Manatee’s Medicare devotees face 2017 open enrollment

People ask Manatee County Commissioner Carol Whitmore for her opinion on all sorts of topics, from global warming to chickens in backyards.

But a constant request Whitmore gets this time of year is from citizens facing Medicare choices, who ask her: “Should we sign up for traditional Medicare during open enrollment, or go with a preferred provider organization or health maintenance organization, and do we really need to spend time researching our favorite drug stores for the drug plan?”

“My answers,” Whitmore says, “are that, from my perspective, I think traditional Medicare is best because if you have a PPO or HMO, you have to stay in your network, which could be a problem if you travel. As far as their drug plans, I tell them, ‘Yes, you have to shop.’ ”

Whitmore is getting hit with questions now because Manatee County residents who are on Medicare or turning 65 or on disability are facing the annual Medicare open enrollment, which runs from Oct. 15 to Dec. 7.

Changes and choices they make, which could save them thousands of dollars, go into effect on Jan. 1, 2017.

SHINE can help people make the choices

Fortunately for Manatee County’s Medicare clients, there is a free organization willing to help them make Medicare choices. The organization is Serving Health Insurance Needs of Elders or SHINE, which is part of the Florida Department of Elder Affairs.

SHINE is presenting 11 “Medicare Enrollment Education” workshops from Thursday through Nov. 14. All are free and open to the public with no reservations needed.

The first workshop is 10-11 a.m. Thursday at the Bradenton Central Library, 1301 Barcarrota Blvd. W., Bradenton.

Sue LaMastro, the Manatee County coordinator for SHINE, leads a fully trained team of workshop leaders in Manatee County that numbers roughly nine.

“We will try to answer all of your questions,” LaMastro said.

How Medicare breaks down

Traditional Medicare has a Part A and Part B. Part A covers hospitals and nursing homes; Part B covers doctors, outpatient surgery, durable medical equipment, and other items in that vein. Since traditional Medicare does not cover drugs, most people buy a Medicare-approved Plan D, which is sold by individual, private insurance companies.

Right now in Manatee County, about 20 individual, private insurance companies are selling Part D plans, LaMastro said.

But a managed care plan, otherwise known as an HMO or a PPO, might be best for some people who find that their favorite doctors are in the plan. The managed care plans are actually a combination of a Part A hospital coverage, a Part B doctor and outpatient, and a Part D drugs. If people chose the managed care plan, they do not need to buy a separate drug plan.

Most people who choose traditional Medicare also buy a Medicare supplemental plan that covers additional costs from Part B. People who are in a managed care plan can avoid the supplemental plan that people get in traditional Medicare.

“People say to me, ‘Carol, if I go through an HMO or PPO, I don’t have to pay the supplemental,’ ” Whitmore said. “But I tell them that then they are trying to find doctors on their list, and if you go out of state it is really difficult. I have the mind-set that no insurance company will tell me where to go. I tell them, ‘If you can afford the supplement, make the choices yourself. Traditional is the best option.’ ”

Whitmore’s fellow Manatee commissioner, Larry Bustle, is 81 and has been on traditional Medicare for many years. His wife, Edie, turns 81 in December. Bustle is retiring from office on Nov. 23.

“I can go anywhere that accepts Medicare,” Bustle said of his choice for traditional Medicare.

But Bustle said he encourages seniors like himself to really educate themselves on all aspects of Medicare in regard to their personal situations.

“I absolutely encourage people to understand what is coming up with open enrollment,” Bustle said.

The importance of checking drug plans

LaMastro often uses the case of her husband, Robert LaMastro, when she explains the importance of choosing the right drug plan.

If the 79-year-old LaMastro does absolutely nothing in this year’s open enrollment, essentially rubber-stamping the plan he was on in 2016, he will pay about $1,400 in 2017 for his drugs, his wife said.

But there is a plan available in 2017 that will lower his drug cost for the entire year to $380.

If he doesn’t catch this, he will lose roughly $1,020.

LaMastro’s situation is a striking example of why tens of thousands of dollars are lost by thousands of Manatee County Medicare recipients who simply do nothing during open enrollment, said Sue LaMastro.

“Statistics tell us that only between 10 to 15 percent of Manatee Medicare recipients actually make changes during open enrollment, and the rest just glance at the changes and close the book,” said Sue LaMastro, who is her husband’s secret weapon for choosing the right plan.

Robert LaMastro’s drug plan choice is a very typical situation many Manatee seniors will face, his wife said.

“When I did the comparison, I found that if he stayed on the plan he was on he would actually be paying about $1,400 a year, which includes the co-payment at the drug store and his monthly premium,” Sue LaMastro said. “But I found another plan that will serve him very well. He just needs to change drug stores and, if he does that, his drugs for the whole year will cost $380.”

So, he is saving more than $1,000 simply by switching drug stores? Why?

“In his case, he was going to CVS, but now he will be going to Walgreens,” Sue LaMastro said. “Why? Because CVS is just a participating drug store in this other plan, but Walgreens is a preferred drug store. So, not only do clients have to think about what tier their drugs are, what company they want to go with, but also what drug store because it makes a big difference whether you use a preferred drug store or just a participating drug store.”

Since the Medicare Part D drug plan came into effect in the mid-2000s, Robert LaMastro has flip-flopped between CVS and Walgreens three times, his wife said.

“Out of Manatee County’s 20 drug plans, the drug stores flip-flop all over,” Sue LaMastro added.

You can also research all the plans available in your county at www.Medicare.gov.

This story was originally published October 10, 2016 at 4:24 PM with the headline "Manatee’s Medicare devotees face 2017 open enrollment."