Tag Archives: Medicare Advantage

An App for Better Dental Health

Long View: Dialing In to Better Dental Health

I have a confession to make. My toothbrush talks to my cellphone, and I’m pretty much OK with that. I’ve brushed my teeth well over 36,000 times in my time on this planet, and suddenly now, in my 50th year, I need my phone to tell me if I’ve been doing it correctly.

Having good teeth is a genetic gift I inherited from my grandmother. She grew up in an era before there was fluoride in the drinking water, and her father didn’t believe in traditional medicine. I wonder if she ever even went to the dentist as a child. And yet, when she passed away, well into her 90s, she didn’t have a single cavity.

I’m lucky to have inherited her teeth DNA. I’ve only had two cavities in my life and both came after a pregnancy and were so shallow I didn’t even need Novocain. So they don’t count.

This is good news because I have a very low gag threshold and can’t stand having any kind of metal dental instrument in my mouth. Just getting X-rays at the dentist once a year is traumatic for me. I have to give myself a pep talk while biting down. “Just breathe and don’t throw up, just breathe and don’t throw up.” If I had to withstand anything more exotic than a quick cleaning, the dentist would probably have to sedate me.

Getting back to my talking toothbrush, thanks to Bluetooth technology, an app on my phone tells me if I’m brushing long enough, too hard, too soft, or not long enough in a certain area. How my phone knows this is pure sorcery in my opinion, but I’m taking my phone’s advice and trying to do a better job of brushing. After all, good oral hygiene is a part of our overall health and well-being.

In my line of work, I get a lot of feedback from seniors on Medicare. Time and time again, one of their questions is, “How am I going to pay for my dental care?” This is a valid question because original Medicare does not pay for dental care. Without purchasing a separate dental insurance policy, the expenses of cleanings, X-rays, cavities, root canals, crowns, partials or even dentures must come out of your own pocket. (Whew, just typing those procedures made me queasy.)

Some people get to remain on their company’s dental insurance policy when they retire. Others will decide to purchase private dental insurance as part of their overall retirement health insurance expenses. Many people that don’t have these options are kind of left wondering what to do now.

There are many Medicare Advantage plans that offer members a set-amount dental benefit along with medical coverage to help offset some of the expense of dental care. It won’t provide as extensive of coverage as a private dental insurance policy does, but the benefit does help offset some (or all if you have teeth like my grandmother’s) expenses of good dental care.

If keeping your pearly whites in working order is a priority for you but the extra expense of full-blown dental insurance isn’t, a Medicare Advantage plan might be a solution. While you’re at it, you can consider looking into one of those high-tech toothbrushes like mine. As your mother always told you, the best dental care starts with good brushing habits.

Lora Felger is a community and broker liaison at Health Alliance. She is the mother of 2 terrific boys, a world traveler, and a major Iowa State Cyclones fan.

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.

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.

HappyHappy, Healthy, Medicare New Year!

Long View & Vantage Point: Steps to a Happy Medicare New Year

Winter preparations are all done, and winter festivals and end-of-the-year holiday celebrations have ended. Just when you think you can sit back and relax, there is still one last item you may need to consider.

If you made any changes to your Medicare plan during the Annual Enrollment Period, here are some actions you can take to help you have a happy Medicare New Year:

  1. Make sure you’ve received your new plan’s member ID card.

If you joined a Medicare prescription drug plan (PDP) that works with Original Medicare, you’ll get a separate card to use when you fill your prescriptions, but you’ll still use your Medicare card for hospital and doctor services.

If you joined a Medicare Advantage plan, like a Health Alliance plan, you’ll get a new card to use when filling your prescriptions and for hospital and doctor visits.

If you need medical care or need to fill a prescription before you receive your ID card and your new coverage has already started, you may be able to use other documents as proof of coverage, like the welcome letter you got from the plan, or even your enrollment confirmation number and the plan’s name and phone number.

  1. Show your new member ID card to your doctor’s office and pharmacist on your first visit of the new year.

If you have stayed with the same insurance company, be sure to replace last year’s card with your new card. If you changed companies, be sure you’re always using your new card.

  1. If you chose to have your plan premium withheld from your Social Security check, don’t be alarmed if you don’t see it deducted right away. It can take up to 3 months from when you made this request to start seeing it withheld from your Social Security payment.
  1. Remember that your deductibles start over at the beginning of the year, so normal copayments won’t start until all applicable deductibles have been met for the year.
  1. Take advantage of your annual wellness visit. This free preventive benefit is designed to help you take charge of your health, learn about preventive services you might need in the future, and establish a baseline for personalized care.
  1. Take advantage of any gym membership benefits from your plan. Many plans offer gym memberships or access to fitness activities, at no cost to you. Our Be Fit benefit helps pay you back for your gym membership or fitness classes, so you can get fit at the gym of your choice.

Wishing you all a happy and healthy 2017!

Sherry Gordon-Harris is a community liaison at Health Alliance. She is a wife and mother of 2 boys and enjoys traveling, collecting dolls, and hosting princess parties and princess pageants.

Breck Obermeyer is a community liaison with Health Alliance, serving Yakima County. She is a homegrown girl from Naches and has a great husband who can fix anything and 2 kids who are her world. When not attending community events or providing Medicare education throughout the Valley, she can be found indulging in her hobbies of homesteading, pioneer cooking, and learning new survival techniques. She also has a strong love for all things Halloween.

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.

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.

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UPDATE: please be advised that the Urbana Plaza Hotel & Convention Center, or the former Holiday Inn, is now called the Wyndham Garden Hotel.

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