Tag Archives: coverage

Time for Change

Long View: Is It Time for a Change?

“Everyone appreciates the long, light evenings. Everyone laments their shortage as Autumn approaches; and nearly everyone has given utterance to regret that the clear, bright light of an early morning during Spring and Summer months is so seldom seen or used.”

This was written by a London builder named William Willett, who proposed daylight saving time from an idea conceived by Benjamin Franklin.

“Spring forward. Fall back,” was how I learned it! I remember daylight saving time when I was a child was a big deal. The Saturday night before the official time change would take place, my entire family worked together to make sure that all the clocks and watches in our household were set, not to mention the clocks in my parents’ cars. It never failed. There was always that tiny clock on the top of our stove that we would miss. My mom always caught it when she went to set the oven timer!

Then, once the clocks were all set, my sister and I pondered whether we lost or gained an hour of sleep. We always had to sit there for a minute or 2 and do the math before coming up with the answer.

For most of us today, time changes are not nearly as complicated as they used to be. Our world is much more hurried, and automation is everywhere. It’s accepted that almost every clock, watch, appliance, iPhone, and computer is programmed for daylight saving time. We really don’t have to worry about making sure all of our timepieces make the change. With our schedules so full, we don’t even realize we’ve gained an hour or lost an hour of sleep.

Just like the time change happens each November, Medicare’s Annual Enrollment Period (AEP) happens each October. Medicare beneficiaries can review their current plan and make any changes they feel are needed from October 15 through December 7.

Every year, the AEP is a good time to check your drugs and review upcoming services with your doctor, then make sure the plan you’re on is still the best fit. You might even want to get your family together to make sure you didn’t miss anything.

Some resources available to help you this AEP include Medicare.gov, which is easy to navigate and packed with information, and Illinois’ very own Senior Health Insurance Program (SHIP). The Illinois Department of Insurance offers this free, impartial counseling service for people who are Medicare-eligible. Visit Insurance.Illinois.gov or call them at 1-800-548-9034. You can also find the nearest SHIP office in this directory, or, in Iowa.

And don’t forget to check out your current insurance info at HealthAllianceMedicare.org. If you need to research plan options, you can “fall back” on us! We’re ready to help with any questions you may have for the upcoming plan year.

Mervet Adams is a community liaison with Health Alliance. She loves her grandson, family, nature, and fashion.

Answers to Your Health Insurance Questions

Vantage Point: Time to Answer Important Health Insurance Questions

It’s that time of year again. My husband comes home with a huge packet of healthcare information. Yep, it’s open enrollment for his employer health plan. It’s time for us to look at the options and choices that best suit our family in the coming year.

Every year, Medicare beneficiaries get this kind of event too. It’s called the Annual Enrollment Period (AEP). Each year from October 15 to December 7, they have the opportunity to look at the options available in their service area and choose which plan is the best for them and their health.

This is an important time for everyone. As we age, our health may change too. Understanding and knowing what coverage is best for you can be a daunting task, so you should ask yourself some very important questions each and every year.

Am I happy with my current plan? What’s changing for the new year? Is the premium going up on the plan I currently have? Do I need more coverage?

I understand that as Medicare members, you’re sent an enormous amount of marketing material during this time of year. All the Medicare Advantage, Medicare Supplement, and prescription drug plan companies are trying to get your attention and your business.

How do you weed through all the material? And even more important questions come up for you each year. Do I know the difference between Medicare Advantage and Medicare Supplement? Is the prescription drug plan I’m currently on the best value for the prescription drugs I’m taking? Finding the answers can be confusing and frustrating.

The answers you seek can be found quickly and easily. Visit our website or call us directly for answers to your health insurance questions. There are also independent brokers available to you, like GHB Insurance located right in Olympia, to help you with all the plan information you receive. In the Thurston County area, there are also SHIBA (Statewide Health Insurance Benefit Advisors) representatives who volunteer their time to help you understand Medicare and all the parts associated with it. They can be found at both the Lacey and Olympia senior centers.

So never fear, your Medicare questions can be answered here. Or at least, we can assist you in getting the answers you need. Remember, you have resources available to you. All you have to do is use them.

Joy Stanford is a community liaison with Health Alliance, serving Thurston County. She’s been involved with Medicare for 20+ years and truly enjoys it. She enjoys gospel, R&B, and country music, and she owns over 100 pairs of shoes.

Finding Medicare During the Annual Enrollment Period

Vantage Point: The Season for Informed Choices

It’s October, and folks living in North Central Washington are looking forward to beautiful fall colors and freshly picked apples. For those on Medicare, it’s also the start of the Annual Enrollment Period (AEP), when beneficiaries can shop for their 2016 coverage. It runs October 15 to December 7. But because of confusing plan changes and choices, some dread the AEP rather than looking forward to it.

But there are people who can help make these decisions easier. A trusted resource for Medicare eligibility throughout the year is the Statewide Health Insurance Benefits Advisors (SHIBA) program. The SHIBA program was formed to help consumers understand Medicare and their options for supplementing it. SHIBA counselors keep client information 100% confidential, and their main mission is to help clients see Medicare plan comparisons so that the client can choose using unbiased and accurate information.

At educational presentations in the past, I’d learned a lot from Dick Anderson, a certified SHIBA counselor, and recently had the pleasure of meeting with him one-on-one. Hearing Dick describe some of his stories captured what a valuable service he and other advisors provide. Counseling to help others by these trained volunteers truly comes from the heart.

Dick says there’s no Medicare plan that’s right for everyone, so instead he tries to get his clients to talk about their individual needs. This helps him determine what’s most important to them, so they can make a measured choice that meets their personal needs.

The rewards for this work are illustrated by Dick’s powerful stories of people from all different backgrounds, incomes, and educational levels who have come to him heavy with feelings of helplessness and confusion and after meeting with him, left with their cloud of anxiety lifted.

At Health Alliance, we strive to have quality, sustainable Medicare plans, but we agree with Dick that there’s no perfect plan for every person’s needs. Therefore, we value and respect the work SHIBA volunteers do to help people make informed choices.

For current Health Alliance members, we’re holding special meetings the first week of October in Wenatchee, Moses Lake, and Omak about our 2016 benefits and to answer any questions.

If you want to meet with a SHIBA counselor, you can make an appointment by calling Community Choice at 1-888-452-0731 or Aging and Adult Care at 509-886-0700.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant and Okanogan counties in Washington. She has four adult sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.

Your Insurance Team's Support

Vantage Point: We Work Together to Support You

Painted in the stairwell of Samaritan Hospital is an inspirational message, “All of us, for each of you.” The same can be said of our Health Alliance Medicare team in North Central Washington that works together to provide elevated customer service for members and our provider partnerships.

Eileen, our program assistant, is the first face members see when they visit the Wenatchee office. Eileen feels that by supporting staff and prioritizing tasks, she can focus all her attention on members when they come in.

“Health Alliance isn’t just insurance coverage,” she says. “It is a place to come if you have questions, are seeking information, or would just like a cup of coffee and an ear.”

Jessica, our bilingual customer service representative, says, “The most rewarding part of my job is having the ability to see our members face to face, build relationships, and let them know I am here to listen and help.”

Through her role at Health Alliance, Teri, our customer service lead, hopes to insure our members only have good experiences when adverse situations arise. Teri credits the overall team from claims to medical management for its support in helping her achieve her goal.

Major procedures, hospitalization, surgeries, and discharge plans all need prior approval, and Cindy, our utilization review nurse on the medical management team, uses her experience in risk management, coupled with patient advocacy, to take care of our members through major health issues, thus controlling unnecessary costs.

Medicare is not only complicated for our members, it can be complicated for providers as well. Therefore, Leslie, our provider relations specialist, works directly with clinical staff members to help them understand policies, procedures, and operating systems. By providing face-to-face customer service at the provider offices, it makes providers’ jobs easier, positively impacting their care of our members.

The Centers for Medicare & Medicaid Services ranks Medicare Advantage plans on a five-star scale, and factors within that quality scale relate to providers assessing, managing, and controlling chronic conditions. Amanda, our coding consultant, works directly with physicians to provide coding education and finds it rewarding when she and the doctors learn something from each other, ensuring overall great health care to our members.

Whether they’re working with members or providers or making medical decisions behind the scenes, these are just a few of the local people committed to working together toward the common goal of ensuring quality of care, setting Health Alliance Medicare apart in North Central Washington.

SEP Changes like Moving

When Change Happens, We Can Help

Things change. We understand that the unexpected is a part of life. But there are ways we can help you get covered when the unexpected happens.

If you weren’t able to get coverage during this Annual Enrollment Period, or if something important has changed and you need a new plan, you may be able to get a Special Enrollment Period (SEP).

During an SEP, you can buy a new plan or make changes to your current plan.

To get an SEP, you need a qualifying life event (something that has changed your insurance needs). Qualifying life events include:

  • Getting Married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area offering different health plan options
  • A change in income or household status, which can change how much government help you can get
  • Losing other health coverage because of:
    • Job loss
    • Divorce
    • Loss of eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
    • Expiration of COBRA coverage
    • Your health plan no longer meets the requirements of the Affordable Care Act (ACA)
    • Reduction or termination of employer contributions
    • Significant increase in the cost of your plan

If any of these items describes your situation, you have 60 days after that event to enroll in a new plan. You can shop with us online or call us at 1-877-686-1168 for help finding a plan.

Your new coverage date will depend on the kind of life event you had and what day of the month you enroll. Learn more about when your new plan will start.

Losing your coverage doesn’t always mean you get an SEP. You can’t get one if you lose your insurance because:

    • You didn’t pay your premiums
    • You chose on your own to quit your other health coverage
    • You lost a short-term plan or (in some cases) a Catastrophic plan

If you can’t get an SEP, you can always get covered with a short-term plan at any time. While they do help with your health costs, they aren’t qualified health plans under the ACA, which means you could still have to pay a tax penalty in the next year.

Still not sure what to do in your situation? Call us at 1-877-686-1168 for help figuring out your options.

Medicare Basics Without an App

Vantage Point: There’s Not an App for That – But We Can Help!

Personal fitness trackers—like the Fitbit® or Jawbone®—are popular devices to help you keep your New Year’s resolutions and stay fit all year long. The fitness tracker collects data and sends it to a phone app that tracks physical activity, calorie intake, and sleep quality. Wouldn’t it be cool if the device included an insurance tab to help people navigate their Medicare benefits, too?

Could you imagine how you’d feel slipping on the device if it said,
• “You have adequate coverage for your current health.”
• “Your doctor is in-network, and the out-of-pocket cost for your upcoming appointment is $10.”
• “Warning, you are nearing the prescription coverage gap.”

Until that technology comes along, Health Alliance Medicare can help explain Medicare basics. Most people paid for Medicare Part A through their payroll taxes while they were working, so they don’t pay a premium now. Part A covers inpatient hospital procedures, but not the doctor who does the procedure.

Medicare Part B covers the doctor and requires a monthly premium. Both A and B have deductibles (what you pay before your coverage kicks in) and coinsurance (a percentage of total cost that you pay). Figuring out coinsurance is tricky because it’s hard to plan what the overall doctor visit or hospital cost will be.

Medicare Part D is for prescription drug coverage. If you don’t choose Part D when you become eligible for Medicare, you could pay a penalty, called the Late Enrollment Penalty, if you add it later. If you pay a lot for your medicine, it’s important to read your monthly Explanation of Benefits to see if and when you’ll fall into the coverage gap.

Medicare Advantage plans, like Health Alliance Medicare, are called Part C and cover every benefit of Original Medicare and more, plus you can add prescription drug coverage. Medicare Advantage plans can be an easy transition for those turning 65 because they look a lot like employer insurance plans.

Until someone invents a Medicare app, consider Health Alliance Medicare your source for information. Helping people get started with the right information to avoid common and costly pitfalls later is the best part of our jobs.

Active with Medicare Advantage Extras

Everyone Loves Extras

We’ve been mentioning Health Alliance Medicare Advantage’s great extras for weeks, today we’re telling you all about them!

Healthways SilverSneakers® Fitness Program

SilverSneakers helps you get fit the way you want, at your convenience. Reach your fitness goals with access to more than 11,000 fitness locations, where you can:

  • Use all basic amenities, plus take SilverSneakers classes*
  • Get guidance and assistance from a Program AdvisorSM
  • Enjoy fun social activities

You can also choose 1 of 4 fitness kits. They help you maintain good health, and gain balance and muscle strength, without leaving your home.

SilverSneakers also gives members a secure online community with access to:

  • Easy-to-use nutrition, fitness, and health tracking tools
  • Fun exercise videos and demonstrations
  • Expert advice on exercise, nutrition, and life skills

Assist America

No matter where you are in the world, Assist America connects you to the help you need. They link you to quality emergency medical care while traveling. These are just a few of the great features our members get:

  • Medical referrals
  • Emergency medical evacuation
  • Medical repatriation
  • Prescription assistance
  • Compassionate visit
  • Return of mortal remains
  • Lost luggage assistance
  • Interpreter and legal referrals

$0 Tier 1 Drugs at Walmart and Sam’s Club

Sound too good to be true? It’s not. Members with prescription drug coverage get Tier 1 prescription drugs at Walmart and Sam’s Club for $0. Tier 1 drugs feature the most-used drugs on our formulary.

You pay low copayments when you go to other in-network pharmacies.

Be Well

We take care of you, when you’re healthy and when you’re sick.

When you’re healthy, we help connect you to:

  • Yearly physicals
  • Routine screenings, like mammograms or colonoscopies
  • Yearly dental cleanings
  • Timely immunizations
  • Member magazines that share health info and plan details
  • Quit For Life stop-smoking program

When you’re sick, we help connect you to:

  • Case Management to help explain your diagnosis and test results, assist with home care, and discuss treatment options
  • Disease Management Programs
  • Anytime Nurse Line

Call 1-888-382-9771 (TTY 711) from 8 a.m. to 8 p.m. weekdays. Or visit HealthAllianceMedicare.org for more info.

Health Alliance Medicare is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment depends on contract renewal. You must continue to pay your Part B premium. Low-cost prescriptions are available at other in-network pharmacies. The benefit information here is just a brief summary, not a complete description of benefits. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium, and/or copayments/coinsurance may change on January 1 of each year.