Disability Questions

CursiveStars

In September I went on FMLA and had hip rads d/t bone destruction and thinning from mets. The rads helped with the constant pain and walking but after a couple of hours on my feet my hip becomes excruciating. Rad Onc says this may be as good as it gets for it. At my job I'm walking and on my feet continuesly for 10 hour shifts (according to fitbit I average 8 miles a day at work). My doc suggested disability and maybe I can work part time. I'm 32 and not married so I support myself and carry my own insurance. I'm most concerned about insurance coverage. Online it says there's a 24 month waiting period before Medicare and I don't qualify for Medicaid. Is Cobra pr Marketplace my only option? Is 24 months accurate? How long did it take you to get approved for SSD? Am I even asking the right questions? I just want to keep working andays my benefits. This blows. Any help would be appreciated!!

Kandy

Do you have long term disability insurance at your current job? If so, you could go out on disability with them. That holds your position for a year. At the end of the year, then you would have to pick cobra up for the next year. You can get ssdi after being out of work for 5 months. Medicare kicks in after 24 months of being disabled. I hope this helps.

iz1999

hi Kandi, I've been out of work for almost 8 months, did not know I could apply for ssdi, I am receiving sdi not the same right

CursiveStars

Kandy it does! I did not know that Long Term disability held my job for a year. I thought they only held it during my 12 week FMLA. So I can continue with my work insurance during that time?

Kandy

Iz1999, are you getting SSI or SSDI. Those are not the same

Cursivestars, I think that is a federal law, not a state law. But they have to hold a position at your company for a year, this does not mean your current position. They only have to hold your current position for the 12 week FMLA which during that time people are on their short term disability. After the 12 weeks then it goes long term and you would be able to keep your insurance during the first year that they have to keep you on payroll. Also, after 5 months you would qualify for ssdi. Then typically your long term check is reduced by whatever ssdi says they are going to pay you. So if your long term is at 70 percent of your income, even when you get ssdi, your monthly amount is still the same but you get a check from each with the total being the 70%. You will have to check with your benefit department but typically after a year, they take you off payroll. They will probably make you take cobra at that point, but you only have a year before Medicare would kick in. Best of luck to you

artistatheart

I am still trying to strategize the best way to eventually extricate myself from work. all of the advice is very helpful as I am so fearful of being without adequate medical insurance. Also I hesitate to talk with my HR Dept as I do not want to raise a red flag that I am even thinking about leaving yet. (Although I would love to have more time at home now) Thanks for the input Kandy!

Longtermsurvivor

Hi Cursive Stars,

I am not a professional - legal, financial or medical, just a well-informed patient. My best professional advice to to choose the best advisors to help you through several difficult processes.

I can't go into detail here...but this is the FMLA rule book: https://www.dol.gov/WHD/FMLA/EMPLOYEEGUIDE.PDF

The job you have now is protected for 12 weeks (page 6), but FMLA allows you to return to work for the same employer for 12 months (page 8).

It sounds like you're eligible for SSDI and applied already??? If you are approved, there is a 5-month wait period for income from disability date that you stopped working and became eligible for disability. It's important that you file for SSDI as soon as possible, but if you didn't then try to get your claim backdated to the earliest date you qualify. Talk with your local Social Security office.

Metastatic breast cancer is covered under the social security compassionate allowances program, so if you qualify and your doctor is on the ball, you shouldn't have a long processing time for your application. But there's still a five month wait for SSDI income. Many employers offer sick time, short term disability and longterm disability coverage for their employees.

A good resource for Illinois residents is the nonprofit Illinois Network of Centers for Independent Living. They can be quite helpful when in understanding your options.

Also, you might have received a different awards letter telling you that you are not eligible for SSI, a different social security income for the disabled that has much stricter eligibility and income restrictions. SSI comes with Medicaid. If your SSDI disability amount is higher than the SSI award, then you'd automatically be refused SSI.

It's true that there is an additional 24 month wait period for Medicare once you become eligible for SSDI. And getting a secondary policy to cover Medicare is going to be very difficult because you are under age 50 and those policies are expensive. More later.

You may need to apply for a COBRA extension, which you must do before or soon after your disability date.

I'm uncertain what Illinois offers residents under the Affordable Care Act, that would be a question for the center for independent living. You may be eligible for medicaid that is not resource or income restricted. You'll need to hunt this out yourself.

This is a long, but helpful bco conversation on using SSDI and claiming benefits, including Medicare.

Cursive Stars, it's up to you to sort this out, maybe with the help of a trusted friend. Try not to quit your job before you've investigated all your options there, including extended FMLA to 12 months, COBRA extension and company sick time and disability programs (short & long term).

The human resource department should be working for you, but since employers pay them, it's possible they'll be arguing against any government guaranteed benefits! If you're aware of your rights, you can defend them. Also, dangle this in front of them, "I'm in danger of bone breaks, does the employer really want to pay an expensive worker's comp claim? Be sued under the ADA (Americans with Disability Act)? Or be a jerk when being a hero is an option?"

Taking care of employees should be an employer's duty, but some try to save every cent by not telling employees their options. Be sure to read your employee's manual and also all your insurance policies.

You're in the best position to care for your rights and protect yourself.

DO NOT QUIT YOUR JOB WITHOUT TAKING CARE OF YOURSELF OR BECAUSE YOU DON'T UNDERSTAND THE RULES!

Remember, I am not a professional - legal, financial or medical, just a well-informed patient.

Best wishes in dealing with these aspects of living with advanced cancer in your 30s. I was diagnosed at age 34 and have learned a lot through experience.

loving kindness, Stephanie

iz1999

hi Kandi, I am getting ssdi and my employer let me go after FMLA and now am paying cobra, so I can apply for ssi? Been out of work since march 2016 and no going back to work anytime soon.

Kandy

To qualify for SSI is much harder. That depends on family income and property owned I think

Longtermsurvivor

Kandy, yes, that's true about SSI.

Also, SSI and any condition not on the compassionate allowance list are often turned down on first and second tries. The processing period for approval can take months and requires special appeals and exams. Finding out how to survive and not bankrupt an individual or family is a huge challenge here.

Before there the compassionate allowances program, many people were denied SSDI & SSI and died before being approved.

That was such a nightmare.

And it's still an insult to have to wait so long, 24 months, for Medicare coverage, UGH!

The applicant with financial resources will still require supplemental policies to cover excess, uncovered medicare costs and a Part D plan.

For a young person like cursive there are so few supplemtental and part D policies available. Those over age 50 have many more choices of medical insurance options, but younger disabled are screwed by the system. The ACA and Compassionate Allowances and Ticket to Work programs have closed a few major gaps, but there are still pitfalls along the way.

There is so much necessary suffering with diagnoses like ours, to have that compounded by the "system" is an insult peculiar to the USA, considering the rest of the developed world. That's why the single payer system in the USA is so popular among many disabled and people with serious illness.

love & happy dreams, Stephanie

iz1999

hi Kandi, I meant SSDI my tablet changed my words. Do you know if income or property counts

Kandy

I thought you wrote you were getting ssdi? If not, yes you should apply. If the Dr writes the original date that you became disabled, they will count 5 months from that point. They will back pay you what is owed. This has nothing to do with income or property owned. Your check depends on how long you have worked. I would encourage you to apply. It's very simple to do it on the internet. I was approved 16 days from when I applied. Very simple. Best of luck to you.

BonnieMen

I too would like to remove myself from the working world. I can still physically do my job (desk work) but that's not where I want to spend the last of my "healthy" days. I want to be out making memories and doing those things I've never had time to do before I'm too ill to enjoy it. As the primary breadwinner in the family, this is not a possibility. I make decent money now but I was a stay at home mom for years and my SSD would be 27% of my current salary. I think I would get more for my kids under 18 but I'm not sure how much that would be. My job doesn't provide any insurance so I get my medical through the marketplace. I have no short or long term disability but I could sign up for AFLAC. From what I understand, I would have to have the policy for 12 months in order for them to pay benefits on a pre-existing condition. Sadly, this is one of the things that I dwell on when I can't sleep - the financial instability.

MargaritaMS

hi Cursive stars, I just want to share my experience with you because not all jobs will be held open for you for an entire year and FMLA does have exceptions. I went out on short term disability when I was diagnosed and stayed on it for it's entire 6 month duration. I also applied for FMLA. When I applied for long term disability after the short term expired, I received a notice from my employer that my employment had been terminated. Two weeks prior to receiving the notice, mind you. When I looked into it, I understood that my position was subject to an exception for FMLA so it did not have to be held for me. That's was one year ago. I am still on the long term disability plan and I was required by the plan toapply for SSDI. I was approved within one month of applying and was paid benefits retroactive to 6 months after the start of my disability - the date of my stage IV diagnosis. Of course, I had to reimburse the disability insurance the entire amount. Now I receive two payments every month, one from SSDI and one from long term disability but the total amount is the same. I have been paying a hefty rate for COBRA since I was terminated. I will eventually have to go on Medicare so I worry about that change and I will plan to keep COBRA through the extension period but i understand that legally they can charge me up to 150% of the premium cost. That doesn't leave much to live on. This is a struggle on so many levels! Good luck sorting things out.

Margarita

Kandy

Bonniemen, to answer your question about children under 18, they get 1/2 of the amount of your SSDI check. That is total. So for instance, if you have one defendant child, they would get 1/2, if you have 2 dependent children they would get 1/4 each, making up 1/2. Best of luck to you. I'm sure that it is very difficult to be in this situation and have to worry about the financial status as well.

CursiveStars

Thanks so much for everyone's helpfullness. I'm so overwhelmed by all of the rules and hoops. For instance Friday I recieved no STD check so when I called them they said I needed a new doctors form. I said they called me and said I was approved for LTD and that would kick in Nov 21. Apparently that doesn't have anything to do with the STD check. So now I guess it's no check for a couple of weeks. Yay.

I'm looking into Marketplace Insurance instead of Cobra. Has anyone used that? Even getting the super pricey PPO option it's still hundreds cheaper then Cobra.

Kandy

Cursivestars, you should check with your disability company as far as your check to see what they need. There is not supposed to be any time without a check in between short and long term disability. It should be a smooth transition. But what does seem to happen is when they pay. One seems to pay ahead and one pays in the rears. But when it's said and done, it should not be any week that you were not paid for. Please contact them and have them clarify this to you

CursiveStars

Thanks Kandy I did on Friday. They said while I was approved for long term I still had to submit a new doctors note to continue to recieve payments. I assumed since the original form my doctor sent said for me to be off until Jan 1st unless otherwise notified and the approval of LTD meant I was set. Apparently not. Since I told them I had an appt on November 3rd they stopped payment until they got a new updated form. I used STD once before under Unum and it was amazing. Under Aetna I've had nothing but trouble, took 8 weeks to get my first check from them and they harass me daily about when I'm going back to work. Very frustrating.

Fitztwins

For those of you who are worried about finances, if you have a good insurance plan, sometimes you can apply for accellerated benefits. This is a payout usually of 80% of your policy. You can bank some, and use the rest to pay off things, then it is easier to live on disability.

salve777

CursiveStars,

Have you considered ADA accommodations?

Longtermsurvivor

I mentioned ADA but I have disabled friends try to preserve jobs or get accommodations and found it took many years to file an appeal be heard.

I'm afraid we don't have years when we have MBC.

I am not a licensed professional and any medical legal or financial field, just a professional patient who pays attention and talks to people.

My best advice is to get the best possible advice. ✌🏼️😉

perky2020

Great information here! BonnieMen, you mentioned you could sign-up for AFLAC. Can we get a policy even after we have been diagnosted with MBC?

Lumpie

Posting this to several threads: I wanted to encourage other MBC'ers to check out and share workplace stories at this new discussion:

MBC and Your Job -- what's your story?

https://community.breastcancer.org/forum/8/topics/...

Interesting thread!

Lumpie

perky2020 and others: Regarding disability coverage through work, often if you start a new job, you will be able to sign up for a disability policies that provide coverage starting right away. Some may ask you screening questions and exclude coverage for pre-existing conditions either permanently or for a period of time. If you are already on the job and want to add disability benefits at your annual enrollment date, there is typically a similar process. These are general provisions and may vary depending on the size of your employer, your state and the terms of the plan offered by your employer. Good luck!