Ageless SPRING 2019

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Know Your

Primary Doctor

Understand Your

Drug Plan



pg. 2 pg. 4 pg. 6




Your primary doctor should

be in your speed dial!

Many of us have a “go-to” person

for certain needs. Take your car, for

instance. Chances are, you don’t take

your car to a different garage every

time it needs attention. Your “go-to”

mechanic knows you and your car, its

history and unique needs.

Similarly, it’s even more important to

have a primary care physician (PCP) as

your “go-to” expert for healthcare. Your

PCP (also called a primary doctor) helps

steer your overall healthcare.

Your primary doctor can discuss any

issues you may be experiencing,

(whether they are physical, emotional

or mental) in just one visit. This

doctor also can provide critical

preventive care, such as screenings

and immunizations, and identify and

treat common medical conditions. You

should see your PCP for an annual

wellness visit or nonemergency

medical care. Your PCP also can make

referrals to specialists, if needed. And,

if you are trying to become healthier,

your PCP can guide you toward better

lifestyle habits.

Your health history also should be an

important part of your conversation

with your primary doctor. This

knowledge can build trust between

the two of you and provide a better

understanding of your health

conditions. If serious conditions such

as diabetes, heart disease or stroke run

in your family, your PCP can look for

early warning signs.

For example, your primary doctor

may notice prediabetes. That’s when

blood-sugar levels are high – but not

high enough to be considered diabetic.

Your PCP can give you advice about

lifestyle changes to keep you from

developing type 2 diabetes.

The more your primary doctor knows

about you, the better healthcare you

will receive. That’s especially true if

you schedule regular appointments.

Research shows that people who have

a PCP, and make regular visits, have

fewer hospitalizations and emergency

visits than those who do not visit a PCP.

With regular visits to your primary

doctor, you can do your best to stay

focused on your healthcare journey.

A primary care

physician is

important to

your health.

Stay healthy and happy this spring.

In good health,


2 Ageless SPRING 2019

You have

FREE benefits!

Are you using them?

Did you know your health plan has free benefits you should use when you are well?

Let’s take a look!

Initial Preventive




If you are a new (first-year)

Medicare Part B enrollee, you

should get an Initial Preventive

Physical Examination (IPPE)

within the first 12 months

that you become eligible for

Medicare Part B. It’s commonly

called the “Welcome to

Medicare” visit and is part

of original Medicare. This

benefit is completely free but

is available only for the first

year of your enrollment. You

must use it or you lose it. You

should take advantage of this

visit, especially if you have been

avoiding going to the doctor

due to cost concerns.


Wellness Visit

After your first year of Medicare

Part B enrollment, you may

schedule one annual wellness

visit each year. Your primary

care physician (PCP) will collect

samples for lab analysis, review

your personal and family medical

history and discuss strategies

for improving your health. This

visit is more than just a visit to

your primary doctor to talk about

health concerns. Your PCP will

assess your mental health and

behaviors by asking a series of

questions to make sure all your

needs are met so that you can

live a full life.

Advance Care


You now can schedule a free

visit to your PCP for advance

care planning. This visit allows

you and your PCP to make

decisions about the care you

want to receive if you become

unable to speak for yourself.

By planning ahead, you can

have control over your

healthcare future, including:

• Deciding what types of

treatments you do or don’t

want if you are diagnosed

with a life-limiting illness

• Getting information on lifesustaining


• Completing an advance

directive, which puts your

wishes for your healthcare

into writing

If you have any questions about any of these benefits, please call one of our nurse case

managers at 1-800-285-6658. Or call your doctor today to set up an appointment.

Ageless SPRING 2019 3



drug plan?


Information is the best medicine

Why are some of

my prescriptions

not covered by


There are several reasons a medication may not be covered by Medicare. A brandname

medication may not be covered if a more affordable generic is available. Some

over-the-counter items (like aspirin and nutritional supplements) are not covered

because of rules set by the Centers for Medicare and Medicaid Services (CMS).

A list of covered prescription drugs is called a “formulary.” These lists change

periodically, and you will be notified when this happens. Most plans prefer drugs

that have lower prices to limit your out-of-pocket costs. Always ask your doctor

to prescribe drugs that are on your plan’s formulary. Generic drugs usually are

the least expensive.

Join My Blueprint at myblueprint.arkansasbluecross.com to access your

plan’s formulary and to see current information about which drugs are covered.

My Blueprint also allows you to learn about your plan, programs and even

includes forms you may need to fill out for your next doctor’s visit.

Why do some


costs change from

year to year?

Why do i need

approval from

insurance for my


4 Ageless SPRING 2019

Medications are like

commodities (oil, gold or

coffee), so their prices can

fluctuate because of changes

in supply, demand, regulations,

etc. Think of drug cost

changes this way: medication

prices rise and fall similarly

to the price of a gallon of

gasoline or a loaf of bread.

Pre-approval by your health

plan is not required for most

prescriptions. Sometimes,

though, a prescription will

require such approval. Some

high-risk and/or expensive

medications require prior

approval to make sure they

are being used safely and

appropriately. Medicare

sometimes requires insurance

plans to verify, in advance, that

certain prescribed therapies

are medically necessary. This

is called prior authorization.


What is


ou may see “TrOOP” in Medicare

literature. This means: true or

total out-of-pocket costs. It is

the maximum amount you need

to spend each year under your

prescription drug plan before you

reach the catastrophic coverage

level and exit the “donut hole.”

The TrOOP amount for 2019 is

$5,100. Once your TrOOP hits

$5,100 for 2019, for the rest of

the year, you’ll pay either a

$3.40 copay or 5% coinsurance

(whichever is greater) for generic

drugs and an $8.50 copay or

5% coinsurance (whichever is

greater) for brand-name drugs.

The Medicare

part d drug benefit

has four stages

Deductible stage

The deductible stage begins when you fill your first

prescription for the calendar year. You pay the full

negotiated price for covered prescription drugs until you

meet your deductible. Deductibles vary, and some plans

may not have one. Once the deductible is met, your

coverage starts.

Initial coverage stage

This stage begins after you meet your deductible. If your

plan does not have a deductible, this is the first stage

of your benefit. During this stage, cost-sharing begins.

That means you pay a copayment or coinsurance for

prescription drugs until you reach your plan’s initial

coverage limit: $3,820 in 2019.

Coverage gap stage

( the so-called donut hole )

This stage starts after the end of your initial coverage

period and continues until you reach the catastrophic

level. If your medications suddenly cost you more, you

may have fallen into the “donut hole.” (Read more about

the “donut hole” in the sidebar to the right.)

Catastrophic coverage stage

You reach catastrophic coverage stage in 2019 after you

have paid a total of $5,100 in out-of-pocket drug costs

for the calendar year. (For more information, read the

TrOOP sidebar on the previous page.)

Donut hole”


You’ve probably heard the term

“donut hole” when dealing with

your Medicare drug coverage. The

reason it has this name is because

Medicare provides coverage

until you reach a limit. In 2019, it’s

$3,820. Then, you may have to pay

more for your medication until you

have paid enough to be eligible

for catastrophic coverage. That

coverage gap in the middle is the

so-called “donut hole.”

Every Medicare plan with drug

coverage has this gap. But why?

Medicare designed this gap to

encourage its members to seek

generics or drug alternatives that

cost less.

How do you get out of the “donut

hole?” It ends when you reach the

out-of-pocket limit for the year –

which is $5,100 for 2019.

The good news? This year, when you

fall into the hole, you’ll pay less for

most prescriptions than you did last

year because of drug discounts.

Ageless SPRING 2019


Break your fall fears

Lower your

risks and raise

your awareness

Falls are the leading cause of injuries for older adults. When they happen, falls

can affect your quality of life. But falls don’t have to be a part of getting older.

The more you can reduce your risk of falls, the more you can increase your

independence and lower your potential for injuries.

Prevent falls with your actions

• Exercise regularly to improve your strength, balance and coordination

• Get up slowly after sitting or lying down

• Wear comfortable shoes that fit properly

• Keep one hand free when carrying things, so you can grab onto

something if you need support

Prevent falls with your environment

• Improve the lighting in your home by using brighter bulbs

• Install grab bars near toilets, bathtubs and showers to help you get up or down more safely

• Place electrical, telephone and computer cords along a wall where you can’t trip over them and

remove all cords from under furniture or carpeting

• Check outdoor walkways for loose bricks and debris, including wet leaves or mold that could cause you to slip

• Install nightlights along the path from your bedroom to the bathroom

• Remove all rugs that may cause you to trip or fall

Talk to your doctor about these fall-prevention strategies

• Exercise or physical therapy

• Vision or hearing testing

• Taking vitamin D

• A cane or walker

If you’ve fallen in the past year, make sure to

tell your doctor about the fall and ask him/her

about any concerns, so you can come up with

a plan to prevent future falls.




Vitamin D adds a

healthy glow

When sunlight lands on your

skin, it makes vitamin D from

cholesterol. That’s why vitamin D

is called the “sunshine vitamin.”

A National Health and Nutrition

Examination Survey found that only

about one-third of Americans were

getting enough vitamin D in their diet.

6 Ageless SPRING 2019

Studies show that a vitamin D

deficiency is a major risk factor for

osteoporosis, falls and fractures. A

deficiency also may increase your

risk for diabetes, cancer, heart

disease, arthritis and poor general

health. Vitamin D helps you fight

off many diseases and is important

for proper nerve function, too.

Surprisingly, there are very few

foods that contain vitamin D

naturally. The best ones are:

• Cod liver oil • Salmon

• Mackerel • Tuna

• Beef liver • Cheese

• Egg yolks

What about milk? In the 1930s,

voluntary fortification of milk

with vitamin D began in America

to eradicate rickets, a vitamin D

deficiency disease that leads to

stunted growth, bowed legs and

delays in motor development in

children. Milk was chosen as the

fortification vehicle because it

was widely available, palatable

to young children and rich in

calcium, phosphorus and vitamins.

Vitamin D now also is added to

other foods such as breakfast

cereals and juice drinks.

A study from the Archives of

Internal Medicine suggests that

older adults can reduce their risk

of bone fractures by taking an oral

supplement of vitamin D every

day. Ask your doctor if you need

a Vitamin D supplement.

Pain Management and Anxiety

Treating the Whole Person

by Jonathan Howland, LCSW

If your doctor told you that you needed

knee surgery but then told you not

to have physical therapy afterward,

you would think he or she was crazy,

right? Or if you were having trouble

speaking after a stroke and your

physician gave you medication but

refused to refer you to a speech

therapist, you would find a new

doctor, right?

A good doctor understands the

importance of medical intervention,

whether it’s surgery, medicine or

some other treatment. They also know

that follow-up therapy is essential to

achieve the best possible outcome for

the patient. And while this principle is

true of physical conditions (like a joint

replacement, stroke or a heart attack)

it is also true for mental health.

And in light of this emphasis on the

mind-body connection, more and

more doctors are understanding the

connection between chronic pain

treatment and the impact of long-term

use of opioids to treat pain.

Pain can come from many sources.

Surgery or a car accident, of course,

can cause pain but so can unresolved

emotional or physical trauma or

even excessive stress. The American

Psychological Association estimates

that nearly one-third of Americans live

with chronic pain.

More doctors now are recommending

psychological treatment to help with

pain management. Some research

has shown that mental health therapy

can help patients learn to cope with

pain, increase self-management of

pain, reduce pain-related disability and

reduce emotional distresss. The bottom

line: managing chronic pain is about

more than fixing a “broken body part” –

it is about “treating the whole person.”

This trend comes at a critical time

because of the devastating impact

of the opioid epidemic in the United

States, which claimed at least

42,000 lives in 2016 alone. Opioid

prescription rates are increasing more

quickly among older patients than any

other group, and older patients now

are more likely than any other group

to be hospitalized for misuse

of prescription opioid medications.

So what might be driving the

escalation of prescribed pain

medication among older adults?

Some possibilities:

• Illnesses and conditions that

come with aging

• Divorce

• “Empty nest” syndrome

(experienced by parents whose

children have grown and gone)

• Death of a parent, spouse or child

As people age, bodies change and

metabolize medications differently,

which can increase the intensity and

duration of a medication’s impact on

their bodies.

Recent research connects chronic

pain with depression and anxiety.

Because a connection may exist,

more doctors are attempting to treat

patients’ mental health and chronic

pain. Many people may take antianxiety

medications (benzodiazepines)

such as Valium, Xanax and Klonopin.

These drugs can cause complications,

including drug overdose deaths, when

combined with opioid medications.

Some states have changed laws or

issued guidelines to doctors to use

extreme caution when prescribing

anti-anxiety medications and opioids.

In some cases, patients may have to

choose between one or the other –

pain management or anxiety

management. But options exist, and

patients should feel empowered to

ask their doctors, “If I’m not able to

stay on the medications I have been

on, what other options are there?”

Finding the right solution could require

some time and effort by the physician

and the patient.

As awareness grows about mental

health treatment for chronic pain,

many physicians may require that

patients who remain on either opioid

medications or benzodiazepines speak

with a mental health professional,

such as a social worker, psychiatrist

or professional counselor.

If you have questions about your

doctor’s recommendations, but are

not certain whom you should ask,

Arkansas Blue Cross and Blue Shield

has nurses and medical social workers

who can help make sure you are

getting the right care, at the right

place, at the right time.

To speak with a nurse or a social

worker, call us at 479-527-2354.

If you are experiencing physical

distress or symptoms of a drug

overdose, contact 911 immediately.

Ageless SPRING 2019


Arkansas Blue Cross and Blue Shield

P.O. Box 2181

Little Rock, AR 72203-2181

Please note: This newsletter is for health education purposes only. We do not offer medical advice or

services. Always consult your treating physician(s) for any medical advice or services you may need.


A publication for Arkansas Blue Cross and Blue Shield

Medicare Advantage members.


Chicken Spaghetti

A favorite at family reunions and potlucks, a lighter version of chicken

spaghetti still can fill your tummy without overloading you with calories.


• 2 cups chopped chicken breast

• 2 cups uncooked spaghetti broken into two-inch pieces (Substitute

either whole-wheat pasta* or spaghetti squash for a healthier dish)

• 1 cup chopped red bell pepper

• 1 cup sliced celery • 1 cup chopped red bell pepper

• 1 cup chopped onions • 1 cup fat-free, low-sodium chicken broth

• ½ teaspoon salt • ¼ teaspoon freshly ground black pepper

• 2 cans (10.75-ounces) condensed cream of mushroom soup (30%

reduced-sodium, 98% fat-free)

• Cooking spray

• 1 cup (4 ounces) shredded cheddar cheese

Nutritional information:

Calories: 261

Protein: 15.2 grams (g)

Total fat: 7.8 g • Sat Fat: 3.9 g

*Substituting whole-wheat spaghetti adds more fiber

Courtesy of Arkansas Blue Cross

and Blue Shield’s Green Leaf Grill

Carbohydrate: 28 g

Dietary Fiber: 2.1 g

Sodium: 652 milligrams


1. Heat oven to 350 degrees.

Makes four one-cup servings per pan

2. Place chicken, spaghetti, celery, red bell

pepper and onions in a bowl.

3. Combine broth, salt, pepper and soup

in another bowl and whisk.

4. Combine all ingredients and mix.

5. Divide mixture evenly between 2 baking

dishes (8-inch or 2-quart) coated with

cooking spray. Sprinkle cheese over top

and cover with foil. Bake for 35 minutes.

6. Uncover and bake an additional 10 minutes.

Did you make this recipe?

Post a picture of your dish to



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