Health and Wellness

For Medicare Members

Health and Wellness Resources

Landmark Health

Landmark Health services are available for eligible Medicare Advantage members. A copay isn’t required for these service.
Landmark Health offers in-home care when you need extra help managing your chronic conditions. They don’t replace your regular doctor. Instead, they work with your doctors and specialists to give you the best care. Landmark Health is perfect for wellness visits, urgent care, or post-hospital care at home without traveling to an office. Get care in the comfort of your own home.
Visit Landmark Health

Phone Number (Toll Free): (833) 355-6029 

TTY: 1-888-451-9957  / 711

 

What services does Landmark Health provide?

  • Medical, behavioral and social care in your home
  • Urgent care home visits

  • Wellness visits

  • Post-discharge visits

  • 24/7 availability

  • Works alongside your regular doctor

Eligbible chronic conditions: 

  • Coronary heart disease

  • Heart failure

  • Chronic kidney disease

  • Diabetes

  • Pulmonary disease

  • Atrial fibrillation

  • Cancer

  • Cerebral vascular disease

  • Dementia

  • Depression

  • Vascular disease

  • Chronic liver disease

  • Hypertension with and without complications

 
 

Case Management

In certain health situations, members are eligible to work one-on-one with a case manager.

Our registered nurses have experience with important health issues and they're here to assist you. Sometimes, health conditions can create risks or complexities that require additional health care support. That's why we're here to help.

The programs are designed to help members better understand and manage their condition. You may be eligible for a case manager if you're diagnosed with any of the following health conditions:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive Heart Failure (CHF)
  • Diabetes
  • One or more complex or chronic medical conditions

Case managers are available at no additional cost to you. Case managers can help you:

  • Learn more about your disease or condition
  • Identify and monitor your health care needs
  • Apply self-management strategies
  • Eliminate obstacles to receiving care
  • Navigate the health care system
  • Identify and locate resources in your community

To request services from a case manager, please call toll free at 1-877-672-7647, Monday - Friday, 8 a.m. to 5 p.m. Eastern Standard Time

To request services from a Blue Medicare HMO or Blue Medicare PPO case manager, please contact Customer Service seven (7) days a week, 8 a.m. to 8 p.m. Eastern Standard Time

Blue Medicare HMO
1-888-310-4110

Blue Medicare PPO
1-877-494-7647

For the hearing and speech impaired
1-888-451-9957 / 711 (TTY)

Diabetes Prevention Program

Starting April 1, 2018, your Medicare Advantage Plan covers a Diabetes Prevention Program for qualified Blue Medicare HMO and PPO members.

Blue Cross NC and Solera Health, a leader in patient education, bring you a Diabetes Prevention Program that can help you make lifestyle changes, lose weight and reduce the risk of getting Type 2 Diabetes. The program is for members who haven’t already been diagnosed with Type 2 Diabetes, end-stage renal disease (ESRD) or kidney failure. Here's what you need to know:

Who Qualifies for the Program?

You don’t need a referral from your primary care provider (PCP), but you must have qualifying lab test results and higher than normal body mass index or BMI. (BMI measures body fat in relation to your weight and height.)

How Can I Participate?

You can get diabetes prevention courses and materials, approved by the Centers for Disease Control (CDC), through educators and heath coaches in your area:

  • You must attend in person, but there will be a limited number of make-up sessions available online.
  • Over the first 12 months, you can try 12 core and core-maintenance sessions.
  • Extra ongoing maintenance sessions will be available based on reaching your weight loss goals.
  • This is a once-per-lifetime benefit, so you can only participate once.

How Do I Enroll?

You can get diabetes prevention courses and materials, approved by the Centers for Disease Control (CDC), through educators and heath coaches in your area:

Step 1: Call the customer service number on the back of your Blue Cross NC member ID card. Ask for help setting up your lab test and to learn about enrolling in the program through Solera Health. Solera will help you find educators in your area who can get you signed up for the core sessions.

Step 2: Get a Patient Referral Form Here PDF Icon, then share it with your PCP and ask them to send your current lab results to Solera.

Medication Therapy Management Program

Members enrolled in Blue Medicare HMOsm or Blue Medicare PPOsm with Medicare prescription drug benefits or Blue Medicare Rxsm may be eligible for the medication therapy management program (MTMP), in accordance with CMS requirements. The Medication Therapy Management Program helps members understand their medications better.

Who's Eligible for the MTMP?

Individual members eligible for the MTMP services must meet all three (3) criteria below:

  • Have at least three (3) of the following chronic conditions: diabetes, chronic obstructive pulmonary disease (COPD), High Blood Pressure, High Blood Cholesterol, chronic heart failure (CHF), or Rheumatoid arthritis.
  • Take at least eight (8) or more prescription medications covered by Part D.
  • Expect to spend more than $4,044 in 2019 on prescription medicines covered by Medicare Part D

What services does the MTMP provide?

The MTM services include the following interventions for members and prescribers.

  • An annual comprehensive medication review (CMR) with a pharmacist to go over prescription and non-prescription medications that you take.
  • Quarterly Targeted Medication Reviews which look for any safety or other issues which may need attention. The member’s prescriber may be contacted if any issues are found.

What is a Comprehensive Medication Review (CMR)?

A Comprehensive Medication Review (CMR) is a person to person review of your medications with a pharmacist or nurse. The appointment usually takes about thirty (30) minutes. During that time the pharmacist will:

  • Review the medicines you take
  • Create a personal medicine list
  • Help you understand how your medicines work
  • Tell you about side effects from your medicines
  • Answer any questions or concerns you have

How do eligible members enroll?

  • If you are eligible, you will be automatically enrolled in the program. Eligible members will receive a letter inviting them to schedule a medication review with a pharmacist.
  • You may return the participation form in the mail OR call a toll-free phone number (1-866-686-2223 or TTY users call 711) between 10:00 a.m. and 6:00 p.m. Eastern Standard Time, Monday through Friday (except major holidays).
  • Participation in the program is voluntary.

How do members opt out (decline) participation in the program?

Members may opt out from participating in the program.

This can be done by calling the telephone number listed in the notification letter (1.866.484.3953 or TTY users call 1-888-247-4145 / 711, 24 hours a day, 7 days a week).

When prompted, enter your opt-out personal security PIN.  You may refuse individual services without having to opt out from the whole program.

What are the program goals?

  • Educate members regarding their medications
  • Increase understanding about how to take medications as prescribed
  • Identify and prevent medical complications related to medication therapy

If you have additional questions:
For more information regarding MTMP and a Personal Medication list from a CMR standardize format, please click on the following:

Members should also refer to their Evidence of Coverage for more details on the MTMP. These programs are not considered a benefit.

Flu and Pneumonia Shots

Getting an annual flu shot is a simple step to protecting your health. You can get a flu shot at doctor offices, local health departments, participating (in-network) walk-in clinics or from immunizing pharmacists. The seasonal influenza (flu) vaccine provides protection against multiple strains of the flu viruses, including H1N1. Check with your doctor to determine the best time to schedule your flu shot.

Members can get a flu shot during flu season, while vaccine supplies last, at any of the following locations:

Physician's Office: Members may schedule an appointment for a flu shot or visit a physician's flu shot clinic. Members who receive other services in addition to the flu shot may have to pay a copayment. To find a provider, visit Find a Doctor or Facility and search for "Primary Care" under the Type of Provider field.

Immunizing Pharmacist or Participating Pharmacy: To get a flu shot − at no additional cost − Medicare members can find pharmacists and clinics with our HealthNAV℠ search tool. Here's how to do it:

Visit the Find a Doctor page or select the Find a Doctor button at the top of this page. Click Find a Doctor or Facility button on the Find a Doctor page. Type "Pharmacist" into the "I'm looking for" box. Click or Select "Pharmacist (Flu & Other Limited Injections)" highlighted in blue under Specialties.

The HealthNAV tool will serve up a list of pharmacists and clinics near you. You can filter your search by changing the information in the "Refine your results" box in the right column of your screen. (Unfortunately, you cannot search by pharmacy name at this time.)

Have You Had Your Pneumonia Shots? Yes, There Are Two

Pneumonia is a serious medical condition which, in many cases, can be prevented. Bacterial pneumonia is caused by a number of different pneumococcal bacteria. Your Blue Medicare Advantage plan covers the two shots that will help protect you from bacterial pneumonia.

You are encouraged to receive your vaccinations at your primary care provider’s office where a record of the vaccines that you received and the dates they were administered will be on file along with your other health information.

You will not be administered both injections during the same visit. At least eleven months must pass between the first and second pneumonia vaccination. The second shot should be a different vaccine from the first one. One vaccine helps prevent 23 types of bacterial pneumonia. The other helps prevent 13 other types of bacterial pneumonia. It does not matter which vaccine is given first.

As part of your Blue Medicare Advantage preventive services, all members are eligible to receive both pneumonia vaccines with no copayment or coinsurance as long as at least eleven months have passed between the first and second vaccination.

If you have other services performed when you go in for your pneumonia shot, you may be charged a copayment or coinsurance for those services. If the pneumonia vaccine is administered by a provider who does not participate with Blue Medicare Advantage, you may have to pay out of pocket and request reimbursement from your Blue Medicare Advantage plan.

Flu Shot - Season Details

Members can get a flu shot during flu season, while vaccine supplies last, at any of the following locations:

Physician's Office: Members may schedule an appointment for a flu shot or visit a physician's flu shot clinic. Members who receive other services in addition to the flu shot may have to pay a copayment. To find a provider, visit Find a Doctor or Facility and search for "Primary Care" under the Type of Provider field.

Immunizing Pharmacist or Participating Pharmacy: To get a flu shot − at no additional cost − Medicare members can find pharmacists and clinics with our HealthNAV℠ search tool. Here's how to do it:

Visit the Find a Doctor page or select the Find a Doctor button at the top of this page.

Click Find a Doctor or Facility button on the Find a Doctor page.

Type "Pharmacist" into the "I'm looking for" box.

Click or Select "Pharmacist (Flu & Other Limited Injections)" highlighted in blue under Specialties.

The HealthNAV tool will serve up a list of pharmacists and clinics near you. You can filter your search by changing the information in the "Refine your results" box in the right column of your screen. (Unfortunately, you cannot search by pharmacy name at this time.)1

1. Formulary, pharmacy network, and provider network may change at any time. You will receive notice when necessary.

Flu Shot FAQs

Q: What do I need to present to receive a flu shot without a copayment?

A: Just show your Blue Medicare HMO or Blue Medicare PPO ID card to receive a flu shot.

Q: Why was I charged a copayment for a flu shot? 

A: If you go to the doctor for a flu shot only, the copayment is waived. However, if you see the doctor for other services, an office visit copayment may be charged.

Q: Who should get the flu shot? 

A: We encourage most people to receive an annual flu shot. Influenza, or the “flu,” can affect people of all ages as it spreads through the air from person to person. The virus can be as contagious as the common cold and is easily transmitted from people who are already infected. You can also get the flu from those who have been exposed, but have not yet developed symptoms. This means that you can be contagious and not even know it.

The Centers for Disease Control and Prevention (CDC) recommend that everyone aged six months and older get a flu shot. The annual flu shot is especially important for certain people who are at greater risk. These include:

  • People who are at high risk of developing serious complications like pneumonia if they get sick with the flu. This includes People who have certain medical conditions including asthma, diabetes, and chronic lung disease
  • Pregnant women
  • People 65 years and older
  • People who live with or care for others who are high risk of developing serious complications. This includes Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease

Q: Who shouldn’t get the flu shot? 

A: Some individuals should not receive the flu shot without consulting their health care provider first. This includes:

  • People who have a severe allergy to chicken eggs
  • People who have had a severe reaction to a flu shot in the past
  • People who ever had Guillain-Barré Syndrome (a severe, paralytic illness, also called GBS)
  • Children less than 6 months of age
  • People who are moderately to severely ill with a fever (they should wait until they are recovered)

Q: Can I get the flu from the vaccine? 

A: Contrary to a popular myth, you cannot get the flu from the vaccine since it is made from inactive, dead viruses that are noninfectious. The flu strain changes each year, so even if you received a flu shot last year, you still need to get another one this year to remain protected.

Q: Can I still get the flu after receiving the vaccine? 

A: Yes. Like other vaccines, the flu vaccine is not 100 percent effective and does not take effect until approximately two weeks after it is received. During this time, you will be just as susceptible to the flu as individuals who have not received the vaccination. Still, the best option to prevent the flu is to get an annual flu shot.

Q: Are there any side effects from the flu shot? 

A: The viruses in the flu shot are not active, so you cannot get the flu from a flu shot. Almost all people who receive the influenza vaccine have no serious problems from it. The most common side effects are soreness, redness or swelling where the shot was given, a low-grade fever and aches. These potential side effects begin soon after the shot is administered and usually last one to two days. Rare side effects include severe allergic reactions. Anyone who is allergic to chicken eggs should avoid being vaccinated, since the virus used is grown in these eggs. If you have any problems after receiving your flu shot, please see your health care provider immediately.

Going Home From the Hospital?

Leaving the hospital can be an overwhelming time. Unfortunately, some people find themselves back in the emergency room after a hospital discharge. The Hospital Discharge Checklist can help you or a loved one avoid this type of situation.

Written Discharge Instructions

Discharge instructions cover what, when and how to do things once you leave the hospital.

  • Make sure your doctor or discharge nurse gives you written discharge instructions before you leave the hospital.
  • The doctor or nurse should review the instructions with you.
  • If you don't understand the instructions, don't be afraid to ask questions.
  • If you have a family member or support person with you, make sure they understand the instructions as well and have the opportunity to ask questions.
  • Make sure that the instructions include a contact name and phone number if you have questions after you get home.

Medications

With some hospital stays, your doctor may prescribe new medications for you to take.

  • Let the hospital staff know what current medications you're taking, including vitamins, herbs, supplements and over the counter medications. It's a good idea to keep a medication list for situations like this.
  • Make sure you understand the reasons for the new medications, plus possible side effects and how often you have to take the new medications.
  • Get prescriptions for new medications. If you're going to have problems getting your prescriptions filled, such as not being able to afford them, let your doctor or nurse know before you leave the hospital.
  • Take your medications as prescribed. Skipping medications can put you at greater risk for health problems.

Signs and Symptoms

Your discharge instructions should provide you with a list of signs or symptoms to be aware of after you leave the hospital.

  • If you start experiencing some of the signs or symptoms your doctor or discharge nurse covered, make sure you follow their instructions for what to do in such cases.
  • If you experience a sign or symptom not covered in the instructions, call your doctor and ask to speak to a nurse.

Follow-up Appointments

Usually, a follow-up appointment is scheduled with the doctor who took care of you during your hospital stay.

  • Be sure to keep your follow-up appointment with the hospital doctor.
  • Schedule an appointment with your primary care doctor as soon as possible. Your primary care doctor manages your overall health. Making sure they know about your hospital stay can help them help you more effectively.

Follow these tips to help make your recovery an easier one and avoid a return visit to the hospital.

Medication Safety and You

As you grow older, certain medications can last longer in the body and increase the risk of harmful side effects. For example, these medications can cause dizziness, confusion, weakness and unsteadiness, which can increase your risk for falls. These medications may also put you at increased risk for certain cancers and other diseases, and potentially decrease your liver and kidney function.

Commonly Prescribed High Risk Medications

The American Geriatrics Society, Pharmacy Quality Alliance, and the Centers for Medicare and Medicaid Services have all identified medications that are - medications that are high-risk or may pose problems for some people as they get older. Some common medications on these lists are muscle relaxants such as cyclobenzaprine (Flexeril), older generation antihistamines such as diphenhydramine (Benadryl and Hydroxyzine), hormones such as estrogens (Premarin) when taken for many years, and sleep aids such as zolpidem (Ambien) when taken for more than 90 days.

What You Can Do

Talk with your health care provider or pharmacist to see if you are at risk. Your provider may be able to prescribe a safer medicine that works just as well.

Tips for Taking Your Medication

Taking your medicines as directed by your health care provider is one of the best things you can do for your health. But staying on track with your medicines can be a challenge. Sometimes you may forget to take your medications. If you do, try these tips to help you remember to take your medicines.

  • Set daily routines. Take your medication right after eating breakfast or right before going to bed.
  • Use a clock or cell phone alarm, calendar, or notes to remind you to take your medicines at the right time each day.
  • Use pillboxes or other daily medicine organizers.
  • Use your smart phone or computer to help you remember. For example, there are applications (apps) you can download that will remind you when to take your medicine.
  • Ask your family and friends to remind you when to take your medication.

Keep in Mind

Don't stop taking your medicines, even if you are feeling well. Always talk with your doctor or pharmacist before changing when and how you take your medication.

Ask your doctor for a 90-day supply of medications that you use on a regular basis. You can get a 90-day-supply through many local pharmacies in our network or AllianceRx Walgreens Prime Mail, our prescription mail service provider.

Sign up for your pharmacy's refill reminder program. If your pharmacy has a reminder program they will let you know when your prescription is ready or contact you when more refills are needed.

Sign up for your pharmacy's home delivery service. Some pharmacies may offer free home delivery service to help you get your medications on time. Find out if your pharmacy offers this service.

Two Ways to Save Money and Time on Medications

  1. Switch to Generic Drugs and Save Money: Many medications are available as generics (non-brand name), which may mean a lower cost for you. Talk to your health care provider to see if a generic may be right for you.
  2. Save Time with AllianceRx Walgreens Prime mail: AllianceRx Walgreens Prime mail is easy to use and you can enjoy the convenience of filling your prescriptions by phone or online and having them delivered to your home.