Manatee's Medicare counselors set to help enrollees

MANATEE -- Medicare's open enrollment for Manatee County seniors begins Thursday and runs through Dec. 7, which means Bradenton's Sue LaMastro and her squad of 10 counselors are getting ready.

LaMastro, who often says, "the devil is in the details," when it comes to analyzing annual Medicare plans, has been a Medicare counselor for 13 years and is the Manatee County coordinator for SHINE, which stands for Serving Health Insurance Needs of Elders.

SHINE, two decades old, is a national program funded by grants through the Centers of Medicare and Medicaid.

Manatee County's SHINE is under the umbrella of the Senior Connection Centers, which were formerly known as Area Agencies on Aging housed in Tampa. Anyone interested in information or attending should call Manatee County's Senior Connection Center at 800-336-2226 and ask for Manatee County SHINE.

"Medicare beneficiaries can get free and unbiased information if they attend an enrollment presentation in their neighborhood," LaMastro said.

LaMastro and her colleagues try to find programs that lower prescription drug costs or provide prescription drugs at no cost.

Open enrollment, which occurs once a year, is the best chance to change plans in Medicare, the federal health insurance designed for people who are 65 or older as well as some younger people with disabilities and people with permanent kidney failure requiring dialysis.

Medicare at a glance

Medicare is divided into different parts. Part A covers hospital insurance.

Part B provides reimbursement for doctor's office visits, lab tests and medical services. It can also cover wheelchairs and walkers if prescribed.

Part C is a separate component that allows private health insurance companies to provide Medicare benefits.

"Part C of Medicare, which includes Heath Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), is known as Medicare Advantage," LaMastro said.

Part D is drug coverage available through private drug companies or HMOs or PPOs," LaMastro added.

"Everyone should have gotten their plan changes by Sept. 30," LaMastro said Thursday. "But often they don't read through them. They turn right to the part of the booklet where the final premium is and say, 'Oh, it went up twenty dollars. I can handle that.' They don't ask, 'Oh, did my drug

move from a Tier 2 drug to a Tier 3 drug that will cost me more for a co-payment? They don't check to see if the drug store they were using in 2015 will still be a preferred drug store in 2016 and if their deductibles have been raised."

What the counselors do during hour long meetings is present facts and answer questions to help seniors formulate strategies, said Patricia Henderson, outreach manager and community liaison for the Senior Connection Center.

"Medicare enrollment can be quite daunting if people have not done it before, even those who are computer savvy," Henderson said. "We get calls from highly educated people who still need our help."

Medicare details in 2016

Some Medicare buzz for 2016 has been about a possible hefty increase in Part B premiums for about a third of the 50 million Medicare holders, LaMastro said.

That includes people who are 65 or older but have chosen to not yet receive Social Security benefits and those who earn more than $80,000 annually, LaMastro said.

"About 70 percent of Medicare recipients will pay $104.90 per month for their Plan B premiums, which is exactly what they paid last year," LaMastro said. "But about 30 percent are going to be slammed for more."

Social Security collectors should be able to avoid a premium increase because federal law requires that any increase in the Medicare premium must be matched by a similar increase in an individual's Social Security benefit.

"There's a provision in federal law involved with cost-of-living adjustments, also called COLA, that has a 'hold harmless' provision," LaMastro said.

Because a cost-of-living adjustment will not take place in 2016, the premiums of those who are on Social Security won't rise, leaving others to cover the Medicare increases, which could rise about 50 percent higher, LaMastro said.

Many impacted have held off drawing Social Security in order to get a higher rate later.

About a half dozen people attended LaMastro's first meeting at the South Library.

"I have talked to a SHINE representative before and I was considering making a change so I thought I would just catch up on information," said attendee Alice Brenneman of the Whitfield area. "I haven't had to do this by myself. They helped me before so I am back again."

John McCormick of Bradenton was also looking for answers to his questions.

"We're here to get some answers and clear up the mass of confusion that surrounds this," McCormick said. "I have Social Security and I have an Advantage Plan but my wife is just going into it so we wanted to get some answers."

Focus on Part D this year

LaMastro urged people Friday to take a hard look at Part D of Medicare. She said it's important to be sure seniors are buying drugs in a preferred drug store as opposed to a participating drug store.

LaMastro showed figures using a Manatee County Medicare client as an example.

"This client, if she goes to a preferred drug store, her whole drug cost for 2016 including her premium and copays will be $1,027," LaMastro said. "If she goes to the drug store right down the block, which is a participating drug store but not a preferred drug store, her drugs will cost $3,486. Same prescription. Same drug company. Two different drug stores. She will save $2,300 a year for her drugs."

The reason for the difference involves the relationship between drug plans and drug stores.

"The individual prescription drug plans, of which there are 17 in Manatee County, each have a different drug list and each have a special agreement with their preferred drug stores where their drugs are cheaper," LaMastro said. "That's why it is very important that even if you are happy with the private drug plan you have you must make sure you are using the right drug store."

In years past, mail order has always been the cheapest alternative for drugs, LaMastro said.

"This year you have to check the difference between mail order and preferred drug store to see which one is the best value for your drugs," LaMastro said.

Lakewood Ranch site new

Seniors in Lakewood Ranch will have a nearby location to receive information and help with their medicare enrollment.

Medicare counseling will be offered on the third Tuesday of every month at the new Daybreak Adult Day Center recently opened by Meals on Wheels PLUS at 10920 East State Road 70 in Lakewood Ranch.

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

Medicare enrollment counseling sessions

Oct. 13: H2U Ellenton, 7042 U.S. 301, Ellenton, 10-11 a.m.

Oct. 14: 1-2 p.m., Anna Maria Library, 5701 Marina Drive, Holmes Beach

Oct. 15: 10-11 a.m., H2U Cortez, 6670 Cortez Road, Bradenton

Oct. 23: 10-11 a.m., H2U Bayshore, 6012 14th St. W., Bradenton

Oct. 27: 10 a.m.-noon, Rocky Bluff Library, 6750 U.S. 301, Ellenton

Oct. 28: 2-3 p.m., Freedom Village, 6406 21st Ave. W., Bradenton

Oct. 29: 10:30-11:30 a.m., DeSoto Towers, 1523 6th Ave. W., Bradenton

Oct. 30: 9-10 a.m., Renaissance on 9th, 1816 9th St. W., Bradenton

Nov. 5: 10 a.m.-noon, Anna Maria Island Library, 5701 Marina Drive, Holmes Beach

Nov. 13: 10 a.m.-1 p.m., Renaissance on 9th, 1816 9th St. W., Bradenton

Nov. 17: 10 a.m.-6 p.m., Rocky Bluff Library, 6750 U.S. 301, Ellenton

This story was originally published October 12, 2015 at 4:31 PM with the headline "Manatee's Medicare counselors set to help enrollees ."