FEEL GOOD STAY ACTIVE WE’LL HELP
pg. 2 pg. 4 pg. 6
CRESHELLE R. NASH,
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
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
Stay healthy and happy this spring.
In good health,
2 Ageless SPRING 2019
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!
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.
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.
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
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
Information is the best medicine
Why are some of
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
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
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
sometimes requires insurance
plans to verify, in advance, that
certain prescribed therapies
are medically necessary. This
is called prior authorization.
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.
part d drug benefit
has four stages
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
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.)
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
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
risks and raise
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
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
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?
• Illnesses and conditions that
come with aging
• “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
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
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.
MPI 8272 5/19 HEALTH AND WELLNESS OR PREVENTION INFORMATION
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
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