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Telehealth Services Covered by Medicare

Due to the coronavirus (COVID-19) health emergency, doctors and other health care providers started using telehealth services to treat COVID-19 as of March 6, 2020. As long as you have seen the health care provider, or another health care provider from the same practice, for an in-person consultation, Medicare will pay 100% of the cost for COVID-19 telehealth consultations with that provider.

What it is: Telehealth, also called telemedicine, provides access to board-certified physicians for minor medical concerns via telephone or live, online video consultation from your home, office, nursing home, assisted living facility, or a hospital.

It saves time and you get the care you need without having to schedule a doctor’s appointment or be exposed to other sick people while sitting in a doctor’s waiting room.

How it works. Call your doctor to find out what your telehealth options are. You will need access to the internet and a computer, tablet or smart phone device. It may also require you to register, download software, or an app to your device. Telehealth services use the same kind of technology as video chat services such as FaceTime or Skype. However, it uses secure, HIPAA-compliant technology and procedures. During your consultation, you can see the doctor and the doctor can see you.

What it costs. Medicare will cover a telehealth consultation as long as you have had a prior in-person office visit with the health care provider or another provider in the same office.

Other times when telehealth makes sense. Telehealth consultations are not intended to treat all types of medical issues. Use telehealth for minor medical issues such as:   

  • Flu-like symptoms
  • A fever
  • A mild rash or skin inflammation
  • Sore throat or allergies
  • If you need to speak with a doctor outside normal office hours and otherwise would consider a visit to your primary care physician or an urgent care center.

Important: Telehealth is not a replacement for emergency services. If you need emergency care, always call 911.

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Benefits Health Options Program

SilverSneakers: Staying active while staying home

Exercise is a key part of maintaining a healthy lifestyle and can support a healthy immune system. We encourage you continue to use your SilverSneakers® benefit to stay active without leaving home. If you’re enrolled in the HOP Medical Plan or the Pre-65 Medical Plan, you have this fitness benefit at no additional costs.

Working out at home

Included in your SilverSneakers membership is SilverSneakers On-Demand which gives you access to 200+ online workout videos. Log in to SilverSneakers.com (or create an account) to view on-demand workouts like SilverSneakers Classic, Yoga, etc.

You can access workout programs that can be tailored to your fitness level on our fitness app, SilverSneakers GOTM. You can modify the exercises to make them easier or harder with just one click.

Download the app at the Apple or Google stores today, or learn more by reading our SilverSneakers Go flyer.

SilverSneakers will also be offering Facebook Live classes. Please visit and follow the SilverSneakers Facebook page for more details.

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Benefits Health Health Options Program Medicare

Medicare Star Rating for the Health Options Program

Each year, Medicare evaluates prescription drug plans and awards a star rating to each plan based on performance. This star rating can be used to help you determine which plans excel based on measured categories, including: customer service, overall member satisfaction and patient safety. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. The Health Options Program’s prescription drug plans received a 4.5 star for 2020, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.

OptumRx COVID-19 FAQs

As of March 6, 2020

The CDC is the primary source for the latest updates on COVID-19. For the most current information, please go to their site: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Does OptumRx anticipate any type of delays to dispense prescription medications?

We do not anticipate delays in dispensing prescriptions from Optum-owned pharmacies (Optum Home Delivery, Optum Specialty, Optum Infusion Services, Avella, Genoa, Diplomat) related to COVID-19. OptumRx is prepared to use anticipatory analysis to determine if, and when, we need to expand operations to include advance dispensing, workforce management, medication access, and more involved in ensuring we secure the medications needed for our patients and ability to deliver those medications to members.

How will OptumRx ensure adequate drug supplies and contingency staffing associated with your home delivery and other supply chains?

We’ve successfully managed challenging situations in the past including H1N1, Epi Pen shortage, and numerous natural disasters. We are monitoring the supply chain and actively working to maintain a reliable inventory. We’re also evaluating drug supplies going out to our pharmacies and ensuring our best practices and disaster recovery plans are implemented to meet the operational requirements of the organization.

Will OptumRx take steps to help members and prescribers adjust to supply chain disruption and find therapeutically equivalent medications in case supply challenges do occur?

Yes, similar to when we have an out-of-stock or recall situation today, we partner with our members and prescribers to identify alternatives and streamline the process to drive a faster turnaround and ensure our members have the therapy they need when they need it.

Will medications used to treat COVID-19 be covered in my plan?

Medications used in supportive care for the treatment of COVID-19 will be covered per the member’s current health plan benefit design. While there is no current treatment other than supportive care, OptumRx is monitoring the use of anti-viral products and production of a vaccine and will continue to aggressively monitor CDC recommendations and outcomes of clinical studies.

Is OptumRx proactively waiving any refill-too-soon edits?

Our first priority is to ensure our members have access to the diagnostic and treatment care they need, and we are continuing to work with our customers and policymakers on this public health challenge. OptumRx is following all guidance issued by the CDC, state and local public health departments in supporting our customers’ needs. OptumRx is actively engaged in monitoring state and federal notices regarding any state of emergency or other dictated actions in response to COVID-19.

What if a member is willing to pay out of pocket to stockpile medications?

Consistent with AMCP and other published policy, stockpiling is not encouraged because shortages are likely to increase when stockpiling occurs. We continue to assess if policy should change as CDC guidance evolves.

If lab test confirmation is required as part of utilization management criteria of a specialty drug, how will OptumRx ensure access to the specialty drug in the case of a quarantine?

OptumRx will evaluate the need to relax required utilization management criteria including any required lab tests for those members impacted by a quarantine.

How will OptumRx support access to a COVID-19 vaccine?

There is currently no approved vaccine for this virus. As soon as one is available, we will work to ensure access for our customers. We have a network of 68,000 pharmacies that can dispense vaccines and we will actively work with our pharmacies to administer any vaccines based on CDC recommendations and national availability.

Can the OptumRx customer service or website help identify local pharmacies in a member’s geography which offer delivery service?

We recommend members contact their local pharmacy directly to check if they offer delivery service or determine if their prescription can be filled by OptumRx’s home delivery service.

How can I find out if my local pharmacy is open to pick up a prescription?

We recommend you contact your local pharmacy directly to determine if they are open and filling prescriptions.

What role will OptumRx Home Delivery play in the distribution of acute prescriptions in the case of quarantine?

OptumRx Home Delivery will continue to play its primary role in the supply of chronic maintenance medications and a limited number of acute medications. OptumRx will continue to work collaboratively with our network of 68,000 pharmacies who are best situated to dispense acute medications.

Are your medications safe, or could they be carrying COVID-19?

At this time, OptumRx has no reason to suspect any concerns with medications being used in our pharmacies and is continuing to monitor the drug supply chain. OptumRx is firmly committed to the highest standards in selecting the vendors from which we source medications. Our prescription medications are purchased from approved sources that are safe and effective, and that have implemented protections that comply with all FDA regulations as well as national standards of the Verified Accredited Wholesaler Drug program (VAWD).

Will OptumRx allow members to change their retail prescriptions to Home Delivery?

If a member is interested in switching a prescription to Home Delivery, they can check through the OptumRx.com website to see if it is available. If a consumer is already on the phone, we will work with them through our normal onboarding process for new Home Delivery customers.

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Health Options Program Office Hours

Individual Consultations Spring 2020

You can schedule a 30-minute individual consultation (not a group meeting) with a staff member of the Health Options Program if you need help that cannot be provided by speaking with a customer service representative at the HOP Administration Unit.

After you register, you will be sent an acknowledgement with driving directions to the location you selected. Information about appointments and driving directions to all locations are also available online or by telephone from the HOP Administration Unit.

Walk-in appointments are NOT available. Since the number of appointments at each location is limited, you must call the HOP Administration Unit in advance at 1-800-773-7725 for available times and to register for your appointment.

Categories
Benefits Health Options Program

Are You Almost 65?

If you’re a PSERS retiree about to turn age 65, we’re eager to tell you about the benefits of joining HOP. We’ll take a number of steps to make sure you understand how the program works.

First, we’ll send you a package of information from four to nine months before your 65th birthday. We mail these twice a year—in the fall for people turning age 65 during the first six months of the following year and in the spring for people turning age 65 in the second half of the year. The package contains a description of the medical and prescription drug benefits available under the Health Options Program—plus a personalized statement that has information specific to you—including your monthly premiums for all your coverage options.

In addition, we conduct group meetings multiple times a year at locations throughout the Commonwealth for retirees approaching age 65. Look for the schedule in the package you receive in the mail.

Also, if you register on this website, you’ll find a personalized statement with all the same information as the printed statement you receive in the mail. Plus, if you misplace or want another copy of your statement, a printer-friendly version is available.

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Medicare

Medicare 2020 Highlights

Each year, if needed, the Centers for Medicare and Medicaid Services (CMS) adjust Medicare’s premiums, deductibles and copays. As a reminder, Medicare Part A covers hospital expenses and Medicare Part B covers other types of medical expenses, including physician services, certain home health services and durable medical equipment. Medicare Part D covers prescription drugs.

Part B Premium & Deductible For 2020

Most people do not pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working. However, to be covered under Medicare Part B, you must pay a monthly premium (in most cases deducted from your Social Security benefit). As required by law, the standard monthly premium is set each year at 25% of the cost for senior beneficiaries. The government pays the remaining 75%. Most Medicare beneficiaries—including those who will enroll in Part B for the first time in 2020—will pay a Part B premium of $144.60. However, some people who get Social Security benefits pay less ($130 on average) and others may pay more if their 2018 modified adjusted gross income is above a certain amount. More about Part B Premium amounts can be found on the “Part B Costs” page of the Medicare website at: www.medicare.gov.

The Part B deductible is $198 for 2020. This is the amount you must pay for health care before Medicare begins to pay for covered services and products. 

The Health Options Program is designed to pay some or all of these deductibles and coinsurances. For example, the HOP Medical Plan pays your Part A deductible and coinsurance for stays in hospitals and skilled nursing facilities, as well as the Part B deductible. The Value Medical Plan also pays 100% of Medicare’s hospital deductible and daily copays but only after you pay the first $300.

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Benefits Health Medical Prevention

Healthy Start to the New Year

Flu season is here. If you haven’t already, schedule your flu shot before the season is in full swing. The Center for Disease Control and Prevention (CDC) recommends annual flu shots because the flu virus is always changing and the vaccine is updated each year to better match circulating influenza viruses. The flu generally peaks in January or February and can still be around through May.

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Food Health

Holiday Hints for Managing Diabetes

The holidays can be an especially hard time of year to avoid unhealthy foods. Use the helpful hints below to better manage your diabetes during this time.

  • Ask the host ahead of time what food options will be available.
  • Avoid hanging around the buffet table and sampling options before sitting down with your plate.
  • Limit or avoid pre- and post-meal cocktails.
  • Check your blood sugar levels more often during the holidays.
  • Pack extra medication and supplies when traveling.
  • Exercise for at least 150 minutes each week.
  • When flying or driving, stay hydrated.
  • Try to stretch every hour or so when traveling long distances.
  • Carry a healthy snack.
  • Avoid adding extra salt to your meals.
Categories
Diabetes Health Medical

Diabetes 101: The Basics

Diabetes is a condition that affects the amount of insulin a person’s body produces. Insulin is important because it moves sugar (glucose) from our bloodstreams into our cells after we eat. This is the main source of fuel for our bodies.

In people with diabetes, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Instead of being used as energy, the glucose builds up in the blood and is passed out of the body. So, the body loses its main source of fuel.

There are different types of diabetes. In certain cases, it can be prevented or controlled without medication. Type 1 Diabetes:

  • Usually affects children and adolescents
  • Requires regular monitoring of blood sugar
  • Meals/snacks can help increase low blood sugar
  • Insulin shots help decrease high blood sugar

Type 2 Diabetes:

  • Usually occurs after age 45
  • The most common form of diabetes
  • Can usually be controlled with diet and exercise

Gestational Diabetes

  • Occurs in the middle of pregnancy and is usually a temporary condition
  • Blood sugar levels can be controlled through diet and exercise
  • Increases a mother’s risk of developing type 2 diabetes after pregnancy

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