TheAdvantageSUMMER. Here s to a Happy and Healthy Summer! 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?

Transcription

1 TheAdvantageSUMMER 2016 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 Here s to a Happy and Healthy Summer! Dear Neighbors, I hope you ve been enjoying all that our Maine and New Hampshire communities have to offer during this wonderful summer season. The long days of July and August are a perfect time to get outside and be active, enjoy fresh-picked local fruits and vegetables, and spend time with family and friends. As we mark the midpoint of the year, it s also a good time to make sure you re taking full advantage of the annual preventive benefits offered through your Generations Advantage plan. If you haven t had your Medicare Wellness Visit and Annual Physical Exam yet, I recommend calling your doctor s office today to schedule these important visits. For your convenience, you can ask your doctor to schedule both appointments backto-back in one longer comprehensive visit. What s Inside? Bone Basics for Women One Trip to the Doctor, Two Important Preventive Care Appointments! Farmers Market Fresh! Green Bean and Grape Tomato Salad Shingles Vaccine Need Help Paying Your Medicare Costs? Ask the Experts Understanding the Donut Hole These visits are a great time to make sure you are up-to-date with all of the preventive tests your doctor recommends. Because we know how important preventive care is to our members health, all Generations Advantage plans cover both of these services each year at a $0 copay when you see a doctor in our network. As you make your summertime to-do list, remember to put caring for your health at the very top. Now is a great time to give your doctor a call and put your health first! Our Prime (HMO-POS) and Value (HMO) Plans are the highest-rated plans in Maine and New Hampshire! Rebekah Dube, PharmD Vice President, Senior Products Martin s Point Health Care

2 Bone Basics for Women Osteoporosis a disease that weakens bones causes fractures in more than half of women over age 50. And those broken bones can lead to more serious health problems. The good news is that diet, exercise, and a healthy lifestyle can help prevent, slow, or stop this disease. The National Osteoporosis Foundation offers these tips to keep bones healthy: Get the calcium and vitamin D you need every day. Do regular muscle-strengthening exercises. Don t smoke and don t drink too much alcohol. Ask your doctor about getting a bone density test and if you need osteoporosis medication. Have you broken a bone within the last year? A bone-density test is the best way to find out if you have osteoporosis. Once you know, your doctor can set up a treatment plan to help prevent another fracture. Talk to your doctor today about scheduling this important (and painless!) test. To learn more and find helpful resources, visit the National Osteoporosis Foundation website 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 February 14; and 8 am 8 pm; and Monday through Friday the rest of the year. Interested in becoming a member? Please call (TTY: 711) Generations Advantage Website 2 Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next. For 2016, Prime, Value, Value Plus, and Focus DC earned 5 Stars and Select earned 4.5 Stars for Overall Plan Rating from CMS. Visit for more information. 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. 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.

3 ONE Trip to the Doctor, TWO Important Preventive Care Appointments! Martin s Point Generations Advantage covers both the Medicare Wellness Visit AND your Annual Physical Exam at a $0 copay when you see an in-network provider. It s important to schedule both of these appointments each year because they offer different kinds of preventive services. At your annual Physical Exam, your doctor performs a hands-on physical examination. The annual Medicare Wellness Visit is a time to talk with your doctor to make a plan for your health goals. Both are important parts of getting and staying as healthy as you can be. For your convenience, ask your doctor to schedule these two important preventive care visits back-to-back on the same day. You ll get comprehensive care in just one easy trip to the doctor s office. Call your doctor today to schedule both of these important appointments! WHAT TO EXPECT AT EACH KIND OF APPOINTMENT: Annual Physical Exam A hands-on examination by your doctor Your doctor will normally do the following: Check your height, weight, blood pressure, and body mass index (BMI) Check your heart, lungs, abdomen, Examine your skin, ears, eyes, nose, etc. reflexes, etc. Review your medical history Talk about any risk factors you may have Discuss and order preventive screenings Annual Wellness Visit A conversation with your doctor You will talk about your current health and set future health goals. You ll work together to create a plan to help you reach your goals. Some important things to talk about: Preventive services you may need Your current medications How much activity is right for you Whether you are feeling depressed Managing bladder control issues How to reduce your risk of falling If you have questions about these exams or your Generations Advantage benefits, please call Member Services. 3

4 Farmers Market Fresh! The best way to eat your veggies! Summer farmers markets are now in full swing and there s no better source for the freshest produce than your local grower. Here are some tips for getting the most out of your visit to the market and a quick and healthy recipe to help you enjoy your fresh finds: Arrive early: Beat the crowd to make sure you get your pick of favorites like fresh peas and berries. Plan ahead: Budget for and buy what you ll use within a week. Did you know many farmers now accept EBT cards? Chat up your farmers: They are a great source for recipe ideas. Try something new: Try samples of new things or ask the farmer about items you ve never tried. To find your nearest farmers market, visit or for New Hampshire. Green Bean and Grape Tomato Salad Choose slim, petite green beans for this summery salad. Crème fraîche adds a nutty flavor and rich texture to the dressing; look for it in your supermarket s cheese section. Substitute lowfat sour cream or nonfat plain Greek yogurt to reduce calories and fat. Ingredients 1 pound fresh green beans, trimmed 1/4 cup finely chopped fresh basil 2 tablespoons minced shallots 2 tablespoons fresh lemon juice 2 tablespoons crème fraîche 1 tablespoon honey 1/2 teaspoon salt 1 pint grape or cherry tomatoes, halved 1 tablespoon pine nuts, toasted Preparation Cook green beans in boiling water for two minutes or until crisp-tender. Drain and rinse with cold water; drain. Combine basil and next five ingredients (through salt) in a large bowl, stirring with a whisk. Add green beans and tomatoes; toss gently to coat. Sprinkle pine nuts on each serving. Serves six. Adapted from recipe by Lorrie Hulston Corvin, Cooking Light, June 2005 Martin s Point in Our Community Go for the Gold at 2016 Maine Senior Games Join other Maine athletes, aged 45 and over, as the Southern Maine Area Agency on Aging celebrates 30 years of senior sportsmanship at this year s Maine Senior Games. 4 Martin s Point is the proud lead sponsor of the Senior Games, which are held June through October at venues throughout southern Maine. From horseshoes to triathlons, there s fun and friendly competition for all. Details are available at

5 Four Fast Facts: The Shingles Vaccine 1 What is Shingles? Shingles is a painful rash related to chicken pox. Almost one in three people in the US will get shingles. As you get older, your risk for getting shingles goes up. 2 Is there a vaccine for shingles? Yes. Zostavax is the vaccine to prevent shingles. The shingles vaccine is recommended for people aged 60 years and older, even if they remember having chicken pox in the past. People who have had shingles in the past can also get the vaccine to help prevent getting shingles again. The vaccine is given as a single dose and is only given once. 3 How is Zostavax covered? Zostavax is covered under Medicare prescription drug coverage (Part D). This coverage is included in the Generations Advantage Prime, Select, Value Plus, and Focus DC plans. There is no drug coverage under the Generations Advantage Value plan. Value plan members would pay the full cost of this vaccine. 4 How can I get the vaccine? On the plans that include Medicare prescription drug coverage (Part D) Zostavax is covered at a Tier 3 copayment. You can get the shot at a network pharmacy and pay a Tier 3 copayment. You will need a prescription from your doctor to get the shot. Members can also get the shot at a doctor s office, but it might cost more. Talk to your doctor if you have questions about whether you should get the shingles vaccine. Ask Your Doctor Need Help Paying Your Medicare Costs? Often, Medicare beneficiaries don t realize they may qualify for government programs that help with Medicare costs. These are two programs that you may qualify for: The Medicare Savings Program lowers the cost of Medicare Part B premiums. The Extra Help program helps pay for Medicare Part D prescription drug coverage. Generations Advantage has partnered with My Advocate, an organization that helps qualifying members apply for or renew their participation in these programs. You may receive mail or a call from a My Advocate representative from their offices in Texas or Florida. There is no cost to our members for this service, and, if you qualify, you could save money. You can contact My Advocate at (TTY: ) Monday through Friday, 9 am 6 pm or visit their website at 5

6 Ask the Experts We invite you to call Member Services any time YOU have a question! Here are some answers to questions members have recently asked: Q. What exactly is a referral? How do I get one to see a specialist? A: In general, a referral is approval from your primary care provider (PCP) for you to see a specialist or get certain medical services. Unlike other plans that may require forms or phone calls, at Generations Advantage, we keep the referral process simple. For Generations Advantage plan members, a referral is just a conversation between you and your PCP about which provider you should see if you need care from a specialist. There are no forms for you or your PCP to send to us. There are no phone calls for you or your PCP to make to us. It s just that simple. It s important to note that members of the Value Plus, Value, and Focus DC plans will want to see specialists in the network. Q: I use a Veterans Affairs (VA) clinic for most of my health care. Do you need to know that I go there? A: Yes! We ask all of our members who are eligible for VA health services to sign a record release form. This form allows the VA to share your health records with us. This helps us understand what tests and services you re receiving at the VA. Signing this form will not affect your coverage with Generations Advantage or with the VA! If you use the VA, call Member Services today and ask us to send you the record release form. Terrence Vickie Q: Where should I get my prescriptions filled? A: If your plan includes Medicare prescription drug coverage (Part D), you can get your prescriptions filled at any network pharmacy. To find a list of network pharmacies go to our website and select Prescriptions & Pharmacies. Or call Member Services for a list. We also have some network pharmacies including Hannaford Pharmacies that offer cost savings on Tier 1, Tier 2, Tier 3, and Tier 4 drugs. These are called our pharmacies with preferred cost sharing. This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, and copayments may change on January 1 each year. Limitations, copayments, and restrictions may apply. 24-Hour Nurse Line 6 Call anytime and a registered nurse will be able to help answer your health questions!

7 Understanding the Donut Hole In 2006, the federal government created Medicare prescription drug coverage (Part D) including the Coverage Gap (sometimes called the donut hole ). This coverage has three phases. The Coverage Gap refers to the phase where you are responsible for paying more for your medications. This illustration helps explain the three phases. It s important to note that the dollar amounts for each phase can change each year. Not everyone falls into the Coverage Gap. Phase 1 Copayments 1 Pharmacies with Preferred Cost Sharing 2 (Including Hannaford pharmacies) 30 day supply 3 Tier 1: $0 Tier 2: $8 Tier 3: $40 Tier 4: $95 Tier 5: 33% Coinsurance Pharmacies with Standard Cost Sharing 30 day supply 3 Tier 1: $4 Tier 2: $15 Tier 3: $47 Tier 4: $100 Tier 5: 33% Coinsurance Mail-Order 90-day supply Tier 1: $10 Tier 5: 33% Tier 2: $37.50 Coinsurance Tier 3: $ Tier 4: $250 PHASE 1: Initial Coverage YOU PAY If YOU PAY If YOU PAY Your cost for each prescription is the GREATER of: PLAN PAYS Total $$ You Pay + Total $$ Plan Pays $3,310 OTHERS PAY Total $$ You Paid in Phase 1 Total $$ You Paid in Phase 2 + Total $$ Paid By Drug Manufacturers 5 $4,850 you move into PHASE 3: Catastrophic Coverage PLAN PAYS Each time you fill a prescription for a covered drug you pay a COPAYMENT. The Plan pays the balance. PHASE 2: Coverage Gap4 In this phase, you pay a LARGER share of the cost of your drugs. Instead of paying a COPAYMENT, you pay a PERCENTAGE of the cost. You will pay 45% of the cost of brand name drugs (plus a portion of the dispensing fee) and 58% of the price for generic drugs. In this phase, you pay a SMALLER share of costs. $2.95 for Generics $7.40 for Brand Name or Then you move into The DONUT HOLE Then 5% of Total Cost This phase continues until the end of the year. On January 1, the process begins again and you start back in the Initial Coverage phase. 1 Formulary tiers may vary by plan. 2 Other pharmacies are available in network. 3 For 90-day supply, multiply 30-day supply amount by three. 4 Member cost shares in the Coverage Gap may vary by plan. 5 The drug manufacturer pays 50% of the total cost of your brand name medications. 7

8 TheAdvantageSUMMER 2016 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 Martin s Point Generations Advantage PO Box 9746 Portland, Maine NONPROFIT ORG US POSTAGE PAID PERMIT #186 PORTLAND, ME Join Us at Grandparents Day with the Sea Dogs! You re invited to an afternoon of fun at the ballpark as Martin s Point Generations Advantage and the Portland Sea Dogs team up to celebrate grandparents and the important role they play in our lives. With pregame family activities and plenty of antics from Sea Dogs mascot, Slugger, this event has become a favorite of Generations Advantage grandparents and their families for the past several years. We hope to see you and your grandkids at the game! JOIN US! Grandparents Day with the Sea Dogs Sunday, August 28, 2016 at 1 pm Portland Sea Dogs vs. Trenton Thunder Hadlock Field in Portland Enjoy the game on us! Martin s Point will give away 500 FREE TICKETS to the first grandparents to RSVP by Thursday, August 25 (limit five per family). Please call to RSVP. Y0044_2016_371 Accepted: 6/24/2016