Allsup: Disabled people experience difficulty in receiveing much-needed treatment

Oct 7 2009

People with disabilities have crucial healthcare needs, but often experience difficulty in receiving much-needed treatment, according to Allsup, a nationwide provider of Social Security disability representation and Medicare services.

“There is significant risk for people with disabilities if they go without care or medications that they need to manage their conditions,” said Paul Gada, Allsup’s personal financial planning director. “Many people, for various reasons, can struggle to get the care they need before and after they become eligible for Medicare.”

An important benefit for those who are awarded Social Security Disability Insurance (SSDI) benefits is receiving Medicare coverage. However, most people must wait 24 months after qualifying for SSDI cash benefits to receive this coverage.

There is considerable debate about what should be done to improve the healthcare system overall and for people with disabilities in particular. In fact, the National Council for Disability report issued on Sept. 30 calls for healthcare reform to address the needs of people with disabilities. The NCD’s suggestions included ensuring that people with disabilities have access to healthcare coverage, making sure it is affordable and removing limitations for pre-existing conditions.

But there are a number of immediate steps that can help people manage costs and access to care, as Allsup outlines below.

Managing Healthcare Costs before Medicare Eligibility

Allsup’s free Personal Finance portal outlines several ways to reduce costs while awaiting Medicare eligibility, including:

• Keep your health insurance coverage. Gada urges people with disabilities to maintain health insurance coverage, if possible. This can be through your spouse’s health insurance plan, private insurance or COBRA coverage through your former employer. If it’s offered, COBRA can provide 18 months of coverage after you leave your job. It’s possible you can extend this coverage for 11 additional months if you are awarded SSDI benefits. Further extensions also are available under certain circumstances through the American Recovery and Reinvestment Act of 2009.
• Better manage your prescription drug costs. Switching to generic drugs, when possible and with your doctor’s approval, may save you 50 to 70 percent on costs, according to the U.S. Food and Drug Administration. Drug companies and some states also offer savings programs for lower income individuals. Eligibility varies by manufacturer and from state to state. Allsup’s Personal Finance section offers links to resources for identifying specific drug assistance programs and state pharmaceutical assistance programs.
• Negotiate your healthcare costs. Consider asking your physicians or providers if they will reduce their rate or provide you with a discount. You can ask about extended payment options or free financing. You also have the option of shopping around for services. For example, is there another hospital or a clinic where you can get the same level of care at a lower cost?

Medicare Enrollment: Selecting the Right Plan

It can be a tremendous relief once someone becomes eligible for Medicare, Gada said. “But to make the most of this benefit, you should evaluate your unique needs before you choose your Medicare plan,” he said.

The following are factors to consider, Gada said, noting that Allsup professionals assist with these and other steps for customers as part of the Allsup Medicare Advisor®, a Medicare plan selection service:

• Factor in your out-of-pocket costs. Traditional Medicare may be inexpensive, but it comes with high deductibles. Medicare Advantage plans may have similar or higher monthly premiums than traditional Medicare, but can offer a zero-dollar deductible and low co-pays. Some plans also cap total out-of-pocket costs. As a result, it makes sense to look at all your options.
• Make sure you are covered for pre-existing conditions. People under age 65 who qualify for Medicare because of Social Security disability may not be able to get supplemental insurance or can face other limitations because of their pre-existing health conditions.
• Make sure your prescription drugs are covered. You should ask each Medicare plan provider being considered if they cover each of the specific medications you need. Find out your co-pay cost. Be specific and try to get responses in writing so you can calculate your true cost of prescription drug coverage from plan to plan.
• Carefully compare plans. People with disabilities often can obtain better healthcare coverage through Medicare Advantage plans than through traditional Medicare with separate supplement insurance (Medigap) and a Part D (prescription drug) plan. However, you are likely to have dozens of Medicare Advantage plans from which to choose. Each plan has different coverage levels and costs, so shop with care.

Choosing a Medicare plan can be daunting for anyone. However, the decision is even more critical for those with a condition that requires ongoing medical treatment or costly medications.

“To arrive at the best decision, you have to understand what your needs are and how they will be covered under each plan,” said Gada. “Then, be sure you re-evaluate your Medicare coverage each year, because both your needs and your options can change.”