The Advantage | ISSUE 3 | 2023

Flu season usually begins to ramp up in October, peaks between December and February, and can run into May. Getting your flu shot as early as September and October is best, but if you haven’t gotten it yet, it’s certainly not too late! Getting a flu shot is the best step in protecting yourself against the flu and can help reduce the occurrence of severe flu-related risks, including hospitalizations or death. The Center for Disease Control (CDC) recommends flu shots to everyone 6 months and older.

Generations Advantage members have two ways to obtain a flu shot at no cost:

Through a participating pharmacy network: Free at Hannaford, Rite Aid, CVS, Shaw’s/Osco, Walgreens, and Walmart when you show your Generations Advantage member ID card. You can also get a flu shot at a pharmacy that is not in the Vaccine Pharmacy Network but you will pay full cost up front and submit a reimbursement request form to Generations Advantage to see if it can be covered by your plan.

Your primary care provider’s office. There is no cost for the flu shot but you may have an office visit copay.

Other steps you can take to prevent the spread of the flu:

Avoid sick people and limit your contact with others when you are sick. You should be fever free for 24 hours before you leave your house for non-medical reasons.

Cover your sneezes and coughs.

Clean and disinfect shared surfaces.

Wash your hands with soap and water. Use hand sanitizer if this is not an available option. 

At some outpatient visits, you may receive a “self-administered drug.” Self-administered drugs are medications you would normally take on your own. When you receive these drugs in an outpatient setting, the facility may bill for them under the Medicare Part B (medical) portion of your health plan.

Under the Part B portion of your Generations Advantage plan, these drugs are generally not covered unless they are specifically required for the outpatient services you receive. This is why, in some cases, you may receive a bill from the outpatient facility for these drugs.

But, there’s good news: If your Generations Advantage plan includes Part D Prescription Drug coverage, these drugs may be covered. You will need to pay the bill you receive from the outpatient facility and then request reimbursement from your plan.

To learn how to request reimbursement for self-administered drugs through the Part D Prescription Drug portion of your Generations Advantage plan, go to MartinsPoint.org/PartD and follow the directions on the Caremark Part D prescription reimbursement form for prescription drugs.

Did you know? Having a history of diabetes doubles your likelihood of having a heart attack or stroke. The good news is that, in addition to recommending exercise and following a heart-healthy diet, being prescribed a statin medication is another step your provider can take to help you lower your risk of these serious medical events.

Statins can reduce the “bad” cholesterol (LDL, or low-density lipoprotein) that forms plaque in your arteries and can lead to strokes and heart attacks. One study found a 24% decrease in the incidence of cardiovascular disease (from plaque) and 16% decrease in all-cause deaths in people 75-84 years old with diabetes who were prescribed a statin.*

Statins are not right for everyone. Some reasons a person may not be prescribed them are liver disease or end stage renal (kidney) disease. Some people experience muscle pains when taking a statin. If so, your doctor may suggest trying a different statin and/or dosage. If you have a history of diabetes or cardiovascular disease, we encourage you to discuss with your provider the risks versus the benefits of taking a statin.

If you have a history of diabetes or cardiovascular disease, we encourage you to discuss with your provider the risks versus the benefits of taking a statin.

One study found a 24% decrease in the incidence of cardiovascular disease (from plaque) and 16% decrease in all-cause deaths in people 75-84 years old with diabetes who were prescribed a statin.

Taking all your medications as prescribed is very important. This is especially true for those taking daily medications to help manage a chronic condition like high cholesterol, high blood pressure, and diabetes. Although you may not feel different if you stop these medications or don’t take them as directed, over time, major complications such as heart attacks, strokes, kidney disease, or even death can occur.

There are many reasons a person may not stick to taking their medication as directed. One is simply not being able to get to the pharmacy on time. Setting up mail-order prescription fills helps make sure you have a steady supply of your medications on hand.

Your Generations Advantage plan offers a convenient mail-order option that delivers your prescriptions right to your mailbox.

To learn more or sign up, please call CVS Caremark Customer Care at 1-888-296-6961. You can also find information in your Generations Advantage plan’s Evidence of Coverage document. 

Osteoporosis is a disease that causes weak bones. It is very common in aging women—about 1 in 5 women over the age of 50 have osteoporosis. Unfortunately, it is considered a “silent” disease as people are often not aware they have it until they have a bone fracture. Fractures can result in loss of functionality, pain, lower quality of life, and even death. If you have a spine fracture or a “fragility” fracture (one that happens with minor or even no trauma), you have a higher risk of having another fracture.

How to find out if you have osteoporosis

Osteoporosis can be diagnosed through a bone density study—a very safe and painless imaging procedure that lasts between 10-15 minutes. If you are a woman who has had a recent bone fracture and you have not had a bone density scan in the last 24 months or since the fracture, we encourage you to have one performed. This will help your provider know if you have osteoporosis, or if your known osteoporosis is getting worse.

 

This information can help determine next steps to manage your care. These could include medications to strengthen your bones, exercise or diet education, or stopping smoking.

Your plan benefits are designed to boost your bone health

For Generations Advantage members identified as being at risk of losing bone mass or of having osteoporosis, a bone density study through an in-network provider is covered at no cost every 24 months. If you have or are at risk for having osteoporosis, ask your doctor if vitamin D and calcium supplements would be right for you. If they are, don’t forget that you can get them using your CVS over-the-counter benefit through your Generations Advantage plan!

At Martin's Point Generations Advantage, the quality of your health care experience matters to us. To better understand your experience, we email a brief survey to our health plan members following their Annual Wellness Visits. It asks about your experience with scheduling your visit, wait times, if you had challenges getting services or care, and more. The survey responses show us areas of strength and opportunity and drive improvements.

You may also receive an annual, anonymous survey that is required by Medicare called CAHPS® (Consumer Assessment of Healthcare Providers & Systems). Unlike the CAHPS, the information from our Annual Wellness Visit Survey is current and not anonymous. This helps us take timely and targeted actions in response to our members' feedback. We hope you'll complete our survey after your next Annual Wellness Visit!