Volume 2 2014 With 4-STAR PLAN RATED BY MEDICARE 2014 Member tips, tools and resources to support a healthy lifestyle LET S GET PHYSICAL: Schedule Your Annual Physical Exam HAVE A HOME HOUSE CALL VISIT Understand the Medicare Annual Wellness Visit Y0067_MBRNEWS2014_V2_0614 IA 07/11/2014 TXP-SETX-MBRNEWSv2 2014
Live Healthy A Healthy Collaboration We want you to feel good during the summer months and all year long. in action Live Healthy This Summer Everyone knows that going to the doctor for an Annual Physical Exam is good for your health. But during the warmer, longer days of summer, it may be tempting to put off this important visit in favor of an extra hour with your favorite seasonal activity. We want you to feel good during the summer months and all year long. That s why this edition reminds you about the importance of seeing your doctor for your Annual Physical Exam. In the coming pages, you ll see why it makes good sense to have this beneficial check-up, especially since the cost is covered under your TexanPlus HMO or TexanPlus HMO-POS plan. As you read through our summer issue, you ll learn about the differences between an Annual Physical Exam and the Medicare Annual Wellness Visit, also available to you at no cost. And, you ll be updated on our Live Healthy services designed to help you see a doctor, obtain needed health screenings, and fill your prescription medications on time. These no-cost services support the care and treatment already being provided to you by your trusted Primary Care Physician so curl up with this latest edition to learn more. We hope you ll review this issue from cover to cover, and that you will contact us if you have any questions about scheduling your Annual Physical Exam or utilizing the Live Healthy Services discussed in these pages. Wishing you good health and many enjoyable summers to come! Erin Page President, Medicare Advantage 2 LIVE HEALTHY WITH TEXANPLUS
In This Issue Volume 2 2014 If you have questions about your plan, contact Member Services at 1-866-230-2513, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 711) 7 days a week. Your opinion matters to us! If you want to submit editorial suggestions or give us your feedback, please contact our Marketing Department. Editor - Keidra Gaston MemberFeedback@UniversalAmerican.com Designer - Eric Figueroa efigueroa@universalamerican.com You may also write to us at: TexanPlus Marketing Department 4888 Loop Central Dr. Houston, TX 77081 The articles in this publication should not be considered specific medical advice, as each individual circumstance is different. Should you feel the need for medical advice, consult your Primary Care Physician. Live Healthy provides health information that supplements the advice of your doctor. You should consult your doctor about specific health concerns. 4 6 7 8 9 10 11 12 13 Understand the Importance of Your Annual Physical Exam Medicare Annual Wellness Visit: Helping you Stay Healthy at No Extra Cost to You Live Healthy Makes House Calls! Dear Dr. Hunt Importance of Breast Cancer Screenings Tips for Getting the Most from Your Live Healthy Rewards Card Free Flu Shots Managing Your Medicines Nifty after Fifty: Fun, Fitness and So Much More! 14 15 Money-Saving ExtraCare Health Card: Value for Our Members Important Savings Opportunity for Members with Prescription Drug Benefits! 3
Understand the Importance of Your Annual Physical Exam Annual Physical Exams are an important way to stay in control of your health. During your annual physical exam your doctor will check you from head to toe, to help prevent illness and make sure you stay healthy. We know that you want you to live healthy and stay independent for as long as possible. That s why TexanPlus covers the cost of your annual physical exam. What to Expect During your Annual Physical Exam Your Primary Care Physician will review your health history, including your medications, vaccinations, and family or personal health issues. This is a great time to raise any questions or concerns you have about your health and your medications. During the exam, your doctor will check your vital signs, including blood pressure, heart rate, temperature, and respiration rate. Your doctor will also check your skin and nails, looking for signs of disease, and will listen to your heart and lungs and check your abdomen. The visit will also include an examination of your head, neck, arms, legs, and joints, and an evaluation of your reflexes, balance, and muscle strength, among other things. During the exam, your doctor may draw blood to test for certain conditions, or may order other lab work. 4 LIVE HEALTHY WITH TEXANPLUS
How to Prepare for Your Annual Physical Exam 1. When scheduling your appointment, ask if you should come on an empty stomach, or if there is anything else you should do before you arrive. 2. Make a list of health concerns to discuss with your doctor. Do you have trouble eating? Do you have any pain? Do you have safety concerns in your home? 3. Make a separate list of the medications you take, and note any side effects or concerns. It may also be helpful to list any vitamins or supplements taken regularly, as they may interact with your medications. YOUR ANNUAL PHYSICAL EXAM AT A GLANCE Know what to expect when you visit your physician. Although exams may differ from doctor to doctor, your physician will likely: Check your blood pressure Listen to your heart and lungs Take your temperature Examine your abdomen Check your reflexes Look at your skin Assess your joints Remember, your annual physical exam is covered by your plan. Schedule your appointment today! Additional Health Screenings During your annual physical exam, your doctor may recommend additional health screenings, such as to test for glaucoma, diabetes, or certain forms of cancer. Some of these screenings are recommended annually. You may find it helpful to bring along your Preventive Screenings Checklist, so you can review recommended screenings and tests with your doctor, and track your progress. A copy of the Preventive Screenings Checklist is inserted in this magazine. Schedule Your Annual Physical Exam Today! If you haven t had an annual physical exam in the last 12 months, call your doctor and schedule your appointment today. Remember, your annual physical exam is covered by your plan. You can also sign up for our Live Healthy Check-Up Reminders program. Through this program, you will be reminded to schedule important annual check-ups, screenings and vaccinations. And for even greater convenience, we can help you schedule appointments with your Primary Care Physician and with your other doctors. 5
Medicare Annual Wellness Visit Helping You Stay Healthy at No Extra Cost to You Are you feeling energetic or sluggish? Do you take multiple medications? Are you at risk for any conditions or diseases? These are the types of questions your Primary Care Physician (PCP) will ask during your Medicare Annual Wellness Visit. Your Medicare Annual Wellness Visit is provided by your doctor or a qualified healthcare professional in your doctor s office. It is given at no cost to you. In fact, Original Medicare covers the Annual Wellness Visit to help people with Medicare stay healthy and prevent illness. During your Annual Wellness Visit, your doctor will: Take routine measurements like height, weight and body mass index Review your personal and family medical history Review your current providers, conditions and medications Screen you for things like tobacco use and depression Make sure that routine screenings, such as breast cancer, high blood pressure, diabetes, and cardiovascular disease, are happening on time Give you vaccines, such as flu or pneumonia Refer you to specialists for other conditions, as needed Your Annual Wellness Visit is different than your physical exam. Your Annual Wellness Visit gives you a chance to work with your doctor to put together a personalized plan to help you stay healthy and prevent illness. It is important to remember that your Annual Wellness Visit does not replace your annual physical exam, so be sure to schedule both of these important visits each year. v When you have your free Annual Wellness Visit, you take control of your health. 6 LIVE HEALTHY WITH TEXANPLUS
Live Healthy Makes House Calls! Do you remember years back, when your doctor would make a house call if you were feeling sick or needed medical care? While it s true that these in-home medical visits are mostly a thing of the past, members of TexanPlus can still receive a check-up in the comfort and privacy of their homes through our Live Healthy House Call program. It s a smart way to stay on top of your health, and identify any medical concerns before they become serious. When you schedule a House Call, you can expect a licensed healthcare professional to give you a check-up, take your blood pressure, and listen to your heart and lungs - all at no cost to you. And, having a House Call visit will not affect your plan coverage in any way. It s also important to know that a House Call will not replace your annual physical exam with your Primary Care Physician. And by sharing results with your doctor, the House Call helps to keep your physician informed of your general health so he or she can better assist in your care. It s a smart way to stay on top of your health, and identify any medical concerns before they become serious. In fact, it s beneficial to have a free House Call visit each year, even if you have had one previously and it s all covered under your plan. What happens during the House Call? During this simple, one-hour visit the licensed healthcare professional will: Review your current medications. Discuss your health conditions and answer any questions you may have Complete some basic lab work, if appropriate Provide you with your House Call report Arrange to have the report sent to your doctor Best of all, you won t need to travel anywhere, prepare in advance, or disrobe. And, you can have a friend or family member stay by your side. So what are you waiting for? To schedule a House Call or learn more, call us at: 1-866-230-2513, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 711) 7 days a week. v 7
Dear Dr. Hunt Dr. Patricia C. Hunt, DO, MHA Senior Medical Director We proudly introduce you to Dr. Patricia Hunt, Senior Medical Director of Universal American, parent company of TexanPlus. Dr. Hunt is Board Certified in internal, preventive, and occupational medicine, and is an experienced chief medical officer, lecturer, and authority in preventive care and related health areas. In her current role, she works closely with the care coordination and medical management teams to help facilitate successful health outcomes for members. Question: If I feel healthy, why do I need to schedule an annual physical exam? Answer: You don t need to be sick to go for your annual physical exam, and it s perhaps one of the best things you can do for your health. Think of yourself as a brand new car. You should have your annual exam for your preventive maintenance to avoid any health issues. During the exam your doctor will speak with you about your general wellness, your diet or daily health habits, and your family history, and will give you a thorough examination to ensure that you continue to stay healthy, strong and independent. Question: What will my doctor look for during the exam? Answer: Your doctor will ask you about any discomfort or pain you may be having, and will examine you closely for signs of illness, disease, or overall change. Your doctor will listen carefully to your heart and lungs for any irregularities, examine your head, neck and abdominal area, and check your joints for signs of arthritis or other conditions. Question: Will the exam lead to other tests or doctor appointments? Answer: Possibly, but remember that any additional tests or exams are recommended by your doctor to help identify health concerns that would keep you from feeling healthy. For example, your doctor may want you to have blood work, or may send you for specific lab tests to identify any concerns that may warrant medication or other treatment. In addition, your doctor may want you to have certain preventive vaccines, like the flu shot or pneumonia vaccine, and may suggest that you schedule some other health tests, like a glaucoma screening with an eye specialist, or a mammogram or colorectal screening. Your doctor will know which tests are right for you, and can monitor your condition and your progress year-over-year, which is why it s so important to be vigilant about scheduling your annual physical exam. v 8 LIVE HEALTHY WITH TEXANPLUS
Importance of Breast Cancer Screenings Your plan covers annual mammograms. You can discuss this with your doctor during your annual physical exam, or at any time of the year. Did you know that breast cancer is the most commonly diagnosed cancer in women?* Early detection is the best defense against breast cancer. When breast cancer is discovered early it is often smaller and located only in the breast, making it easier to treat.* That s why the American Cancer Society recommends having a screening mammogram each year starting at age 40 through age 74. These screenings are covered by your plan. Mammograms are used for early detection of breast cancer. A screening mammogram is an x-ray of the breast that is used to detect lumps or other changes. It typically includes two x-rays of each breast. A mammogram can detect lumps or tumors that cannot be felt during a self -breast exam or clinical breast exam. The American Cancer Society now recommends yearly mammograms starting at age 40 and continuing until age 74. As a member, your plan covers a screening mammogram every year. Ask your doctor about having your mammogram. You can discuss this during your annual physical exam, or at any time of the year. You can track your appointment on your Preventive Screenings Checklist. A copy of the checklist is included in this magazine. A mammogram is an important step toward early breast cancer detection. Don t forget to schedule this life-saving screening! v Live Healthy Member Rewards When you complete five health actions this year, such as by having your breast cancer screening, you can receive $50 in Live Healthy Member Rewards. To learn more, see page 10. * Breast Health: Mammography, Live Healthy Library, Krames StayWell, May 2014 For more information on this topic, visit the Live Healthy Library at https://memberlink.universalamerican.com. 9
REWARDS Tips for Getting the Most from Your Live Healthy Rewards Card If you ve already earned your $50 Live Healthy Rewards card or if you are close to doing so Congrats!* You have taken important steps to maintain or improve your health. In the process, you have also earned valuable Rewards dollars! Here are a few helpful tips for getting the most from your card: Tip #1: Use money-saving manufacturer or retailer coupons, or take advantage of other special offers to stretch your Rewards dollars. Tip #2: Purchase generic (store brand) merchandise. Many generic medications, foods, and drinks are made from the same ingredients as name-brand counterparts and can save you money. Check with the store manager or pharmacist to compare and decide what s right for you. Tip #3: Use your CVS ExtraCare Health card and receive savings at CVS Pharmacy locations. The card entitles you to a 20% discount on CVS/ pharmacy brand healthrelated items!** For details, see page 14. Look at all you can buy! As a reminder, you can use your $50 Live Healthy Rewards dollars at any of these participating retailers: CVS/pharmacy Boston Market Red Lobster Olive Garden NEW as of September 2014! Seasons 52 Fresh Grill Kmart Sears Tell Us About Your Rewards! Have you used your Rewards dollars to buy special items or to enjoy a nice meal? Let us know! Your feedback helps us improve the program so we can continue offering savings and Rewards to our members. LiveHealthyRewards@UniversalAmerican.com 1-866-215-0062, 9:00 a.m. to 6:00 p.m. Eastern Time (TTY users call 711) Monday Friday Want to Be Rewarded? There s still time to earn Live Healthy Rewards. If you have not already enrolled for 2014, call us today to get started, then complete 5 of these health actions by December 31, 2014.* Annual physical exam Annual flu shot Glaucoma test Cholesterol screening Colorectal cancer screening Breast cancer screening (women only) Prostate screening (men only) 1-866-215-0062, 9:00 a.m. to 6:00 p.m. Eastern Time (TTY users call 711) Monday Friday. *To be eligible for a pre-paid Live Healthy Rewards card, you must report completed health actions by 12/31/14. Allow at least 60 days for claims processing (most claims are processed within 60 days, but they may take longer in some cases). **Discount applies to non-sale items priced $1 or more. Prescription drugs and non-health items are not eligible for the discount. 10 LIVE HEALTHY WITH TEXANPLUS
Free Flu Shots Valuable No-Cost Protection from the Flu When autumn arrives, so does the potential to catch the flu. The flu brings body aches and pains, fever, and coldlike symptoms, and may prevent you from doing activities you enjoy for up to one week or more. And since the flu is very contagious, you will need to stay at home to recover and avoid spreading the virus to others. To help prevent you from catching the flu, your plan offers you free flu shots. It s one of the many services from our Live Healthy program, designed to help you stay healthy and independent, and get the most out of life. Anyone can get the flu, but older adults and people with health problems are at high risk of having serious flu-related complications. So, it s important to protect yourself. You are most likely to get the virus during flu season, which can start as early as October and end as late as May. Since the flu virus changes every year, the best way to prevent the flu is to get vaccinated annually. Be aware that it can take up to two weeks for the shot to offer you full protection, which is why it s smart to get vaccinated early. If you will be having your annual physical exam, talk with your doctor about getting your flu shot. You can ask your doctor to give you the flu shot, or you can go to a local pharmacy offering this service. We suggest that before you have your flu shot, which is covered under your plan, you ask if any out-of-pocket costs will apply. Getting your free flu shot is one smart way to Live Healthy. For more information about the flu and the flu vaccine, visit the Live Healthy Library at https://memberlink.universalamerican.com/. v Live Healthy Member Rewards When you complete five health actions this year, such as by having your free flu shot, you can receive $50 in Live Healthy Member Rewards. For more information, see page 10. 11
Managing Your Medicines Have a New Prescription? Ask Your Doctor You may already know that some prescription medicines have unwanted side effects, even if they have been prescribed to help you feel better, stay active, and enjoy activities without pain or discomfort. But do you know that some medications can cause serious problems for older adults, such as raising the risk for falls due to dizziness or drowsiness? This is why it s so important to discuss your concerns with your doctor and with your pharmacist, so they can help you avoid dangerous side effects or drug interactions. Some common medications that have a high potential for side effects in older adults are: zolpidem (a sleep aid) glyburide (a diabetes medicine) estrogen therapy (hormones) Side effects from medications, such as sleepwalking, confusion, disorientation, and other problems, can be caused by age-related changes in the body. Changes in body fat, muscle mass, or kidney and liver function can affect how medications are absorbed and processed in the body. Dosage and frequency can also play a role. Since everyone reacts differently to medications, it s important to ask your doctor or pharmacist about common side effects. If you experience problems while taking a medication, contact your doctor or pharmacist immediately. And remember to discuss your medications during your annual physical exam, as this is a good opportunity for your doctor to determine if any changes to your prescriptions are needed. Have a New Prescription? Ask Your Doctor These Questions What is the drug for? What are the possible side effects? When should I take the medication? What if I forget a dose? Are there any foods, drinks or activities that I should take or avoid? Can I take this medication with my other prescriptions? Can I continue taking my vitamins, minerals, and supplements? v For more information on this topic, visit the Live Healthy Library at https://memberlink.universalamerican.com 12 LIVE HEALTHY WITH TEXANPLUS
Nifty after Fifty : Fun, Fitness and So Much More! As part of your plan benefits, you receive unlimited free access to Nifty after Fifty wellness and fitness centers. If you haven t yet visited a Nifty location, look at what you ve been missing: A personal session with an exercise expert to design a fitness program just for you. This Step it Up program helps you track your progress, and rewards you for participation and for meeting your exercise goals. Admission to classes, such as Nifty s exclusive Brainaerobics TM, to sharpen your memory, and Reviving Your Driving TM to improve your driving skills. Nutritional counseling to help you manage your weight, boost your energy and improve your immune system. Monthly planned activities that include socials, potlucks, games, movie matinees, costume contests, holiday celebrations, and more. Meeting new people can keep your mind sharp and your spirits up! *Physical Therapy is not available in Beaumont location. Enjoy all of this, and more at no cost to you. Nifty after Fifty centers can be located in: Katy, Memorial, North Houston, Pasadena, Sugarland, and Beaumont. Enjoy unlimited free access. Visit any location to learn more, or contact 1-(855) BE-NIFTY or visit www.niftyafterfifty.com Need Physical Therapy? The Path to Recovery Begins at Nifty after Fifty If you are recovering from an injury, you can receive Physical Therapy at many Nifty after Fifty locations - even if you haven t visited for fitness or activities. Simply ask your doctor for a referral. Your plan s regular Physical Therapy co-pays will apply. Enjoy personalized care and treatment provided by experienced physical therapists, all in the comfort of Nifty after Fifty wellness and fitness centers.* Once you ve recovered, you can stay fit at Nifty by using your plan benefit. To learn more, contact 1-(855) BE-NIFTY or visit www.niftyafterfifty.com.v 13
Money-Saving ExtraCare Health Card Value for Our Members When you enrolled in TexanPlus, you received a money-saving CVS ExtraCare Health Card. This special card entitles you to a 20% discount on CVS/pharmacy brand health-related items purchased at CVS/pharmacy retail locations nationwide, or through the CVS website at www.cvs.com.* There s no obligation for you to use the card, but it can offer you valuable savings on regular price CVS brand health-related items. The card is available to you at no cost, as part of our commitment to bring greater value and savings to our members. The ExtraCare Health Card can help save you money on first aid supplies, pain relievers, cold and cough remedies, allergy relief products, and more. The 20% discount is applicable to thousands of items available throughout CVS/pharmacy retail stores and on the CVS website. And if you have earned a $50 Live Healthy Rewards card, here s a way to get more out of your Rewards dollars. Use your Rewards dollars at CVS/pharmacy locations, and apply your CVS ExtraCare Health card to the purchase of applicable items for 20% in savings. For more information about Live Healthy Rewards, see page 10. Need to replace a lost or missing CVS ExtraCare Health card, or have general questions about using the card? Contact CVS/Caremark as follows: 1-888-543-5938, 8:30 a.m. to 7:00 p.m. Eastern Time, Monday through Friday. Live Healthy Check-Up Reminders If you ve been forgetting to schedule important doctor appointments, use our Live Healthy Check-Up Reminder service, and we ll remember for you! We will call and remind you when it s time to schedule your appointments for preventive physical exams, screenings and vaccinations. And for even greater convenience, we can help you schedule appointments with your Primary Care Physician and with your other doctors via a three-way conference call. It s easy to remember your doctor appointments when you use this helpful service. To learn more, call Member Services at the phone number listed on the back of your Member ID card. v *Eligible items must be valued at $1 or more. Non-health related items and prescriptions are excluded. 14 LIVE HEALTHY WITH TEXANPLUS
Important Savings Opportunity for Members with Prescription Drug Benefits! Call today to get started 24/7 support! 1-888-648-9629 TTY users call 1-866-236-1069 Go online at www.caremark.com. Mail a completed order form available at www.caremark.com. If you are a member with prescription drug coverage, you can use your Medicare Part D Mail Service benefit to get prescriptions shipped to your home through Mail Service. Your prescriptions will be filled through a preferred mail service pharmacy, and you have the option to sign up for automated delivery. Through Mail Service, you ll receive a 3 month supply of prescription drugs for a 1 month copay!* At a local retail pharmacy, the same 3 month supply would cost you more! You ll save up to 60% on brand-name and generic drugs you take regularly.** MAIL SERVICE OFFERS COST SAVINGS, AND SO MUCH MORE! No paperwork to complete when ordering by phone or online. No trips to a local retail pharmacy to fill your prescriptions. Orders shipped directly to your door at no charge (standard shipping). The CVS Caremark Mail Service pharmacist will contact your physician for your 90-day prescription. Less work for you! Once the mail service pharmacy has your order, you should expect to receive your prescription within 7-10 business days. If you do not receive your prescription drug(s) within this time, please call Member Services at the phone number listed on the back of your Member ID card. *3-month (90-day) supply of most prescription drugs for a 1-month (30-day) copay, excludes Tier 5 Specialty drugs. Available only from a preferred mail service pharmacy and filled during the initial coverage stage. See the Formulary and Evidence of Coverage (EOC) for availability and copays. **You will save more or less than this amount depending upon the monthly copay of your drug(s). 15
4888 Loop Central Dr. 4888 Houston, Loop TX Central 77081Dr. Houston, Health or wellness TX 77081 or prevention information Health or wellness or prevention information 4-STAR PLAN RATED BY MEDICARE 2014 YOUR 2015 ANNUAL NOTICE OF CHANGE (ANOC) AND EVIDENCE OF COVERAGE (EOC) DOCUMENTS These important plan documents will be sent to you in the mail during the month of September. To be well informed about your 2015 plan, please review these documents very carefully. And remember to keep them in a safe place, so you can reference them throughout the year. NOT RECEIVING OUR MONTHLY E-MAIL MESSAGES? SIGN UP TODAY! Send your e-mail address to: MemberFeedback@UniversalAmerican.com Write us at: TexanPlus, Marketing Department, 4888 Loop Central Drive, Houston, TX 77081 TEXANPLUS ON FACEBOOK! Join our community! Visit us 24/7 at http://www.facebook.com/texanplus for important news and information, or to have a little fun! Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. TexanPlus HMO and TexanPlus HMO-POS are Health plans with a Medicare contract. Enrollment in these plans depends on contract renewal.