Former investment advisor is grateful for help navigating the SSDI process and understanding his Medicare options
Wildwood, Missouri: Given the complexity of the Social Security disability system and the agency’s growing backlog of claims, Ray Przybylowski wasn’t surprised that it took two and one-half years to receive his award. But he was grateful he had help along the way, guiding him through each level of the process to a successful conclusion.
After qualifying for Social Security
Disability Insurance (SSDI) and subsequent Medicare coverage, Mr. Przybylowski needed professional assistance to help him research and sort through the different
Medicare plans, criteria and coverage options. Making the right health care choices are important for anyone, but for individuals with disabilities that often require additional medical attention, making the right choice is critical for ensuring ongoing care. Toward that end, Mr. Przybylowski wanted to identify the plans that best met his needs.
For both securing SSDI benefits and selecting Medicare coverage, he turned to Allsup for expert guidance and execution. Allsup is a leading provider of SSDI representation and other financial and healthcare-related solutions for individuals with disabilities.
“Allsup has been terrific. They kept me informed throughout the SSDI process and really advocated for me,” said Mr. Przybylowski, 62, who has atrial fibrillation and additional health conditions that required he seek SSDI benefits after working for more than 34 years in the financial services industry.
“Based on my experience with Allsup’s
SSDI representation, I was happy to try their
Medicare Advisor program,” Mr. Przybylowski continued. “Allsup researched all the programs based on my criteria, presented me with an easy-to-follow custom report identifying the best options and walked me through each step of the enrollment process.”
Allsup Delivers Expertise for Making Informed Medicare Choice
Allsup’s approach was ideal for the Medicare assistance Mr. Przybylowski sought.
“Rather than spending hours poring over the dozens of different programs and still risk picking the wrong plan, individuals that use Allsup Medicare Advisor® know they can rely on Allsup to narrow their choices to the best options,” explained Paul Gada, Allsup’s personal financial planning director. “We understand the system and the special needs of those with disabilities. So, we are able to efficiently identify the optimal programs for our clients.”
Individuals are eligible to receive Medicare coverage 24 months after the Social Security Administration determines they have a disability. The waiting period can be expensive if you are trying to treat and manage a disability.
Mr. Przybylowski did have private health insurance. However, the premium was a hefty $1,000 per month to cover himself and his wife and did not provide the level of coverage they truly needed.
Unfortunately, this is a common situation for individuals with a disability awaiting Medicare eligibility: costly private insurance that delivers less than is needed and often has individuals short-cutting the medical care or prescription drugs they need to manage their disability. Even worse, individuals can continue down this same path once they select a Medicare program if they don’t understand the various components of the program they select. Using a program like Allsup Medicare Advisor helps ensure individuals will select the plan that meets their health care requirements.
Support Start to Finish with Allsup Medicare Advisor
Allsup Medicare Advisor offers a comprehensive approach to selecting the right Medicare program, starting with needs assessment and ending with the actual enrollment of the client in a Medicare program.
The first phase of the
Allsup Medicare Advisor service is to work with clients to identify their most important coverage requirements. For Mr. Przybylowski those requirements were ensuring his
Medicare plan had a low monthly premium, was accepted by his physicians and covered his medications.
With a detailed understanding of Mr. Przybylowski’s priorities as well as knowledge about his medical condition, age, state of residency and other factors, Allsup Medicare Advisor consultants conducted a thorough, unbiased analysis of the various available Medicare programs.
With literally dozens of Medicare programs available in most markets, Allsup conducts the heavy lifting of screening the programs against the client’s criteria and using proprietary rating systems to help narrow down the choices even further to those most suited for the individual. Often, this requires calling the Medicare provider and checking on any detail that is not clear, such as verifying that specific physicians are included in a plan.
“It’s crucial that people have the complete information so they can make the right choice,” said Kelly Wyatt-Bisciotti, Disability Life Planning Center supervisor for Allsup. “Cutting corners by choosing too little coverage may put a person at an even greater risk for an unexpected financial burden. Choosing extra coverage can be costly as well and still not sufficiently cover a person’s medical expenses.”
Further complicating the choice is the need to know the difference between traditional Medicare and Medicare Advantage plans.
Basic, traditional Medicare is not costly. Hospital coverage (Part A) is free and medical coverage (Part B) is generally inexpensive. For example, the premium would be $96.40 per month in 2009 for individuals with $85,000 or less in income. However, because traditional Medicare coverage is limited, most people also secure supplemental “Medigap” insurance and prescription drug coverage (Part D). Not only does this add to the cost, but it is difficult for those with disabilities to acquire supplemental insurance. For example, they often are subject to a six-month waiting period for pre-existing conditions, and states can severely limit Medicare supplement insurance options available to individuals with disabilities.
Medicare Advantage plans, however, are required to accept almost all Medicare beneficiaries because medical history cannot be a barrier to enrollment. Medicare Advantage plans, at a minimum, also provide all the hospital and medical coverage offered by traditional Medicare. Depending on the plan, they can offer additional benefits such as dental care, hearing and vision screening, prescription drug programs and other services that would otherwise only be covered by a Medicare supplemental policy or Part D prescription drug coverage.
From a financial perspective, the overall costs under a Medicare Advantage plan should be less than if a person used traditional Medicare and Medigap policies. Additionally, many individuals find Medicare Advantage plans more convenient because all health care coverage is under one policy and the individual, therefore, doesn’t have to coordinate benefits between different plans and providers, as would be the case with traditional Medicare and supplemental insurance policies.
Because many individuals with disabilities don’t have a solid understanding of the differences, they may end up choosing traditional Medicare when a Medicare Advantage plan would be a better option given their circumstances. For Mr. Przybylowski, who’d already placed a premium on convenience and reducing his healthcare costs, the simplicity and cost savings offered by Medicare Advantage plans were particularly appealing.
“Allsup took the time to educate me on my options so I had a good idea of not only what I wanted but a clear understanding of the plans that would be best suited for me,” he said.
Once Allsup identified plans meeting Mr. Przybylowski’s needs, they were further screened across several quality and performance criteria. Allsup then provided a customized report of all the plans meeting his requirements and identified the plans that best matched his needs. Included in this detailed, plain-language report was an overview of Mr. Przybylowski’s requirements, including a detailed listing of his providers, prescription drugs and other preferences; a comparison of the three plans that best met his stated preferences, including coverage and cost detail; and a summary of next steps to be taken in selecting and enrolling in a Medicare plan.
“At a glance, I could see the providers, their quality ratings, premium costs and other highlights to quickly assess my options,” said Mr. Przybylowski. “The report also provided detailed information comparing the selected Medicare Advantage plans to traditional Medicare plans and identified all the key benefits of the recommended plans.”
After delivering the report, an Allsup Medicare Advisor consultant walked Mr. Przybylowski through the findings so he could quickly narrow in on the one he wanted. He then was easily enrolled in his chosen plan.
“Allsup made this easy for me,” Mr. Przybylowski said. “The plan I chose meets all my needs. My premium is just a fraction of what I’d been paying for private insurance. It has all the prescription drug coverage I’d been seeking and my physicians all accept the insurance.”