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Residents who gathered in a conference room at CenterPlace at Mirabeau Point
last Wednesday were quickly introduced to a theme of wellness.
Beginning
with a presentation by Mary Ann Wilson, host of the "Sit and Be Fit"
television program, attendees learned the importance of staying informed and active
in the quest for good health.
"You have to make exercise a priority
in your life because it's going to pay dividends," said Wilson.
While
Paul Weeks, a sales representative for Spokane Community Care, didn't follow Wilson
in leading the audience through balance and stretching drills, he did provide
a valuable lesson in maintaining flexible and reliable healthcare.
Spokane
Community Care was one of a number of companies to emerge after the Medicare Modernization
Act of 2003. Known as "Medicare Advantage" programs, such companies
contract with Medicare to administer people's healthcare benefits.
Weeks
was quick to point out the benefits of a program that has planted roots in the
Inland Northwest.
"We're right here in Spokane and we're going
to continue to be here," he said. "We've made an investment in
Spokane."
A look at the company's history over the past few years
appears to prove Weeks correct. Since originating in 2004, Spokane Community Care
has now contracted with every area hospital as well as over 450 of the leading
healthcare providers in the region. Recognized names like the Rockwood Clinic,
Northwest Orthopedic and the Spokane Eye Clinic have come on board in recent years.
Mike Thompson, sales manager for Spokane Community Care, points out
the emphasis the program places on catching illness before it spreads. There is
no cost for immunizations, pap smears, prostate exams, blood work, colonoscopies
and other preventative procedures.
Thompson tells the story of one patient
who went in to see a doctor for a physical and was given a clean bill of health.
Not long after the exam, the man signed up with Spokane Community Care and visited
another doctor, this time for a more complete checkup. The results showed clogged
arteries and the need for heart bypass surgery.
"His original doctor
just didn't check it," Thompson said. "The preventative medicine has
proven very successful - it's like having a second opinion."
Another
trademark of the program's proactive pursuit of wellness includes free memberships
to a variety of local health clubs. Thompson pointed out that doctors should be
consulted before beginning any exercise program.
The annual enrollment
period for Medicare Advantage plans and Medicare's Part D Prescription Drug plan
runs until Dec. 31, 2006. After that, there will be one more opportunity to switch
to a like plan until March 31, 2007. The annual enrollment period will begin again
on Nov. 15, 2007.
Spokane Valley resident JoAnn Howard attended one
of the first informational meetings sponsored by Spokane Community Care in 2004
and soon found those who administered the program were able to bring the Medicare
picture into sharp focus.
"They were very generous to answer all
our questions," she said. "It made being on Medicare and being older
less stressful."
Cataract surgery last year cost Howard only $150
in out of pocket expenses. Earlier this year, she went in for blood tests on her
kidney and liver after experiencing pain in her abdomen. The co-pay for the visit
was $10, while the tests amounted to just under $7.
All those who qualify
for Medicare are eligible for Spokane Community Care coverage. There are three
levels of membership, starting with the basic plan which carries no charge for
the premium and includes a $15 co-pay for a doctor's visit, $30 for a specialist.
Under the Basic plan, members receive a $28 monthly refund to their Social Security.
The
Plus plan also involves no monthly premium charge, though no Social Security refund.
Doctor's visits run $10 while specialists are $25.
Under the Premium
plan, members pay a $35 monthly premium and $5 co-payments for doctor's visits;
specialists run $20. Both the Plus and Premium plans include the Medicare Part
D prescription drug coverage and a $9 charge for a 30-day supply of generic drugs.
The 30-day supply for preferred medications is $40 under the Plus plan and $39
under the Premium. Those who order two months of medications through the mail
get the third month free.
The "doughnut hole" phase of Medicare
Part D speaks of a gap in prescription drug coverage after a spending limit is
reached with coverage resuming after the beneficiary covers another amount in
out-of-pocket expenses. Spokane Community Care and some other Medicare Advantage
programs help during that time by offering discounts on medications. Spokane Community
Care provides its generic drugs for $18 throughout the uncovered period.
Thompson
points out that there are other options for people when picking a Medicare Advantage
plan, noting that Spokane Community Care "may not work for everyone."
Other companies that offer similar plans include Asuris, Sterling and Secure Horizons.
Earlier
this year, John Austin, a physician who helped launch Spokane Community Care,
visited Spokane Valley to describe the benefits of Medicare Advantage plans. Austin
talked to residents about the mission of providing reliable, affordable and efficient
healthcare.
"Our goal is to provide a product that will help people
with costs and make sure they receive top-notch care," Austin said.
With
nine people working out of Spokane Community Care's local office in the Rockpointe
Center, Thompson said program members can be assured of a quick response to problems
or concerns. A grievance system is in place to consider coverage of any procedure
or medication not currently covered by Medicare.
"They can complain
to us anytime they want," Thompson said.
Program staff call pharmacists
or doctors to straighten out issues, streamlining the process and taking the headaches
out of healthcare. In the end, Thompson said, organizations like Spokane Community
Care reduce fraud and provide more money to put back into the program. For patients
like Howard, the approach has meant cost savings and a healthier outlook.
"It's
a program that people who aren't rich can afford," she said. "They take
care of you." Want to find out more? Spokane Community
Care can be reached at the Spokane office by calling 325-8004 or 1-800-573-8609.
To learn more, visit www.spokanecommunitycare.com.
The Loss and Healthcare Foundation offers free prescription medications
to low-income seniors. To learn more, call, toll-free, 1-888-380-6337 or visit
www.a2zmedline.com. Catholic
Charities (358-4250) and other local agencies like Spokane Neighborhood Action
Programs (456-7111) are also available to help seniors with emergency assistance.
Aging and Long Term Care of Eastern Washington, 1222 N. Post, is available
to answer questions about Medicare and healthcare in general. They can be reached
by calling 458-2509. For more information on Medicare, call, toll-free,
1-800-633-4227. For your state insurance counseling program, call, toll
free, 1-800-677-1116 or visit www.shiptalk.org.
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By
Craig Howard
