Molinalogo

• Getting Care     

  We Want to Give You Good Care!

   

  Senior Whole Health works with your providers to give you good health care. We make choices about your care based on what you need. We also look at your benefits. We do not reward providers to deny you care. We also do not reward staff or other people to deny you care or give you less care. We do not pay extra money to providers or our staff members to deny tests or treatments that you need to get better or stay healthy.

   

  Please call Member Services if you ever have a concern about your health care. You can also talk to our nurses about getting needed care. Our nurse staff is here to take your call 7 days a week (except holidays) during normal business hours. They can answer questions about how we make health care choices.

   

  We also want to remind you that Molina Medicare has a Nurse Advice Line to help answer questions you may have about your health. There are nurses ready to help you 24 hours a day, 7 days a week.

   

  Click here for our frequently asked questions.

• Virtual Care     

  Get expert health care from the comfort of home.

   

  Senior Whole Health is pleased to offer you virtual care through additional telehealth services. You can simply search the Senior Whole Health Provider Online Directory to find a Primary Care Physician who is able to provide services online or over the phone.

   

  Virtual Care means:

   

  • Convenient online or phone visits, from wherever you are.
  • You’re treated at NO COST! Visits are free for Senior Whole Health members.

   

  If at any point your symptoms worsen or you feel like you are experiencing a medical emergency, call 911 or proceed to the nearest emergency room.

   

• Case Management & Complex Case Management     

  Living with health problems and managing them can be hard. We have programs that can help. Case Management is when a trained nurse at Senior Whole Health works with you and your Primary Care Provider (PCP). The nurse will help you get the care you need.

   

  We also have a Complex Case Management program for members with difficult health problems who need extra help with their health care needs. Both programs allow you to work with a nurse. The nurse can help you learn more about your health problems. He or she can teach you how to better manage them.

   

  The nurse also will work with your family or others who help care for you. The nurse will work with your provider to make sure you get the care you need.

   

  There are many ways you can be referred to a program. One way to enroll is through your provider. You also can self-refer to the program by calling Member Services. There are certain requirements that you must meet.

   

  This program is voluntary and is offered at no cost to you. You can choose to be removed from the program at any time.

• Care Coordination     

  Care Coordination is a service for any adult or child who is receiving health services for an ongoing health problem. This health problem can be either physical or mental.

   

  A Care Coordinator’s job is to:

   

  • Help you find services that are not benefits. This could be physical therapy with the schools or "Meals on Wheels".
  • Help you access services that you are eligible to receive.
  • Help coordinate appointments and tests.
  • Help coordinate transportation.
  • Help access resources to help individuals with special health care needs and/or their caregivers deal with day to day stress.

   

  How can I help my Care Coordinator help me?

   

  Write down your questions. This will help you remember things when you have a lot to talk about.

  Tell your Care Coordinator about all your appointments and tests. Not being aware of all the details of your case can make it harder for your Care Coordinator to help you.

   

  If you feel that you need emergency treatment, please get help first or call 911.

• Caregiving     

   

  Caregiving is the act of giving help to someone to keep them safe and healthy in their home. A caregiver can be a family member, friend, or neighbor. Caregiving needs can be both planned and unplanned.

   

  Unplanned caregiving needs can happen in times of:

   

  • An unexpected surgery
  • An unexpected health issue such as a stroke

   

  Planned caregiving is when a health issue or surgery is known before. In the most common cases, caregivers are needed to help a member with a long-term sickness or to support those who cannot handle some part of their daily needs without help. For Medicare members, many often want to age-in-place in their own home. Having a part-time or full-time caregiver can help them.

   

  Many caregivers and members want to talk to Molina Healthcare about benefits or making health care choices. There are levels of forms and approvals based on what the caregiver needs to do. Some of these forms come from the state.

   

  Protected Health Information From HIPAA: The member or their Personal Representative can complete this form. This lets Molina share PHI but does not require them to do so.

   

  Appointment of Representative Form (CMS-1696): An appointed representative is a family member, friend, doctor or other person approved to act on your behalf in filing a grievance, coverage determination or appeal.

   

  If you would like to appoint a representative, you and your appointed representative must complete this form and mail it to Molina Healthcare at:

   

  Molina Healthcare
  Attn: Service Fulfillment
  200 Oceangate Ste 100
  Long Beach, CA 90802

   

  Durable Power of Attorney: If a member needs help in making health care choices, they should fill out the Durable Power of Attorney form for their state, which can be found here.

   

  This information does not, and is not intended to, constitute legal advice. Readers of this information should talk to a lawyer to get help about any legal matter.

   

  For more help about caregiving, including a caregiving checklist, and forms, visit MolinaCaregiving.com.

   

  Local support for members and caregivers can be found at findhelp.org and care.com.

   

• Molina Guided Care     

   

  Guided Care is a type of specialized health care that focuses on you and your serious illness or condition, such as:

   

  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure (CHF)
  • A combination of serious conditions like diabetes or stroke

   

  Our focus is to reduce pain, stress, and confusion.

   

  Members who begin Guided Care can see:

   

  • Improved symptoms
  • Reduced hospitalizations
  • Fewer unnecessary or unwanted treatments
  • Support for both the member and their family and caregivers

   

  In short, we want to give you and your family the best quality of life possible.

   

  Guided Care may be available to those who have Medicare Advantage or who have both Medicare and Medicaid, also known as D-SNP (Dual Eligible – Special Needs Plan).

   

  Your primary care physician (PCP) can refer you to a Guided Care provider. Talk to your PCP if you or someone you care about has a serious illness or condition. Your PCP can tell you if it would be helpful to start Guided Care.

   

  Sometimes a member is not able to make the decision to start Guided Care themselves. In these cases, a family member or caregiver may need the member’s approval to make healthcare choices.

   

  There are forms and approvals based on what the caregiver needs to do. Some of these forms come from the state.

   

  Protected Health Information Form: The member or their Personal Representative can complete this form. This lets Molina share PHI but does not require them to do so.

   

  Appointment of Representative Form (CMS-1696): An appointed representative is a family member, friend, doctor or other person approved to act on your behalf in filing a grievance, coverage determination or appeal.

   

  If you would like to appoint a representative, you and your appointed representative must complete this form and mail it to Molina Healthcare at:

   

  Molina Healthcare
  Attn: Service Fulfillment
  200 Oceangate Ste 100
  Long Beach, CA 90802

   

  Durable Power of Attorney: If a member needs help in making health care choices, they should fill out the Durable Power of Attorney form for their state, which can be found here.

   

  This information does not, and is not intended to, constitute legal advice. Readers of this information should talk to a lawyer to get help about any legal matter.

   

  For more information about Molina Guided Care, visit MolinaGuidedCare.com.

   

  Local support for members and caregivers can be found at MolinaHelpFinder.com.

   

• Non-Emergency Medical Transportation     

  Senior Whole Health Medicare Choice Care (HMO), Senior Whole Health (HMO D-SNP) and Senior Whole Health NHC (HMO D-SNP)

   

  You can get a ride to your health care appointments such as office visits, physical therapy, dialysis or to pick up prescriptions at your local pharmacy. If you have recurring appointments, these can be scheduled ahead of time..

   

  Senior Whole Health Medicare Choice Care (HMO)

   

  Transportation Reservation Number: (877) 375-0041 (TTY: 711), 24 hours a day, 7 days a week.

   

  Senior Whole Health (HMO D-SNP) and Senior Whole Health NHC (HMO D-SNP)

   

  Transportation Reservation Number: (877) 375-0041 (TTY: 711), 24 hours a day, 7 days a week.

   

  Things to remember:

   

  • It is important to call 2 calendar days in advance of your appointment to schedule the transportation.
  • If you need to cancel your transportation services, please call 24 hours in advance of your appointment.
  • If you require special assistance such as wheelchair accessible, please mention that when making your appointment so the most appropriate transportation can be arranged.
  • You will need prior authorization if you travel over 100 miles for a one-way trip.

   

  Molina Medicare Complete Care (HMO D-SNP) does not offer Non-Emergency Medical Transportation.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   
• Supplemental Dental     

  Senior Whole Health Medicare Choice Care (HMO)

   

  In general, preventive dental services (such as cleaning, routine dental exams, and dental x-rays) are not covered by Original Medicare.

   

  We cover additional dental benefits that Original Medicare does not cover.

   

  These benefits are detailed separately below under the Dental services (Supplemental) category.

   

  Supplemental dental services covered include, but not limited to:

   

  Routine Preventive dental care:

   

  • Oral Exams: 2 visits every year
  • Prophylaxis: 2 visits every year
  • Fluoride Treatment: 2 visits every year
  • Dental X-rays:

   

  Members can receive one of the following per calendar year:

   

       − Up to 4 bitewings (D0272/D0274) OR

       − Up to 6 periapicals (D0220/D0230) OR

       − Up to 1 panoramic (D0330) every 5 years

   

  To find an in-network routine preventive dental provider close to you can:

   

  Search online – using our supplemental dental provider online search tool at https://www.dentaquest.com/en/find-a-dentist.

   

  In addition, if you choose to utilize a provider that is not in network, or, if you have additional dental needs above and beyond the routine preventive dental care, you have a benefit allowance for any dental needs that are not covered by Medicare and/or Medicaid. This benefit allowance will be loaded to your MyChoice card at the start of your benefit period.

   

  The MyChoice card is not a credit card. You cannot convert the card to cash or loan it to other people. Cosmetic procedures are not covered under this benefit card. Funds are loaded onto the card on each benefit period (annually). At the end of each benefit year, any unused benefit allowance will not carry over to the following period or plan year. If you leave the plan any unused allocated funds revert to the plan upon your effective disenrollment date.

   

  MyChoice Card allowances may only be used to access the specified supplemental benefit up to the defined limit. This allowance may only be used by the members and may not be applied to any other benefit or cost.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   

  Senior Whole Health (HMO D-SNP) and Senior Whole Health NHC (HMO D-SNP)

   

  Get preventive dental care and select comprehensive care through Medicaid (MassHealth).

   

  Senior Whole Health Medicare Choice Care Select (HMO) does not offer Supplemental Dental benefit.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   

• Supplemental Vision     

  Senior Whole Health (HMO D-SNP),Senior Whole Health NHC (HMO D-SNP) and Senior Whole Health Medicare Choice Care (HMO)

   

  We have partnered with a Vision Vendor to give you more value for your routine vision needs!

   

  Supplemental Vision services covered include, but not limited to:

   

  • One routine eye exam every calendar year
  • An eyewear allowance

   

  You can use your eyewear allowance to purchase:

   

  • Contact lenses*
  • Eyeglasses (lenses and frames)
  • Eyeglass lenses and / or frames
  • Upgrades (such as, tinted, U-V, polarized or photochromatic lenses).

   

  *If you choose contact lenses, your eyewear allowance can also be used to pay down all or a portion of your contact lens fitting fee. You are responsible for paying for any corrective eyewear over the limit of the plan’s eyewear allowance.

   

  You pay $0 for up to one routine eye exam (and refraction) for eyeglasses every calendar year. You have an eyewear allowance every calendar year.

   

  For your routine eye exam, to find an in-network routine preventive vision provider close to you can:

   

  Search online – using our supplemental vision provider online search tool at MolinaHealthcare.com/Medicare

   

  Supplemental benefits are offered by the plan to help with items or services that are generally not covered by Medicare. All benefits must be used in the plan year and are only available if you are enrolled at the time services are rendered.

   

  Senior Whole Health Medicare Choice Care Select (HMO) does not offer Supplemental Vision benefit.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   
• Over-the-Counter (OTC) Benefit     

  Senior Whole Health Medicare Choice Care (HMO) and Senior Whole Health Medicare Choice Care Select (HMO)

   

  You have an allowance on your Healthy You card each quarter for non-prescription OTC health and wellness items like vitamins, sunscreen, pain relievers, bandages, and cough and cold medicine.

   

  You can use your MyChoice card:

  • In Store: Through participating retail locations.
  • Online: Visit NationsOTC.com/Molina
  • By Phone: Call (877) 208-9243 (TTY: 711) to speak with a NationsOTC Member Experience Advisor, 24 hours a day, 7 days a week, 365 days a year.
  • By Mail: Fill out and return the OTC Order Form in the OTC Product Catalog.

   

  Things to remember:

  • You can visit flex.molinahealthcare.com for information about your Healthy You card.

   

  Senior Whole Health (HMO-D-SNP) and Senior Whole Health NHC (HMO D-SNP)

  You have an allowance on your Healthy You card each quarter for non-prescription OTC health and wellness items like vitamins, sunscreen, pain relievers, bandages, and cough and cold medicine.

   

  You can use your Healthy You card:

   

  • In Store: At select participating retail locations.
  • Online: Visit www.mybenefitscenter.com
  • By Phone: Call (888) 794-7268 (TTY: 711) Monday to Friday, 8 a.m. to 7 p.m., EST.
  • By Mail: Fill out and return the OTC Order Form in the OTC Product Catalog.

   

  Things to remember:

  • You can visit www.mybenefitscenter.com for information about your Healthy You card.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   

• The Silver&Fit® Fitness Program     
  The Silver&Fit® program offers you access to participating fitness centers and/or a Home Fitness Kit.

   

  If you have a caregiver, you can bring them with you to help you use the fitness center’s services and equipment.

   

  There are two ways to start using your Silver&Fit benefit:

   

  • Go to SilverandFit.com. After registering on the website, you can find fitness centers, pick a Home Fitness Kit, and search for online classes.
  • Call Silver&Fit customer service at (877) 427-4711 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m., local time, excluding holidays.

   

  Molina Medicare Complete Care (HMO D-SNP) does not offer Silver&Fit® Fitness Program benefit.

   

  To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

   
• Healthy Actions Program     

  Senior Whole Health wants to help you reach your best health! As a member of SWH, you can receive rewards for completing healthy actions throughout the year. We want to help encourage you on your path to well-being!

   

  All you must do is:

  • Complete your healthy actions between 1/1/2024 - 12/31/2024
  • Claim your rewards by 1/31/2025

   

  WHAT ARE HEALTHY ACTIONS?

   

  Healthy actions are preventive and wellness visits with your doctor. You and your doctor can discuss a personal care plan based on your health needs. Although routine care visits cannot prevent health problems, they can help detect illnesses before they become more serious.

   

  WHICH HEALTHY ACTIONS CAN I COMPLETE?

   

  The grid below shows a list of health screenings that are available for SWH members. Talk with your doctor to determine which screenings are right for you.

   

  Screening	Description
  Annual Wellness Visit	Yearly check up with your doctor to create a preventive care plan.
  Blood Pressure Screening	Blood pressure screening completed by your doctor for adults ages 18-85 diagnosed with hypertension.
  Breast Cancer Screening	Mammogram to check breast tissue for breast cancer in women ages 50-74.
  Colon Cancer screening	Screening (fecal occult blood test, flexible sigmoidoscopy, colonoscopy, computed tomography colonography or stool DNA test) to check for signs of colon cancer in adults ages 50-75.
  Diabetes A1c Test	Blood test to check your blood sugar levels for adults ages 18-75 with diabetes.
  Diabetes Eye Exam	Yearly exam with your eye doctor to check the health of your eyes for adults ages 18-75 with diabetes.
  Diabetes Kidney Health Evaluation	Both urine and blood tests completed by your doctor to check the health of your kidneys for adults aged 18-85 with diabetes.
  Flu Shot	Yearly vaccine to lower your chances of getting seasonal flu.
  Osteoporosis Management	Noninvasive bone density screening for women ages 67-85 to check the strength of your bones after a fracture.

   

  WHO DO I COMPLETE MY HEALTHY ACTIONS WITH?

   

  Call your doctor to schedule a visit. You can find a doctor online using the Find a Provider tool at MolinaHealthcare.com or your My Senior Whole Health portal. You can also call the Health and Wellness Line at: (833) 671-0428, TTY: 711, Monday – Friday, 8 a.m. to 5 p.m., local time, for assistance.

   

  HOW DO I CLAIM MY REWARD?

   

  You can claim your reward by:

   

  Mail – You will receive an attestation form to your mailing address which you can fill out and send back to us; no postage is required.

   

  Phone – Call the Health and Wellness Line at: (833) 671-0428, TTY: 711, Monday – Friday, 8 a.m. to 5 p.m., local time.

   

  THINGS TO KNOW ABOUT YOUR REWARDS

   

  Your rewards will be loaded onto your Healthy You Card.

  
  

  Use your earned rewards to buy healthy food and produce at the same stores that already take Healthy You.

  
  

  Find participating stores at MyBenefitsCenter.com. Visit your My Senior Whole Health portal to get more information.

  
  

  This incentive is for in-store use only. You cannot use this incentive online.

  
  

  The rewards stay on your Healthy You card in the incentives purse as long as you are a SWH member. Renewing members will have their incentives roll over into their new plan year.

  
  

  If you leave SWH and you have incentives dollars left in your purse, you have the option to receive a CVS gift card.

  
  

  Watch a video at SWHFlexcard.com to learn more.

  
  

  Rewards are awarded for healthy actions completed between January 1, 2024 – December 31, 2024. You can earn only one reward this year for each eligible completed screening.

  
  

  Senior Whole Health’s reward program is subject to change without notice based on guidance from the Centers for Medicare and Medicaid Services (CMS) and the state.

  
  

  If you have questions or need help, please call the Health and Wellness line at (833) 671-0428, TTY: 711, Monday – Friday, 8 a.m. to 5 p.m., local time

   

• 24-Hour Nurse Advice Line     

  Senior Whole Health Medicare's Nurse Advice Line has highly trained nurses that can help you 24 hours a day, 365 days a year.  They can help you decide what to do to get your family feeling better fast. A nurse can help you decide if you or your child should see a provider right away. There are times where you have questions, but you do not think you need to see your provider. We can look up health information from a trusted source and provide recommendations based on symptoms Call the Nurse Advice Line. You can talk to a nurse in your language about any health problem. Our Nurse Advice Line receives more than 500,000 health advice calls from Senior Whole Health Medicare members across the United States every year.

   

  Our call center has been reviewed and approved by a national quality review organization (URAC) since 2007. They will help you 24 hours a day, 7 days a week.

   

  Senior Whole Health (HMO-D-SNP) and Senior Whole Health NHC (HMO D-SNP): (888) 794-7268

   

  Senior Whole Health Medicare Choice Care (HMO) and Senior Whole Health Medicare Choice Care Select (HMO): (833) 685-2108

   

  For the deaf and hard of hearing, please call TTY: 711

  

   

• Sexual and Reproductive Health     

  Senior Whole Health is here to help you with your sexual and reproductive health. Your MassHealth (Medicaid) coverage pays for things like:

   

  • Testing and treating for infections passed through sex
  • Birth control to stop pregnancy
  • Family planning

   

  Learn more about the sexual and reproductive services MassHealth covers at MassHealth Sexual and Reproductive Health Services for Members. This page is in six languages: English, Chinese, Haitian Creole, Portuguese, Spanish and Vietnamese.

   

• Other standard benefits     

  Check your Member Materials and Forms to see all the standard benefits offered by Molina Medicare.

   

For more information or if you have questions, please call Member Services.