US Family Health Plan eNews 2021 Issue 4
Posted 10/12/21
For more of eNews Member Newsletter
IN THIS EDITION:
It’s Time for Your Flu Shot!
Now more than ever, it is especially important to stay as healthy as possible and protect yourself and your family by getting the flu shot. The Centers for Disease Control (CDC) recommends everyone 6 months and older get a flu vaccination every season. This is especially important for those people at high risk or who have chronic health conditions.
TRICARE® covers the flu vaccine. For information on the flu shot, and how you can get it, please visit the TRICARE information page on flu vaccine coverage .
Protect yourself and your loved ones by keeping up to date with the latest CDC recommendations and seasonal flu updates. Learn more about seasonal flu prevention, symptoms, and resources. https://www.cdc.gov/flu/index.htm
Important: The CDC has announced that it is safe to receive your flu and your COVID-19 vaccines at the same time. The most important thing is that you receive each as soon as you can for the best protection.
Avoid Using Antibiotics in Adults with Acute Bronchitis
Acute bronchitis–also known as a chest cold—cannot be cured with antibiotics. A chest cold occurs when the airways of the lungs swell and produce mucus, making you cough. This can last up to three weeks and is usually caused by a virus.
Antibiotics aren’t helpful because, bacteria rarely cause bronchitis, the side effects of antibiotic treatment can cause harm ranging from a minor rash to very serious conditions such as antibiotic-resistant infections and an infection called C. diff that causes diarrhea and colon damage.
Usually, acute bronchitis gets better on its own. Here are some suggestions of things you can do to feel better:
- Get plenty of rest
- Drink plenty of fluids
- Use a humidifier or cool mist vaporizer
- Use saline spray for a stuffy nose
- Breath in steam from a shower or hot bowl of water
- Suck on lozenges (not recommended for children under four years old)
- Use honey (not recommended for children under one year old)
- Take over-the-counter pain relievers and cough/cold medications if desired
Martin’s Point US Family Health Plan Earns “High Performance” Rating
The Martin’s Point US Family Health Plan has received a 2020-2021 “High Performance” rating—4.5 out of 5— for 2020-2021, from the National Committee on Quality Assurance (NCQA), with an individual rating of 5 out of 5 for Patient Experience!
NCQA uses measures of clinical quality (HEDIS®) and patient experience (CAHPS®) and standards from the NCQA Accreditation process to annually rate over 1,000 health plans (over 90%) across the country. NCQA evaluates health plans on the quality of care patients receive, how happy patients are with their care, and the health plans’ efforts to keep improving.
We work hard to provide excellent care and service to our members and are proud to have earned this distinction. You can feel proud, too, and confident you have chosen one of the highest-quality plans available in the nation.
Learn more about NCQA ratings on our website.
Reminder: TRICARE® Prescription Copay Increases in 2022
IMPORTANT NOTE ABOUT WALMART/SAM'S CLUB PHARMACIES: Effective December 15, 2021, Walmart and Sam's Club will no longer be a part of the TRICARE pharmacy network. This will NOT impact our US Family Health Plan members, as your plan uses a different pharmacy contract. US Family Health Plan members can continue to use Walmart and Sam's Club pharmacies for urgent-need, non-maintenance prescription fills.
For your planning purposes, we want to let you know that TRICARE will be raising member copays on prescription drugs beginning January 1, 2022. These increases will affect all US Family Health Plan members except dependent survivors of active-duty service members (ADSMs), medically retired service members and dependents of medically retired service members. These members will see no change in their prescription drug copays in 2022.
2022 Prescription Copays
| Retail Network Pharmacies (e.g. Rite Aid, CVS, Walgreens) (up to a 30-day supply) | Martin’s Point On-Site and Mail-Order Pharmacies (up to a 90-day supply) |
|||
|---|---|---|---|---|
| Current | Effective 1/1/22 | Current | Effective 1/1/22 | |
| Generic (Tier 1) | $13 | $14 | $10 | $12 |
| Brand-Name (Tier 2) | $33 | $38 | $29 | $34 |
| Nonformulary (Tier 3) Brand and Generic |
$60 | $68 | $60 | $68 |
| Non-Covered Drugs (Tier 4) | 100% cost of the drug | 100% cost of the drug | 100% cost of the drug |
100% cost of the drug |
TRICARE Young Adult Premium Increase
Please be aware that monthly premiums for the TRICARE Young Adult program will increase to $512.00 effective January 1, 2022. Information about this program is available at https://www.tricare.mil/tya.
An Update on COVID-19 Vaccines and Booster Doses
COVID-19 Vaccines
With the rise in COVID-19 cases due to the COVID-19 Delta variant, we continue to encourage you to receive the COVID-19 vaccine as soon as possible, if you haven’t already.
Pregnancy and Vaccine Safety
The Centers for Disease Control and Prevention (CDC) has released data citing that the mRNA vaccines (Pfizer and Moderna) are safe and effective in pregnancy. We encourage all pregnant members to get the vaccine as soon as possible to reduce severe risks of COVID illness and pregnancy complications. If you have questions, please don’t hesitate to talk with your provider. Updated information can be found on the CDC website.
Booster Doses
Currently, those aged 5-11 years are eligible for a pediatric dose of the initial Pfizer(r) COVID-19 vaccine, those aged 12 and over are eligible for the adult dose of the initial Pfizer vaccine, and those aged 18 and over are also eligible for Moderna and Johnson & Johnson brand initial vaccines. Certain groups have been authorized to receive a third or booster dose with the ability to mix and match vaccine brands. For the most up-to-date information about COVID-19 and vaccines, visit the US Centers for Disease Control and Prevention (CDC) website at cdc.gov.
Managing Diabetes for Your Best Health
Diabetes is a lifelong, chronic condition where there is not enough insulin in the body to effectively help with digestion after eating. If you have diabetes, it’s important to complete all your monitoring and testing:
- Have an annual physical
- Check your blood pressure regularly and keep it under control (under 140/90)
- Have a Hemoglobin A1c (HbA1c) test at least twice a year and keep your blood sugars under control
- Have your eyes examined yearly
Have your kidneys tested yearly
In addition to being sure you have all your monitoring and testing completed, be sure you take care of yourself at home:
- Take medications as your provider has instructed
- Know your blood sugar results
- Know how to treat low and high blood sugars
- Keep active and exercise
- Eat well
- Maintain a healthy weight
Learn more about diabetes and things you can do to take good care of your health if you have diabetes.
Planning Ahead: What You Must Know about Coverage for Long-Term Care
Advances in science and the increased focus on our health are allowing us to live longer, which means planning for the future is more crucial now than ever before. As we age, many of us may find ourselves needing the services of assisted living, memory care facilities, or nursing homes. Planning for these expenses is important.
You should know that long-term-care expenses are generally not covered by any health insurance plans. This is true for traditional Medicare as well as TRICARE® plans, including both the US Family Health Plan and TRICARE for Life. There are many companies that offer long-term-care insurance options, including the Federal Long-Term Care Insurance Program. The Federal Long-Term Care Insurance Program (FLTCIP) is available to eligible federal and US Postal Service employees and annuitants, active and retired uniformed service members, and certain qualified relatives. They can be reached at 1-800-LTC-FEDS (1-800-582-3337) or on their website ltcfeds.com. There is sometimes additional financial assistance for that long-term-care coverage through your state’s income-based Medicaid program. Information can be provided to you by your local Medicaid office.
You may need to change your insurance plan: If you are a member of the US Family Health Plan at the time you enter a long-term-care facility, you may need to change your insurance plan. To remain eligible for the US Family Health Plan, members must be able to meet all three of these managed-care criteria:
- Must be able to get to and continue to use an in-network primary care provider
- Must be able to get to and use in-network specialists
- Must be able to use the Martin’s Point Mail-Order Pharmacy for all maintenance medications (or one of our Martin’s Point Pharmacies (retail) in Portland, Maine or Portsmouth, New Hampshire)
What to do if you enter a long-term-care facility:
- Contact your Martin’s Point US Family Health Plan Member Services team as soon as you know you will need to enter a long-term-care facility. We can help you determine if you need to make an insurance change. If you are unable to meet the requirements to remain enrolled in the US Family Health Plan, we will help you transition out of the Plan to another TRICARE plan.
- For those who are eligible for Medicare, you may want to switch to TRICARE for Life as your backup if you need to disenroll from the US Family Health Plan. To be eligible for TRICARE for Life, you must already be enrolled in Medicare Parts A & B.
We hope that this information helps you plan for your future. If you have any questions at any time, please reach out to us by contacting Member Services at 1-888-674-
Health and Wellness Resources
Check out our online Health and Wellness feature pages covering important health topics:
You’ll find lots of helpful information and resources to support your and your family’s best health!
