Medicare Open Enrollment and Advantage Plans

Did you know Medicare Open Enrollment is happening now through December 7th?  Do you have a Medicare Advantage Plan or wondering what one is? Medicare Advantage Plans are basically private versions of Medicare.  They sometimes cover more services than Medicare A and B, such as include Medicare Part D.  However, sometimes they do not cover all services provided by Medicare.

The Federal Government used to subsidize these private health insurance plans but the Patient Protection and Affordable Care Act is reducing this subsidy to save costs.  

One of California’s largest Medicare Advantage plans is pulling out of Medicare in 2012.

As of 2012, Freedom Blue Medicare Advantage Plan will no longer be available.  If you are currently covered through Freedom Blue, you should have been notified of the upcoming change and your need to choose a new Medicare Plan. The Open Enrollment period is October 15 – December 7, now is the time you can change your Medicare health plan and Part D coverage and/or return to Original Medicare. Coverage changes become effective January 1, 2012. We know this can be an overwhelming task and want to help you understand what this means to you.

Freedom Blue is a PPO plan, which means you select an "in network" doctor from a long list of providers.  You don't usually need a referral to see a specialist or an "out-of-network" doctor.   However, if you see an out of network provider, the PPO covers you at a lower rate than in-network and you will have a larger coinsurance or patient responsibility amount. PPO is the most flexible type of plan with the largest list of in network providers. 

With the termination of Freedom Blue, there will no longer be a PPO Medicare Advantage Plan available to Beneficiaries in Fresno County.  The options available are:

Traditional Medicare, you can use any doctors and facilities that accept assignment for Medicare.  Most doctors and facilities do accept Medicare assignment, such as avecinia.      

HMO, which requires you to use only doctors and facilities that are contracted with that particular HMO.  You generally need a referral from your primary care doctor to see a specialist.   Avecinia is not a contracted with any HMOs

HMO-POS,  similar to an HMO, you also have the option to receive some services from doctors or hospitals that are not in the plan's network, usually at a higher cost than a standard HMO plan. Avecinia is not contracted with any HMO-POS plans.

**Some Medicare Advantage plans offer Medicare prescription drug coverage, but other plans do not.    Don't forget to explore your prescription drug options.

    

These plans all have their pros and cons, and varying degrees of out of pocket costs.  Make sure that you educate yourself so you can choose the best plan for your health and your budget.  In our experience with Medicare and Medicare Advantage plans, we have found traditional Medicare the easiest to work with.  Traditional Medicare may not offer all the services some Medicare Advantage plans offer, but we have found that traditional Medicare is less likely to deny or request prior authorization for benefits it does cover. 

A great resource to help you better understand your Medicare choices is HICAP (the Health Insurance Counseling & Advocacy Group - http://www.cahealthadvocates.org/HICAP/).  HICAP provides free, objective information and counseling about Medicare.  The Fresno representative is Wayne McMillen at Clovis Senior Center.  Appointments can be made by calling 559-324-2750 (here’s a link to their October Newsletter with an article by Mr. McMillen: http://www.ci.clovis.ca.us/SiteCollectionDocuments/SeniorServicesDivision/October2011Newsletter.pdf)

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Medicare's Annual Wellness Visit

Healthcare Reform was a hot topic in 2010 and continues to be as we start the new year!  There are many benefits introduced by the reform and one very important one that is set to start January 1^st, 2011 is Medicare’s new Annual Wellness Visit!  You may be asking yourself, “What is an Annual Wellness Visit?”   and  “Is it worth it for me to come in when I’m not sick?”- the answer to the second question is easy- YES!  If you want to know what an Annual Wellness Visit is, read on!

The Annual Wellness Visit  is Medicare’s answer to providing a preventive (or well check) visit with a few extras that research has found helps you live healthier, happier lives. AND IT’S ALL FREE for Medicare patients (if you have a Medicare Advantage plan, verify with your insurance provider that they too will cover your co-pay and deductible for Medicare’s Annual Wellness Visit)!  Prior to enacting this new law and benefit, Medicare did not cover the physical portion of a preventive visit and only covered certain screening tests.  More importantly, it did not give physicians and their patients a chance to sit down and talk about their general health, well-being and what the future may hold.  Now, by scheduling and attending your Annual Wellness Visit when you are not sick, you can get the following along with a wellness visit:

1. Measurement of individual height, weight, Body Mass Index (“BMI”) , blood pressure (“BP”), and other routine measurements as deemed appropriate, based on the beneficiary’s medical/family history;
• Measuring your BMI, blood pressure and other vitals gives us a quick picture of your current health.  We can tell if you are at risk for diabetes, cardiovascular disease and other health concerns just by a few simple, but vital, pieces of information.
2. Establishment of individual’s medical, family and social history;
• Knowing your most up to date family, medical and social history helps us determine if there are genetic or other reasons your risks may be greater than the average person.
3. A list of prescription medication;
• By reviewing your current list of medications, we can make sure you are not being prescribed too many medications or medications that have negative interactions with each other.  Our Athenahealth Electronic Health Record program will in most cases have a current list of medications if you have been getting them from a pharmacy and using your insurance.
4.  Establishment of a list of current providers and suppliers that are regularly involved in providing care to the individual;
• Knowing who else you are seeing and for what health issues allows us to better coordinate your care and get in touch with the right physician if we need to.
5. Detection of any cognitive impairment that individual may have (review of risk of depression, mood disorders, Alzheimer’s, etc.);
• A simple questionnaire helps us determine if there might be potential  mental health issues we should plan for while we can. 
6. Review of individual’s functional ability and level of safety;
• This will help us make sure that you are not in any danger of hurting yourself.
7. Establishment of a list of risk factors and conditions for which more intervention is recommended or is under way;
• Knowing and understanding the health risks you may be facing can save you the trouble of unnecessary visits to the hospital or even worse when it is too late.
8.  Personalized health advice and possible referral/follow-up for other covered preventive services such as weight-loss consultation, smoking cessation, diabetes management consultation; cholesterol management consultation, high blood pressure consultation, fall prevention and/or nutrition.
• Medicare realizes the importance of prevention and along with providing for a free Annual Wellness Visit, is also offering free services designed to help prevent, manage and reduce the most common health concerns for patients your age.
9. Establishment of a written screening schedule/checklist for the next 5-10 years as recommended by the United States Preventive Services Task Force;
• Knowing when to get proper screening is just as important as knowing what types of screening you may need.
10. (Not a part of the Annual Visit as of 1/3/2011 but it is a discussion we recommend you have with your primary care physician during your Annual Wellness Visit)Voluntary advanced care planning if desired (verbal or written information regarding the patients wishes in case an injury or illness  causes the patient to be unable to make health care decisions at that point)
• This is an important but often over-looked aspect of your health and well-being.  Knowing what you would like done, or not done, when it comes to important health decisions is good for your family, your provider and you.  Why wait until you can’t make that decision to have someone else make it for you?

Each year after your initial Annual Wellness Visit, your provider should follow up with you with another wellness visit where your list of medications, providers, risk factors are updated and your current health and well-being are re-evaluated.   If you can make your follow up wellness visit right after your Annual for the same day 12 months later, you won’t have to remember about making it later.  

What does this all mean for you/Why you should make an appointment for your Annual Wellness Visit?

A stitch in time saves nine.  This time honored adage has never been truer when it comes to your health and well-being.  Preventive medicine, that is medicine and services that help you from being sick or help you manage your current conditions so they don’t get worse, is the most important thing you can do to save your life, save your money, help your family,  and even help the overall health care system and the American economy.   For example, if during your Annual Wellness Visit, it is determined that you have or are at risk for Diabetes and then you take advantage of the free Diabetes Management services, you are more likely to control or not even get Diabetes.  Controlling or not even getting Diabetes can save you hundreds of dollars a month just in prescriptions.  We have had patients save over $500 a month by getting their Diabetes under control. If you don’t control your Diabetes and end up in the hospital because you need to be put on dialysis, your bill can be in the thousands.  That can be money in your pocket and money the hospital and government can save. 

Other benefits of getting your annual wellness visit and the yearly follow up are:

·         It’s an opportunity for you and your health care provider to discuss your health during a time when you are not in for a sick visit and therefore are not worried about  a how you’re feeling at the moment;

·         Planning out what visits you might need, based on your health condition and risk factors, in the beginning of the year can help you make sure you have the time to take care of the things you need to take care of;

·         It’s an opportunity have an open and honest discussion with family members (after your visit, you should meet with family members to discuss what you and your health care provider discussed during our annual visit such as your current health, risks, additional screenings that might be necessary, and what you would want done in case of an emergency);

·         IT’S FREE!

So make your appointment today!  You can call our office at 559-450-7299 to make an appointment or make an appointment request through the patient portal (go to www.avecinia.com, then click on “My Account” to access your patient portal).  When making an appointment, make sure you ask that it is for your Annual Wellness Visit (as long as you have not had your Welcome to Medicare Visit in the past 12 months or you are not new to Medicare within the past 12 months).  Your appointment will be for approximately 25-30 minutes (including time to fill out some questionnaires).  Although we have a list of your current medications, providers, family, personal and social history in our Electronic Health Record program, bring a list so we can confirm the information is accurate.  During your visit, you will be asked to complete a questionnaire that will become part of your Personalized Prevention Plane.  If you would like to fill this questionnaire out with the help of someone prior to the visit, just ask us and we can mail, email or fax it to you or you can download a copy from the Patient Portal under “Medical Forms” (the forms will be called Medicare Annual Wellness Visit Forms). 

 

We are excited that Medicare is offering this incredible, valuable opportunity for you without any cost to you! We highly recommend you make your Annual Wellness Visit appointment as soon as possible, or if your family member or loved one is with Medicare, have them make an appointment as soon as possible (or make it for them if you are their care taker).  See you soon!

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Health Care, Wellness and the Affordable Care Act of 2010

As the valley’s premier Integrative Medicine and Wellness center, avecinia wellness center is committed to your care and well-being.  As such, we are committed to helping empower you so you can make the best choices when it comes to your healthcare and well-being.  Your choice in health insurance should never effect your decisions about improving your health and well-being.  However, since the cost of health insurance is an important factor, it is vital for you to be well informed so you can make the best choice for you and/or your family. We hope the following information helps guide you towards better health and well-being.

In March of 2010, the President signed into law the hotly debated Affordable Care Act.  Whether you agree with the act or not, it is now the law and many of its provisions and benefits kicked in September 23^rd.  But they only apply to new plans, or plans that begin on or after September 23, 2010.   Here is a summary of these benefits, benefits to come and how they affect you (we categorize them by who they affect).  As always recommended, call your insurance provider, employee benefits manager, or a licensed Health Insurance Broker if you have questions about your plan.

For everyone:

•   Preventive Care
• Plans starting on or after September 23, 2010 will cover all your costs for a Preventive Care visit.  That means you do not have to pay a copayment, co-insurance or any deductible for preventive health services such as recommend screenings, vaccinations and counseling.  Keep in mind that coverage is only for in-network providers, and is only applicable if the preventive service is the primary purpose of the visit.  If the preventive service is in addition to other services, your plan may require to pay for the visit. If you have questions, please call your health insurance provider to verify which services are considered preventive and are free to you (i.e., you have no copay, co-insurance or deductible).  When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  If you need to discuss any service or health issue outside what your health insurance plan covers as a preventive service, your provider has to submit that information to the health insurance plan and you may be billed for the visit because it is no longer considered a preventive visit.   
• An End to Pre-Existing Conditions for Children
•  Health Insurers cannot deny children (under 19 years old) health insurance because of preexisting conditions. A ban on adult discrimination will take effect in 2014.  That means if your plan went into effect after September 23, 2010 and in November your child is hospitalized because of a severe asthma attack.  Your new plan cannot deny payment for the hospitalization due to your child’s “pre-existing condition.”  Keep in mind that insurance companies are now reducing the number of children only plans. When looking for an insurance plan, make sure it covers your kids!
•  Coverage for young adults under the age of 26
• Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance plan until they turn 26.  This applies to your kids even if they are married or can get insurance from their employers group plan.  Your child does not have to be living with you or be financially dependent on you.   Keep in mind that you must enroll your children within the open enrollment period. 
• Doctor Choice & ER Access
• The Act helps preserves your choice of primary care physician within your health insurance plans network.  It also prohibits health insurance plans from requiring a referral before you can see a OB-GYN in your network.  Importantly, the Act prevents health insurance plans from requiring higher copayments or co-insurance for out-of-network emergency room services and it prohibits plans from requiring prior approval before seeking emergency room services from a provider or hospital outside of your plan’s network. Keep in mind that you will still be responsible for the difference between the amount billed by the out of network provider and the amount paid by your health insurance plan.
•   Insurance Cancellation
• Health Insurers cannot retroactively rescind (declare your policy invalid from the date you started your policy) your insurance policy for an honest mistake or missing information that has no bearing on your health.  That means if your plan went into effect after September 23, 2010 and you are later diagnosed with cancer, your health insurance provider cannot rescind your plan because you left out your hospitalization for a broken arm 6 years ago. Keep in mind that intentionally falsifying or misleading the insurance company still gives them cause to rescind your policy.  Your health insurance provider has to give you 30 days notice before it can rescind your policy so you can appeal the decision or find new coverage.
• Appealing Health Plan Decisions
• You now have the right to appeal your health insurance providers denial of payment, service or treatment.  If your plan upholds its denial, you have the right to ask for an independent review.  Keep in mind that your state may have additional rules/regulations that effect your appeal.  For more information in California, click here.
• Lifetime and Annual Limits
•  Lifetime limits on most benefits are prohibited on plans issued or renewed after September 23, 2010.  Annual Limit are being phased out as well.  No plan that begins after September 23, 2010 can set an annual limit lower than $750,000.  By January 1, 2014, no annual limits will be allowed on most covered benefits. Keep in mind that the ban on limits only applies to essential services.  Some plans may be eligible for a waiver if complying with the ban on the limit would mean a significant decrease in benefits or increase in premiums.

For Medicare:

• Preventive Care
• Medicare must now pay for 100 percent of the cost of annual physicals and other preventive care visits (see above for more information).
•  Seniors Receive “Donut Hole” Rebate
•  Seniors with Medicare prescription drug coverage that have reached their coverage gap in 2010 will get a 1 time tax free $250 rebate. Beginning in 2011, Medicare recipients will receive 50% off of covered brand-name drugs while in the “donut hole.”
•  Stronger Medicare Anti-Fraud provisions
• Visit www.stopmedicarefraud.gov to see how you can help curtail Medicare fraud.

For Businesses:

•  Small business tax credit for providing health insurance
• Small business with less than 25 employees may be eligible for a tax credit of up to 35% to offset the cost of providing health insurance to their employees.  If you are a small business owner, check with your accountant to see if you qualify or how you can qualify.
• Wellness Program Grants for Small Business
•  Small business with less than 100 employees may be eligible for grants to cover Wellness Programs that started after March 23, 2010.  Grants will be available in 2011.
• Early Retirement Reinsurance Program
• The Act provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.

To learn more about the provisions of the Affordable Care Act, visit www.healthcare.gov.  To learn more about Medicare, visit www.n4a.org.  
This video is a helpful summary

Choosing an Health Insurance Plan

If you are purchasing a health insurance plan on your own or your employer gives you the option to select from a variety of health insurance plans, visit the California Department of Insurance PPO Ratings to learn which plans had the best rankings. According to the Department of Insurance, Aetna PPO, CIGNA PPO and Health Net of California PPO rated the highest as rated by their members across a variety of standards.  As a practice, we have noticed that Aetna, CIGNA, and United Healthcare provide coverage for a wide range of services, have less administrative burdens, and are more consumer friendly and oriented than other health insurance companies.  You can also contact a licensed Insurance Broker who will help guide you through the insurance maze and help you find the plan that best fits your needs.  A broker will do this for you for free because they get a commission from the insurance company.  Overall, insurance companies pay the same amount of commission so a licensed broker should not be swayed towards one policy or another but should help you find the solution that is best for you.  If you are looking for a broker or have questions in general, contact Shane Moore at Valley Employee Benefits & Insurance Solutions.  He can be reached at (559) 325-2500 or by email at shane@valleyemployeebenefits.com.  If you have other questions, please call or email avecinia wellness center’s insurance specialist, Colette Vaquilar at (559) 450-7298 or billing@avecinia.com. Visit www.avecinia.com and "like" us at www.facebook.com/avecinia




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!