Help with practical considerations (insurance, etc)

I don't know the answers to all your questions.  But Don should get coverage on your insurance because he'll have "continuous coverage".  Group policies can't descriminate as long as the person doesn't have a break in coverage for more than 63 days. (Obama's insurance descrimination package doesn't take place until 2014 for adults, I believe).   So if you go straight from his coverage to yours, he should be covered.

Another thing I would check out with your company's insurance is their "out of pocket maximum".  Typically, you pay out a certain amount ($1000 or $2000 maybe more) and then you are covered at 100%.  This doesn't include co-pays, but it does include most medical procedures, etc.  Definitely worth talking to an HR or insurance rep for your company.

I'm sure others will answer with more knowledge of Medicare and disability.

Best wishes,

Janner

I don't know the answers to all your questions.  But Don should get coverage on your insurance because he'll have "continuous coverage".  Group policies can't descriminate as long as the person doesn't have a break in coverage for more than 63 days. (Obama's insurance descrimination package doesn't take place until 2014 for adults, I believe).   So if you go straight from his coverage to yours, he should be covered.

Another thing I would check out with your company's insurance is their "out of pocket maximum".  Typically, you pay out a certain amount ($1000 or $2000 maybe more) and then you are covered at 100%.  This doesn't include co-pays, but it does include most medical procedures, etc.  Definitely worth talking to an HR or insurance rep for your company.

I'm sure others will answer with more knowledge of Medicare and disability.

Best wishes,

Janner

Don should be eligible for social security with no diffiulty.The paperwork can be done on the internet. The issue is that you get no payment for 6 months. Date of diagnosis should take him back a few months.  They might use the date as the first date that he did not work.  BUT, medicare starts 2 years from the first payment. So basically 2 years plus 6 months.  I worked the first 2 years as stage IV and they used my recurrance date to start my wait time.

Depending on your financial situation Don might be eligible for medicaid. Maybe someone elso can help you with that.

I found when I was diagnosed that if I told them I was't coming back I would immediately loose my benefits (I was on something called  sick bank where days were shared). I was advised by human resourses to not put in my notice till the last minute. I was a teacher so for me that meant that  didn't tell them till the end of the year.  I didn't get my health insurance through them so I don't know how that works.

Cobra is government regulated. Their has to be an agency that can give you information without you speaking yet to Don's employer.

Linda

Don should be eligible for social security with no diffiulty.The paperwork can be done on the internet. The issue is that you get no payment for 6 months. Date of diagnosis should take him back a few months.  They might use the date as the first date that he did not work.  BUT, medicare starts 2 years from the first payment. So basically 2 years plus 6 months.  I worked the first 2 years as stage IV and they used my recurrance date to start my wait time.

Depending on your financial situation Don might be eligible for medicaid. Maybe someone elso can help you with that.

I found when I was diagnosed that if I told them I was't coming back I would immediately loose my benefits (I was on something called  sick bank where days were shared). I was advised by human resourses to not put in my notice till the last minute. I was a teacher so for me that meant that  didn't tell them till the end of the year.  I didn't get my health insurance through them so I don't know how that works.

Cobra is government regulated. Their has to be an agency that can give you information without you speaking yet to Don's employer.

Linda

HI! How old is Don? Medicare won't do anything until he is a certain age if he ends up on ssdi. One thing to look into is Don's long term disability at his workplace. It is one of those things people forget about and don't apply for it…he needs to do it BEFORE he quits…It gives monthly payments as long as he is sick and doesn't return to work. He and his company has probably paid in to it. The amount is based on his salary.

HI! How old is Don? Medicare won't do anything until he is a certain age if he ends up on ssdi. One thing to look into is Don's long term disability at his workplace. It is one of those things people forget about and don't apply for it…he needs to do it BEFORE he quits…It gives monthly payments as long as he is sick and doesn't return to work. He and his company has probably paid in to it. The amount is based on his salary.

HI! How old is Don? Medicare won't do anything until he is a certain age if he ends up on ssdi. One thing to look into is Don's long term disability at his workplace. It is one of those things people forget about and don't apply for it…he needs to do it BEFORE he quits…It gives monthly payments as long as he is sick and doesn't return to work. He and his company has probably paid in to it. The amount is based on his salary.

HI! How old is Don? Medicare won't do anything until he is a certain age if he ends up on ssdi. One thing to look into is Don's long term disability at his workplace. It is one of those things people forget about and don't apply for it…he needs to do it BEFORE he quits…It gives monthly payments as long as he is sick and doesn't return to work. He and his company has probably paid in to it. The amount is based on his salary.

Michelle, I feel that it is unrealistic for Don to consider returning to work for the
foreseeable future. Although I have no knowledge (apart from what I have read) of how the
health system works in your country, I would like to give some general thoughts about your
situation.

One important thing is that Don's oncologist(s) should provide some form of written
statement(s) to support the fact that he cannot work for an extended period of time. I
assume that he will be filing for disability, so having medical information in writing
will be needed. I wouldn't be surprised if Don's treating doctor is asked to complete some
official forms to help with any claims that you may be making.

Another consideration is – who is going to help Don if you are at work? If he continues to
do well, he won't need much assistance at all. However, if his condition worsens will
there be someone who can help him if needed?

Take care

Frank from Australia

Michelle, I feel that it is unrealistic for Don to consider returning to work for the
foreseeable future. Although I have no knowledge (apart from what I have read) of how the
health system works in your country, I would like to give some general thoughts about your
situation.

One important thing is that Don's oncologist(s) should provide some form of written
statement(s) to support the fact that he cannot work for an extended period of time. I
assume that he will be filing for disability, so having medical information in writing
will be needed. I wouldn't be surprised if Don's treating doctor is asked to complete some
official forms to help with any claims that you may be making.

Another consideration is – who is going to help Don if you are at work? If he continues to
do well, he won't need much assistance at all. However, if his condition worsens will
there be someone who can help him if needed?

Take care

Frank from Australia

Michelle

Get with the Social worker on Don's team and have them help you apply for a program called Medically needy.  You can not be denied coverage from it.

 

Hugs and Smiles

Dawn

Michelle

Get with the Social worker on Don's team and have them help you apply for a program called Medically needy.  You can not be denied coverage from it.

 

Hugs and Smiles

Dawn

I suggest you talk to someone at the cancer clinic or hospital you frequent. They usually have a person who specializes in these issues. I live in a small town of 60,000 and we have such a person at our cancer clinic. They can at least get you started and help you avoid wasting time going down the wrong road.

Good luck It will take some tenacity and patience on your part. But as a mel caregiver, you already have that!

Nicki, Stage 3b

I suggest you talk to someone at the cancer clinic or hospital you frequent. They usually have a person who specializes in these issues. I live in a small town of 60,000 and we have such a person at our cancer clinic. They can at least get you started and help you avoid wasting time going down the wrong road.

Good luck It will take some tenacity and patience on your part. But as a mel caregiver, you already have that!

Nicki, Stage 3b

Michelle,
I believe that Don can get Cobra just for himself. I remember going on Cobra as a dependent when my husband switched to Medicare. If his coverage is superior to what you will be getting at your job, you might want to seriously consider the Cobra for him. It is available for 18 months, but an extension to up to 36 months might be allowed if he is disabled (someone correct me if I’m wrong). You will need to find out the cost – it can be quite high – and compare it to what it will cost paying for medical care under your plan. Someone else brought up the point of needing to also consider what happens if you must leave your job to help him.

Good luck, this is a very difficult decision, but you are asking good questions and will be better prepared to discuss this with the sources of help mentioned by the other posters.

Jule

Michelle,
I believe that Don can get Cobra just for himself. I remember going on Cobra as a dependent when my husband switched to Medicare. If his coverage is superior to what you will be getting at your job, you might want to seriously consider the Cobra for him. It is available for 18 months, but an extension to up to 36 months might be allowed if he is disabled (someone correct me if I’m wrong). You will need to find out the cost – it can be quite high – and compare it to what it will cost paying for medical care under your plan. Someone else brought up the point of needing to also consider what happens if you must leave your job to help him.

Good luck, this is a very difficult decision, but you are asking good questions and will be better prepared to discuss this with the sources of help mentioned by the other posters.

Jule

Michelle,

I have been working my way through this over the past year. I have stage IV melanoma and stopped working after my last surgery. Anyway, I'll tell you what I can. My experience was with a large, publicly held company. There may be different rules for smaller, privately owned organizations but I think most of this still applies. Your best resource will probably be the social worker at your cancer center or hospital.

1) Don should qualify for Social Security. Get the social worker to help fill out the forms or advise you. Make SURE you check to see if he has any short or long term disability through work. Often, these will provide 50% or more of his income and it will be partially or totally tax free. Short term will cover for the first 6 months and long term will take over after that. If he has short term disability, he will probably want to get off of the FMLA so he can get paid. With regard to long term, the insurance company will have a ton of paperwork but if SS is approved, they will probably approve as well. Stay proactive, they will drag their feet, lose your paperwork, etc. but in the end it will be worth the effort. Keep in mind you will still need to file for SS even if he has private coverage because insurance companies require it and also because he will need to be on SS to qualify for Medicare.

2) Medicare will kick in 24 months from the date of his disability  (5 months after his date of eligibility or 29 months from the last day worked.

3) COBRA coverage can be continued for just 1 person. We dropped my wife's coverage but have continued mine. Also, my wife has her own medical but no dental or vision so we continued those benefits for her and just cancelled the medical. Normally COBRA only continues for 18 months but it will continue for up to 29 months as long as the reason for employment termination is disability so there will be no lapse in coverage. Some HR people don't know this. MAKE SURE the official reason for resigning is DISABLED or ILLNESS and follow up with the administrator directly to confirm continuation of COBRA benefits. COBRA coverage will probably cost more because you will have to pay the employer's portion of the premium as well as the individual portion. With a family this could be significant. Your HR person can tell you how much. As for your employer's insurance, this should be a "qualifying event" and you should be able to pick up the family on your coverage without any medical questions however I don't know the rules on preexisting conditions.

4) I don't know about state insurance but if all else fails, there is a high-risk insurance pool available. You will have to do some research but I am sure he would qualify. Now, there is usually a requirement that the person can't have had any insurance coverage for 6 months but I recently heard this requirement can be waived for some cancer patients. I doubt this is available as an alternative to COBRA.

5) LIFE INSURANCE-If he has employer provided life insurance, don't let it lapse. The group life insurance provided by employers can be converted to a private policy but you have to ask HR for the forms and it will probably be expensive because the employer's group policy is TERM and the conversion policy will be WHOLE LIFE. In my case I also have to pay the premiums on an annual basis; monthly was not an option. That said, you are right, there really is no alternative.

6) This is income-dependent. You can find info on the SS website.

7) I struggled with this question, too but most HR professionals will help you and act as your advocate as long as you are an employee. Once employment is terminated, you will pretty much be on your own.

This process can be stressful particularly when you are going through the trials of this disease but there are resources available and it's worth the effort. My thoughts and prayers are with you and your family.

 

Michelle,

I have been working my way through this over the past year. I have stage IV melanoma and stopped working after my last surgery. Anyway, I'll tell you what I can. My experience was with a large, publicly held company. There may be different rules for smaller, privately owned organizations but I think most of this still applies. Your best resource will probably be the social worker at your cancer center or hospital.

1) Don should qualify for Social Security. Get the social worker to help fill out the forms or advise you. Make SURE you check to see if he has any short or long term disability through work. Often, these will provide 50% or more of his income and it will be partially or totally tax free. Short term will cover for the first 6 months and long term will take over after that. If he has short term disability, he will probably want to get off of the FMLA so he can get paid. With regard to long term, the insurance company will have a ton of paperwork but if SS is approved, they will probably approve as well. Stay proactive, they will drag their feet, lose your paperwork, etc. but in the end it will be worth the effort. Keep in mind you will still need to file for SS even if he has private coverage because insurance companies require it and also because he will need to be on SS to qualify for Medicare.

2) Medicare will kick in 24 months from the date of his disability  (5 months after his date of eligibility or 29 months from the last day worked.

3) COBRA coverage can be continued for just 1 person. We dropped my wife's coverage but have continued mine. Also, my wife has her own medical but no dental or vision so we continued those benefits for her and just cancelled the medical. Normally COBRA only continues for 18 months but it will continue for up to 29 months as long as the reason for employment termination is disability so there will be no lapse in coverage. Some HR people don't know this. MAKE SURE the official reason for resigning is DISABLED or ILLNESS and follow up with the administrator directly to confirm continuation of COBRA benefits. COBRA coverage will probably cost more because you will have to pay the employer's portion of the premium as well as the individual portion. With a family this could be significant. Your HR person can tell you how much. As for your employer's insurance, this should be a "qualifying event" and you should be able to pick up the family on your coverage without any medical questions however I don't know the rules on preexisting conditions.

4) I don't know about state insurance but if all else fails, there is a high-risk insurance pool available. You will have to do some research but I am sure he would qualify. Now, there is usually a requirement that the person can't have had any insurance coverage for 6 months but I recently heard this requirement can be waived for some cancer patients. I doubt this is available as an alternative to COBRA.

5) LIFE INSURANCE-If he has employer provided life insurance, don't let it lapse. The group life insurance provided by employers can be converted to a private policy but you have to ask HR for the forms and it will probably be expensive because the employer's group policy is TERM and the conversion policy will be WHOLE LIFE. In my case I also have to pay the premiums on an annual basis; monthly was not an option. That said, you are right, there really is no alternative.

6) This is income-dependent. You can find info on the SS website.

7) I struggled with this question, too but most HR professionals will help you and act as your advocate as long as you are an employee. Once employment is terminated, you will pretty much be on your own.

This process can be stressful particularly when you are going through the trials of this disease but there are resources available and it's worth the effort. My thoughts and prayers are with you and your family.