› Forums › General Melanoma Community › Help with practical considerations (insurance, etc)
- This topic has 20 replies, 9 voices, and was last updated 13 years, 5 months ago by Doug in Portland.
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- July 17, 2011 at 1:54 am
Evening, all.
It has become apparent to Don and I that although he is doing better cancerwise, it's not going to be realistic for him to go back to work. This round of chemo is kicking his butt, and with some of the side effects I've read that one can get from BRAF inhibitors (his next step after chemo stops working), it seems unlikely he will improve enough for at least a while.
This leaves me with lots of questions that I'm hoping some of you here can give me some answers to, or at least give me some idea where I could get the answers.
Evening, all.
It has become apparent to Don and I that although he is doing better cancerwise, it's not going to be realistic for him to go back to work. This round of chemo is kicking his butt, and with some of the side effects I've read that one can get from BRAF inhibitors (his next step after chemo stops working), it seems unlikely he will improve enough for at least a while.
This leaves me with lots of questions that I'm hoping some of you here can give me some answers to, or at least give me some idea where I could get the answers.
Currently, our health insurance is through Don's work, which of course, will complicate matters considerably. His FMLA runs out about mid-August. I am going back to work this week to save up what's left of my FMLA, since he seems to be self-sufficient and my teenaged kids will be home.
I will have the ability to pick up health insurance at my work for the family once Don's runs out. The trouble is that the coverage is not nearly as good. Basically, it is 80-20 for all services. I am extremely concerned for a couple of reasons. One: I don't know if the insurance at my work will even insure him due to his illness. Is that one of those things that Obamacare outlawed? Two: Frankly, we cannot afford to put Don on an insurance policy like this. In May alone, we wracked up $100, 000 in medical bills that were paid in full by our current insurance. Paying 20 percent of bills like this would bankrupt us.
Okay. The questions-
1) How do we go about filing for disability for Don? What are the chances he would qualify for this kind of help?
2) Does anyone know whether he would qualify for insurance coverage thru Medicare?
3) If not, can COBRA be carried for just one person instead of the whole family if you had family coverage when you left that job?
4) My understanding is that he won't qualify for state insurance unless he can't get insurance otherwise. If my insurance does accept him, is there any recourse for us to get financial aid for the horrible 20 percent coinsurance? Or some place we can appeal to for state insurance due to financial hardship because of his diagnosis?
5) If he pays an extra fee in his paycheck currently for life insurance, is there any way to pick up this insurance when he leaves? It's obvious that he won't ever qualify for another plan, so it's very important we maintain this one.
6) Does anyone know if his being not able to work anymore would qualify us for other programs like food stamps, things like that?
7) If we know Don won't be going back to work at his old job, how soon do we talk to human resources about it? We obviously don't want to be screwed over. Also, would it make sense to get the ball rolling on COBRA now so that perhaps it will be all set once his FMLA expires?
Sorry to be tossing a crapload of questions out there, but I figure I'd ask and see if anyone has any info/suggestions/ideas.
Thanks in advance for all your replies!
Michelle, wife of Don
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- July 17, 2011 at 2:54 am
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
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- July 17, 2011 at 2:54 am
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
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- July 17, 2011 at 3:45 am
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
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- July 17, 2011 at 5:30 am
Michelle,
You can file SSDI online…Don will get his first check 6 mos. after his stage 3 diagnosis and last day of work…you might want to ask some of these questions concerning your insurance coverage with HR…i would definitely talk to social worker at hospital-they are pretty savvy and know some shortcuts, grants, ect….depending on Don's age…he will not be able to get medicare until 2 years into SSDI… i know this all sucks…if you belong to a union or if Don does…sometimes you can pay premiums without losing coverage as long as you pay dues…this is the route i am taking…might be also a good time to talk to an estate atty…you can bet darn sure no politician will ever be faced with such choices…
boots
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- July 17, 2011 at 5:30 am
Michelle,
You can file SSDI online…Don will get his first check 6 mos. after his stage 3 diagnosis and last day of work…you might want to ask some of these questions concerning your insurance coverage with HR…i would definitely talk to social worker at hospital-they are pretty savvy and know some shortcuts, grants, ect….depending on Don's age…he will not be able to get medicare until 2 years into SSDI… i know this all sucks…if you belong to a union or if Don does…sometimes you can pay premiums without losing coverage as long as you pay dues…this is the route i am taking…might be also a good time to talk to an estate atty…you can bet darn sure no politician will ever be faced with such choices…
boots
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- July 17, 2011 at 3:45 am
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
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- July 17, 2011 at 5:46 am
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.
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- July 17, 2011 at 5:46 am
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.
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- July 17, 2011 at 5:46 am
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.
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- July 17, 2011 at 5:46 am
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.
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- July 17, 2011 at 6:16 am
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
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- July 17, 2011 at 6:16 am
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
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- July 17, 2011 at 3:14 pm
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
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- July 17, 2011 at 3:14 pm
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
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- July 19, 2011 at 12:54 am
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
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- July 19, 2011 at 12:54 am
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
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- July 19, 2011 at 9:21 am
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.
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- July 19, 2011 at 9:21 am
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.
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