CONNECTIONS CARE. Now is the time to take charge of your health! MEDICARE 2015 ISSUE II. Healthy Eating. Get Moving!

Transcription

1 MEDICARE 2015 ISSUE II CARE CONNECTIONS Now is the time to take charge of your health! It s important to make healthy food choices and to stay active. Here are some tips in both areas. Healthy Eating Balance your calories: Enjoy your food but eat less. Avoid oversized portions. Foods to increase: Make half your plate fruits and vegetables. Make at least half your grains whole grains. Switch to fat-free or low-fat (1%) milk. Foods to reduce: Compare sodium in foods like soup, bread and frozen meals and choose foods with lower numbers. Drink water instead of sugary drinks. Get Moving! Being active is an important part of a healthy lifestyle and may help you remain independent. Studies have shown that physical exercise may reduce stress, reduce risk of falls, improve symptoms of depression and help to slow a decline in thinking skills as people age. Some safety tips to help you get started (check with your doctor before starting a new exercise routine): Do a little light activity, such as easy walking; Drink liquids; Dress appropriately for the heat and cold; When you re out walking, watch out for lowhanging branches and uneven sidewalks; and Use safety equipment such as helmets for biking. Moderate exercise for the average older adult includes things like walking briskly on a level surface; swimming; dancing; gardening; mowing; raking; cycling on a stationary bicycle; and bicycling. Older adults who have been inactive for a long time will need to work up to these activities gradually. Tip: Get your annual wellness visit and work with your primary care physician (PCP) to get your preventive screenings and care. A wellness visit is a good step to take for your health. It s also covered every 12 months at no cost to you. You can also call our 24-hour Nurse Advice Line 7 days a week. The Nurse Advice Line is free to members and available whenever you have a health-related question or concern. Call (TTY ). Sources: Y0070_NA028535_WCM_NEW_ENG CMS Accepted WellCare 2015 NA_12_14_NA

2 Your Mental Health is Also Important Mental health is one of your greatest assets. It helps you focus at work, overcome obstacles, get along with the people around you and get well and stay well. For this reason, depression screening is an important aspect of your whole body care. WellCare covers one depression screening per year at no cost to you. Please talk to your primary care physician (PCP) if you have concerns. You may also contact us by calling Customer Service at the number on the back of your member ID card. We can help you locate a behavioral health practitioner in your area and with scheduling an appointment. If you or someone you care about is in crisis, please seek help immediately. Call 911 or visit a nearby emergency department or your health care provider s office. You can also call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at (TTY ). Utilization Management: Reviews to Ensure the Right Care WellCare has a process for reviewing the care our members receive. It s called Utilization Management, or UM for short. UM focuses on making sure our members get the right care, at the right time and in the right setting. It s how we make treatment decisions. If you ever have questions about UM or our coverage decisions, or need language assistance, our Customer Service team can help. You can reach us by calling the number on the back of your member ID card. 2 Care Connections

3 Women s Corner: Osteoporosis at a Glance Osteoporosis, or thinning of the bones, is a condition that affects many women later in life. Osteoporosis is a disease of the skeletal system characterized by low bone mass and deterioration of bone tissue. Osteoporosis leads to an increased risk of bone fractures, typically in the wrist, hip and spine. People at the greatest risk for osteoporosis include those who are in these categories: Female White/Caucasian Post-menopausal women Older adults Small in body size Eating a diet low in calcium Physically inactive To learn more about osteoporosis, talk to your doctor. He or she may advise on getting a bone mass measurement, which is a procedure to identify bone mass, detect bone loss or determine bone quality. Your WellCare plan may cover this at no cost to you. Check your Evidence of Coverage (EOC) or call us at the number on the back of your member ID card to see if you re eligible. Men s Corner: High Blood Pressure (Hypertension) at a Glance Source: Centers for Disease Control and Prevention, everyone/basics/vitamins/ calcium.html Did you know you can have high blood pressure, or hypertension, and still feel just fine? That s because high blood pressure often does not cause signs of illness that you can see or feel. If high blood pressure isn t controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, kidney failure and other health problems. To control your blood pressure, try the following: Don t smoke. Manage stress levels. Maintain a healthy weight. Exercise daily. Avoid drinking alcohol. Eat a healthy diet. Reduce your salt intake. You can also have your doctor check your blood pressure yearly. A reading of 119/79 or lower is normal blood pressure. If you re taking medications, take them as directed by your PCP. Your plan may cover blood pressure screenings as part of your preventive care screenings. For more information, check your Evidence of Coverage (EOC) or call us. Source: Centers for Disease Control and Prevention, publication/high-blood-pressure#control Care Connections 3

4 It s a Good Time for Preventive Care At WellCare, we want what s best for our members. We encourage you to be good to yourself. And one of the best ways to do this is to get all the preventive care services you need to stay healthy. What are preventive care services? They re screenings and tests such as: blood pressure screening; measure of body fat (BMI); blood tests; bone density test; screening for depression; vision and hearing screening; and screening for cancers. Here s a list of some of the preventive health screenings that we cover at no cost to you: Glaucoma Flu shot Pneumonia shot Diabetes Colorectal cancer Prostate cancer Osteoporosis Cholesterol management Mammograms Pap tests Preventive care screenings are applicable based on age, sex and health condition, and according to your doctor s recommendation(s). Be sure to check your Evidence of Coverage for a full list of no-cost screenings available to you. You can find your Evidence of Coverage at Refer a Friend If we ve helped you, then you may know other Medicare-eligible people who could benefit from our services. If so, ask them to give us a call at (TTY 711) Monday-Friday, 8 a.m. to 8 p.m. to discuss what they need in a health plan. 4 Care Connections

5 Where do I go to get care? Emergency vs. Urgent Care Your Primary Care Provider (PCP) is your most cost-effective source of care, and is trained to coordinate all your health care. You should see your PCP for all non-emergency, nonurgent health care needs. You should seek medical attention from an urgent care center for illnesses or injuries that need care immediately, but where your health is not in serious danger. Some symptoms that can be treated at urgent care include: Fever without rash Minor trauma such as a common sprain Painful urination Persistent diarrhea Severe sore throat Vomiting Tip: To find the nearest urgent care facility, visit our website at or call Customer Service at the number on the back of your member ID card. If you feel you need emergency care, seek help immediately at the nearest hospital. Some instances may include: Persistent chest pain Persistent shortness of breath or wheezing Severe pain, particularly in the abdomen or starting halfway down the back Severe heart palpitations Intestinal bleeding Loss of vision Head and eye injuries Broken bones or dislocated joints It can be difficult to know what issues are urgent and which are not. For advice, you can always contact your PCP or the 24-hour Nurse Advice Line at (TTY: ). Source: scripps.org, items/4231-should-you-go-to-the-emergency-room-orurgent-care Need More Provider Options? Point-of- Service (POS) Gives You Flexibility WellCare offers a network of quality health care providers. Yet there may be times when you will want to see a provider who isn t part of our network. If your plan has a point-of-service (POS) option, you can see a provider outside of our network. These visits may cost more because you ll have to pay a coinsurance (a percentage of the fee for a specific service) rather than a fixed co-payment, but POS plans offer flexibility when you need it. Also, you may need a prior authorization from us before the visit. Check your Evidence of Coverage or call Customer Service to get more details about what s included in the POS option. One of our representatives will be glad to help! Care Connections 5

6 You May Qualify for Extra Help for Drug Costs On a limited income? You might qualify for Extra Help to pay for your prescription drug costs. Many people are eligible for these savings and don t even know it. To find out more about help with drug costs: Contact your Social Security office at , between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call Or visit Call MEDICARE ( ), 24 hours a day, 7 days a week. TTY users may call Customer Service can also answer your questions about Extra Help. The number is on the back of your member ID card. Tip: Did you get Extra Help paying for your prescription drug costs last year? To get assistance again this year, you must apply for recertification. Or maybe you already get Extra Help, but your co-pays and premiums are higher than expected. In either case, you can submit copies of your Best Available Evidence to us. Best Available Evidence includes documents that show you qualify for Extra Help. To learn more, call the Customer Service number on the back of your member ID card. 6 Care Connections

7 How Care Management Can Help You Our Care Management team will work with you, your family and providers to help you achieve your health goals. The program pairs a member with a care manager. The care manager is a nurse who can help the member with issues such as: Complex medical needs Solid organ and tissue transplants Children with special health care needs Lead poisoning If you would like to inquire about this service, call Customer Service. We can tell you about the program and assist you with contacting a care manager. The number is on the back of your member ID card. There is no charge for this service. Need Assistance Managing a Chronic Condition? Disease Management is Care Management specifically for members with chronic conditions. Trained specialists are standing by to help members with chronic health problems manage their conditions and live better lives. Chronic conditions include, but are not limited to: Asthma Diabetes Hypertension Heart disease HIV/AIDS If you re interested in finding out how those with chronic conditions can take control of their symptoms and learn about all WellCare has to offer them, please call us at the number on the back of your ID card. We can send you educational materials. In some cases, you may get coaching from a registered nurse. Care Connections 7

8 P.O. Box Tampa, FL PRSRT STD U.S. Postage Paid Wellcare Health Plans Health and wellness or prevention information WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/coinsurance may change on January 1 of each year. WellCare uses a formulary Visit Our Website to Stay Informed! Did you know you can find a wealth of information about our plans and benefits at Download an updated copy of your Evidence of Coverage (EOC), which details what s covered in your plan, find guidelines for getting care, see the rights and responsibilities for members, and more. You can also find information on: Behavioral health guidelines Preventive health guidelines Medical record documentation Notice of Privacy Practices Utilization management guidelines Criteria and review availability Quality Improvement (QI) program evaluation In This Issue Hello, and welcome to the second issue of Care Connections in In this issue, you ll find information about preventive care screenings; tips on eating well, exercise and mental health; and where to find the latest drug coverage updates. There s so much more we cover, so please take a moment to explore what s inside. As always, we wish you good health MA