a wise plan - blue cross of idaho€¦ · prescription drug plan quality, drug plan customer...

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NEWSLETTER FOR MEDICARE ADVANTAGE MEMBERS

A wise Plan

- we Provide Five-Star Service

- out-of-Pocket Maximumsexplained

- heart health

how a checkup can save you money

WINTER 2010

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blue cross of idaho bcidaho.com/medicare 2

Remember telling your kids, “Money doesn’t grow on trees”? Lately, every dollar seems more precious. At Blue Cross of Idaho, we understand this and want to provide tools to help you manage your healthcare costs. It’s why we pack every issue of One to One with information about your coverage options and tips to control spending.

One of the best ways to take care of both your health and your wallet is to visit your doctor annually. Checkups let your doctor monitor important health indicators like blood pressure and give you an opportunity to learn more.

When you visit the doctor, bring a list of medications and supplements you take and compile any questions you have as well as information about changes you’ve noticed in your body. If you don’t understand anything the physician says, speak up. Feel free to take notes and ask questions. It’s your health, and your doctor’s there to help.

Read more about the benefi ts of checkups on page 6. And be sure to visit us online at bcidaho.com/medicare for more helpful resources.

medication updateBlue Cross of Idaho encourages the use of generic drugs as a safe and usually less costly alternative to brand-name drugs. Below are brand-name drugs that have recently been released in a generic form.

Brand Name generic Name Medication Use

Alphagan® P brimonidine glaucoma

Allegra-D® fexofenidine allergies

Acular® ketorolac eye allergy symptoms/eye inflammation

ONE TO ONE

It Begins With You and Your Doctor

= stAtE OF HEAltH

time to QuItThe facts are undeniable: Smoking is bad for your health. If you’ve chosen to quit, don’t go it alone.

Blue Cross of Idaho’s Quit for Good program guides you through the process of becoming a non-smoker with step-by-step support.

Sign up at bcidaho.com/medicare for this free six-week online program. From the member home page after you log in, click the “Start now!” icon under WellConnected, then choose “Click here to log in!” under the Personal Health Assessment header on the left side of the page.

Look under the Stress tab on the WellConnected page, where you’ll fi nd Behavioral Change Programs including Quit for Good.

Idaho Quitline (cdhd.idaho.gov/chec/services/cessation.htm), provides information and telephone counseling sessions.

You may also have coverage for smoking cessation medications. To fi nd out, check your Evidence of Coverage or call customer service.


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blue cross of idaho bcidaho.com/medicare

Remember telling your kids, “Money doesn’t grow on trees”? Lately, every dollar seems more precious. At Blue Cross of Idaho, we understand this and want to provide tools to help you manage your healthcare costs. It’s why we pack every issue of One to One with information about your coverage options and tips to control spending.

One of the best ways to take care of both your health and your wallet is to visit your doctor annually. Checkups let your doctor monitor important health indicators like blood pressure and give you an opportunity to learn more.

When you visit the doctor, bring a list of medications and supplements you take and compile any questions you have as well as information about changes you’ve noticed in your body. If you don’t understand anything the physician says, speak up. Feel free to take notes and ask questions. It’s your health, and your doctor’s there to help.

Read more about the benefi ts of checkups on page 6. And be sure to visit us online at bcidaho.com/medicare for more helpful resources.

3

= WEllNEss

Help Your HeartMedications, supplements and smart lifestyle choices improve your cholesterol levels.

Approximately one in every six adults—16.3 percent of the U.S. adult population—has high cholesterol. People with high cholesterol are twice as likely to develop heart disease. Lowering your cholesterol can reduce your risk for having a heart attack.

The fi rst line of treatment for high cholesterol is regular physical activity and a healthy diet. Quitting smoking also helps.

In addition to lifestyle changes, your doctor may prescribe medications to help reduce cholesterol. One type of medication for treating high cholesterol is a statin. Statins help lower LDL, the “bad” cholesterol, by blocking the production of cholesterol. Statins may also prevent blockage in your blood vessels by removing plaque from your artery walls.

Some well-known brand medications include Lipitor®, Zocor® and Crestor®. Less expensive generic drugs include lovastatin, simvastatin and pravastatin. Ask your doctor if these may be right for you.

Over-the-counter supplements like niacin, fl axseed and fi sh oil have been shown to help improve cholesterol levels when used in combination with a healthy diet and exercise. As with any supplement or vitamin, consult your doctor fi rst to ensure they won’t interact with your existing medication or health conditions.

dOn’t FORGet: taking cholesterol-lowering medication doesn’t give you a free pass to misbehave! A healthy lifestyle is critical to reducing your risk for heart disease.

Brand Name generic Name Medication Use

Alphagan® P brimonidine glaucoma

Allegra-D® fexofenidine allergies

Acular® ketorolac eye allergy symptoms/eye inflammation

It Begins With You and Your Doctor

= stAtE OF HEAltH

time to QuItThe facts are undeniable: Smoking is bad for your health. If you’ve chosen to quit, don’t go it alone.

Blue Cross of Idaho’s Quit for Good program guides you through the process of becoming a non-smoker with step-by-step support.

Sign up at bcidaho.com/medicare for this free six-week online program. From the member home page after you log in, click the “Start now!” icon under WellConnected, then choose “Click here to log in!” under the Personal Health Assessment header on the left side of the page.

Look under the Stress tab on the WellConnected page, where you’ll fi nd Behavioral Change Programs including Quit for Good.

Idaho Quitline (cdhd.idaho.gov/chec/services/cessation.htm), provides information and telephone counseling sessions.

You may also have coverage for smoking cessation medications. To fi nd out, check your Evidence of Coverage or call customer service.


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4 blue cross of idaho bcidaho.com/medicare

The RIGHT ChoiceSurveys confi rm that we’re providing great service.

If you’re a member of one of Blue Cross of Idaho’s Medicare Advantage plans, congratulations. You’ve made

a smart decision. Survey and research conducted during 2009 indicate we’re doing well by our members!

Five Stars According to the United States

Department of Health & Human Services, Blue Cross of Idaho plans received top overall rankings, receiving 4.5–5 stars, with the 5-star ranking placing Blue Cross of Idaho in the top 15 percent of Medicare Advantage plans nationwide.

Secure Blue PPO, Flexi Blue PFFS and True Blue HMO were assessed

based on information from member surveys, feedback from clinicians and data from Medicare reviews. The plans were given top scores in many categories, including overall prescription drug plan quality, drug plan customer service, telephone customer service, and drug pricing and patient safety.

Learn more about the results by visiting medicare.gov and selecting Compare Health Plans.

Above Average Every year, the Centers for

Medicare & Medicaid Services (CMS) performs a survey that measures the experiences of members of Medicare Advantage plans. The survey is called CAHPS, which

stands for Consumer Assessment of Healthcare Providers and Systems.

This year, for example, our True Blue HMO plan scored at or above national averages. Members indicated that we provide very good customer service and do a great job helping them get care quickly.

We’re also glad to hear that the majority of our members would

be willing to recommend our drug coverage to others.

What It Means to YouMore than just scores, surveys

tell us that members like you are speaking up and helping us improve our products and services.

Our staff reviews the results closely to fi nd where we can improve and what matters most to our members.

2009 CAHPS ReSultS HigHligHts

“In the last 6 months, how often did your plan’s customer service give you the information or help you needed about prescription drugs?”

Nationally, 58% replied “always”

true Blue HMO: 68% “always”

“In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed?”



“In the last 6 months, how often did your plan give you all the information you needed about which prescription medicines were covered?”



“In the last 6 months, how often was it easy to fi ll prescriptions your doctor prescribed?”



Based on 2009 Medicare Advantage CAHPS results issued October 2009 by the Centers for Medicare & Medicaid Services


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blue cross of idaho bcidaho.com/medicare 5

Surveys confirm that we’re providing great service.

If you’re a member of one of Blue Cross of Idaho’s Medicare Advantage plans, congratulations. You’ve made

a smart decision. Survey and research conducted during 2009 indicate we’re doing well by our members!

Five Stars According to the United States

Department of Health & Human Services, Blue Cross of Idaho plans received top overall rankings, receiving 4.5–5 stars, with the 5-star ranking placing Blue Cross of Idaho in the top 15 percent of Medicare Advantage plans nationwide.

Secure Blue PPO, Flexi Blue PFFS and True Blue HMO were assessed

based on information from member surveys, feedback from clinicians and data from Medicare reviews. The plans were given top scores in many categories, including overall prescription drug plan quality, drug plan customer service, telephone customer service, and drug pricing and patient safety.

Learn more about the results by visiting medicare.gov and selecting Compare Health Plans.

Above Average Every year, the Centers for

Medicare & Medicaid Services (CMS) performs a survey that measures the experiences of members of Medicare Advantage plans. The survey is called CAHPS, which

stands for Consumer Assessment of Healthcare Providers and Systems.

This year, for example, our True Blue HMO plan scored at or above national averages. Members indicated that we provide very good customer service and do a great job helping them get care quickly.

We’re also glad to hear that the majority of our members would

be willing to recommend our drug coverage to others.

What It Means to YouMore than just scores, surveys

tell us that members like you are speaking up and helping us improve our products and services.

Our staff reviews the results closely to find where we can improve and what matters most to our members.

2009 CAHPS ReSultS HigHligHts

“In the last 6 months, how often did your plan’s customer service give you the information or help you needed about prescription drugs?”



“In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed?”



“In the last 6 months, how often did your plan give you all the information you needed about which prescription medicines were covered?”



“In the last 6 months, how often was it easy to fill prescriptions your doctor prescribed?”



Based on 2009 Medicare Advantage CAHPS results issued October 2009 by the Centers for Medicare & Medicaid Services


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BLUE CROSS OF IDAHO BCIDAHO.COM/MEDICARE 6

I gnorance may be bliss, but when it comes to your health, knowledge is power. Since quite

a few medical problems don’t show symptoms until they are very serious and costly to treat, it’s important to visit your doctor for a checkup every year. Pick a date you won’t forget—like your birthday or wedding anniversary—and schedule your exam for that day every year. Then, prepare to talk with your physician about the following medical issues.

three to watchType 2 diabetes has become

increasingly common in our country. The symptoms of elevated blood sugar can be subtle, so a blood test is needed to diagnose the condition.

High blood pressure develops silently, too. Blood pressure should be less than 120 systolic (the top number) over 80 diastolic (the bottom number), according to the American Heart Association. Anything above this may eventually increase your risk for a stroke or heart attack.

You can only test for high cholesterol using a blood test. But it’s a major risk factor for heart disease.

Each of these three conditions can be managed and, sometimes, eliminated with the correct lifestyle choices. However, left untreated, they can lead to serious, costly health problems like heart attack or stroke.

As a member of one of Blue Cross of Idaho’s Medicare Advantage programs, you have coverage for your annual exam for just the cost of one copayment! Remember: Visiting your doctor for that annual checkup is an investment in your healthy future.

We understand the importance of managing your household budget. A signifi cant part of your spending nowadays may be for medications and medical care. To help you understand and plan for health costs, we’ve compiled these common member questions.

what exactly is a copayment?A copayment is a fi xed dollar amount (for example, $20 or $30) you

have to pay for specifi ed covered services such as a doctor offi ce visit or prescription medicine. Copayments vary based on the type of coverage you have and are applied each time the service is provided.

what are out-of-pocket maximums?Your out-of-pocket maximum in 2010 is $3,000. This $3,000 is not a

deductible—it is the maximum amount of money you pay as your share of healthcare costs. So, the copayment for offi ce visits and the copayment for any hospitalization, as well as any other cost-sharing expenses you have during the year, add up. And when they reach $3,000, your Blue Cross of Idaho Medicare Advantage coverage will start picking up all the covered expenses at 100 percent—and you won’t have any more cost sharing for the year.

The out-of-pocket maximum is an additional benefi t designed to protect you from unexpected costs. Looked at another way, the total amount of your out-of-pocket maximum is the most you will pay for healthcare costs this year.

The cost of your premiums and your Part D copayments do not count toward your out-of-pocket maximum. However, once you pay a total $3,000 in cost sharing in a given year, all other covered services from that point on are paid at 100 percent!

Save Money, See Your DoctorRegular checkups deliver cost savings in the long run.

QA

QA

IF YOU HAVE QUESTIONS about your coverage, Blue Cross of Idaho can help. Visit bcidaho.com/medicare and select Compare Plans.Or call us at 1-888-494-2583. If you’re hearing-impaired, call TTY 1-800-377-1363.


IS-7

BLUE CROSS OF IDAHO BCIDAHO.COM/MEDICARE 7

I gnorance may be bliss, but when it comes to your health, knowledge is power. Since quite

a few medical problems don’t show symptoms until they are very serious and costly to treat, it’s important to visit your doctor for a checkup every year. Pick a date you won’t forget—like your birthday or wedding anniversary—and schedule your exam for that day every year. Then, prepare to talk with your physician about the following medical issues.

three to watchType 2 diabetes has become

increasingly common in our country. The symptoms of elevated blood sugar can be subtle, so a blood test is needed to diagnose the condition.

High blood pressure develops silently, too. Blood pressure should be less than 120 systolic (the top number) over 80 diastolic (the bottom number), according to the American Heart Association. Anything above this may eventually increase your risk for a stroke or heart attack.

You can only test for high cholesterol using a blood test. But it’s a major risk factor for heart disease.

Each of these three conditions can be managed and, sometimes, eliminated with the correct lifestyle choices. However, left untreated, they can lead to serious, costly health problems like heart attack or stroke.

As a member of one of Blue Cross of Idaho’s Medicare Advantage programs, you have coverage for your annual exam for just the cost of one copayment! Remember: Visiting your doctor for that annual checkup is an investment in your healthy future.

We understand the importance of managing your household budget. A signifi cant part of your spending nowadays may be for medications and medical care. To help you understand and plan for health costs, we’ve compiled these common member questions.

what exactly is a copayment?A copayment is a fi xed dollar amount (for example, $20 or $30) you

have to pay for specifi ed covered services such as a doctor offi ce visit or prescription medicine. Copayments vary based on the type of coverage you have and are applied each time the service is provided.

what are out-of-pocket maximums?Your out-of-pocket maximum in 2010 is $3,000. This $3,000 is not a

deductible—it is the maximum amount of money you pay as your share of healthcare costs. So, the copayment for offi ce visits and the copayment for any hospitalization, as well as any other cost-sharing expenses you have during the year, add up. And when they reach $3,000, your Blue Cross of Idaho Medicare Advantage coverage will start picking up all the covered expenses at 100 percent—and you won’t have any more cost sharing for the year.

The out-of-pocket maximum is an additional benefi t designed to protect you from unexpected costs. Looked at another way, the total amount of your out-of-pocket maximum is the most you will pay for healthcare costs this year.

The cost of your premiums and your Part D copayments do not count toward your out-of-pocket maximum. However, once you pay a total $3,000 in cost sharing in a given year, all other covered services from that point on are paid at 100 percent!

to verify your plan’s copayment requirements and out-of-pocket maximum as well as deductible and coinsurance information, review your Summary of Benefi ts or evidence of Coverage. If you still have questions, call the customer service number on your Id card.

Wallet watchAll you need to know about out-of-pocket expenses.

QA

QA

IF YOU HAVE QUESTIONS about your coverage, Blue Cross of Idaho can help. Visit bcidaho.com/medicare and select Compare Plans.Or call us at 1-888-494-2583. If you’re hearing-impaired, call TTY 1-800-377-1363.

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JoIn the Crowd It’s not too late to change your Blue Cross of Idaho Medicare plan. For top-notch service and benefits, we’ve got you covered. If you have questions while choosing health insurance, let us help. Visit bcidaho.com/medicare and select Compare Plans. Or call Blue Cross of Idaho at 1-888-494-2583. If you’re hearing-impaired, call TTY 1-800-377-1363.

For general guidance about medication, physical conditions and healthcare procedures, call a registered nurse any time of day. The Blue Cross of Idaho 24/7 Nurse Advice Line can answer health questions and direct you to further care if you require it. Since we’ve been open, we’ve helped hundreds of callers! It’s a free service dedicated to helping members just like you.

Need to Speak to a Nurse?Call the 24/7 Nurse Advice Line at 1-866-220-3138.


a wise plan - blue cross of idaho€¦ · prescription drug plan quality, drug plan customer...

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