Philadelphia, Pennsylvania—Jeffrey Rubin has to take daily medications to manage multiple sclerosis and its side effects. This includes a daily injection to slow the course of the disease, pills for his back, migraine medication and medicine to keep him alert because some of the other medicines make him tired. In all, Mr. Rubin takes about a dozen medications that cost more than $3,600 a month.
Mr. Rubin suffered his first MS attack on Memorial Day 2006. He was 39 years old, a quality control inspector at a medical packaging company and father to four young children. He was “officially” diagnosed with MS in June 2006. After suffering a second MS attack in August, his employer terminated him.
“It happened very fast. In a matter of three months, I went from working, being active and playing with the kids to being in a wheelchair without a job,” said Mr. Rubin.
Meanwhile, his medical costs and the family’s living expenses were mounting.
“I couldn’t make ends meet trying to afford healthcare, medications, food and paying the mortgage,” said Mr. Rubin. “So after we’d been in the house for six years, the bank quickly started foreclosure proceedings; no matter what I tried to do to save the house, the mortgage company didn’t want to help. They told me there were no re-modification loans available for disabled people, and we eventually lost our home.”
In December 2006, he was awarded Social Security
Disability Insurance (SSDI) benefits. But he still did not have health coverage. Under current regulations, SSDI beneficiaries must wait an additional 24 months after receiving SSDI cash benefits before becoming eligible for Medicare.
His medical needs were far exceeding his ability to pay for medical care.
In early 2007, he was relieved to finally qualify for Medicaid. However, that relief quickly evaporated once he learned that only two of his doctors would accept his Medicaid. Also, even with Medicaid, he still had medical bills of a few hundred dollars a month.
With mounting costs and limited income, Mr. Rubin’s only option was to file for bankruptcy.
“I had so many medical bills, my car had been repossessed, my home was in foreclosure, and collection agencies were coming after me for the unpaid medical charges,” said Mr. Rubin. “I felt like I had no choice, and I was becoming more ill every day.”
Finding an Ally in Allsup Medicare Advisor®
Having endured all of this, Mr. Rubin’s next challenge was figuring out Medicare, as his eligibility for the program finally approached. Based on past experience, trying to go it alone through the SSDI and Medicaid process, he was concerned.
“One thing I learned since becoming sick is that government organizations that deal with disability and medical issues tend to send you information, go away and expect you’ll know what to do,” said Mr. Rubin. “I had always worked and had health insurance with my job. I’d never dealt with these things. I didn’t know how they should work or how to apply for help.”
But this time, Mr. Rubin didn’t have to go it alone. In fact, he didn’t even have to go out and find help. Allsup found him.
In the summer of 2008, Mr. Rubin was interviewed by National Public Radio for a story on the Medicare waiting period.
“When we heard what he had endured in less than two years, we knew we had to help,” said Paul Gada, Allsup’s personal financial planning director. “Allsup, which has been offering Social Security disability representation and Medicare-related services for nearly 25 years, was just introducing Allsup Medicare Advisor. This service provides an objective, custom-designed evaluation to help people with disabilities select the Medicare option that best fits their needs.”
Mr. Rubin was glad to hear from Allsup.
“Before speaking to Allsup, I had no idea there were so many Medicare programs to choose from. I thought the government sent you a card and you’d just use that,” said Mr. Rubin. “If Allsup hadn’t been there to explain this to me, I would have been really confused and probably made mistakes.”
Someone Finally Explains and Listens
The first thing Mr. Rubin appreciated was that Allsup took charge and started to guide him through the process from the outset.
“They conducted a thorough interview with me, gathering information on all my medications and doctors, which doctors I wanted to make sure to keep and other details about my situation, including my financial situation and my Medicaid eligibility,” said Mr. Rubin. “They asked me what was most important to me. So, I was able to set those priorities.”
Allsup then researched all the available plans in the Philadelphia area to determine the plans that met Mr. Rubin’s requirements. Using a proprietary evaluation and rating methodology, Allsup identified the three plans that best suited Mr. Rubin’s needs. These findings were captured in a comprehensive, customized report.
“The report Allsup sent to me was extremely helpful. It listed all the plans and had the details written out on the top three plans so I could compare them. It listed all my doctors, all my medications and detailed how things would be covered,” said Mr. Rubin. “With my medical condition, taking on a task like this would have been overwhelming. Having Allsup take my information and narrow all of this down to just a few options that would be best for me – that was a godsend. They made it a lot easier for me to make a choice and relieved all the stress I felt.”
After the plan was sent to Mr. Rubin, an Allsup representative walked him through the details step by step.
“The personal service Allsup provided was so important. Finally, I had someone to talk to who knew all about this and was willing to take the time to explain it to me. I’m grateful to everyone at Allsup that worked on my behalf,” said Mr. Rubin.
Allsup was happy to be working with Mr. Rubin, though sorry they’d not learned about his situation earlier.
“As we reviewed Mr. Rubin’s history and spoke with him, we could see that in the more than 18 months that he had Medicaid coverage, no one had ever properly explained it to him. Because he didn’t know how it worked, he ended up paying for a lot of things that should have been covered,” said Mr. Gada.
“We’ve watched so many of the people we’ve helped get their Social Security disability benefits really struggle with healthcare and financial issues,” Mr. Gada continued. “We often end up being an informal source of knowledge for them and, more recently, have introduced a series of healthcare and financial services tools to help people like Mr. Rubin with these issues from the onset of disability.”
Now, from the time they first apply for disability benefits, through the SSDI claims process and then the two-year waiting period for Medicare eligibility, Allsup offers services, including SSDI representation, Financial Matters online tools and information about health and financial issues specific to people with disabilities and Allsup Medicare Advisor.
Narrowing in on a Plan
Of the three top healthcare plan choices Allsup identified, Mr. Rubin narrowed in on two: a traditional
Medicare plan with Part D prescription drug coverage that would coordinate with his existing Medicaid; and a Medicare Advantage plan.
While both plans would meet his needs, Mr. Rubin chose the Medicare Advantage plan. The Medicare Advantage plan he selected is an HMO plan that is only available to people that are dual-eligible for Medicare and Medicaid coverage. As a result, it provides all the benefits of traditional Medicare and Medicaid as well as prescription drug coverage in a single source.
“I like the idea of dealing with just one provider. I forget things and the simplest task can be a problem, so one insurance card versus three is just easier for me,” said Mr. Rubin. “Also, the plan I selected is an HMO from a provider I’ve had coverage from in the past. Traditional Medicare seemed more costly because you have to pay 20 percent of the total bill, up to a certain amount. With an HMO there sometimes is a copayment, but it’s $5 or $10, which is a lot easier for me to afford.”
Allsup coordinated with the Pennsylvania Medicaid office to ensure that the plans presented offered the highest benefit level available. Allsup also made certain Mr. Rubin understands he qualifies for Low Income Subsidy (LIS), which is an added benefit to help ensure he pays no more than a few dollars for any prescription drug co-pays ($2.25 for generic drugs and $5.60 for brand-name drugs per prescription in 2008).
“All my medications are covered under my Medicare Advantage plan now except my Vitamin D, which is over the counter. Allsup got on the phone and called Medicare and the local Medicaid office to see if even that could be covered,” said Mr. Rubin. “Knowing I won’t have to skip medications or reduce dosages anymore to get by is a tremendous relief.”
Moving On
While Mr. Rubin is relieved he’ll finally have access to the healthcare and medicines he needs, when he needs them, he’s tentative about his financial future given the struggles he’s been through these past two years waiting to be eligible for Medicare.
“I am trying to be optimistic, but cautiously. Every day the cost of living is going up. I’m trying to find a cheaper place to live. However, I hope to have a home of my own again, someday,” said Mr. Rubin. “I’ll be happy if having health coverage again saves me enough so that I don’t have to ask a friend to help me out, or I have a little extra so that the kids can buy some new clothes. I hope that’s what happens.”
Mr. Rubin is determined to move on. He would like to do public speaking to help others learn from his experience and better understand MS.
“It makes me feel good when I go out and talk to people. Sometimes they call me back to ask more questions. I’ll tell my story a million times over if it will help someone,” he said. “I became very ill quickly, and needed to protect my family while treating my sickness and keeping us sheltered. I made mistakes, but I’ve learned a lot, too. So I want to help other people that may unexpectedly find themselves in the same position.
“I’ve had to deal with many people who have tried to take advantage of me due to my situation and disability. So I am extremely thankful to Allsup, my family and friends, and fellow ‘MS-ers’ for all the support and kindness given to my family.”