a newsletter for Viva Medicare members

Transcription

1 a newsletter for Viva Medicare members Thank you for being a Viva Medicare member! Look inside for great information about how you can enjoy life to the fullest! This information is not a complete description of benefits. Call (TTY users dial 711) for more information. Spring 2019

2 you for allowing us to Thank serve you! We know you have many choices when it comes to your health plan. We are honored to have you as a Viva Medicare member! Rated Four Stars or Higher for the Last Four Years 1 Thank you for making us who we are! Highest Members Rating of a Plan Given in Alabama 2 Remember to take advantage of your great Viva Medicare benefits like: $0 Copay for Primary Care Physician Visits Over-the-Counter Allowance Preventive, Diagnostic & Comprehensive Dental Coverage Viva Health Cafés if you need face-to-face assistance or want to attend a free and fun event Coverage for Vision, Eyeglasses & Contact Lenses Fitness Center Membership Allowance $0 Copay for Diabetic Testing Supplies Don't forget! You also have these discounts and services available to you just because you re a Viva Medicare member! Hearing Care Solutions Get discounted pricing on hearing aids. Call , Monday - Friday, 7am - 7pm. CVS Pharmacy ExtraCare Health Card Members with drug coverage receive a 20% discount on more than 1,300 CVS pharmacy brand health-related items valued at $1 or more. Home Delivery Pharmacy Home delivery of your medicine may help you save money. Call the CVS Customer Care Team at , Monday - Friday, 7am - 7pm. V-Care Our wellness program can help members with complex/or chronic conditions. Call , Monday - Friday, 8am - 5pm, for more information. Philips Lifeline Receive discounts on several products from Philips Lifeline medical alert service. Call ext or visit vivahealth/. 1 2 Every year, Medicare evaluates plans based on a 5-Star rating system. The Star Ratings referenced are for contract years Based on the 2019 Medicare & You Handbook for Alabama. 3

3 Join us for a free & fun event at your local Viva Health Café! Please call your local Viva Health Café to reserve a spot at our events. Space may be limited! Ask the Expert: Social Security Benefits Social Security can be confusing get all your questions answered at this informational event! Florence: 4/25/ AM Hoover: 4/25/ AM Grand River (Leeds): 4/25/2019 2PM Montgomery: 4/25/ AM Mobile: 4/25/ AM Control Your Numbers with Viva Medicare! Diabetes Education Florence: 4/8/ AM Hoover: 4/9/ AM Grand River (Leeds): 4/10/ AM Montgomery: 4/11/ AM Mobile: 4/12/ AM Viva Health Check-Up Day Stop by your local café anytime during this event to get your important health screenings! Florence: 5/6/ AM Hoover: 5/7/ AM Grand River (Leeds): 5/8/ AM Montgomery: 5/9/ AM Mobile: 5/10/ AM If you have diabetes, this is the event for you! Games Galore! Bring a friend and enjoy some of your favorite games at the café! Florence: 5/21/ AM Hoover: 5/21/ AM Grand River (Leeds): 5/21/ AM Montgomery: 5/21/ AM Mobile: 5/21/ AM Learn to Eat Healthy with Viva Medicare! Healthy Eating & Nutrition Education Florence: 6/3/ AM Hoover: 6/4/ AM Grand River (Leeds): 6/5/ AM Montgomery: 6/6/ AM Mobile: 6/7/ AM Healthy Cooking Demonstration Watch a healthy recipe get made, and try a sample when it's complete! Florence: 6/19/ AM Hoover: 6/19/2019 1PM Grand River (Leeds): 6/19/ AM Montgomery: 6/19/2019 2PM Mobile: 6/19/ AM Viva Health Café Locations Florence North Alabama Medical Center 1751 Veterans Drive, Suite 290 Florence, AL Hoover K Montgomery Hwy. Hoover, AL Grand River (Leeds) 6200 Grand River Blvd. E., Ste. 442 Leeds, AL Montgomery B Eastern Blvd. Montgomery, AL Mobile 3071 Dauphin St. Mobile, AL For accommodation of persons with special needs at meetings, call (TTY users dial 711). 5

4 Bladder Control Treatment Options Bladder leakage and control problems, also known as incontinence, are a common medical issue. Your Primary Care Physician (PCP) will ask you at your yearly wellness exam if you are having leakage of urine, urgency or frequency problems, or bladder accidents. It is important to openly share and discuss any issues you may be having. There are many products and treatment options available to help treat these issues. Your PCP can treat most issues. He or she may order testing to make sure you get the best treatment for your condition. There are also doctors who specialize in bladder problems (urologists) that your PCP may recommend. Want Additional Resources? There are great tools online! Explore the National Association for Continence's website at Or, check out the Simon Foundation's resource page at resources/organizations-resources. And remember, Viva Medicare is always here to help! Dietary Changes Some foods are known to irritate the bladder and should be reduced or removed from your diet. Caffeine and alcohol encourage the kidneys to produce more urine. Artificial sweeteners and fruits such as citrus, pineapple, and tomatoes also can be irritating to the bladder. Get lots of fiber in your diet to promote bladder health by preventing constipation. A full bowel will press on the bladder and can make incontinence worse. Bladder Training Exercises Kegel exercises are helpful to improve bladder strength. You can perform Kegels by repeatedly squeezing and relaxing the muscles that you use to hold your urine. There are also special medical clinics that focus on bladder control treatment called Continence Clinics available in Viva Medicare s provider network. Your PCP can help you access these special services if you need help. Over-the-Counter Continence Supplies There are over-the-counter products available at drug stores to help manage incontinence. These include absorbent pads for leakage problems, disposable underwear or diapers, and creams to protect skin and help prevent problems with rashes and skin breakdown. Your Viva Medicare over-the-counter (OTC) benefit catalog contains many of these items. You can call OTC Health Solutions at (TTY: ) Monday through Friday, 8 a.m. to 7 p.m., for help understanding or using your OTC benefit. Prescription Medications There are prescription medications available to help with incontinence issues. Some medications help control spasms, and others work on blocking the nerve that triggers the urge to urinate. Talk to your doctor if you feel you need medication to help with incontinence. Prescription medications like these are covered by Viva Medicare plans that include Part D prescription drug coverage (all plans except Viva Medicare Select (HMO)). Surgical Procedures If your bladder control issues are severe, your doctor may recommend you have a surgical procedure. If surgery becomes necessary, your Viva Medicare plan can provide coverage when medical guidelines are met. 6 7

5 BLADDER SYMPTOM QUESTIONNAIRE The questions below ask about how bothered you may be by some bladder symptoms. Some people are bothered by bladder symptoms and may not realize that there are treatments available. Answer the questions below, then cut this page out and take it to your next doctor s appointment. Discuss your answers with your doctor! How bothered have you been by: 1. Frequent urination during the daytime hours? 2. An uncomfortable urge to urinate? 3. A sudden urge to urinate with little or no warning? 4. Accidental loss of small amounts of urine? 5. Nighttime urination? 6. Waking up at night because you had to urinate? 7. An uncontrollable urge to urinate? 8. Urine loss associated with a strong desire to urinate? It s Member Survey Season! Each spring, the Centers for Medicare & Medicaid Services (CMS) conducts two member experience surveys on a random sample of Viva Medicare members. Consumer Assessment of Healthcare Provider and Systems (CAHPS ) a yearly member experience survey. Some CAHPS results are published in the Medicare & You handbook and on the Medicare Options Compare Web site ( Health Outcomes Survey (HOS) a survey that asks about your health each spring with a follow-up survey to the same members two years later. If you receive a survey from CMS, please take time to fill it out and return it. Your answers to the survey questions do not affect your ability to get government benefits (such as low income assistance or disability). Your feedback lets us know how we and your doctors and other health care providers are doing and how we can improve. Additionally, the results of these surveys are a big part of how Medicare decides Viva Medicare s Star Rating. Our goal is to keep our CMS Star Rating of 4 or more stars by continuing to provide outstanding service and strong benefits. We sincerely want your health care experience to be positive and are here to help you meet your health care needs. Thank you for being our member. We want to earn your loyalty and appreciate you trusting us as your Medicare Advantage plan. NOTES FOR TALKING TO YOUR DOCTOR: Talk to your doctor about your answers to the questions above. For one week, write down each time you urinate and any leakage or bladder symptoms you have. Share your notes at your doctor's visit. Ask your doctor how your diet, lifestyle, health, and medications you take may affect your bladder symptoms. Ask your doctor about the treatment option that may be best for you. National Coverage Determinations The Centers for Medicare & Medicaid Services (CMS) can change the coverage rules that apply to an item or service under Medicare. Some changes may include what benefits and services are covered, what benefits and services are changing, and what Medicare will pay for an item or service. When this happens, CMS issues a National Coverage Determination, or NCD. Below is a listing of the NCDs for 2019 so far: 2/2019: Implantable Automatic Defibrillators 3/2019: Next Generation Sequencing (NGS) Further information on each of the above NCDs can be found at 8 9

6 We shared an article this past winter in the Enjoy Life! member newsletter titled Comprehensive Addiction & Recovery Act (CARA). That article explained the efforts Viva Medicare would be making to educate our members on this law and offer ways our members can reduce the likelihood of opioid overuse. The following tip sheet offers educational information regarding the new policies for opioid prescriptions. Information for Members with Medicare Part D Prescription Drug Benefits Prescription opioid pain medications like oxycodone (OxyContin ), hydrocodone (Vicodin ), morphine, and codeine can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose, and death. These risks increase the higher the dose you take, or the longer you use these pain medications, even if you take them as prescribed. Your risks also increase if you take certain other medications, like benzodiazepines (commonly used for anxiety and sleep), or get opioids from more than one doctor and/or pharmacy. Medicare is dedicated to helping you use prescription opioid pain medications more safely and is introducing new policies for opioid prescriptions in the Medicare Part D prescription drug program beginning in January Safety reviews when opioid prescriptions are filled at the pharmacy Viva Medicare and your pharmacist will do safety reviews of your opioid pain medications when you fill a prescription. In some cases, Viva Medicare or your pharmacist may need to first talk to your doctor. Viva Medicare or your pharmacist may do a safety review for: Potentially unsafe opioid amounts. If you take opioids with benzodiazepines like Xanax, Valium, and Klonopin. New opioid use you may be limited to a 7-day supply or less. This does not apply to you if you already take opioids. If your pharmacy can t fill your prescription as written, including the full amount on the prescription, the pharmacist will give you a notice explaining how you or your doctor can contact us to ask for a coverage decision. If your health requires it, you can ask us for a fast coverage decision. You may also ask us for an exception to our rules before you go to the pharmacy so you ll know if we will cover the medication. Drug Management Programs (DMPs) Starting January 1, 2019, we will have a DMP. If you get opioids from multiple doctors or pharmacies, we may talk with your doctors to make sure you need these medications and that you re using them safely. If we decide your use of prescription opioids and benzodiazepines isn t safe, we may limit your coverage of these drugs. For example, under the DMP, we may require you to get these medications only from certain doctors or pharmacies to better coordinate your health care. Before we place you in our DMP, we will notify you by letter. You ll be able to tell us which doctors or pharmacies you prefer to use to get your prescription opioids and benzodiazepines. After you ve had the opportunity to respond, if we decide to limit your coverage for these medications, we will send you another letter confirming our decision. You and your doctor can appeal if you disagree with our decision or think we made a mistake. The second letter will tell you how to contact us to make an appeal. Note: The safety reviews and DMPs should not apply to you if you have cancer, get hospice, palliative, or end-of-life care, or if you live in a long-term care facility. Talk with your doctor Talk with your doctor about all your pain treatment options including whether taking an opioid medication is right for you. There might be other medications you can take or other things you can do to help manage your pain with less risk. What works best can be different for each patient. Treatment decisions to start, stop, or reduce prescription opioids are individualized and should be made by you and your doctor. For more information on safe and effective pain management, visit CDC.gov/drugoverdose/patients. Additional Resources Contact us for additional information. You can find contact information on the back of this newsletter or on your membership card. Other resources include: Your Guide to Medicare Prescription Drug Coverage at: How Medicare Drug Plans use Pharmacies, Formularies, & Common Coverage Rules at: Call the State Health Insurance Assistance Program (SHIP). Visit or call MEDICARE for the phone number of your SHIP. For resources and information about the National Opioid Crisis go to: or the Center for Disease Control (CDC) at:

7 417 20th Street North Suite 1100 Birmingham, Alabama PRSRT STD US POSTAGE PAID BIRMINGHAM, AL PERMIT NO Viva Medicare is an HMO plan with a Medicare contract and a contract with the Alabama Medicaid Agency. Enrollment in Viva Medicare depends on contract renewal. Health and wellness or prevention information. H0154_mcdoc2222A_M_02/17/2019 We're so happy you're a part of the Viva Medicare family! If you need us, help is just a phone call away. Call Member Services toll-free at (TTY users dial 711). Hours: Mon - Fri, 8am - 8pm; Oct 1 - Mar 31: 7 days a week, 8am - 8pm. Or, you can visit us online at Viva Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務. 請致電 (TTY: 711).