The
Advantage
F A L L
2016
A NEWSLETTER FOR MEMBERS OF
M a r t i n ’ s P o i n t G e n e r at i o n s A d va n ta g e
Enjoy the gifts of the season
with peace of mind!
Dear Neighbors,
What’s Inside?
••Breathe Easy as the
Seasons Change!
The changes all around us make autumn a special time
for all of us in New England. Every year I look forward to
the day when that first tree on my road changes color—I
know exactly which one will pop first. That’s when it’s
time to get the sweaters out and put the apple pie in
the oven.
Despite all the changes that come with fall, there is one important
constant that holds true, no matter the season—our commitment
to deliver the highest quality health plans to the communities we
serve. And, once again this fall, we’re very happy to announce
that Martin’s Point Generations Advantage plans have earned
Medicare’s highest overall plan rating in Maine for the seventh
year in a row and for all five years that we’ve offered our plans in
New Hampshire!
••How to Fight the Flu
••Four Fast Facts:
Diabetic Retinopathy
••Go Green— Receive
Plan Materials by Email!
••Autumn Puzzler
••Ask the Experts
••Staying on Your Feet:
A Fall-Risk Checklist
We also recently received our CAHPS * survey results. This
member satisfaction survey is mailed to some members each
spring. It’s a chance for our members to rate us on a number of
topics regarding their experience and satisfaction with our plan.
I’m very pleased to announce that all of our plans achieved the
highest rating for:
••Customer Service • Getting Needed Care • Rating of Health Plan
As a Mainer myself, I’m very proud to bring such high quality,
customer-focused plans to our families, neighbors, and friends.
No matter what the season, know that your health continues to be
in good hands with Generations Advantage!
Best in health,
Rebekah Dube, PharmD
Vice President, Senior Products
Martin’s Point Health Care
*CAHPS is a registered
trademark of the
Agency for Healthcare
Research and Quality.
Martin’s Point
Generations Advantage
2017 plans have received
the highest quality
ratings in Maine and
New Hampshire!
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
Breathe Easy
All Through
the Seasons!
For people who have asthma or COPD, winter months can be a challenge.
Both cold outdoor air and warm, dry, indoor air can trigger symptoms.
As the season changes, here are a few tips to
help you breathe more easily as the weather
turns colder:
••Always carry your emergency
medicine with you, even if just going
for a quick walk to the mailbox.
••Wear a scarf. Cover both your mouth and
nose to help warm the air you breathe.
••Avoid going out on very cold days.
Ask friends or neighbors for help
shoveling or walking your dog.
••Clean filters on your furnace every fall.
••Dust and vacuum often to reduce allergens.
••Ask your doctor if using a humidifier
is right for you.
Avoid colds, flu, and pneumonia. Do what you
can to prevent serious illness:
••Get your flu and pneumonia shots.
••Wash your hands to avoid getting a cold.
••Stay away from people who are ill.
Generations Advantage Contact Information
Member Services (for current members) We are available 8 am–8 pm, seven days a week
from October 1 to February 14; and Monday
through Friday the rest of the year.
1-866-544-7504 (TTY: 711)
Interested in becoming a member? Please call.
1-888-640-4423 (TTY: 711)
Generations Advantage Website
www.MartinsPoint.org/Medicare
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. For 2017, all Generations Advantage plans earned 4.5
out of 5 Stars for Overall Plan Rating from CMS. Visit www.Medicare.gov for more information.
Martin’s Point Generations Advantage is a health plan with a Medicare contract offering HMO,
HMO-POS, HMO SNP, and PPO products. Enrollment in a Martin’s Point Generations Advantage
plan depends on contract renewal. Material presented in this newsletter is not intended to replace
your health care provider’s medical advice. If any information in The Advantage newsletter conflicts
with provisions of your health plan’s Evidence of Coverage (your contract), the provisions of your
contract prevail. Martin’s Point Health Care complies with applicable Federal civil rights laws and
does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION:
Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le
1-866-544-7504 (ATS :711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de
asistencia lingüística. Llame al 1-866-544-7504 (TTY: 711).
2
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
Stay Healthy Through Flu Season
How to Fight the Flu
Why Fight the Flu?
As flu season nears, it’s comforting to know
that your Generations Advantage plan has you
covered. Generations Advantage members have
two ways to get a yearly flu shot at no cost:
The flu is caused by viruses
that can spread from person
to person. It can make some
people very sick, causing
hospitalization and even
death. Most people who end
up in the hospital due to flu
are 65 years old or older.
1. Vaccine Pharmacy Network
You should not be charged if you get your flu shot at
any of these participating pharmacies. Remember to
show your Generations Advantage member ID card:
••Hannaford Pharmacies
••CVS (including former
Target pharmacies)
••Rite Aid
••Shaw’s/Osco
••Walgreens
••Walmart
Other pharmacies also participate in the network,
including several independent pharmacies. If you
do not see your pharmacy listed above, please call
Member Services. If your pharmacist has any trouble
submitting your claim, he or she should call our Medicare
Part D Pharmacy Help Desk at 1-800-364-6331.
2. Primary Care Provider Office Visit
If you get your yearly flu vaccine at your primary care
provider’s (PCP’s) office, you may be charged a normal
copayment or coinsurance for the office visit, but
you will not be charged for the vaccine itself.
It is especially important
for older people to get a
flu shot each year because
they are at a higher risk for
serious complications from
flu, including pneumonia. Flu
can also worsen conditions
like congestive heart failure,
asthma, or diabetes.
The best way to prevent
the flu is by getting a flu
shot each year. It can take
two weeks to develop
immune protection after
your flu shot, so getting
it in early fall is best.
Be sure to get your flu
shot this season and
protect yourself and your
loved ones from flu!
IMPORTANT NOTE FOR Value Plan Members!
Your flu shot benefit works differently. If you go to your PCP’s office there is no cost for
the vaccine, but you may be charged a regular copayment for the office visit. If you go to
ANY pharmacy, you’ll have to pay for the vaccine up front and submit a reimbursement
form to us. Forms are available on our website or by calling Member Services.
24-Hour Nurse Line
Call anytime! A registered nurse will help answer
your health questions. Call 1-800-530-1021.
3
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
Four Fast Facts:
Diabetic Retinopathy
1
What is diabetic
retinopathy?
If you have diabetes, the high blood sugar
can damage the tiny blood vessels in your
retina—the light-sensitive tissue at the back of
your eye. This is called diabetic retinopathy.
Diabetic retinopathy can lead to blurry vision,
and even blindness. In fact, it is the leading
cause of blindness in American adults.
2
Who is at risk for
diabetic retinopathy?
People with diabetes are at risk. The longer
you have had diabetes, the higher your risk.
Almost half of Americans with diabetes
have some level of diabetic retinopathy.
3
What are the symptoms
of diabetic retinopathy?
There are usually no symptoms in the
early stages of diabetic retinopathy. The
disease can get worse without you knowing
it, until it starts to affect your vision.
If you have diabetes, get a
dilated-eye exam
each year.
4
If I have no symptoms,
how do I know if I have
diabetic retinopathy?
Because symptoms may not be felt until
the disease is advanced, it’s important
that people with diabetes get a dilatedeye exam each year. As part of this exam,
your doctor will put drops in your eyes
that will dilate (widen) the pupil. This
helps your doctor examine your retina.
If you do have retinopathy, there are
ways to help slow down the progress of
this disease and prevent future vision
loss. Talk to your doctor today!
Adapted from “Diabetic Retinopathy: What You
Should Know” from the National Eye Institute.
Go Green—Receive Plan Materials by Email!
Generations Advantage will soon offer
electronic versions of many plan-related
materials! You can choose to receive certain
materials securely through your email instead
of receiving a paper copy in your mailbox.
Please note: We will not send confidential
personal health information via email; you will
continue to receive those materials in the mail.
Your privacy is important to us! We will
protect your email address and delivery
information under the same guidelines as
outlined in the Notice of Privacy Practices.
To receive an updated Notice, please contact
our Privacy hotline at 1-800-297-8616.
To receive materials via your email, please go to www.MartinsPoint.org/Paperless
4
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
1
Autumn
Is in the
Air!
2
3
4
Puzzles are a great
way to keep your
brain in shape!
5
6
7
8
9
10
11
12
13
14
15
Down
Across
3. Trees that lose their leaves.
16
6. The earliest in the season that
this ski mountain opened was on
October 3, 1996, 20 years ago.
10. The ______ ______ Fair took place
in Unity on September 23, 24, 25.
11. October 25 marks the 30th anniversary
of Game six of the 1986 World Series.
This game is memorable to Red Sox fans
as it marked a game-ending error by
Red Sox first baseman, Bill _______.
12. A group of geese.
1. Last year Maine orchards produced
35.6 million pounds of ______.
2. The regular seasonal movement
of birds to wintering grounds.
4. The first Thanksgiving dinner took
place in 1621 between members of the
Wampanoag tribe and the Plymouth
Colony in what is now _____________.
5. To spend the winter in a
dormant condition.
7. The nickname for a New Englander
who goes South for the winter.
13. September 22 marked the first
day of autumn this year, which is
also known as the _______.
8. Maine’s largest agricultural
fair is the ________ Fair.
15. The full moon closest to the equinox.
14. Since 1941, Thanksgiving has
been celebrated on the ______
Thursday in November.
16. A ______ of apples weighs 42 pounds.
9. Trees that do not lose their leaves.
For answers, please see page 6.
5
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
Ask the Experts
Q: How is the shingles shot
(Zostavax®) covered?
A: On the Generations Advantage plans
that include Medicare prescription
drug coverage (Part D), Zostavax is
covered at a Tier 3 copayment. (It is
not covered under the Value plan.)
If you get the shot at a pharmacy, you
will need to bring a prescription from
your doctor. The shot will cost $40 at
pharmacies with preferred cost sharing
(including Hannaford Pharmacies) or $47
at pharmacies with standard cost sharing.
What you pay will differ if you’re in the Part
D Coverage Gap (donut hole). Getting the
shot at a doctor’s office might cost more.
Q: How do I find a doctor or
specialist who is in the network?
A: You can search the Provider Directory
on our website www.MartinsPoint.org/
Medicare by selecting “Providers &
Hospitals” on the home page. You can
also call Member Services for help.
Q: What is the Late Enrollment
Penalty? Why do I have to pay this?
A: This is a penalty amount Medicare adds to a
member’s monthly Medicare Part D premium.
Medicare charges this penalty if a member
does not have “prescription drug coverage”
for more than 63 days in a row. “Prescription
drug coverage” means coverage under a
Medicare drug plan or another plan whose
James
Steven
prescription drug coverage is at least as
good as Medicare drug coverage (“creditable
coverage”). The penalty amount depends on
how long the member went without coverage.
The member will have to pay the late
enrollment penalty each month as long as
he or she has Medicare prescription drug
coverage (Part D). The amount can change
each year.
For more information see your Evidence of
Coverage booklet or call Member Services.
This information is not a complete description
of benefits. Contact the plan for more
information. Benefits, formulary, pharmacy
network, and copayments/coinsurance may
change on January 1 each year. Limitations,
copayments, and restrictions may apply.
CROSSWORD ANSWERS
ACROSS:
DOWN:
1. apples
2. migration
4. Massachusetts
5. hibernate
6
7. snowbird
8. Fryeburg
9. evergreen
14. fourth
3. deciduous
6. Sunday River
10. Common Ground
11. Buckner
12. gaggle
13. equinox
15. harvest moon
16. bushel
THE ADVANTAGE | MEMBER NEWSLETTER FALL 2016
Staying on Your Feet: A Fall-Risk Checklist
As we grow older, changes in health and medication can lead to falls. The good news is that
there are steps you can take to prevent falls, and those steps can begin with taking a look at your
personal risk for falling.
Use this checklist to help identify your fall risks and to learn more about what you can do to stay
active, be independent, and prevent falls.
Check “YES” if you experience
this (even if only sometimes)
If you checked “YES”:
••Show your doctor this checklist and
Have you fallen at all in
the last six months?
NO
Do you take four or
more prescription
or over-the-counter
medications every day?
NO
Do you have any difficulty
walking or standing?
NO
Do you use a cane, walker, or
crutches to help you walk?
NO
YES
••Ask for training so you can use equipment safely.
Do you have to use your arms
to get up from a chair?
NO
YES
••Ask for ways to strengthen your legs.
YES
talk about your risks and how to
protect yourself from future falls.
YES
••Keep an updated medication list and review it
with your doctor or pharmacist at each visit.
••Ask if side effects could increase your fall risk.
YES
••Tell your doctor about any pain, soreness,
weakness, or numbness in your legs and
feet. Do not ignore these symptoms.
••Tell your doctor about any difficulty walking.
••Ask about treatment options
like physical therapy.
Physical therapy might help.
••Exercise at least three times a
week for 30 minutes.
Do you ever feel unsteady on
your feet, weak, or dizzy?
NO
YES
••Tell your doctor and ask for treatment options.
••Review all your drugs with your
doctor or pharmacist.
Has it been more than
two years since your
last eye exam?
NO
YES
••Schedule an eye exam.
Has your hearing gotten
worse or do people say you
have a hearing problem?
NO
YES
••Schedule a hearing test.
••If you get hearing aids, ask for
training on their proper use.
The more “YES” answers you have, the greater your chance of falling. If you haven’t seen your
doctor recently, schedule an appointment and take this list with you and discuss it with your doctor.
This checklist was adapted from the Washington State Department
of Health, Injury & Violence Prevention Program.
7
The
Advantage
F A L L
2016
A NEWSLETTER FOR MEMBERS OF
Health and Wellness or Prevention Information
M a r t i n ’ s P o i n t G e n e r at i o n s A d va n ta g e
DID YOU
KNOW?
$0 Annual Breast
Cancer Screenings
All Generations Advantage
plans cover an in-network
screening mammogram
each year at no cost.
And, no PCP referrals are
needed for this screening.
Talk to your PCP about
how frequently you should
have this screening and
take advantage of a benefit
that could save your life.
A Grand Day for Baseball!
Thank you to the Generations Advantage grandparents
and families (over 1,100 of you!) who came out to
celebrate our third annual Grandparents Day with
the Sea Dogs! Your attendance helped clinch our
donation of $10,000 to the Southern Maine Area
Agency on Aging’s Meals on Wheels program.
Find more game day photos at http://goo.gl/w37qSK
Y0044_2016_506 Accepted: 10/25/16