Working With a Health Insurance Advocate

Individuals with special needs often require health services that can be difficult to find among the offerings of traditional health insurance plans. Navigating any policy can be challenging, but finding the best, yet most affordable, coverage that includes untraditional items can seem downright impossible.

Before giving up altogether, however, search out the one person who will surely shed some light on the matter: a health insurance advocate. Scott Steiner, a financial planner with Lincolnshire, Ill.-based Ehlert Financial Group and a licensed Advocate with Protected Tomorrows, explains more about these invaluable individuals:

Q: What is a health insurance advocate?

A: A health insurance advocate is a person who specializes in the area of health insurance and health programs. He/she assists individuals in obtaining the appropriate health plans based on their unique needs.

Q: How can a health insurance advocate help an individual with special needs?

A: An advocate who specializes in assisting individuals with special needs can be of great assistance because they are aware of the challenges these individuals face when trying to get the best health care possible. An advocate will help an individual with special needs obtain the most comprehensive health care benefits available to them.

Q: How does a health insurance advocate determine which plan would be best for a client?

A: Health insurance advocates work one-on-one with individuals and families to learn more about their needs. They will match the best available health program(s) to each person’s unique needs. Advocates also work to make people aware of risks that they may not have considered regarding their health. For instance, what if due to health issues someone was unable to work or needed skilled nursing care? There are special types of health insurance programs to address these issues that go beyond what is offered by “traditional” health insurance. Advocates must constantly educate themselves to stay current with the many health programs available.

Q: What types of issues do individuals with special needs have when dealing with health insurance?

A: Individuals with special needs may have difficulty qualifying for many types of health insurance. Most individually purchased health insurance programs require underwriting, which means the applicant must medically qualify for the insurance. People with certain health issues may have certain conditions excluded from their policy or may be denied coverage entirely. If group health insurance is available through an employer or a family member, coverage may be easier to obtain because these policies often do not have underwriting requirements.

Q: Are there any special types of health insurance available for individuals with special needs?

A: Individuals with special needs may qualify for some government benefits such as Medicare, Medicaid, Supplemental Security Disability Income (SSDI) and Supplemental Security Income (SSI). These programs are available under different circumstances, and there are generally limitations on income and/or assets a person may have to qualify for them. These programs are extremely complex, so it is very important that someone with special needs works very closely with an advocate to help obtain and keep these benefits.

Q: Is asking for assistance from a health insurance advocate expensive?

A: Generally not. In more complex situations, some advocates may charge a fee for their time and expertise, but even this fee pays for itself many times over when weighed against not obtaining expert advice.

Q: How can interested individuals get in touch with a health insurance advocate?

A: The best way is word of mouth. People should always ask friends and family if they know and trust someone who works in their area. The Internet is also a very useful tool for locating advocates in a particular area. Once an advocate is located, people should always meet with them in person to ensure that they feel comfortable working with this person. Advocates are also available by contacting Protected Tomorrows at (847) 522-8086 or by visiting the website at

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