A former medical specialist, Melinda Gibson was familiar with the healthcare profession, but understanding Medicare was entirely new to her. To ensure she had the necessary coverage, she knew it was crucial that she quickly learn the Medicare language. Ms. Gibson turned to Allsup to help her decipher the complex Medicare system and enroll her in a program that met all her requirements.
Great Falls, Montana: Melinda Gibson’s first experience working with Allsup was when the company helped her apply for her
Social Security Disability Insurance (SSDI) benefits after an automobile accident left her with permanent disabilities. Rather than going it alone in the initial stages, as many SSDI applicants do, Ms. Gibson recognized the importance of seeking professional support from the outset.
“Allsup took care of everything, start to finish,” she said. “They prepared all the paperwork, made sure my claim kept moving through the process and kept me informed. I knew they were always just a phone call away.”
Because Allsup secured an on-the-record award, Ms. Gibson didn’t have to appear before an administrative law judge. Not only does an on-the-record decision mean a speedier decision, it also means less anxiety, hardship and inconvenience. That’s because the claimant doesn’t have to prepare for and travel to a stressful courtroom hearing.
In addition to securing monthly income, another major SSDI benefit is qualifying for healthcare coverage through
Medicare. SSDI beneficiaries are eligible for Medicare coverage 24 months after the Social Security Administration determines they have a disability.
While waiting for Medicare coverage, Ms. Gibson initially purchased
COBRA coverage through her former employer. She also purchased private health insurance, but it was costly and didn’t cover much of what she needed, leaving her to pay expensive medical and prescription drug costs.
As a result, Ms. Gibson welcomed finally qualifying for Medicare – until she realized just how complex making the right Medicare choice could be.
“I thought I should be able to figure this out myself,” she said. “But I didn’t know that much about Medicare and the particular considerations for people with disabilities, let alone taking into consideration issues related to my own specific situation. I’m pretty sure I would have gotten myself into a real fix if I’d tried to do this on my own. I probably would have gotten frustrated, given up and ended up just getting traditional Medicare. That would have cost more and wouldn’t have covered what I needed.”
Instead, Ms. Gibson turned to the Allsup Medicare Advisor® for help. This service provides an objective, custom-designed evaluation to help people with disabilities select the Medicare option that best fits their needs.
Comprehensive, Customized Information and One-on-One Discussions
Thousands of Medicare plans nationally and dozens locally are available in most areas. The first step in the Allsup Medicare Advisor process is an in-depth conversation between the client and an experienced Allsup specialist. The goal is to identify the client’s needs. The Allsup representative collects information such as the client’s location, health history, prescriptions, medical provider preferences and financial situation.
For Ms. Gibson, the most important criteria in selecting a Medicare plan was to ensure her physicians would accept the insurance, and that all or most of her prescription medications would be covered.
After analyzing Ms. Gibson’s situation, Allsup conducted an analysis of the available plans in the Great Falls, Mont., area where she lives. They then determined those plans that met her requirements by using a proprietary evaluation and rating methodology and identified the three plans best suited to her needs.
Allsup presented Ms. Gibson with a comprehensive, customized report. It detailed all options in her area and then highlighted the three best options, including the programs covered and associated costs, such as premiums, co-pays and coverage limits. Allsup also compared the chosen plans to help Ms. Gibson understand various relevant aspects of each. This included easy-to-understand information about traditional and
Medicare Advantage programs and prescription drug issues, including the Medicare prescription drug “donut hole.”
“In just a few dozen pages, Allsup put together a thorough report showing the plans that best met my needs—supported by all the background I needed to understand why these were the plans I should be evaluating,” said Ms. Gibson. “There’s no way I could have collected and processed all that information in the timeframe in which I had to make a decision.”
Next, an Allsup Medicare Advisor specialist walked Ms. Gibson through the options detailed in her customized report. The specialist also discussed the various considerations that went into determining the top options.
This included an explanation of the benefits of Medicare Advantage programs when compared to traditional Medicare for people with disabilities. For example, while traditional Medicare supplemental insurance (also known as Medigap) can initially preclude coverage for pre-existing conditions, Medicare Advantage programs are required to accept almost all Medicare beneficiaries. Medicare Advantage programs also may offer benefits not covered by traditional Medicare, such as prescription drug coverage or dental, hearing and vision care. Particularly important for SSDI recipients with limited income, Medicare Advantage programs generally cost less than traditional Medicare with Medigap coverage.
“Having good, affordable healthcare is probably one of the most critical factors in ensuring quality of life for people with permanent and long-term disabilities,” said Bonnie Vielweber, director of Allsup’s Medicare operations and services. “We want to help people like Melinda make the right choices. Just as importantly, we want to make sure they have a better understanding of healthcare issues under Medicare so that they can be informed healthcare consumers.”
In Ms. Gibson’s case, the prescription drug donut hole built into Medicare also was a critical issue because it could leave her with thousands of dollars in non-covered prescription drug costs. The
donut hole is a coverage gap that occurs in some prescription drug plans (PDPs) associated with Medicare. In 2009, the gap begins when an individual’s total drug costs reach $2,700, including the portion paid by Medicare and the individual’s own out-of-pocket deductibles and co-payments. The individual then has to pay 100 percent of the next $3,453.75 out-of-pocket costs for prescriptions until total drug costs reach $6,153.75, after which Medicare prescription drug coverage resumes.
Although Medicare D plans do not cover prescription costs while in the donut hole, some Medicare Advantage plans will continue to cover all or certain drugs during the gap. The premiums for some of these plans can be more costly, but the premium cost is offset by the savings in prescription drug costs.
“Before Allsup sent me the report and walked me through the details, I didn’t know anything about Medicare Advantage programs or the prescription drug donut hole,” said Ms. Gibson. “This was information that no one had told me about, and I really needed to know. So, having Allsup there to educate me was really important.”
Ensuring a Smooth Enrollment Process
After studying the various options with Allsup, Ms. Gibson selected a Medicare Advantage plan. An Allsup Medicare Advisor specialist joined Ms. Gibson on the call with the insurance provider to facilitate the enrollment process. This assistance included verifying the coverage and cost information the provider had presented in its literature and helping Ms. Gibson answer some of the more technical questions.
This support was crucial. During the call, Allsup discovered that the provider would not cover a costly medication, even though the plan’s literature stated it would cover generic drugs during the Medicare prescription drug donut hole. This medication cost more than $800 a month, meaning there would be significant out-of-pocket costs for Ms. Gibson. Based on this information, the Allsup specialist immediately stopped the enrollment process.
The specialist then met again with Ms. Gibson to discuss the other plans. The subsequent Medicare Advantage plan that Ms. Gibson chose had a higher premium than the initial plan. This plan, however, covered all generics, including her $800 medications, ultimately lowering her overall costs.
“You really have to peel back the surface and look at what’s inside, understand this in the context of your situation and run different scenarios to see how different factors influence different options,” said Ms. Vielweber, who has 20 years of health insurance experience. “Then you have to double-check all of this during the enrollment. It’s a very complicated process and takes persistence and a level of expertise to do it right.”
Ms. Gibson recognizes and welcomes this expertise. “The whole process Allsup went through was so helpful. They listened to me, they provided me with organized, easy-to-understand information specific to my situation, they took time to educate me, and they followed through to make sure I enrolled in a plan that was right for me.”
She also has advice for others: “Don’t feel bad because you don’t know something. It’s important to know there’s help available, and you should take advantage of it.”