People with Disabilities Awaiting Medicare Coverage Need to Know Health Options, Allsup Says

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With Medicare more than 24 months away, individuals need to secure interim healthcare support ranging from COBRA to drug assistance programs

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If you have a chronic disability that has forced you to stop working, you cannot afford to be without resources to help you minimize your healthcare costs and ensure your access to needed healthcare services

About 46 million Americans went without health insurance coverage some time during 2007. The impact of not having healthcare coverage can be even more pronounced for the millions of individuals with disabilities.

However, according to Allsup, a leading provider of Social Security disability, financial and healthcare-related services to people with disabilities, there are options if individuals understand the Social Security disability process and know where to look for support.

People awarded Social Security Disability Insurance (SSDI) benefits eventually do become eligible for healthcare coverage under Medicare. However, Medicare is available to most individuals only 24 months after qualifying for SSDI benefits. In reality, the time frame is even longer because SSDI benefits are not available until five full months after the onset of disability.

During the interim years, a number of medical services may be required to treat an individual's disability and ensure he and his dependents are receiving necessary care. Additionally, simply getting through the SSDI application process requires furnishing the Social Security Administration with up-to-date medical records based on recent medical examinations.

"If you have a chronic disability that has forced you to stop working, you cannot afford to be without resources to help you minimize your healthcare costs and ensure your access to needed healthcare services," said Paul Gada, Allsup's personal financial planning director.

There are a number of options for people awaiting Medicare eligibility, and details are available through Allsup's free Financial Matters personal finance portal. In particular, Gada notes COBRA or other private insurance; drug assistance programs or switching to generic drugs; and learning to negotiate healthcare costs.

Weighing COBRA Costs and Benefits

Someone who has lost a job because of a permanent disability can elect to continue using their former employer's group health plan through COBRA coverage. Employers who sponsor a group health plan with 20 or more employees are subject to COBRA, which allows former employees, their spouses and children to maintain coverage under the employer's health plan for 18 months of continuation coverage after they leave the organization. This can be extended for 11 additional months if the former employee is determined by the Social Security Administration to be disabled within the first 60 days of COBRA continuation coverage.

The downside of COBRA coverage is cost. Former employees' premiums are not offset by the employer as they often are for existing employees. This means that the premium for the first 18 months of COBRA can cost up to 102 percent of the plan cost for those still employed. The rate also can rise as high as 150 percent for the 11-month disability extension period.

Even so, COBRA coverage generally is less expensive than getting comparable individual private health coverage. In addition, if a person is continuing coverage when taking COBRA, he does not have to fear that pre-existing conditions won't be covered.

"If at all possible, you do not want to go without health insurance," said Gada, adding that if COBRA or private health insurance is not possible, individuals should investigate government programs, such as Medicaid, veterans assistance benefits, or state and local health services that provide health insurance coverage on a needs basis.

Learning about Drug Assistance Programs and Generic Drugs

People who can't afford their medications may lower their doses or simply stop taking the medications. However, many drug companies and many states have programs that offer lower income individuals help in covering drug costs. Eligibility varies by manufacturer and from state to state. Allsup's Financial Matters offers links to resources for identifying specific drug assistance programs and state pharmaceutical assistance programs.

Switching to generic drugs also is worth investigating and can provide a 50 to 70 percent savings, according to the U.S. Food and Drug Administration. While generic drugs have the same active ingredients as their brand-name counterparts, the inactive ingredients can differ. Therefore, it's important for individuals to ask their doctor first if using a generic drug is an option.

Negotiating Healthcare Costs

Most individuals are reluctant to ask about medical costs - let alone try to get a healthcare provider to reduce the cost. Yet, this can yield results. Keep in mind that most providers are not getting paid their established fees by insurance companies. They are being reimbursed at a lower rate.

Gada encourages people to do their homework: know how much is going to be charged and then ask for a better price. Consumers should ask providers about reduced rates for procedures, and the availability of free financing or extended payment options. They also may want to shop around. For example, is there another hospital where they can get the same level of care at a lower cost?

Many health providers also honor health discount programs, which can offer 10 to 50 percent savings on various health services and healthcare-related products.

"It doesn't cost anything to ask, but it can cost a lot if you don't ask," said Gada. "When you have high healthcare costs and limited income, which is often the case for individuals with disabilities awaiting Medicare, you're really cheating yourself by keeping quiet."

About Allsup

Allsup, Belleville, Ill., is a leading nationwide provider of financial and healthcare-related services to people with disabilities. Founded in 1984, Allsup has helped more than 100,000 people receive their entitled Social Security Disability Insurance or Medicare benefits. Allsup employs about 500 professionals who deliver services directly to consumers and their families, or through their employers and long-term disability insurance carriers. For more information, visit

Mary Jung            
(773) 429-0940        
mtjung @        

Dan Allsup
(800) 854-1418 ext 5760
djallsup @


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Mary Jung

Dan Allsup
Allsup, Inc.
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