Tag Archives: medical

Making Sense of Medicare Advantage and Medicare Supplement

Vantage Point: Medicare Supplement or Medicare Advantage? What’s the Difference?

Have you ever had a conversation with a friend or family member where you were both thinking that you’re talking about the same thing, but then you realize (usually after much confusion and the conversation has drifted a bit), that you’re in fact not talking about the same thing?

The conversation comes to the point where you find that you’re talking about two different things, an “apples and oranges” conversation.

I think that there are a lot of “apples and oranges” conversations when it comes to what Medicare Supplement and  Medicare Advantage plans are. We’re talking about insurance with both, but they are different things.

Medicare Supplement plans, also known as Medigap plans, work with Original Medicare, which is Part A (hospital) and Part B (medical) coverage. They help pay for all or part of the 20% that Original Medicare doesn’t pay for, depending on what plan you choose. Medicare Supplement plans do not include prescription drug coverage, so if you want that, you’ll have to pick up a prescription drug plan separately.

Medicare Advantage, also known as Part C, are plans where a private insurance company replaces Original Medicare. Medicare Advantage plans have the same Part A hospital coverage and Part B medical coverage that you’d get with Original Medicare. (Remember, you’d still pay your Part B premium if you get a Medicare Advantage plan.) Plus, Part D prescription drug coverage is included in many Medicare Advantage plans. That means you’d have hospital, medical, and drug coverage together in one plan. Medicare Advantage plans may come with extras as well.

Now that the Annual Enrollment Period is here, you’ll be better equipped to have the “apples and oranges” conversations if they come up. If you still want more direction when it comes to your options, there’s a great local service available called SHIBA (Statewide Health Insurance Benefits Advisors). SHIBA is a free service of the Washington State Office of the Insurance Commissioner, Consumer Protection Division and can be reached at 509-902-1114 or 1-800-562-6900  It has great volunteers who can help you.

You can also come into our local office in Creekside Business Park, and we can go over anything you’re confused about in person, bit by bit.

We at Health Alliance Northwest in Yakima are here to help our community learn what the various parts of Medicare are to help each person make informed decisions that are the best for them. (The best choice might not be us, and we’re okay with that!)    

Breck Obermeyer is a community liaison with Health Alliance Northwest, serving Yakima County. She is a small-town girl from Naches and has a great husband who can fix anything and 2 kids who are her world.

In Case of Medical Emergency

Long View: What Is a Medical Emergency?

According to Medicare.gov, a medical emergency is a situation where “[Y]ou believe you have an injury or illness that requires immediate medical attention to prevent a disability or death.”

It seems pretty straightforward, so why are there so many questions around the decision to get treatment at your local emergency room?

An emergency room (ER) provides some of the most sophisticated diagnostic options in a hospital and the most immediate care to patients in crisis.

The list of possible emergencies is endless, so it’s important for you to recognize how serious your injury or illness is and to know the best way to get treatment for it.

Many of us have heard about folks with medical emergencies driving themselves to get treatment or catching a ride with a family member. Please don’t. Driving yourself puts you and others in jeopardy and delays the start of your treatment. Dialing 911 brings you the treatment quickly and gets you to an emergency room faster than a white-knuckle trip across town, dodging traffic lights.

Dr. Frank Friedman, one of our medical directors who specializes in emergency care, said, “A true emergency is one that can’t wait. It is something causing such severe pain or such a risk to life or limb, for oneself or a loved one, that it can’t wait hours, or a day or two, to be seen by one’s own doctor or healthcare provider.”

If it’s not an emergency but you need medical care to keep an illness or injury from getting worse, call your doctor. If your doctor can’t see you right away or the office is closed, urgent care (or convenient care) can help you get treatment quickly.

Over the years, I have heard some interesting and alarming questions from our members. This FAQ can help answer those questions.

Q. I just got one of your policies, and I’m having severe chest pain. Will you cover me for an ER visit?

A. This is one of the most unsettling questions we receive. If you’re experiencing severe chest pain, don’t call your plan, call 911. It’s as simple as that.

Q. Do I have to pay a copay when I get there?

A. No, they should be able to bill you, so there’s no reason to wave your credit card around as they wheel you through the front door. In fact, under federal law, an ER has to evaluate and stabilize you in an emergency medical situation, without regard for your ability to pay.

Q. What if I have special conditions they need to know about?

A. Keep a list of your medications with you. MedicAlert’s medical IDs or the Yellow Dot program can also help you share this information. And many smart phones have features that let you add emergency contacts and medical information. Plan ahead.

Q. What are some examples of when I should go to the ER and when I should go to my doctor or urgent care?

A. Visit the ER for emergencies like chest pain, broken bones, poisoning, shortness of breath, fainting, and seizures. For things like a constant fever, strep throat, sprains, the cold or flu, earaches, or minor infections like pink eye, call your doctor or visit urgent care.

Will you recognize a medical emergency? Probably yes, so trust your judgment, act quickly, and please be careful out there.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

Inspirational Stories

Inspirational Stories for the New Year

With the internet, it’s easy to see how small actions can make a big difference, especially in charity and medical funding. For the new year, we’re bringing you some inspirational stories that motivate you to get involved.

The story of Devon Still’s daughter who has cancer and how the Bengals have rallied around her and fighting the disease is both moving and inspiring.

A new mom whose heart hadn’t beat in 45 minutes spontaneously resuscitated last year, astounding doctors.

Did you see the viral story of Batkid last year and how San Francisco and Make-a-Wish came together to make his dreams come true? Learn more and get involved.

We all know the impact a nurse’s care can have, especially this Boston Marathon bombing victim who married his nurse.

Read the inspirational story of how one little boy’s kindness launched a charity.

These twin sisters were separated at birth and found each other online. Now they help others reunite.

A boy in Canada raised over $54,000 for his friend’s cerebral palsy surgery by selling lemonade.

Protecting Your Baby with Vaccines

The Importance of Vaccines: Myths vs. Facts

A little boy in Germany has died, the first death in the current measles outbreak. While people take sides about vaccines in the news and politics, the medical world’s feelings are clear.

Vaccines, or immunizations, are a time-tested and scientifically proven way to prevent certain diseases to protect your kids and our society.

What are vaccines?

Vaccines, immunizations, or shots are kinds of drugs you can take to help your immune system. Inside your body, they act like the diseases they’re supposed to prevent and trick your body into producing the kinds of cells it needs to fight a certain disease. By doing this, vaccines teach your body how to beat real infections when they happen.

When enough people are vaccinated, 90 to 95% of the population, it is enough to protect everyone, which helps get rid of diseases altogether.

Inoculation, an early form of vaccines, has been saving lives since the year 1000 in China. And waves of diseases and struggles to find treatments and cures across history have shown that sometimes, vaccines are our first and best form of protection.

Get more history on vaccines and the diseases they fight with this project from The College of Physicians of Philadelphia, The History of Vaccines.  

How well do they work?

Some of the scariest and most painful diseases to ever exist have been nearly wiped out by vaccination. And smallpox, one of the deadliest diseases, has been completely wiped out around the world. By doing so, according to Unicef, we’ve saved approximately 5 million lives each year.

And other diseases, like polio, have been close to being wiped out, too.

According to data from the Centers for Disease Control and Prevention (CDC), more than a dozen of the most deadly sicknesses humans have ever seen have been nearly wiped out in the last 200 years since vaccines were made. This infographic from Leon Farrant, also shared in this ThinkProgress article on vaccines, shows their power:

ThinkProgress Vaccine Infographic

Still not convinced? The Wall Street Journal can visually show you the data piece by piece for some of the main diseases your doctor vaccinates you against.

If they work so well, why are we even talking about them?

Diseases that we hadn’t seen much in the last few years, like measles, are making a comeback.

Those diseases are coming back because parents aren’t vaccinating their kids as much as they used to. And once the population falls below that 90 to 95% vaccination rate, those diseases are able to come back. And even with modern medicine, you can still die from them.

So why are parents taking that risk? Because of an old medical study that has been discredited, says The New York Times.

In 1998, a doctor said that he had linked the measles, mumps, rubella (M.M.R.) vaccine and autism in children.

Dozens of scientists and studies proved his work wrong, saying his research was bad since he’d only studied 12 kids, which is a tiny sample when doing scientific research. The British medical authorities even took away his medical license.

This is the only time a link has ever been made between vaccines and autism, and scientists and the medical field proved it wasn’t true. As this Guardian article talks about, later research studies have even made a lot of data disproving a link between the MMR vaccine and autism. Yet the story stuck.

People also worry that vaccines are just being produced by a big company to make money, not to protect patients. But as this New York Times article points out, many doctors lose money by giving you vaccines, and historically, many makers of them have made very little money off them.

As Newsweek points out, some statistics have also been skewed in a negative way. The CDC keeps a database of adverse effects from vaccines, which it’s required to do by law. Since 2004, 69 people have died after getting a measles vaccine. However, not necessarily because of the vaccine. In some cases, their death was completely unrelated, but the reporting system just gives the cold, hard numbers, not the cause-and-effect relationship between patients’ deaths and the vaccine. Numbers like these are sometimes used to convince people that vaccines are dangerous.

But the fact is that vaccines save many lives around the world. According to the World Health Organization (WHO), the measles vaccine alone has saved 15.6 million lives between 2000 and 2016.

The government, your insurance companies, doctors, and pharmacies make vaccines affordable and easy to get for one reason and one reason only: to save lives.

Don’t risk your family or your community. Health Alliance covers immunizations for our members, and we can help you stay up-to-date.

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Terms Jumble

Long View: Don’t Let Lingo Keep You from the Care You Need

When I was (considerably) younger, I read that a concert I wanted to attend was “SRO.” I was certain that meant “Sold Right Out,” and there was no way we could go. I was disappointed, but hey, you can’t win them all. Years later a friend told me another show was “SRO,” and I only then found out it meant “Standing Room Only.” My misunderstanding became the source of much merriment.

Industry-specific terms, acronyms and lingo are common in almost every business. I know the health insurance business has a lot, but have you ever heard two electricians talk? What about computer repair technicians? It’s all foreign to me.

Terminology, acronyms, and lingo are simply shortcuts for information-sharing between people in the same business. They are not meant to exclude others, but they do. The difference between the terms “copayment” and “coinsurance” can seem small, unless you are the person paying the bill. So, what can we insiders do to lessen the impact and be more inclusive?

About two years ago, Health Alliance started an internal plain language push. We took a close look at our written materials—brochures, guidebooks, letters, our website, and more—and realized we could make things easier to understand. We simplify or explain industry lingo, without losing the important information.

If you’re on the receiving end of lingo, stop and ask for clarification. If that is not possible, jot down a note so you can follow up on your own. This is especially important with your health care. Make sure you understand what your doctors tell you. They are insiders to the medical world, so they might not realize you need more explanation. Always ask questions if you’re confused. Your doctor will appreciate you taking the time to make sure you understand so you can take good care of yourself.

I am sure some of you are frightened to know I am learning how to text on my smartphone. Many of you are familiar with this digital language and its acronyms and lingo, but it’s new to me. Don’t worry, I was pointedly told “LOL” doesn’t mean “lots of love.” LAL (Live and Learn).

(Give this word search on commonly used insurance terms and their definitions a try!)