Tag Archives: medicare

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

SaveSave
Making the Most of a Senior Center

Vantage Point: Not Your Grandmother’s Senior Center

Have you been in a senior center lately? Well, I’m here to tell you, it is in no way like you’d think it would be. Hip, active, and happy people are taking classes, having a laugh at the welcome table, or volunteering behind the desk. Bingo? Sure, they still have bingo, however they have much more than that these days.

Senior centers bring older adults together who want to gather, socialize, and continue to learn. Before working in the Medicare healthcare industry, I’d never ventured into a senior center. Fast forward several years, and it’s where I may spend part of any given day and where I learn the most about our senior population.

Olympia Senior Center is one such center. It is a thriving, bustling, happy place. The welcome table is where you can find me, along with an eclectic group of awesome, interesting, and vivacious older adults who are always ready to welcome a new person to the center or to the community.

I regularly attend the community awareness meetings that take place at the center every Wednesday. Each Wednesday of the month is different. One meeting provides valuable information on various subjects, activities, and projects around the Thurston County area.

Once a month, a community member presents a travelogue about their trip to an adventurous destination. They show a presentation with vivid pictures and give great details about the points of interest from their trip, plus the details of costs, transportation, and accommodations.

This month, the travelogue’s destination was Vietnam, presented by DJ Marks. She is an excellent presenter and kept the group engaged throughout her presentation. While it would not be the first choice for some of us in the group, we all agreed that it was a spectacular look into the culture and history of the country.

On another Wednesday, the group views TED Talks, which are short, powerful videos on various topics. We’ve explored many themes and subjects over the past few months, like money, fear, political divides, and reforming the American justice system. All of these topics have evoked emotional, professional, and spiritual ideas and opinions during discussions.

I asked Sara Rucker-Thiessen, who coordinates these Wednesday meetings, what makes this center different from people’s expectations of a senior center. She said, “We go way beyond leisure activities and incorporate continuing academic learning and discussion of current social issues, along with the fun activities like dances and bingo.”

Other centers around Thurston County incorporate many of the same activities as the Olympia Senior Center; however, what’s great about Olympia is how it’s tailored its center to fit the countless members who show up every day to stay active, be motivated, and get inspired.

I have learned many things from these well-versed and well-lived individuals. One of them being, don’t think you know what’s going on in the senior center until you go in and find out for yourself.

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.

Going to Your Well-Woman Visit

You and Your Well-Woman Visit

Your insurance covers an annual well-woman visit. But what exactly does that mean?

Your yearly well-woman visit can be either a combination of your annual physical and care specific to you as a woman or a separate appointment for just that care.

Preventive Care at Your Well-Woman Visit

Your plan covers a lot of preventive care and screenings, many of which you’ll get at your yearly physical. But for some of the care, you’ll probably want to schedule a separate well-woman visit with a specialist, like a gynecologist, or even multiple appointments with your doctor and different specialists.

Depending on timing and what your doctor recommends, this care includes:

Screenings & Care
  • Osteoporosis screening – For women over age 60, depending on risk factors
  • Domestic and interpersonal violence screening and counseling
Cancer Screenings & Counseling
  • Breast cancer genetic test counseling (BRCA) – For women at higher risk
  • Breast cancer mammography screenings – Every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling – For women at higher risk
  • Cervical cancer screening – For sexually active women
Sexually Transmitted Infection (STI) Screenings
  • Sexually transmitted infections counseling – For sexually active women
  • Chlamydia infection screening – For younger women and other women at higher risk
  • Gonorrhea screening – For all women at higher risk
  • HIV screening and counseling – For sexually active women
  • Human Papillomavirus (HPV) DNA test – Every 3 years for women with normal cytology results who are 30 or older
  • Syphilis screening – For women at increased risk

And if you’re pregnant or may become pregnant, there’s even more preventive care covered for you.

Prepare for Your Visit

Preparing with questions, and answers to your doctor’s questions, can help you make the most of your visit.

Know Your Family History

Talk to your family members, especially your mom, about your family’s history of women’s health issues. For example, as a woman, you’re more likely to get breast cancer if it’s genetic on your mom’s side of the family. So knowing this information can help your doctor keep an eye out for genetic issues you’re at risk for.

Talk to Your Doctor

Prepare for your appointment by knowing any questions or issues you want to talk to your doctor about. Some things you might want to ask include:

  • What immunizations or shots you need, like the HPV vaccine
  • If you should get STI screenings
  • Help getting pregnant or birth control options
  • How to do self-exams to regularly check for breast cancer
  • Mental and social health concerns, like relationship issues or domestic violence questions
  • Specific issues you might be having, like problems with your menstruation or abnormal pain or cramping

Know What’s Covered

Log in to Your Health Alliance or search by your member number to see what preventive care your plan covers.

Or use our general preventive care guidelines and prescription drugs or our Medicare preventive care guidelines to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can also check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready to go to your well-woman visit, log in to Your Health Alliance to find a covered doctor, or start searching for doctors in our network.

Your Preventive Care

Your Yearly Preventive Care and Physical

Getting your yearly physical, where you can get covered preventive care and screenings, helps you be your healthiest. It’s important that you not only know what’s recommended for your age and what you need to stay up to date, but also that you get to the doctor for this each year!

What Happens at Your Physical

Each year, you should schedule a physical with your doctor to focus on your health and wellness. At the appointment, you can:

  • Keep track of your health habits and history
  • Get a physical exam
  • Stay up-to-date with preventive care
  • Get education and counseling and set health goals

Health Habits & History

One of the first things that happens at your annual appointment is a nurse or your doctor will ask you to answer some questions about your health and family history, including questions about:

  • Your medical history
  • Your family history
  • Your sexual health and partners
  • Your eating and exercise habits
  • Your use of alcohol, tobacco, and other drugs
  • Your mental health history, including depression
  • Your relationships and safety

This info can help you in the future. From getting diagnosed to being protected and helping you in an emergency, this information can help save your life.

Physical Exam

At your yearly physical, you can expect your doctors or nurses to:

  • Measure your height and weight
  • Calculate your body mass index (BMI) to check if you’re at a healthy weight
  • Take your blood pressure and temperature

From there, your doctor may give you your regular preventive care screenings and shots or refer you to a specialist for certain screenings, counseling, or care.

Preventive Care

As an adult, certain preventive care and screenings are covered for you, depending on timing and what your doctor recommends.

Immunizations (Shots)

Doses, recommended timing, and need for certain immunizations can vary based on your case:

  • Diphtheria
  • Flu shot
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (Chickenpox)
Condition Screenings & Care
  • Aspirin use – To prevent heart disease for adults of a certain ages
  • Cholesterol screening – For adults of certain ages or at higher risk
  • Blood pressure screening
  • Type 2 diabetes screening – For adults with high blood pressure
  • Colorectal cancer screening – For adults over 50
  • Depression screening
Weight Management
  • Obesity screening and counseling
  • Diet counseling – For adults at higher risk for chronic disease
Alcohol & Tobacco Use
  • Alcohol misuse screening and counseling
  • Tobacco use screening – For all adults and cessation interventions for tobacco users
  • Lung cancer screening – For adults 55 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  •  Abdominal aortic aneurysm – A one-time screening for men of certain ages who have ever smoked
Sexually Transmitted Infection (STI) Screenings
  • Sexually transmitted infection (STI) prevention counseling  – For adults at higher risk
  • Hepatitis B screening – For people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and American-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence
  • Hepatitis C screening – For adults at increased risk and once for everyone born from 1945 to 1965
  • HIV screening – For everyone ages 15 to 65 and other ages at increased risk
  •  Syphilis screening – For adults at higher risk

Women also have some additional covered screenings and benefits. Get more details about this specific preventive care while learning about your well-woman visits.

And learn more about what preventive care the United States Preventive Services Task Force recommends you get and when.

Education, Counseling & Health Goals

Your doctor can help you manage your conditions or diseases and prevent future problems by talking to you about your life and health each year.

Your doctor might have valuable handouts, websites, advice, and information to help you take care of yourself or might want to refer you to a specialist who can help you further.

Your doctor is also the perfect person to help you set goals to maintain or improve your health. From quitting smoking and knowing how to self-check for cancer to changing your diet and exercise for your weight, cholesterol, or blood pressure, your doctor can help you plan to be your healthiest.

Prepare for Your Visit

Preparing yourself with questions to ask and answers to your doctor’s questions can help you make the most of your visit.

Know Your Family History

Your family’s history of health and wellness is an important part of your own health record. Histories of illness and disease can help doctor’s look out for issues that run in families and more.

This family health history tool can help you track your family’s health, so that you’re always organized to talk to your doctor. Not sure about your family history? Filling this out is the perfect time to talk to family members for firsthand details.

Talk to Your Doctor

Prepare for your appointment by knowing any questions or issues you want to talk about ahead of time. Some things you might want to ask:

  • What immunizations or shots you need
  • Your diet and eating healthy food
  • Advice for exercise and getting active
  • Mental health concerns, like depression and anxiety
  • Specific issues you might be having, like sore joints, back pain, migraines, and more

Know What’s Covered

Learn more about your covered immunizations. And log in to Your Health Alliance or search by your member number to see what preventive care your plan covers.

You can use our general preventive care guidelines and prescription drugs or our Medicare preventive care guidelines to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready to go to your annual physical, log in to Your Health Alliance if you need to set a Primary Care Provider (PCP) and find a covered doctor, or start searching for doctors in our network.

Surviving the Sandwich Generation

Vantage Point: The Importance of Support While in the Sandwich Generation

My husband and I are starting to talk about future property purchases, which has led to many conversations about what we would want in a house or property. I want land. He wants something that he doesn’t have to fix up. Our conversations have swung from a giant, ridiculous wish list to then coming back to reality about what’s on that wish list.

One theme that I’ve been consistent with in all of our talks is that I want a place to take care of my parents when they get older in the future. This is so true for my mother, as her family has often lived into their 90s.

This notion of caring for them on my property has been solidified even further with how unsure Medicare is, how expensive the healthcare system is, and the fact that I want them to have the best care while staying close to family. I figure I can achieve this by buying a property that’s big enough to parcel out a place for my parents.

I haven’t really thought of all the logistics, but the plan is stuck in my mind, and it’s framing what kind of property and home I want. This type of thinking has also led to conversations with my father about what he thinks they would like and need, if and when the time comes for them to sell their home and live with us.

When this happens, if not a little before, I’ll officially be smack dab in the classification of the sandwich generation, the people who are responsible for not only caring for their own kids, but also for their aging parents. According to the CDC, as of 2008, there were 34 million unpaid family caregivers in the United States. I’m sure that figure is much higher now.

I saw my mother do this with her mother, so I’m not afraid of the season when it comes; I just want to be prepared. Being prepared means thinking now about what will make life easier for all of us in the future.

It’s also about knowing and looking out for the pitfalls. I’ve heard from many others that this season of life can be so rewarding while you’re in it, but it can also be very taxing, so it’s important to be extra vigilant in taking care of yourself. In order to keep loving others, we have to keep loving ourselves.

This means that sometimes you need a break! This break could be a spa day, a long walk, a furious cardio kickboxing session, or just talking to others who are in similar situations. It takes a village, right?!

I’ve compiled a list of some support groups for those who are in this situation. Some support groups are local, and some are virtual, but they are all there as resources for support. And if you want something more local that fits what you’re going through, you can always start your own support group. There are tons of advice and tips online on how to make a new group successful. I think the best advice I saw when researching this article was to keep it simple and to feel accomplished even if only 1 or 2 people show up.

Local Support Groups

Memorial Hospital’s support groups

Alzheimer’s Association Caregiver Support Groups

Granger – For Spanish-Speaking Caregivers – Starting Soon
Estela Ochoa
Call 206-529-3877 before attending for location, time, and further details.

Yakima – For Caregivers
Location: St. Timothy’s Episcopal Church
4105 Richey Rd.
Yakima, WA 98908
Meeting Time: 2nd Thursday of the month, 1 to 2:30 p.m.
Contact Elaine Krump at 509-969-3615 before attending.

Yakima – For Spanish-Speaking Families
Call Manuel at 509-833-3334 before attending for location, time, and further details.

Online Support Groups

Caring.com has a broad list of caregiving groups for you to choose from. Access to these groups requires a free member account.

AgingCare.com has some groups for you to choose from, and you don’t have to become a member to access these groups.

Caregiving.com has online caregiving support groups, daily caregiving chats, and blogs written by family caregivers.

 

Breck Obermeyer is a community liaison with Health Alliance Northwest, 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.

Getting Older with Grace

Long View: How Do You Know You’re Getting Older?

When I started working in the Medicare department, I was ignorant about Medicare and insurance of any kind. It seemed like a growth industry, and I was blessed with 7 family members over the age of 75.

15 year later, I have a much more personal interest in the subject. This aging thing is not as easy as I thought it would be. Things change.

I’ve made progress in the meantime. I used to think being online and connected was not that necessary. Now I couldn’t live without it.

Please note, the perception that older people don’t like to use technology is false. According to Nielsen research published in 2009, 89% of people 65+ have personal email and use it regularly. And as of 2015, Pew Research Center reports 59% of those over 65 go online, and 35% of everyone over 65 uses social media, approximately 16 million people.

I used to take extra time getting ready for a big event. When I was done, I would look in the mirror and say, ”You look good.” Now, when I go through all the same steps, I look in in the mirror and say, “You look clean.”

When did I stop hearing, “You look great,” and start hearing, “You look great for your age”? Probably around the same time folks went from saying, “I like your new glasses,” to “Your new glasses take 5 years off your face.” Ugh.

I’ve learned not to ask anyone how old they are unless they are under the age of 12. Even then, I would think twice about it. If anyone forces you to guess how old they are, make a fair guess, and then subtract 15 years. No one ever complains.

From 2014 to 2060, the older population, people age 65 and older, in the United States will more than double from 46 million to over 98 million. More surprising, the oldest of the older population, people over age 85, are the fastest growing segment, according to the U.S. Census Bureau.

Aging is tough. Often we have to forgo many of the activities of our youth such as:

  • Driving a car
  • Living independently
  • Eating anything you want
  • Staying up all night
  • Getting a haircut
  • Worrying about the small stuff (Oh wait, that’s a good thing.)

Personally, as I navigate this process of maturing, I try to remember we are all getting older. It’s not always an easy process, so I hope my friends and family help me do it with grace and dignity.

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.

Making a Difference on Every Call

Vantage Point: Making a Difference

As our Annual Enrollment Period (AEP) came to an end, I sat back and thought of all of the work our team had done. Each year, prospective members call in to get information to determine if Health Alliance is the right fit for their needs.

Of course we go over the basics, like monthly premiums, copays, and out-of-pocket maximums, but that is all very black and white, and not every situation is the same or so simple.

At Health Alliance, the expectation is to go the extra mile for our members and prospects. Our potential members rely on our expertise to guide them in the right direction.

This past AEP, I had someone call in asking if our plan covers a certain medication that’s given at the doctor’s office. My immediate response to the caller was, “I don’t know, but let me research that for you.”

I wanted to make sure they were making the right choice by switching to our plan. After doing some research and calling our pharmacy department, I called them back and shared the details I’d gathered.

Later, I got the chance to meet the potential member to go over our plans in person. They could not thank me enough for gathering the information and told me my phone call back was a nice surprise. We gained credibility and their trust by taking the extra step to respond to their particular situation.

I was actually surprised because I didn’t feel like I had done that much, but after thinking about it for a while, I realized it really is the little things that count the most to our members. This is a perfect example of why our role as liaisons is so important for our community and what sets Health Alliance apart.

As liaisons, we go out of our way to give our members the most accurate information we can and to take away the pressure of those difficult and complex questions. Our job is to simplify and educate. We’re making a difference every day, no matter how big or small.

Jessica Arroyo, born and raised in Wenatchee Valley, is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. During her time off, she enjoys spending time with her husband and infant son.