Tag Archives: coverage

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.

Medicare Advantage Mythbusting

Long View: Medicare Advantage Truths Might Just Change Your Mind

As I travel around the Illinois countryside, I hear the same misinformation about Medicare Advantage over and over. To tackle some of that, here’s a Q and A.

Question: When I join a Medicare Advantage plan do I lose my Medicare coverage?

Answer: No. If you have a Medicare Advantage HMO or PPO plan, a private health insurance company that has a contract with Medicare, like Health Alliance Medicare, provides the services instead of Original Medicare. People who disenroll from Medicare Advantage plans revert to Original Medicare. In either case, no one loses Medicare coverage.

 

Question: Will I be able to stay with my current doctors?

Answer: Probably, especially with Health Alliance Medicare. That’s why it’s important to check any plan’s provider directory to confirm your doctors work with the plan. People who select a Preferred Provider Organization (PPO) plan can use out-of-network providers, but they typically pay more when they receive services.

 

Question: We travel and might need to use the emergency room. Will Medicare Advantage plans only cover me for emergency care when I’m close to home?

Answer: No. Medicare Advantage plans cover out-of-area emergency and urgently needed care.

 

Question: If something serious happens and we need lots of services, could we predict how much we would pay for care?

Answer: Yes. Medicare Advantage plans have an annual Out-of-Pocket Maximum (OOPM), also called a Yearly Limit. When a Medicare Advantage member reaches that limit, the health plan pays 100 percent for Medicare-approved services. This amount doesn’t include the premium and other limited expenses. You can estimate what your expenses would have been last year on the Medicare Advantage plan you are considering.

 

Question: Medicare Advantage sounds good for me, but wouldn’t the premium be too costly for my 88-year-old mom?

Answer: Not at all. One of the best things about Medicare Advantage plans is the premium is the same no matter the member’s age. You and your mom would pay the same monthly premium if you had the same plan, unless either of you could get extra help paying for coverage based on your income.

 

Question: Would I have to deal with all the paperwork I get when I receive services from Original Medicare plus a Medicare Supplement plan?

Answer: No. You would have much less paperwork with a Medicare Advantage plan. In fact, that’s one reason Medicare Advantage plans exist, and I’m all for less paperwork.

 

Remember, the Medicare Annual Enrollment Period, or AEP, runs from October 15 to December 7. That’s the only time most people can change their coverage for the following year.

If you are thinking about a change for yourself or a loved one, you will have to do a bit of research. Trusted resources like Area Agencies on Aging and your local senior center can help.

Please consider Health Alliance Medicare a resource, too.

We all want to make well-informed choices that don’t depend on myths and misinformation.

AEP Autumn

Vantage Point: It’s That Time of Year

Days are warm and evenings crisp. Orchards bustle during the pear and apple harvest. It is my favorite time of year, but for seniors it can be stressful because of Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7. This is the time of year when most Medicare beneficiaries can choose or change their Medicare coverage.

Better-than-ever health care coupled with healthier lifestyles means people are living longer. With that, living on a fixed income means many seniors worry about having affordable health care for years to come.

One of the most common questions we hear in our Wenatchee office is, “What is the difference between a Medicare Supplement and Medicare Advantage plan (also known as Part C)?” Learning about each product can help people understand what best fits their lifestyles, pocket books, and health care needs.

Whether choosing a Supplement or Advantage plan, you must continue to pay your part B premium.

Medicare Supplements work much like a secondary insurance. They pick up their share of the covered health care cost after Medicare pays, depending on what plan you purchase. For example, it may pick up 10 percent of the 20 percent coinsurance (meaning you would still pay 10 percent). Supplements will not cover any cost Medicare denies, and some Supplements require medical underwriting to gauge the health of the individual. Premiums, or the cost you pay for the coverage each month, are generally more expensive. Like with Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans replace Original Medicare, which means hospital and doctor visits are paid directly by the plan. Many Advantage plans also include prescription coverage making for one tidy package. To be clear, you still keep all your Medicare benefits. There is no medical underwriting, and premiums are generally lower. Advantage plans also cover extras that Medicare does not, like dental and fitness programs. They also work closely with provider offices to help coordinate care. This helps many members stay healthier. Advantage plans have contracts with provider offices so a member normally must chose a doctor within the plan’s network.

Health Alliance takes Medicare seriously, and our Wenatchee office and helpful customer service representatives are a resource you can count on to help make a great decision for you during AEP and beyond.

Visit us at 316 S. Fifth St. in Wenatchee from 8 a.m. to 5 p.m., weekdays. Or call 1-877-561-1463, TTY 711, from 8 a.m. to 8 p.m. daily. That looks like a toll-free number, but our local representatives are on the other end waiting to help.

Washington Beauty

Wowed by Washington: Illinois Native Trades Cornfields for Orchards

Emily Beach, a Health Alliance employee in the Communications Department, visited Washington to learn more about the members we serve and what it’s like to live in North Central Washington.

I was overjoyed at the chance to visit North Central Washington and learn more about the area and the Health Alliance Medicare members we serve.

I had been to the Olympic Peninsula, but knew the other side of the mountain held experiences untapped. My 3-day tour featured a first-time health fair, tours of everything from hockey rinks to senior centers, and a run along the Columbia River.

It was important for me to visit Washington because I knew the population was as diverse as the geography. Health care and coverage isn’t one-size-fits-all, and it’s so important for us to know our members. My goal wasn’t just to see the beautiful sights, but to see what is important to the people living in North Central Washington.

And my goal now that I’m back in Illinois is to translate those hopes, joys and lessons into our communications with Health Alliance Medicare members to support our employees who live and work there, too.

My first day in Washington was cut short. Travel woes struck me and my travel partner, Ericka Williams, who leads the Health Alliance Medicare sales team. A couple flight delays and a missed connection put us in Wenatchee after midnight. The next morning, with the help of some coffee, we headed to the Wenatchee YMCA for the first local National Senior Health & Fitness Day event.

We were both thrilled with how well the Health Alliance Medicare event came together. More than 100 visitors tried new fitness classes, got a health screening and talked with a variety of vendors. Shannon Sims, our community liaison, worked so hard to make the event a success. And we couldn’t have done it without the help of the Wenatchee YMCA.

SS Class

Event participants enjoy a SilverSneakers class at the Wenatchee YMCA.

Emily and Shannon

Shannon and I representing Health Alliance Medicare at the first local National Senior Health and Fitness Day.

HA Booth

 

After the event, we walked to McGlinn’s for lunch. I tried the famous beer bread and enjoyed a white garlic pizza. The pub was inviting and fun, and the food delicious! We were also excited to hear our waitress was a Health Alliance Medicare member. I love hearing what our members have to say about how much they like their plans from us. I’m glad she spoke up on seeing our Health Alliance shirts and badges!

McGlinn's

 

Shannon was the “hostess with the mostess” for the whole trip.

Her passion for the community is truly infectious. She inspired me to kick my jet lag after lunch and head over to Quincy. I loved seeing the orchards along the way. Shannon explained how to tell the difference between cherry and apple orchards and pointed out the signs labeling the different types of apples. I was also surprised at how quickly the landscape changed from the desert cliffs in Wenatchee to the fields of Grant County.

And there were tumbleweeds! My previous trip did not prepare me for that.

After our drive through Grant County, Shannon got me back to Wenatchee, where Ericka and I grabbed some grub at Pybus Public Market. Public markets are not common in Illinois, and I loved the fresh air and atmosphere. I truly think spaces like that bring communities together. We ate at South, where I enjoyed a shrimp burrito with a kick!

Pybus

I loved visiting Pybus Public Market. The open space with local roots is perfect for building community.

Though fatigue was definitely knocking, I knew I had to squeeze in a run on the Loop Trail along the Columbia River. I didn’t brave the full 13 miles, but I enjoyed a nice three-mile jog and sunset on the river. What a beautiful place!

Columbia

How could I not enjoy a run with a view like this?!

This was just day one! Check back early next week for more stories from my trip!

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Essential Health Benefits: Get More for Your Money

Upgrading to the Meal

That glorious moment when the server at a restaurant clarifies that your meal comes with a drink … not for an extra cost, but with. Wow, what a moment. As of January 1, 2014, your health insurance plan comes with Essential Health Benefits.

If you’ve been a Health Alliance member before, we’ve covered many of these benefits for years, so you won’t see or feel much change. But if you’re new to us, welcome and enjoy!

Essential Health Benefits stretch across 10 categories. By law, no matter your age, gender, or medical history, you’re covered in these 10 areas.

Essential Health Benefits

Details

Ambulatory Patient Services Care you get at a doctor’s office, clinic, or outpatient surgery center, including home health services and hospice care.
Emergency Services Care provided in an emergency situation where you believe your health is in serious danger, like chest pain, a broken bone, or unconsciousness.
Hospitalization Care from doctors, nurses, and hospital staff, room and board, surgeries, and transplants you receive during your hospital stay, or care in a skilled nursing facility.
Laboratory Services Testing to help a doctor diagnose an injury, illness, or condition, or monitor how well a treatment is working.
Maternity and Newborn Care Prenatal care through newborn care.
Mental Health Services and Addiction Treatment Inpatient and outpatient care to treat a mental health condition or substance abuse.
Rehab Services and Devices Services and devices to help you regain mental and physical skills lost because of injury, disability, or a chronic condition.
Pediatric Services Wellness visits and recommended vaccines and immunizations for infants and children, as well as dental and vision care for children under 19 years old.
Prescription Drugs Antibiotics and medicines to treat an ongoing condition, like high cholesterol.
Preventive and Wellness Services and Chronic Disease Treatment Physicals, immunizations, preventive screenings, and care for chronic conditions, like asthma and diabetes.

*Some services do have limits.

Young Invincibles Growing Up

Young Invincibles Feel the Love for Health Insurance

Young Invincibles

Young invincibles are young, healthy, independent, and don’t have a lot of cash to throw around, but, like everyone else, they need help when it comes to:

  • Understanding their options under the new health care law
  • Choosing the plan that’s best for them
  • Listening to their mother

ecard1

Conventional Wisdom

All kidding aside, the conventional wisdom surrounding young invincibles in need of insurance isn’t so conventional, after all. Sure, they aren’t flocking to the exchanges in droves, but they aren’t avoiding them, either.

In fact, according to this article by Aaron Smith, co-founder and executive director of Young Invincibles, as well as this press release from his organization’s website, it seems these youngsters are signing up in numbers proportional to the overall population, and possibly even at a higher rate than their older and wiser counterparts.

So good job, Mom—it turns out you raised them right!

What’s the Deal?

This may be their first time around the health insurance block, but the appeal to reason, and their very limited budgets, is bringing youthful buyers to the table. One small car or bike accident, sports injury, or even a bad case of mono could add up to HUGE medical bills that a struggling student or first-rung employee could never afford.

While many feared the typical response to the pay premiums vs. pay a tax penalty debate would be to just pay the penalty, stats show many young invincibles can do the math:

Paying a penalty and all of their potential medical costs for a year is not a good deal.

Not so Invincible, After All

It’s important to note that young invincible isn’t a title these people gave themselves. Obviously, they’re well aware it’s a big, dangerous world out there, and the smart play is getting yourself covered.

In fact, not only are your super-smart kids signing up to protect their wallets, they’re actually signing up to protect their (gasp!) health. They’re taking advantage of subsidies to buy up from the high-deductible catastrophic plans many assumed they would purchase, and investing in more benefit-rich Silver, and even Gold and Platinum, plans.

And why wouldn’t they? With many plan premiums starting under $100 a month, it’s a small price to pay for peace of mind and financial security.

Take Good Care of My Baby

So Mom, while we know you always want to take care of your kids, maybe it’s OK to let them leave the nest. And here’s something else that might ease your mind:

We’re here to help.

Keeping your family healthy and safe is a priority for us, too. Maybe you already have our group or individual plans, or know someone else who does. After all, we’ve been helping people find plans that meet their needs and situations for over 30 years, since before most of the young invincibles were even a gleam in anyone’s eye!

We have great plans, a great network of doctors and hospitals, and great people ready to explain the options, answer questions, and find the right match for your babies, as if they were our own.

Get signed up. To learn more or shop for plans, call 1-888-382-9771, visit us online at HealthAlliance.org, or stop by our Anthony Drive location in Champaign today!

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