Health News

Manatee counselors ready to run Medicare comparisons

MANATEE -- When your wife is a counselor with Serving the Health Insurance Needs of Elders, also known as SHINE, one of the perks is that she will run your Part D drug plan comparisons for you each year.

"She checks to make sure I'm getting the best deal," a smiling Perico Island resident Bob LaMastro, 77, said of his wife, Sue.

Besides scrutinizing numbers for her husband, Sue LaMastro has helped thousands of other seniors in Manatee County over the last 12 years who have sought out her one-on-one Medicare counseling or attended one of her roughly 20 annual Medicare presentations.

LaMastro, who turned 65 in May, is extremely busy right now since Medicare Open Enrollment runs Wednesday through Dec. 7.

For those who have never heard of it, SHINE, according to LaMastro, is a free, volunteer-based health insurance counseling program administered through the Area Agency on Aging by the Florida Department of Elder Affairs. There are eight SHINE counselors in Manatee County, including LaMastro.

"We are dedicated, professional, nonpartisan volunteers who help seniors navigate through the health insurance system," Sue LaMastro said.

LaMastro is a passionate advocate for SHINE.

"Your choice of Medicare plans and how you will access that coverage is as important as estate planning," LaMastro said. "I tell people do not make the choice based on information you hear in the gym or on the grocery line.

"Shine counselors are trained volunteers who live and work in your community," she added. "We have data specific to your county."

LaMastro warned against solicitors during the enrollment period.

"Get ready for the unsolicited phone calls and the papers stuffing your mail boxes and even some that look 'official,'" she said. "Do not make this decision on what a salesman convinces you is the right one. We do not sell anything. We provide the information and guidance to empower you to make the correct choice for you. Indeed it may even be different than your spouse's."

Key decisions to be made

Dani Donohue, a SHINE liaison in the Tampa area, also wants seniors to realize there is help out there to understand Medicare.

"My thoughts are that everyone should take time to review their plans," Donohue said Monday. "Not only do the plans change each year, we change and our needs change from year to year.

"SHINE counselors talk to many Medicare beneficiaries that have to choose between paying their mortgage, purchasing life-sustaining medications and food," Donohue added. "This makes Medicare choices supremely important. Many people are overwhelmed, but SHINE is here to help ease the burden."

SHINE provides free, unbiased counseling, Donohue said.

"SHINE can help by assisting with applications for financial assistance programs such as the Medicare Savings Program, which pays the client's Part B premium and Extra Help, which lowers their co-pay on prescription drugs," Donohue added.

Sue LaMastro says 10,000 people in America turn 65 every day, which is the eligibility age for Medicare.

Bob LaMastro turned 65 in 2002. Back then, there was no Part D for prescription drugs in Medicare and LaMastro, as did others, paid out of his pocket for his drugs, which included medicine for his high blood pressure and cholesterol.

Medicare paid 80 percent of his doctor bills. Medicare also paid his hospital bills except for a $1,000 deductible, Sue LaMastro said.

Since he could afford it, Bob LaMastro, a retired doctor, purchased a supplemental plan for the co-pays and deductibles that Medicare does not pay, covering 100 percent of his hospital and doctor, but not drugs.

The plan, AARP Plan F, cost him about $150 per month in 2002 and has since gone up to about $224.

Sue LaMastro says getting the supplement is a good idea if the client can afford it.

"It's just like homeowner's insurance," Sue LaMastro said of the Plan F supplement. "A senior who has a $90,000 open heart surgery can easily pay at least $5,000 out of pocket by the time everything is added up. Plan F picks that up."

Bob LaMastro's health was good when he was 65.

"But things happen and we don't stay 65 forever," Sue LaMastro said.

Shortly after he turned 67, LaMastro had a cancerous kidney removed, and, four months later, open heart surgery,

"We didn't have to pay any deductibles," Sue LaMastro said. "We just took the two cards, Medicare and AARP, and everything was covered.

"During that time we still had to pay for all of Bob's drugs," LaMastro added.

On Jan. 1, 2006 the Part D, which provides Medicare drug coverage, became law. Part A of Medicare is hospital coverage, Part B is doctor expenses. Part C is managed care and Part D is drugs.

Drugs is where Medicare got confusing, Sue LaMastro said.

"People ask me, 'Am I getting the best price for my drugs?'" LaMastro said.

She puts all their information into a Medicare computer and puts on screens to check many aspects.

Sue LaMastro uses her husband as an example.

"First, we checked the changes booklet that arrived in late September from Bob's 2014 insurance company," LaMastro said. "I then counseled Bob and did a comparison, using his present plan and two of the cheapest annual drug cost plans that were on the market.

"After comparing preferred and participating drugstores and tier levels of his drugs, I arrived at the result -- which said he needed to change plans."

What happened is that some of her husband's drugs, which were all tier 1 in 2014, had changed to a tier 2, which resulted in an increase in co-pays.

"It's easy for Bob to have made a critical mistake, because he, like many others, just checked the increase in the monthly premium as opposed to checking the tier movement of his drugs along with the super discount he would get using a preferred drugstore," LaMastro said.

For example, the drug Nifedepine, which is a high blood pressure medicine, had a $0 co-pay for tier 1 under his old insurance in Walgreens in 2014.

But now, in 2015, it is a tier 2 drug that has a $29 co-pay for three months' supply in his old insurance, LaMastro said.

"But I found if Bob chooses the plan I recommend, he will be able to go to CVS and still pay $0 for his three-month supply because CVS is a preferred drug store in this plan and Walgreens is only a participating drug store. Bottom line, Bob's annual drug costs, including premium, deductible and co-pays in CVS is $374.40."

However, if Bob LaMastro remained with his prior plan and used CVS his same drugs in a plan that does not even have a deductible will cost him $2,262.40.

Sue LaMastro will be giving a presentation on Medicare from 1-3 p.m. Tuesday at H2U -- Health to You, under the umbrella of Blake Medical Center -- at 6670 Cortez Road W.

To make an appointment with LaMastro or one of the other seven SHINE counselors, call 1-800-336-2226 and request a Manatee County SHINE volunteer.

Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.