homes, or home-bound members. Health visits $150 first visit Initial evaluation, X-rays $195 *Only offered in the following California counties: Los Angeles and Orange HEARING 1-866-344-7756 http://hearingcaresolutions.com/ caremoremember/ Left untreated, hearing loss hinders communication and ultimately diminishes social interaction & quality of life. Hearing Care Solutions simplifies care by offering fixed discounted prices on digital hearing aids. Premium - $1,500 (Retail $4,200) Advanced - $1,100 (Retail $2,800) Superior - $800 (Retail $1,800) Annual hearing exam at no charge for all Medicare-eligible members National Network Several major manufacturers to choose from One-year supply of batteries 1-800-675-5485 www.connecthearing.com Connect Hearing is one of the largest networks of hearing health care centers in the US. We offer exceptional hearing care with locations nationwide to serve you. Our Hearing Care Professionals are highly educated and practice the philosophy that the most successful hearing aid solutions must fit precisely within your lifestyle and everyday communication needs. 30% discount off Connect Hearing list price on hearing aids Free Hearing Evaluation Price Match Guarantee 3 years of free batteries with hearing aid purchase 3 year warranty and 3 year loss & damage Visit us at connecthearing.com for more details.
56 MEDICAL & WELLNESS SUPPLIES 1-888-737-2055 www.acadderson.com/caremore We are a medical products distributor dedicated to providing the finest quality products available at competitive prices. Receive between a 10% - 30% Discount Incontinence Supplies Aids to Daily Living Bath Safety Items Mobility Products Personal Hygiene Skin Care Products Bed and Accessories Orthopedics 1-800-522-1448 www.natallergy.com/caremore National Allergy is pleased to offer you a 15% discount on every purchase you make with us! Allergies and asthma getting the better of you? Need more than tissues to get relief? Then it s time to take advantage of the discount offered by National Allergy Supply. As a CareMore member, you re eligible to receive a 15-percent discount off the already discounted prices for our non-drug products including pillow and mattress encasings, air filtration products, sinus relief products, asthma compressors & nebulizers and personal care products. Receive 15% discount on every purchase. 1-800-255-3749 www.allergycontrol.com/caremore Allergy Control Products goal is to help make allergy sufferers homes and lifestyles healthier and more manageable. Receive discounts on allergy products for physician-recommended products for relief from allergies, asthma, sinusitis, sensitive skin and more: Save 25% on allergy Control Pillow & Mattress Encasings Plus, save 20% on a wide range of these products, including: Hypo-allergenic bedding Allergen-removing laundry & carpet products Air filters Sinus rinses and sinus care Hypo-allergenic personal care products Humidity and mold reducers Just enter or mention promotional code VPWELL when ordering to apply your discount! Just enter or mention promotional code MEMBER15 when ordering to apply your discount.
VISION 57 1-888-811-3161 www.enhancedvision.com Low vision assistive technology enables people to read, write and fully participate in life. Enhanced Vision has the most comprehensive line of easy-to-use and affordable low vision products from simple digital magnifiers to advanced video magnification systems with HD and text-to-speech (OCR). Select from products that provide you with portability, distance viewing or just reading at home. Receive 10% off on all products. 1-800-452-7737 www.glasses.com Glasses.com has the latest, brand-name frames for just a fraction of the cost of typical retailers, every day. As your personal glasses stylist, our job is to help you find the glasses you love and we ve come up with some fun ways to find the perfect pair, like our free inhome try-on and our 3D virtual try-on app. We promise you ll be delighted with your experience and if you aren t we ll make it right. 100% satisfaction guaranteed. Every time. $20 off orders over $100 Free shipping and free returns 100% satisfaction guaranteed 1-800-266-8228 www.1800contacts.com 1-800 CONTACTS, is the largest retailer of contact lenses in the United States, and is dedicated to providing you with an easy, hassle-free way to purchase contact lenses. At 1-800 CONTACTS, you will receive the exact same contact lenses your doctor prescribed, delivered to your door, at a great price. $20 off orders over $100 Free shipping and free returns 100% satisfaction guaranteed