Advocate Health Advisor’s licensed agents get to make a positive impact on people’s lives every day. Sometimes their impact is helping people save money without losing the benefits that are most important to them. Other times Advocate agents help Medicare-enrollees discover additional benefits they can access without paying anything more (sometimes even paying less).

This is the story of Chris, a Medicare enrollee who called Advocate Health Advisors in response to a letter he received and ended the call feeling the letter had been sent to him by a guardian angel. The names in this story have been changed to protect the identity of our client.

Every dollar matters for those on fixed-income.

Advocate’s agent, Jerry, answered the call from Chris (names have been changed for privacy). Chris received a piece of mail from Advocate notifying him that he may be eligible for a plan with an amazing additional benefit – a debit card that is automatically loaded with $50 each month to be used for buying healthy foods. One way Advocate works to improve the health and quality of life for all Medicare-eligible enrollees is by promoting some of the lesser-known benefits that might be available based on an enrollee’s unique situation.

Since Chris is disabled and unable to work, this healthy food card benefit sounded like it could be a big help and called the number on the letter. Jerry and Chris chatted and discovered they had quite a bit in common. After asking Chris a little about his current situation and needs, Jerry was able to confirm that because of Chris’s life circumstances, he was already qualified for both Medicare and Medicaid, or also known as a “dual-eligible”. This means he was eligible to enroll in a type of plan specificlaly tailored tow ork with Medicaid, called a Dual Special Needs Plans (DSNP). After Jerry saw which plans Chris was eligible for, he got excited because he knew everything he was going to be tell Chris was going to be good news.

DSNP enrollees rarely understand all the benefits available

DSNP-qualified individuals are often eligible for health benefits well-beyond those provided through Medicare Part A (hospital insurance) and Part B (medical insurance) for very little or no extra cost. Medicare Part C (or Medicare Advantage) plans are offered by independent insurance carriers and combine traditional Medicare coverage (Part A and B) with a robust list of additional, ancillary benefits that can make a real impact on well-being and quality of life.

Chris knew that he was currently enrolled in Medicare but was unsure whether he was still enrolled in Medicaid. Like most, Chris found the amount of mail and paperwork he received regarding his coverage to be overwhelming. He had been encouraged by the Department of Human Services to find an insurance advocate who could help him understand his options. While that wasn’t the reason Chris called Advocate Health Advisors, he expressed to Jerry, “looks like you’re my advocate helping me sort all this out.”

Far more than the monthly healthy foods credit

By the end of the call, Chris enrolled in a PPO plan specially designed for people with Medicare and Medicaid for no cost to him whatsoever. The PPO gave him flexibility to see the doctors he chooses without the need for pre-approval from his primary care doctor, and he received additional benefits far exceeding the Healthy Food Card he initially called in about.

Because of his level of eligibility, Chris’s new benefits included:

  • No monthly premium, no co-pays, no co-insurance
  • $100 per month toward over-the-counter health costs
  • $50 per month toward Healthy Food Card
  • Dental coverage
  • Hearing coverage
  • Vision coverage
  • Silver Sneakers benefit
  • Up to 100 days in a skilled nursing facility fully covered
  • Personal Emergency Response System

Simplifying Medicare and Advocating for Clients

After hearing all the benefits he would receive with his new Medicare Advantage plan, Chris said “it’s like the pot of gold at the end of the rainbow.” Advocate Health Advisors and our agents take great joy in our work. We get to know each one of our clients, listen to understand their needs and priorities, simplify the Medicare enrollment process, and help ensure they receive the best benefits they can to meet their needs. And we do all of this to make a positive impact on the health, well-being and quality of life for every Medicare-eligible person we meet.