The holidays are quickly coming. We hope that you have all looked at your Medicare options for 2015. If your plan won’t be available, we urge you take action and make the changes that are best for you. If you have not yet made your decision and need help comparing the many plans available, please contact the Hawaii SHIP (State Health Insurance Assistance Program) as soon as possible for assistance.
After any change, study your plan material and answer some questions:
Are my medications covered and at what tier?
If my name brand or generic drug is tier 2/4 (preferred) and medically necessary; and if I cannot tolerate the comparable drug at a lower level — I can ask for an exception.
Are my providers in the network?
If my current provider is not in my new HMO network, I will need to look for a new provider using my recently received provider directory.
Have I provided my new plan card to my doctor’s office?
Please do this on your first visit so that your providers will request payment from the correct insurance company.
Every January, even if you are happy and healthy, it’s good to schedule an “annual wellness visit” with your primary care doctor. Sit down and discuss your health goals for the year and schedule any needed preventive benefits. Your doctor will ask you to fill out a questionnaire called a “health risk assessment;” this will help them to develop a Personalized Prevention Plan just for you. If your doctor is in the network or accepts assignment, then you pay nothing for the wellness visit. If the healthcare provider performs additional tests or services during the same visit (tests that are not covered under this preventive benefit), you may have to pay a coinsurance or deductible. Besides the Personalized Prevention Plan, your annual wellness visit also includes: a review of your medical and family history; making a list of current providers and prescriptions; routine measurements, including height, weight, blood pressure; testing for any cognitive impairment; personalized health advice; a list of health risk factors and treatment options for you; and a screening schedule for appropriate preventive services. Eleven months must have passed since your last visit for your annual wellness visit to be a covered service. To make sure it is covered, make it part of your regular annual January routine.
Have a safe and healthy holiday season — if you have extra time, consider volunteering with Hawaii SHIP. There is no better way to help your community. Give us a call or visit us online for more information.