Tag Archives: Medicare Advantage

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.

Join Us at Our Enroll Expo

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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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Quality Customer Service with Health Alliance

Why Should I Choose Health Alliance?

Medicare’s Annual Enrollment Period (AEP) is in full swing, and you might be wondering why you should pick a plan with Health Alliance?

Insurance for Real Life.

We treat you like a person, not a policy. We don’t like to brag, but we have a pretty amazing team. Every person, from front office to corner office, wants you to be your best.

Tens of thousands of network physicians
Hundreds of network hospitals
Nearly 300,000 members
500-plus Health Alliance employees and growing to serve your needs
One goal. Deliver top-notch insurance that fits your needs and budget

You Can Relax Knowing You’re Covered

We are always building our network to give you a large network of doctors, hospitals, and clinics you trust.

If you’re miles from home and outside your network, we have services linked to getting quality emergency medical care while traveling 100 miles from home or abroad through Assist America.

We Are Here to Help

We love hearing from our members. So whether it’s in person, on the phone or through social media, when you have a question, our Customer Service reps are here for you.

You’ll never have to jump through hoops to get answers. They give personal help to over 40,000 callers each month and connect members to answers in 15 seconds or less, on average. They resolve 99.6% of issues on the first call.

They’re also happy to meet with you. Just stop in Monday through Friday. We’re at 206 W. Anthony Drive in Champaign, IL or 316 S. Fifth St., Wenatchee, WA.

Our Medicare seminars are informational meetings we hold all over our service areas during the AEP, so you can find one close to you.

Extra Benefits

Our Medicare Advantage plans have extra benefits like SilverSneakers Fitness Program, $0 Tier 1 drugs at Walmart and Sam’s Club, Assist America, and our Anytime Nurse Line.

We also help you settle in. We mail you your member materials. We will also call you to verify that your coverage is in place and talk to you about making the most of your benefits.

Health Alliance will take care of you every step of the way. It’s no wonder 96% of our members unpack their bags and stay awhile.

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.