When you’re feeling under the weather and need your prescription filled, there is something said for speedy service that is professional and above all: caring. Chances are, you’ve spent more time than you wanted to in the waiting room at your doctor’s office.
You don’t feel well, and the last thing you want to do is stop somewhere else to fill your prescriptions. All of it is enough to make you want to call your mother to come take care of you. Well, that’s exactly what the folks at OC Pharmacy had in mind when they opened for business.
We’ve covered OC Pharmacy in the past, however, this issue is a little bit different. This fall, OC Pharmacy has teamed up with Merrill Insurance Services, two small businesses that call South Orange County their home, to help our seniors better understand and navigate one of the most complicated life events: signing up for Medicare.
You may thinking, “that’s not hard at all, I was auto-enrolled without doing a thing and have had that plan for years!” If you’re one of those people then you are in for a surprise.
Medicare plans are not great at communicating. What they don’t tell you is that your plan may change every year. The plan that you currently have is supposed to inform you of any changes, but it’s usually by mail and either gets lost or tossed out with the junk mail. OC Pharmacy and Merril Insurance have always had great communication and a common goal to help our senior population. Now we are taking it to the next level by helping seniors nail down the best plan for 2016.
This fall, OC Pharmacy began offering free Medicare prescription drug plan (PDP) reviews to the community seniors. You don’t have to be a current OC Pharmacy patient to participate, just call them up to make an appointment. They will sit down with you, verify your medication list, and review your Medicare drug coverage for 2016 and what your options are, all at no cost to you. You’ll be able to see exactly how much you will pay out of pocket for things like co-pays. You’ll know ahead of time whether a medication will need a pesky prior-authorization come January so OC Pharmacy can prepare for it now instead of in January when the medical industry is in a frenzy adjusting to all the new changes that come annually. You can even see which plans will try to force you to switch to their mail order services, or even worse, to CVS!
Now, the drug portion of your Medicare plan is only one part of your whole multi-part Medicare coverage. To keep it simple, think of Medicare as two portions: (1) Drug coverage, and (2) Medical coverage. Of course, there is more to it than just those two segments, but those 2 will probably impact you the most: your medical coverage determines what doctors you can see, what hospitals you can go to, what your office-visit co-pays are, etc. and your Drug coverage determines what drugs you’re allowed to take, when you’re allowed to take them, and your co-payment amounts. While OC Pharmacy doesn’t have the necessary tools to help you with the medical coverage portion of your plan, Merrill Insurance Services can help you identify the best medical coverage for you.
For this issue, we sat down with Omeed Askari from OC Pharmacy and Denice Merrill from Merrill Insurance Services to answer some questions about Medicare Enrollment:
Sorbet: When should seniors start thinking about scheduling their appointments with OC Pharmacy and Merrill Insurance Services?
Merrill Insurance Services: NOW is the time to call. Get in this month The deadline to make changes is Dec 7th.
Sorbet: Why should a person contact your agency “Merrill Insurance Services, Inc” rather than using their Financial Planner, Auto Insurance Provider, or a general Insurance Broker?
MIS: Merrill Insurance Services, Inc. focuses on Medicare choices exclusively, not a shop that tries to do multiple insurances. Look for a “Medicare Broker” and ask this question specifically! We are Medicare Brokers which means we are licensed to represent a large variety of plans in your area.
This fall, OC Pharmacy began offering free Medicare prescription drug plan (PDP) reviews to the community seniors. You don’t have to be a current OC Pharmacy patient to participate, just call them up to make an appointment.
Sorbet: Why is the system so complicated?
OC Pharmacy: Medicare used to be a lot easier to handle when it was a single-payer, federal-run insurance system. Medicare was semi-privatized under the Bush jr. administration in 2003 under the “Medicare Modernization Act”. This meant that private insurance companies would create Medicare departments, with their own rules, payment structures, etc. This change really complicated things, and made them more expensive, for seniors as well as doctors and pharmacists. We all lost. Only the insurance companies gained.
Sorbet: Other than contacting you to get enrolled for 2016, what can patients do to make the Medicare part of their life simpler?
OCP: Unfortunately, Medicare is very political. The only way to effect change in Medicare is to contact your elected officials. Luckily, at OC Pharmacy, we have a political expert to navigate the field. We can help you deliver a decisive message to your representatives. We need to do this as a community; we need to tell our representatives they’ve lost our votes if they don’t take the greed out of Medicare. Private companies are setup to make a profit, and it seems wrong to us at OC Pharmacy that insurers should take advantage of our retired seniors like that. Now is the time to make your voices heard! If you live in San Juan, your Reps are either Dana Rohrabacher or Darrell Issa. It’s also important to reach out to our California Senators, Barbara Boxer and Dianne Feinstein.
At the moment no other brokerage in the area is offering this type of partnered-service like OC Pharmacy and Merrill Insurance Services.
Sorbet: As a patient, what is the most effective way to contact my elected official?
OCP: Great question. The best method is a bit old school: writing a letter. All you need to do is write a letter addressed to your representative, but send that letter to your local newspaper’s editor. Staffers from the offices of elected officials put together a daily report showing any editorials from the top newspapers in their district. For example, trying to reach Rep. Darrell Issa of San Juan (District 49)? Send a letter to the editor at the Capistrano Dispatch. Trying to catch Senator Boxers attention? Send a letter to the editor at the OC Register. So few people do that these days that your letter is bound to be published and end up on your representative’s desk the following morning!
Sorbet: Why not use Merrill Insurance Services for selecting both the prescription drug portion and the medical portion of a Medicare plan?
MIS: OC Pharmacy is doing something that other pharmacies have never done which is to pro-actively gather the seniors list of medications from history and help to provide choices that would help them to stay with their local pharmacist. Research has shown that seniors that utilize a local pharmacy with personal contacts are more likely to take their medications regularly and overall have better success.
Sorbet: Omeed, why should seniors use Merrill Insurance Services instead of enrolling in a new plan with you?
OCP: While we’re able to help a patient enroll through the whole process, when it comes to the Medical coverage portion of a Medicare plan we just don’t know enough in the pharmacy. Denice and Stephen at Merrill Insurance Services have many years of experience navigating Medicare plans and they are experts when it comes to enrolling a patient in their Medical coverage plan.
Sorbet: Denice, can you explain what a preferred pharmacy is?
MIS: OC Pharm is a “Preferred Pharmacy” with many Medicare plans and this is going to become an even more important aspect as our Medicare benefits change over the next few years. “Preferred” status allows for seniors to get their medications locally at a lower cost.
Sorbet: Omeed, how can your joint-services with Merrill Insurance Services make the enrollment process easier for patients?
OCP: When we know the plan details in advanced of the 2016 effective date, OC Pharmacy can pro-actively call the doctor’s office directly to discuss medications that may be equivalent or alternatives in cases where a medication may be very costly and look for lower cost options.
Sorbet: Why come to Merrill Insurance Services and OC Pharmacy over other brokers and pharmacies offering similar services?
MIS: At the moment no other brokerage in the area is offering this type of partnered-service like OC Pharmacy and Merrill Insurance Services. The insurance industry has changed significantly over the last few years and unless you have a broker that really knows Medicare, you can be lead down the wrong path. Some insurance agents only work with or for one company you’ll only hear how great that company’s benefits are, but not know if there may be better alternatives especially when it comes to medications.
Sorbet: How do Medicare Plans come up with the co-pays amount?
OCP: Every Medicare insurance plan has different costs on the medications they cover. This is called a formulary. OC Pharmacy and Merrill Insurance Services review all plans in your area to help you make the decision that best fits your needs. This is where Merrill Insurance Medicare Brokers & OC Pharmacy staff members will work together to help seniors to find their best solutions for 2016!
Sorbet: So what do seniors need to do to get started?
OCP: Just call us at (949) 429-5102, ask for Sarah, and schedule your Medicare Enrollment Review today!