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In this issue

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Thank you and welcome to WellSense

We’d like to take a moment to welcome all our new and returning members. Which health insurance you choose is an important decision for both your health and your wallet. We want to thank you for trusting us.

If you have any questions or concerns about your coverage, you can always get the latest information about your benefits at wellsense.org or by calling us at 855-833-8128 (TTY: 711). Thanks again for being the best part of WellSense – our member.

We're glad you're here!

 Coming soon: Your new member portal

We’re excited to announce you’ll soon have a new and improved WellSense member portal to help you manage your health. You’ll be able to access the member portal by downloading the new WellSense mobile app or by clicking the “log in” link at wellsense.org on your computer or phone starting May 1. With the new member portal you can:

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Track your benefits, claims and costs

Easily view your benefits, deductibles and claims so you’re always in the know.

  
Manage your primary care provider (PCP)
Select, confirm or change your PCP and specialists on your device.
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Find care fast
Search for urgent care clinics or pharmacies nearby, so you get the care you need— when you need it.
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Receive personalized health reminders
Stay on top of your health with reminders for checkups and screenings.
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Access your digital ID card
Access a digital copy of your member ID card and upload other health cards, like any you have for dental or vision benefits, so you always have them when you need them.
  • Preventive services
  • Fluoride treatments for members of all ages
  •  Dental sealants for members younger than 21
  • Pain relief and treatment of infections 
  • Fillings and crowns
  • Root canal treatment

Your brain health matters

Most people know the kind of healthy habits that keep you in good general health, like eating right and getting regular exercise, but what about our brains? You might think the most complicated and delicate part of your body might be hard to care for, but it’s surprisingly simple to do so when you focus on small, everyday habits.

Many of the same habits needed to maintain good physical health can also keep your brain healthy. These include staying active, eating nutritious foods, keeping chronic illnesses well-managed and getting quality sleep. There are also more brain-focused habits that can lower the risk of cognitive decline, like keeping your mind engaged on a hobby.

Reading, doing puzzles or playing word games can all help your brain stay healthy. Your brain can also benefit from regular social activity, like spending time with friends or family or participating in regular gatherings, such as faith-based services or board game nights at your local public library.

Another key step is staying on top of your annual wellness visit, which can help you identify any issues you may miss on your own. These yearly check-ups include a quick cognitive screening and are always provided at no cost to you. They’re the best way for you and your doctor to stay on top of your health for both brain and body. Plus, we’re now offering a $25 member reward card just for attending!

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Understanding key insurance terms

Learning some key terms can help you understand how health insurance works. Here’s a simple guide to a few common terms you’ll see when using your WellSense Medicare Advantage coverage.

To learn more about these and other terms commonly used when dealing with health insurance, visit healthcare.gov/glossary or call Member Service at 855-833-8128 (TTY: 711). We’ll be happy to answer your questions.

The amount you pay each month to keep your insurance active, just like a subscription fee. 

The amount you must pay each year for covered health services each year before we start helping with costs. Most WellSense Medicare Advantage plans* have a $0 deductible, so we help with healthcare charges right away.

*If you are enrolled in an Added Value (HMO) plan, you will have a $283 deductible for Medicare Part B services, which includes most routine and outpatient care. If you enrolled in Medicaid in addition to an Added Value plan, your Medicaid plan covers the $283 deductible.

A fixed amount you pay when you receive certain services, such as a doctor’s visit or urgent care. Copays don’t count toward your deductible, but they do count toward your out-of-pocket maximum. 

The percentage of costs you pay for healthcare after meeting your deductible.

Example: If your coinsurance is 20%, you pay 20% of the price we’ve negotiated with your provider for their services, and we pay the other 80%.

The list of prescription medications covered by your plan. The list includes details like how much your copay is or whether you need prior authorization to fill the prescription. 

The most you’ll pay for covered care in a year. After reaching it, we pay 100% of covered services for the rest of the year — no more copays, no more coinsurance. 

Healthcare services meant to keep you healthy and that you should get even if you aren’t sick, like your Medicare Annual Wellness Visit, vaccinations and recommended screenings. These are covered at no cost to you.