Partners in Health Special! edition s &
e Plan Updat tion a Free Medic ok Guidebo
Your 2016 Benefits Guide Healthy Ways to Avoid Holiday Blues Adding More Value to Your Plan and Lifestyle
Simple. Affordable. Personal. Your local health plan A HEALTHY LIFESTYLE MAGAZINE | FALL 2015
contents FALL 2015
2016 Benefits Guide Member Activities and Programs Page 4 Benefits Summary Pages 6-7 Prescription Drug Benefits Pages 8-9 Extra Health and Wellness Services Pages 10-11 Free Diabetes Meters and Test Supplies Available in 2016 Page 15 2016 Annual Member Meetings Back page
PREVENTION Stay Healthy This Fall Page 5 Get the Health Care You Need Page 12 3 Steps to Beat Heart Disease and Stroke Page 13 2016 Preventive Screenings Checklist Page 14 Healthy Ways to Avoid Holiday Blues Page 15
Refer Your Friend Do you have friends or family members who could benefit from the low monthly premiums and affordable coverage that StableView Health provides? If so, tell them about the plan benefits and convenience you enjoy as a StableView Health member. Enrolling is quick and easy to do. And now is the time to make the switch just in time for 2016. For more information, visit our website at www.StableViewHealth.com or call 1-866-792-0180 today.
Your Partner for Quality Health Care The best health care is based on a true partnership—between you, your doctor and your health plan. We are your partner in healthy living, dedicated to helping you get the most out of your health care so you can live your life to the fullest. Our mission, and our passion, is helping you make sound health care decisions. We take pride in partnering with our members to improve their health.
Your Health Plan Just Got Better Whether you are new to Medicare or an experienced plan member, you need a partner you can count on. At StableView Health, we design our benefits around the way you live and offer you simple, clear options along with reasonable, predictable costs. We Appreciate Your Membership We know that as a wise health care consumer, you have many health plan options from which to choose. That’s why we’re so grateful that you’ve chosen StableView Health as your Medicare Advantage plan. Together with our physicians, hospitals and other providers, we work hard to make available a health plan that is not only affordable but offers you more than what you get with Original Medicare. We’re local in Kentucky We’ve learned that bigger isn’t always better. We built our plan from the ground up with input from area doctors, hospitals and health care experts to provide locally minded health care. As a member-focused, not-for-profit organization, we strive to offer affordable Medicare Advantage services that meet your needs and fit your budget. Your Coverage Just Got Better Be sure to review the Annual Notice of Change and Evidence of Coverage booklets we recently mailed to your home. These documents outline the changes to your benefits in 2016. As we enter the 2016 Annual Enrollment Period (Oct. 15 – Dec. 7), please make sure to take the time to look through your plan materials carefully so that you fully understand any changes to your benefits. Our friendly, knowledgeable Customer Service staff is here to answer any questions you might have.
Here are a few highlights from our 2016 plan benefits: • No monthly premium changes • Predictable copays on many services • Preventive dental benefits • $1,000 annual per ear hearing aid allowance and routine vision included at no additional cost • No prescription drug coverage deductible • Enjoy the freedom to see any provider in our service area, in- or out-of-network, with NO referral
Your StableView Health plan will automatically renew at the beginning of the year, so there’s nothing you need to do to continue enjoying your health plan coverage benefits with StableView Health. As always, we are here to assist you with any questions you may have. Give us a call at 1-866-792-0180 or visit us online at www.StableViewHealth.com to learn more. We are so grateful that our members choose to stay with us year in and year out. It tells us that we’re doing things the right way.
StableView Health is an HMO-POS plan with a Medicare contract. Enrollment in StableView Health depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Call Customer Service at 1-866-792-0180 (TTY users should call 711). StableView Health hours of operation are 8:00 am to 8:00 pm, Monday – Friday and 8:00 am to 8:00 pm, Monday – Sunday, October 1 through February 14. Y0113_2016_70MA0815_ALL CMS Accepted
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Opportunities for Fun and Fellowship Members come first at StableView Health. Throughout the year, we host regular activities for our members. They give members a chance to meet each other and allow us to get to know you. This year, we’re excited to again offer different ways for us to connect.
Annual member Meetings Designed with input from members like you, our annual member meetings give you a chance to ask questions about the plan. See the back page of this issue for a list of upcoming meetings. Member Advisory Committee Are you passionate about StableView Health? Or do you have suggestions that can help enhance the services that StableView Health has to offer? If so, we’d love to hear from you. Every quarter, StableView Health representatives meet with a group of volunteers to discuss how to improve your health plan and make sure our members have a positive experience. It’s a great way to learn from members like you about what’s working and what could be improved and to gain other valuable insights you might have.
Want to Join Our Member ! Advisory Committee? If you’re interested in becoming a representative on this fun and engaging team, visit the Member Center at www.StableViewHealth.com and fill out an application today. We look forward to hearing from you soon.
Stay Healthy This Fall There are so many ways to celebrate the fall season. Perhaps you like to walk or jog along local paths or have friends and family over for a special meal. To enjoy every moment, you’ll want to feel your best. Taking a few precautions may help ensure that you stay healthy throughout fall and winter.
Precaution Against Colds and Flu Many holidays are celebrated in the fall and winter— right at the height of cold and flu season. Getting immunized is the best way to reduce your risk for the flu. While there’s no guaranteed way to keep from catching a cold-causing virus, you can make it less likely by doing the following: • Wash your hands. Use warm water and soap. Scrub for at least 15 seconds. • If you can, stay away from sick people. • Eat a balanced diet, don’t smoke and get plenty of sleep and exercise. You’ll be less likely to get sick if your resistance is up. Manage Chronic Conditions When life gets hectic, taking care of yourself is even more important and may be particularly tricky for people with a long-term condition such as diabetes or a respiratory condition. Your doctor can help you plan ahead for specific challenges. Here are some other things to keep in mind:
• If you’re traveling, pack medicines in a bag that you can carry with you. Make sure you check and comply with Transportation Security Administration guidelines. Don’t forget to pack extra medicine and supplies in case they aren’t available at your destination or you’re away longer than planned. • Before staying with family or friends, ask about smoking habits if you have asthma or chronic obstructive pulmonary disease (COPD). Tell your hosts about anything else that may affect your condition. At a hotel, request a nonsmoking room. • Cold air may trigger an asthma attack or angina. Be prepared if you’re spending time outside by having easy access to your asthma or heart medicine. • Watching what you eat and drink may be an important part of your treatment plan, especially if you have high blood pressure or diabetes. To help you stick with your plan, try taking slivers of your favorite foods instead of full servings. When you mingle, avoid standing near the food tables. If you have diabetes and are drinking alcohol, keep your intake in a safe range. Mix club soda with dry wine for a low-alcohol, lowsugar wine cooler.
Did You Know? ! Medicare covers the cost of annual flu shots and other preventive services to keep you healthy. Fall 2015 5
2016 Benefits Summary
This chart shows what our 2016 plan offers members. Turn the page for more benefit details.
Classic Plus Rx (HMO–POS) Offered in Bourbon, Fayette, Jessamine, Scott and Woodford counties In-Network
No premium required for this plan
No medical deductible
Classic Plus Rx (HMO–POS) Coverage continued
$4,900 out-of-pocket limit every year for all Medicare Parts A and B member cost sharing excluding Part D pharmacy
No limit on the out-of-pocket member cost sharing
Inpatient Hospital Care
Diagnostic Tests, X-Rays, Lab & Radiology Services
$250 copay per day days 1–7 $0 copay per day days 8–90 $0 copay for additional days
Lab Services: $15 copay per day, per visit X-rays: $20 per day maximum Diagnostic Procedures & Tests: 20% coinsurance per day maximum Diagnostic Radiology Services (not including X-rays): 20% coinsurance Therapeutic Radiology Services: 20% coinsurance
Lab Services: $15 copay per day, per visit X-rays: $25 per day maximum Diagnostic Procedures & Tests: 40% coinsurance per day maximum Diagnostic Radiology Services (not including X-rays): 40% coinsurance Therapeutic Radiology Services: 40% coinsurance Y0113_2016_99MA0715_9492 CMS Accepted
Primary Care Office Visits
Specialist Office Visits
$5 copay $0 copay for annual physical
$240 copay not waived if admitted
$75 copay waived if admitted within 24 hours for same condition (includes worldwide coverage)
$10 copay $0 copay for annual physical
$240 copay not waived if admitted
$75 copay waived if admitted within 24 hours for same condition (includes worldwide coverage)
Routine Vision Services
Outpatient Services/ Surgery
Physical, Occupational, Speech & Language Therapy
Medically necessary ambulance services
No prior hospital stay required 100 days per benefit period
You may go to any emergency room if you reasonably believe you need emergency care
$120 limit for eyewear every 24 months with $25 copay
$175 copay at ASC* $200 copay at outpatient hospital facility $35 copay for outpatient clinic
$35 copay per visit
$0 copay per day days 1–20 $160 copay per day days 21–51 $0 copay per day days 52–100
$0 copay for 1 routine eye exam per year $25 copay for 1 pair of glasses, contacts or lenses $0 copay for 1 pair of standard eyeglasses or contact lenses after cataract surgery
40% coinsurance for ASC* 40% coinsurance for outpatient hospital facility 40% coinsurance for outpatient clinic
$50 copay per visit
$50 copay for 1 routine eye exam per year 40% coinsurance for 1 pair of standard eyeglasses or contact lenses after cataract surgery Not covered for other glasses, contacts, or lenses
*Ambulatory Surgery Center
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2016 Prescription Drug Benefits
Here’s an overview of costs and coverage with your plan, which includes the Medicare prescription drug benefit.
Classic Plus Rx (HMO–POS) Offered in Bourbon, Fayette, Jessamine, Scott and Woodford counties In-Network
Initial Coverage Limit
No prescription drug deductible
$4,850 total out-of-pocket maximum
$2.95 copay for generic (including brand drugs treated as generic) and $7.40 copay for all other drugs, or 5% coinsurance
Preventive dental coverage
Good dental habits can protect your overall well-being. You’re covered for preventive dental care to help you stay healthy. You have only a $10 copay per visit for the following when performed by a network provider: • 1 routine cleaning every six months • 1 fluoride treatment every six months • 1 exam every six months • 1 X-ray every six months
Prescription Drug Tiers and Coverage
Below is what you can expect to pay for prescriptions in each level, or tier, of our formulary at network pharmacies.
Classic Plus Rx (HMO–POS)
Retail or Mail Order 31-Day Supply
Retail or Mail Order 62-Day Supply
Retail 93-Day Supply
Mail Order 93-Day Supply
Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
$2 $10 $38 35% coinsurance 33% coinsurance
$4 $20 $76 35% coinsurance 33% coinsurance
$5 $25 $95 35% coinsurance 33% coinsurance
$6 $30 $114 35% coinsurance 33% coinsurance
Our drug formulary is divided into five levels, or tiers. Each tier is for a different drug type. The amount of coverage for a drug is determined by which tier it’s on.
Tier 1 Tier 2 Tier 3 Preferred Generic Drugs Generic Drugs
Preferred Brand Drugs
Tier 4 Non-Preferred Brand Drugs
hearing aid coverage
Your plan now includes coverage for hearing aids. There’s no copayment required, and we’ll cover up to $1,000 per ear toward the purchase of aids from Hearing Care Solutions.
StableView Health is an HMO-POS plan with a Medicare contract. Enrollment in StableView Health depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. Fall 2015 9
2016 Benefits Guide
Adding More Value to Your Plan and Lifestyle StableView Health wants to give you all the tools you need to start or maintain a healthy lifestyle. As a StableView Health member, you have access to additional benefits that are included in your plan at no extra cost.
Silver&Fit® Fitness Program Get fit. Have fun. Be healthy®. The Silver&Fit program is designed specifically for Medicare beneficiaries. This program can help you maintain your health and feel great doing it! By exercising regularly and meeting new people, you can be Silver, Fit, and Fabulous® too! What you get: • Get a local gym membership at no additional cost through the Silver&Fit network program. • Enjoy all the standard amenities of the gym including special Silver&Fit exercise classes designed with you in mind. • Standard amenities may include cardiovascular equipment, resistance/weight training, exercise classes and more. • Many Silver&Fit fitness facilities offer Silver&Fit exercise classes two times a week, quarterly social events at the facility, and fitness advisers to assist you in using the amenities. • If you don’t want to go to a gym, you also have access to home fitness kits in lieu of a fitness facility membership (limit two kits per benefit year). To find a Silver&Fit location near you, visit www.SilverandFit.com or call 1-877-427-4788.
Vision Care Annual routine eye exams are an important part of your overall health care. With VSP vision coverage, you’ll get personalized care that focuses on your eyes and overall wellness. The coverage also provides great savings, is simple to use, and offers the latest eyewear styles and brand names. What you get: • No-cost annual routine eye examination. • A $120 hardware allowance toward the purchase of vision hardware like eyeglass frames or contact lenses, with a low $25 copay (every 24 months). 10
• With VSP’s vision coverage, your basic lenses are covered in full. Any lens options, such as progressives, are offered at a discount of 20 to 25 percent. • Additional pairs of glasses or sunglasses are offered at a 20 percent discount when using a VSP vision provider. • Need Lasik surgery? Use a VSP provider and get an average 15 to 20 percent discount on laser surgery. • No copayment for Medicarecovered glaucoma tests. Information about VSP and eye care is available by calling 1-800-877-7195 or visiting www.VSP.com.
Hearing Care Get an annual routine hearing exam covered at $0 copay through Hearing Care Solutions. In addition, get an annual $1,000 allowance toward hearing aids per ear. What you get: • Annual routine hearing exam at no charge • Two-year supply of batteries at no charge and three-year comprehensive warranty, including loss and damage • 30-day hearing aid evaluation period • Fixed, discounted pricing on hearing aids from major manufacturers • No-interest, free financing for up to 12 months for qualified applicants • Plus: Your plan includes a $1,000 allowance per ear toward the purchase of hearing aids
To schedule your free hearing exam, call 1-866-344-7756 or visit www.HearingCareSolutions.com for more information.
iRx Prescription Drug Discount Program We’re proud to be able to help you with your health care costs by including iRx ProgramTM inside your StableView Health (HMO-POS) ID card at no cost. This program gives you discounts on brand-name and generic prescription medications not covered by your insurance*. What you get: • Instant savings with no qualifying • Accepted at more than 60,000 participating pharmacies • Absolutely no enrollment fees and no monthly or ongoing fees • There’s no limit to the number of times the program can be used • And best of all, you already have it! It’s in your StableView Health ID card. *Savings average 25 percent, with potential savings of up to 75 percent—based on 2014 national program savings data. DISCOUNT ONLY—NOT INSURANCE. To learn more about these benefits, call StableView Health at 1-866-792-0180 or visit www.StableViewHealth.com. As your partner in health, we are committed to providing you with the tools, resources and benefits you need to live a healthy, long life.
Switching Primary Care Providers? One of the things you enjoy as a StableView Health member is the convenience and flexibility to choose your own primary care provider. We know that, for various reasons, people may change primary care providers. But did you know that if you switch primary care providers, you need a new plan ID card? If you’re looking to switch or have already switched your primary doctor, give us a call at 1-866-792-0180 so we can send you a new ID card with your most current information. Medicare requires that your ID card be current so that your benefits are administered properly. For example, if you switched primary care providers and started seeing this new doctor, but your ID card lists another doctor instead, you may be subject to a different copay than the low primary care provider copay you currently pay. At StableView Health, we want to make sure that it’s easy to get the care you need, when you need it, and from the doctors you trust. If you have questions about how to switch or would like to switch primary care providers, please call us at 1-866-792-0180.
Fall 2015 11
Ralph Alvarado, M.D. Medical Director for StableView Health
Get the Health Care You Need Your doctor may hold the medical degree, but no one knows your health better than you. That’s why it’s important to partner with your doctor and to become involved with your care. Seeing your doctor regularly for routine medical care, asking questions and gaining a better understanding of your health can help you stay well and prevent future problems.
Stay on Top of Preventive Care An easy way to engage in your care and build a partnership with your doctor is to schedule an Annual Wellness Visit with him or her. With Medicare Part B, an Annual Wellness Visit is covered, and you pay nothing for the visit. During this visit, you will work
with your doctor to create a plan that outlines what you can do to improve your overall health. For example, you can talk about ways to increase your physical activity or barriers that are keeping you from being as active as you’d like. You can also discuss your diet and ways you could improve it to meet certain goals. If you need to lose weight, for instance, your doctor may recommend some changes like filling up on a variety of fresh fruits and vegetables or creating lowercalorie versions of favorite meals. Your doctor may also advise you to have certain health screenings as part of your wellness plan. Medicare Part B covers a wide range of preventive screenings, including: • Bone density • Cardiovascular disease
• Diabetes • Mammographies • Colorectal cancer • Glaucoma tests • Prostate cancer If you receive a flu shot, hepatitis B vaccine or pneumococcal shot, those are covered, too.
Plan in Advance for Regular Care For conditions like heart failure, your doctor may also advise more frequent visits to check on your health. Making appointments for wellness visits or follow-up care in advance can ensure that you get in to see your doctor when you want to and won’t have to wait. You’ll have the care you need to live a longer, healthier life.
Visit the Wellness Resources section of our website for information to help you live healthy, including recipes, disease management tips, videos and more! 12
3 Steps to Beat Heart Disease and Stroke Whether you’re watching TV or walking your dog, your heart works hard for you. Each day, a healthy one beats 100,000 times and pumps about 2,000 gallons of blood. To reduce your risk for heart attack and stroke, which are leading causes of death and disability in the U.S., do your part for your heart. Taking these important steps can help keep it healthy.
Talk with your doctor about aspirin use Taking a low dose of aspirin daily can help prevent heart attack and stroke if you’re at high risk. Aspirin thins your blood to help prevent blood clots from forming in your arteries. When blood clots rupture, they can block blood flow to your heart (heart attack) or brain (stroke). Talk to your doctor about whether aspirin therapy is right for you. check your blood glucose Too much glucose (sugar) in your blood because of prediabetes or type 2 diabetes can lead to heart disease and other serious health problems. A simple blood test, called an HbA1c, can help you and your doctor know if your diabetes management plan is working. The test is an average of your blood glucose control over the past two or three months. Ask your doctor about the HbA1c and whether you should have the test.
quit it Smoking damages and thickens blood vessels, which can pave the way for clots to form. Smokers are two to four times more likely to experience heart attack or stroke than nonsmokers. A smoking cessation counseling program can help you break the habit. We’re on a Mission StableView Health is serious about preventing heart attack and stroke. We’re taking part in the Million Hearts Campaign, a national drive to help prevent 1 million heart attacks and strokes in the U.S. by 2017. Million Hearts focuses on preventing heart disease and stroke by knowing your ABCS: • Aspirin therapy • Blood pressure control • Cholesterol management • Smoking cessation To reduce your risk, have your cholesterol and your blood pressure checked regularly, too. Follow your doctor’s advice, which may include making lifestyle changes and/or taking medication. Preventing 1 million heart attacks and strokes starts with one person. Do all you can to take charge of your heart health. For more information, visit www.MillionHearts.hhs.gov. Fall 2015 13
Your Checkup Checklist
Preventive care is the key to staying healthy and living longer. We’ve gathered important preventive health services in this checklist. Ask your primary care provider which screenings and exams you need and use this chart to keep track. Medicare covers many preventive services at no additional cost to you.
SCREENING & TESTING
General Health Annual Wellness Visit
Bone Density Test
Every 2 years or as medically necessary
Ask your doctor
High Blood Pressure Screening
Annually or as medically necessary
Cancer Breast Cancer Screening
Colorectal Cancer Screening • Fecal occult blood test • Flexible sigmoidoscopy • Colonoscopy
Once every 12 months Once every 4 years Once every 10 years
Diabetes Blood Glucose Test
At least twice a year
Dilated Eye Exam
Hemoglobin A1c (HbA1c) Test
Kidney Function Screening
Immunizations Flu Vaccine
Initial pneumococcal vaccine followed by a second vaccine 1 year after
Other Fall Risk Screening
Discuss with your physician
Healthy Ways to Avoid Holiday Blues During the holidays, does it feel like everyone is celebrating except you? The holidays can be an emotional time for many. Try these tips to navigate the season successfully.
Keep your expectations realistic You may feel pressure to take on more tasks than you have energy for or give more gifts than you can afford. Overextending yourself and not being able to follow through can make you feel worse. Only commit to those things you know you’ll be able to do. If other people ask more of you than you can handle, you can always say no. Make time for exercise When you’re active, your brain releases chemicals that improve your mood and decrease stress. Exercise protects your mind, too. Experts recommend 150 minutes of moderate-intensity exercise, such as brisk walking, each week.
Talk to someone You don’t have to go it alone. Talk about your problems with someone close to you, such as a friend or family member. It can help you feel better. They may also help you think of your problems in a new way and recommend solutions you haven’t considered before. Be honest with your doctor, too. Tell him or her what you’re going through. There are treatments for depression that can help. Take care of yourself When you treat your body right, you’re able to deal with problems more easily. Don’t skimp on sleep. Avoid sugar and caffeine. They can cause a dip in your energy level and leave you feeling worse. And fill your diet with health-boosting foods like fruits, vegetables, beans and whole grains.
Free Diabetes Meters and Test Supplies Available in 2016 Starting January 1, StableView Health will only cover Abbott blood glucose meters and test strips. Abbott makes both the FreeStyle and the Precision Xtra. All other products will NOT be covered. StableView Health will replace your current blood glucose meter at no cost. By using one of the meters and test strips from Abbott, you will have no-cost sharing. Getting a new meter is quick and easy when you do one of the following. Simply ask your doctor for a new prescription and bring it to your local network pharmacy or your pharmacist. Or call Abbott Diabetes Care at 1-866-224-8892 or visit them online at www.ChooseFreeStyle.com to get a free meter. Fall 2015 15
Learn about your benefits, get health tips and more!
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Health and wellness or prevention information
Annual Member Meetings Join us for an upcoming annual member meeting to learn more about your plan benefits and changes for 2016. Registration is required. Register online at www.StableViewHealth.com. St. Joseph Office Park Building D 4th Floor, Room 3 1451 Harrodsburg Road Lexington, KY • October 1, 1:00 p.m. • October 7, 1:00 p.m.
Questions? Call Us Today!
1-866-792-0180 (TTY: 711) StableView Health is open: Monday – Friday, 8:00 a.m. – 8:00 p.m.; Monday – Sunday, 8:00 a.m. – 8:00 p.m., between October 1 and February 14
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