HEALTH & WELLNESS
We will be here to support our members through this change.
2025 Medicare Changes:
How will they impact you?
Network Health President and CEO, Coreen Dicus-Johnson breaks down the new regulations
Coreen Dicus-Johnson
EDITORIAL STAFF
Chief Administrative Officer Penny Ransom
Strategic Mar keting and Communications Manager Romi Nor ton
Strategic Mar keting and Communications
Coor dinator Julie Heinzel
Super visor Creative Design
EDITORIAL BOARD
Debra Sutton
Amber Smits, Angela Keenan, Jeanne Wittig, Romi Norton, Stacy Schwandner, Susan Wendt, Theodore Regalia
ASK NETWORK HEALTH
If you have questions about anything you read in this issue of Concierge, call the member experience team at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m. We're available every day, 8 a.m. to 8 p.m. October 1–March 31
Concierge is an annual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2024 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.
Your Member Portal
Our goal at Network Health is to make it easy for you to manage your health plan. We work hard to ensure you understand and are comfortable with your plan. That’s why we created the Network Health member portal. Access your portal at login.networkhealth.com by scanning this QR code with your smartphone camera or type the address into your favorite browser.
Ensuring Secure Information
We are adding an extra step when you log into your member portal, similar to other services like online banking. This extra step helps protect your account with a choice of quick and easy extra methods to verify your identity, as well as your username and password.
Soon, you will be required to set this up as you log into your member portal. It is essential the contact information in your member profile is up-to-date before you complete this security step. Please take a few brief moments to log in and verify these details are accurate. To review and update your personal information ahead of time, log in at login.networkhealth.com and visit the Account section in the upper right-hand side of your dashboard.
For more information or additional assistance please call Network Health’s Member Experience Team at 800-378-5234 (TTY 800-947-3529), Monday-Friday from 8 a.m. to 8 p.m.
Mailing Preferences
Choose which information you want to receive in the mail and which information you want to receive via email. You can go paperless and receive communications via email. Or, if there are communications you’d rather receive as hard copies through the mail, you can select that preference. The choice is yours.
To select your preferences, simply log in to the portal, click your name in the upper right corner and select Change My Communication Preferences. From there, you can choose email for some or all the available categories. Make sure to click Next to save your choices.
Plan Information
The member portal is your personalized online account where you can find information specific to your health plan. It is a secure, password-protected account that keeps you well informed and provides plan information at your fingertips.
• Benefits and coverage overview
• Out-of-pocket expenses tracker
• Claims detail and status
• Monthly explanation of benefit (EOB) statements
• Access your mobile Network Health member ID card (or request replacement hard copies)
• Select or update your personal doctor
More Resources
The member portal also provides seamless connections to other valuable resources.
• Pharmacy benefits and claims information*
• Virtual visits
• Your health questionnaire
• Wellness programs and tools*
The portal works great on your mobile phone and is built to be viewed on any smart device. That means you have access to your important information wherever you go – the pharmacy, doctor’s office or even on vacation. Just visit login.networkhealth.com
*Not all Network Health plans have a wellness program or pharmacy benefits. Check your plan documents for details.
Required Information
There are several organizations that exist to help improve the quality of health care across the United States, including the National Committee for Quality Assurance (NCQA), the Wisconsin Office of the Commissioner of Insurance (OCI) and the centers for Medicare & Medicaid Services (CMS). They use a variety of performance measurement tools and regulations to help ensure consumers are protected and receive quality health care services.
At the link provided, you'll find information on these specific topics.
• Access to Network Health Care Management Employees and Services
• Ensuring You Receive the Service You Deserve
• Falls and Osteoporosis
• The Impor tance of Exchanging Information
• Keep Yourself Safe from Medicare Fraud
• Know Your Member Rights and Responsibilities
• Networ k Health’s Focus on Quality
• Submitting a Claim for Reimbursement
• What is Population Health Management
• How Do Health Plans Make Decisions
• Evaluating New Technologies
You can download this information at networkhealth. com/required-info. If you do not have access to the internet and need a hard copy, please call our member experience team at the number on the back of your Network Health member ID card.
New Search Functionality on networkhealth.com
The Find a Doctor and Find a Pharmacy search functionalities on networkhealth.com have been updated.
Like our old search tool, this new enhanced version allows you to find in-network providers and provider and facility information. However, the look and feel has been updated, making it easier to find the information you need for the insurance plan you have.
The new tool also allows for scheduling access for Froedtert Health doctors.
You can start using Network Health’s enhanced search by visiting networkhealth.com and clicking on the Find a Doctor or Find a Pharmacy buttons. You can also download an informational how-to document at networkhealth.com/newsearch
Plan Business Phone Calls
If you would like to opt out of phone calls from us about Network Health products or services available to you outside of your current coverage, you can do so at any time. To opt-out, submit a written request to the following.
Network Health
Attn: Compliance 1570 Midway Place Menasha, WI 54952
Please note, you may still be contacted by phone to discuss your current plan offerings and may also be contacted in writing about other products and services available to you.
Busting Those Myths on Aging
By Amber Smits, quality revenue and health equity program supervisor
Myth: Growing older means you will have weak, brittle bones.
Reality: Some bone loss is a normal part of aging, but osteoporosis is not.
Osteoporosis is a condition in which bones become fragile and weak because new bone creation doesn’t keep up with old bone removal. Untreated osteoporosis leads to brittle bones making you more susceptible to fractures, height loss of up to 1.5 inches, shortness of breath, hunched posture or low back pain. Unfortunately, osteoporosis is not reversible. Once you have it, the next step is to manage the amount of bone loss you experience. Taking steps to prevent falls and making changes in your diet, activity level and medications can help you to slow or even stop bone loss. Working with your personal doctor helps you make the right decisions for preserving your bone strength.
Myth: Older people should limit physical activity.
Reality: Regular, moderate physical activity keeps your heart and lungs strong.
It can also help you manage stress. Weight-bearing exercises such as walking, can improve both bone health and balance. If you're embarking on an exercise program for the first time, talk with your personal doctor about your general health and health conditions to determine the activities that are best for you.
Myth: Falling is something that happens as you get older.
Reality: Falling is not a normal part of aging.
It’s estimated that one in four adults over the age of 65 will experience a fall every year. Falls may result in broken bones, hospitalization and even death. The good news is that falls can be prevented. Strength and balance exercises, checking your vision, making your living environment safer and managing your medications are easy steps you can take to prevent a fall. If you need help evaluating your medications, call a local Network Health Pharmacist at 888-665-1246 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
Seniors are capable of slowing down the aging process through healthy habits like proper nutrition, physical activity and mental stimulation. That’s why you see so many older adults out walking, at the local gym or exercising in other ways. They also enjoy keeping their brains active through sudoku, crossword puzzles and a variety of other creative, brain-challenging activities. After reviewing these three myths, the most important fact is to partner with your personal doctor during your annual wellness visit to come up with a game plan to stay strong and healthy.
2025 Medicare Changes: How will they impact you?
By Jon Race, Photography courtesy of Insight's Women of Influence 2024 Awards
In April 2024 the Centers for Medicare & Medicaid Services (CMS) published a new rule that will affect Medicare in many different ways. To help ensure Network Health members are informed about the upcoming changes, Coreen Dicus-Johnson – President and CEO of Network Health – sat down for a short interview regarding the changes.
Question: There has been a lot of talk about how Medicare is going to change for 2025. What can you tell us about those changes?
Coreen Dicus-Johnson: Well, this past April, the Centers for Medicare & Medicaid Services, or CMS, published a new rule that affects Medicare in a wide variety of ways. CMS makes changes and adjustments every single year. However, this year’s changes are larger, and we expect they will affect more people.
Q: Exactly what are the changes?
Coreen: There are many parts to this new rule. The changes that will be the most impactful to our Medicare members are 1) the redesigning of Medicare Part D, the prescription drug benefit and 2) the opportunity to use a Medicare prescription drug payment plan.
Q: Are these changes just for Network Health or do they apply to all health plans?
Coreen: These changes are nationwide and will affect all health plan organizations, not just Network Health, and not just here in Wisconsin. The new CMS rule redesigns how Medicare Part D plans work and features the largest changes for Medicare Part D since the plan was created in 2006.
Q: What exactly is changing with Medicare Part D benefits?
Coreen: One of the biggest is the coverage gap, or what we call the donut hole, is going away. The way it works now, in 2024, is when Part D members reach a combined total prescription drug spend of $5,030 between the health plan and Part D member cost, they are responsible for 25 percent of their prescription drug cost until they reach $8,000. This is their out-of-pocket maximum. That is the coverage gap, or the donut hole. That gap is the “space” between $5,030 and $8,000. Once you hit that $8,000 out-of-pocket maximum and “close that gap,” Medicare and Network Health pay the remainder of your cost.
In 2025, the coverage gap goes away. Once a Part D member spends $2,000 in out-of-pocket costs toward their prescription drugs covered under Medicare, the health plan, Medicare and drug manufacturers will pay the rest.
So, in essence, members’ out-of-pocket costs will go from $8,000 a year to $2,000 a year in 2025.
Eliminating the coverage gap is great news for our Medicare Part D members. It means what they will pay in the end is greatly reduced. However, the cost of drugs is going to be paid for differently. Medicare will pay a portion, drug manufacturers will pay a portion and Network Health will pay a portion as well. And due to the new CMS rules, Network Health’s portion will be larger than what it was in 2024.
Q: What does this mean for Medicare Advantage Part D plan coverage as we head into 2025?
Coreen: That’s the million dollar question, isn’t it? What does this all mean? Well, health plan options will always vary by plan and by carrier. But CMS defines a minimum benefit standard that must be met by all health plans. With these new rules, CMS is adjusting that standard, and all health plans are required to comply with these new rules. The details may be different, but the base plans will meet the same standard as required by CMS.
Q: What do all these changes mean for Network Health’s Medicare Advantage and Part D plans?
Coreen: The change is big. And no doubt about it … it’s going to affect a lot of people and a lot of health plans. But at Network Health, our mission is to create strong and healthy Wisconsin communities. These new CMS rules are not going to change that. We will adapt and make changes to ensure we can continue to offer effective and affordable health plans while staying in compliance with these new rules.
We will be here to support our members through this change. This is not the first time significant changes have occurred regarding health insurance. The Affordable Care Act was passed back in 2014 and it completely changed the health insurance landscape. Thousands of people had to switch health plans as insurance plans reduced or left their service areas.
Network Health did not go anywhere. When members were left to find new health plans, Network Health stayed. We made
sure our members kept access to their health plans. And, we’re going to do the same now.
Network Health will continue to serve northeast and southeast Wisconsin just like we have for over 40 years.
Q: Moving on to the second change you mentioned, the Medicare prescription payment plan. What is it and who is affected by it?
Coreen: Starting January 1, 2025, CMS requires all Medicare Part D plans to offer members an option to pay their out-ofpocket prescription drug costs in the form of a capped monthly payment, instead of paying it all at once. It’s just like its name says, it’s a payment plan.
However, the Medicare prescription payment plan does not affect everyone with Medicare Part D. This is an opt-in plan that members can take advantage of if they choose. The plan does not reduce member cost. It is a payment plan allowing members to take what they might owe at the beginning of the year and spread out those costs throughout the year.
Q: Is there anything else you would like to add?
Coreen: For over 40 years, Network Health has been a trusted expert in health plans. A lot has changed over those four decades, and Network Health has remained as dependable and reliable as ever. We provide health plans in 23 Wisconsin counties to over 77,000 Medicare members. We plan on doing the same thing for the next 40 years. The new rules are not going to change that.
Network Health will continue to serve northeast and southeastern Wisconsin just like we have for over 40 years.
Coreen Dicus-Johnson
What Our Members Say About Us
You would think I chose Network Health because I worked there, but that’s not actually true. I did my homework like everybody else does and my neighbors, friends, family, most of them have Network Health. I’ve heard nothing but positive things about their customer service.”
Bev V., Network Health member
That’s all we’ve ever had. I don’t ever want to leave Network Health because we are so totally satisfied.”
Candy L., Network Health member
We like that it’s a local company and the plan itself was exactly what we were looking for. It’s hard to compete with Network Health.”
Ron P., Network Health member
Living and working in the areas we serve allows us to focus on our mission of building healthy and strong Wisconsin communities. In October, members from across northeast and southeast Wisconsin can learn more about the 2025 Medicare Advantage plan benefits at our Experience Network Health events from October 8 through October 23. If you cannot attend, a pre-recorded version will be placed in your member portal. Just one of the many ways that Network Health provides members with the personalized support they need to make informed decisions about their health care.
• Meet your Network Health pharmacy, member experience and care management teams
• Lear n what’s new for Network Health’s Medicare Advantage Plans in 2025
• What your benefits are and how to use them
• Answers to common Medicare Advantage plan questions
• Lear n about resources available to you
Network Health Diabetes Prevention Program
By Sam Clark, community wellness supervisor
Network Health is the first health plan in Wisconsin to offer the Medicare Diabetes Prevention Program (MDPP). This free program is led by the Centers for Disease Control and Prevention (CDC). Classes are offered every other month.
This program consists of a one-year series of facilitator-led group sessions for individuals with prediabetes. There is no cost to the program if you are enrolled in Medicare Parts A and B.
The program focuses on dietary changes, increased physical activity and behavior change strategies. MDPP classes are designed to help individuals make small changes that lead to big differences in their overall health. Program participants may also learn to manage other conditions like high cholesterol or high blood pressure with fewer medications.
The Network Health MDPP program delivers incredible results. To be included in future classes, email NHpreventT2@ networkhealth.com or pre-register at networkhealth.com/wellness/prevent-t2-ma and a Network Health Wellness Coordinator will follow up with you.
Know someone who is enrolled in our commercial or individual and family plans and could benefit from this program?
Network Health also offers a diabetes prevention program, Prevent T2, to our commercial, individual and family plan members as well. Virtual classes are offered twice a year. To learn more, visit networkhealth.com/wellness/prevent-t2
Froedtert ThedaCare Health, Inc. Sole Owner of Network Health
Froedtert ThedaCare Health, Inc. is now the sole owner of Network Health. Froedtert Health and Ascension Wisconsin signed a definitive agreement in which Froedtert Health purchased Ascension’s interest in Network Health. Prior to this agreement, each provider system owned 50 percent of Network Health. On January 1, 2024, Froedtert Health and ThedaCare finalized their agreement to come together as one organization called Froedtert ThedaCare Health, Inc.
We believe the new ownership structure will enable Network Health to provide even better support for our communities and members, presenting further opportunity for us to grow and deliver an exceptional health plan experience.
This ownership change will not disrupt your access to our provider network. Ascension is still an in-network provider.
Great things are on the horizon for Network Health and our members. We look forward to serving you for years to come.
Finding Lower-Co$t Medications
By Anna Peterson Sanders, PharmD, BCGP, pharmacist
Seems like we’ve been stuck in a cycle of ever rising prices and it feels as though nothing is immune to inflation – housing, food, gas, you name it. If you’ve been to your pharmacy, you likely noticed how prices have crept up over time.
Fortunately, there are tools at your disposal that can help to bring down your cost at the pharmacy register.
1. Know your formulary
A formulary is a list of prescription drugs covered by your insurance and includes important information such as tier placement, quantity limits and prior authorization requirements. Review this list with your personal doctor so they can help you choose a lower-cost product in a medication class that has options. The lower the tier, the lower the cost. If you have a Network Health plan with pharmacy benefits, you can find a list of covered drugs at networkhealth.com/look-up-medications.
2. Use your Network Health member portal to price drugs
Sign in at login.networkhealth.com and enter in your medication and zip code. Local, in-network pharmacies will display your coinsurance or copayment for each store. This is a great way to quickly see which pharmacies near you have the best cost options.
3. Websites like GoodRx.com and SingleCare.com
Search your medications to see if you discover a better price than what you find in your member portal. If you do, print the coupon from the website or use a QR or barcode from your smart phone app to present to your pharmacist when picking up your medication in person. Please note that this option does not count toward your deductible since it is a program that works outside of your health insurance.
4. Mark Cuban Cost Plus Drug Company (Cost Plus Drugs)
If you are looking for a lower cost alternative for prescriptions, Cost Plus Drugs is available online only as a mail order pharmacy option at costplusdrugs.com. While this pharmacy doesn’t offer every drug, the ones they include are at a fantastic savings. To keep costs low, registration and communication are done online through Cost Plus Drugs. You must pay the full cost initially out-of-pocket and submit a claim to Express Scripts for reimbursement and credit toward meeting to your deductible. Prescription reimbursement claim forms can be found at networkhealth.com/medicare/pharmacy-information.
5. Do you qualify for a Patient Assistance Program?
Medications like Ozempic®, Jardiance®, Eliquis® and Entresto® have manufacturer sponsored Patient Assistance Programs where Medicare members may qualify for free medication. Visit RxAssist.org to review if your medication has a program available. Program information, qualifications, application and phone number for questions are found on the website. Reviewing if your medication has an assistance program and if you qualify could translate to valuable savings.
6. Are you on insulin?
Through the Inflation Reduction Act, all insulins are $35 for a one-month supply. However, if your prescription is calculated as a 31-day supply, it will cost the same as a two-month supply, or $70. If this happens to you, work with your personal doctor or a local Network Health Pharmacist on how to get the most value out of your prescription. Adjustments such as filling a lesser or greater amount or adjusting how the prescription is written are good options to ask about.
7. Call your local Network Health pharmacist
Reach out to us Monday–Friday from 8 a.m. to 5 p.m. at 888-665-1246 or pharmacist@networkhealth.com. We can help you look at alternative therapies, price out costs and seek assistance.
1570 Midway Pl.
Menasha, WI 54952
Earn Rewards with Our Member Referral Program
Love your Network Health Medicare Advantage Plan? At Network Health, we value the power of community and believe that great experiences are meant to be shared. As a member, we reward you for telling others about Network Health.*
Our Medicare member referral program continues and is very popular. To refer somebody, they must meet the following criteria.
• Have Medicare Parts A and B
• Not cur rently enrolled in a Network Health plan
• Li ve in our service area
If your friend or family member meets these criteria and is looking for a high-quality Medicare Advantage plan that goes above and beyond, have them call our Wisconsin-based sales advisors at 844-850-5284 (TTY 800-947-3529), every day from 8 a.m. to 8 p.m., to let us know you referred them.
You can earn up to four $15 gift cards for a variety of stores each year. Once your referral calls us, we will contact you to choose the gift card you prefer.
*Licensed agents who are appointed with Network Health are not eligible for these gift cards
