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Health & Disability Insurance

This video was originally published by LiveStrong on February 10, 2010, here.

Those affected by cancer need to understand health and disability insurance. This is an overview of things you need to know under current laws. To learn more, consult with those knowledgeable about insurance matters. If you are working, talk with your employer’s benefits coordinator and the insurer.

There are often changes in how people in the United States receive health care coverage. Some of these changes may benefit people affected by cancer. To learn more and stay up to date, visit HealthCare.gov. Also, the LIVESTRONG Cancer Navigation Services offers guidance about insurance and other cancer-related issues.

If You Have Health Insurance

1. Read your policy to learn what is covered and not covered. Talk with the insurer to get answers to your questions. You also need to understand what the plan requires. For example, there may be certain limits on when you are allowed to submit insurance claims or to appeal claim denials.

If you do not have a copy of your insurance policy, ask the insurer for another. You do not have to tell the insurer about your cancer diagnosis at the time you request the copy.

2. Continue to pay the full amount of your insurance premiums on time. This will keep your health coverage active. An insurer cannot deny benefits for covered medical services when your policy is active. If you do not pay the full premium on time, your policy will be closed (or lapse). If your policy is closed, health coverage will stop.

After a cancer diagnosis, it can be very hard to find new coverage if an existing insurance policy lapses. If a new policy can be purchased, it will likely cost much more and have longer waiting periods. It may also exclude certain benefits due to medical history.

What to Think About in a Health Insurance Plan

3. Follow all of the insurance plan’s rules. For example, many insurance plans require that you contact them to get specific medical services pre-approved. This means that your health care provider’s office should contact the insurer before sending you for tests or other treatment.

Make a list of all your current health care needs. Include services and treatments that you may need in the future. Compare your health plan benefits to expected medical needs. This will help you decide whether you already have the coverage that you need.

If You Don’t Have Health Insurance

Begin to look for ways to find coverage if you have concerns about having no health insurance. Check out options such as:

  • Group insurance through a union or as a member of another group.
  • An individual health insurance policy that you buy for yourself.
  • Federal or state benefit programs that are based on your income and disability.
  • Services through county, community and hospital programs.
  • Insurance coverage under the health plan of a loved one.
  • A new job that offers group health coverage.
  • The insurance options finder tool at finderhealthcare.gov.

Types of Insurance Coverage

Group health plans are offered through groups with employees or members such as:

  • Employers.
  • Credit unions.
  • Labor unions.
  • Trade groups.
  • Organization or association groups

These plans cover a large group of people. The insurer cannot refuse to insure any members of the group health plan. However, health conditions that existed before enrolling in the plan (called pre-existing conditions) may not be covered right away. This is defined by the policy.

Individual health plans are purchased by one person. The cost is usually much higher than group plan coverage. This type of plan may not cover certain pre-existing health conditions. When you apply, the insurer will review your medical history and decide what a plan will cost. They may decide not to sell the health coverage to you.

How to Find Out About High-Risk Pool Coverage

High-risk pools—Many states have organized private, self-funded insurance coverage offered through high-risk pools. These are plans for people who have not been able to get other insurance. Proof of this inability to get other insurance may be required when you apply such as copies of denial letters from insurers. The National Association of Health Underwriters (NAHU) offers a consumer guide to high-risk health insurance pools.

Laws that Affect Health Insurance Coverage

Be sure to keep your health insurance if you have it. If you lose your insurance, it may take time or cost more to purchase another health policy. Three important laws affect health insurance coverage.

Affordable Care Act of 2010 puts health insurance reform into effect over a period of years. The following changes in insurance coverage may help people affected by cancer:

  • Private insurance companies cannot deny coverage to children (under age 19) with pre-existing conditions such as cancer.
  • Health plans cannot drop a person from coverage when they become sick.
  • No lifetime dollar limits on coverage through individual and group health insurance plans.
  • Young adults can be covered under a parent’s insurance policy until they reach age 26.
  • Seniors with Medicare benefits to receive discounts on brand drugs by 2013. The coverage gap will be closed completely by 2020.
  • High-risk insurance pools set up in every state to provide coverage for the uninsured.
  • Medicare and new private health plans will cover preventive services (like breast, cervical and colorectal cancer screening) with no co-pays and deductibles.

For more information and updates about the Affordable Care Act, visit healthcare.gov.

Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) is a federal law that provides the right to continue health benefits for a certain amount of time after leaving a job. The former employee must sign up within a certain time frame and pay the full premium amounts. It also applies to loved ones who were covered by the employee’s health insurance plan.

If you know that you will be leaving your job:

  • Talk with your employer’s benefits department. Find out how and when leaving your job will affect your health benefits.
  • Learn about the COBRA coverage that will be offered when you leave your employer. Ask how much it will cost.
  • Find out about the dates for signing up and for making payments. Pay the full amount on time every month.
  • Ask when COBRA payments will start and how long the health benefits will last.
  • If needed, ask if you can get insurance benefits beyond the initial COBRA coverage period. Some plans allow this in certain cases.
  • Find out if your state offers insurance programs or other ways to keep your health insurance after COBRA.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law. It protects those covered by group health insurance plans. It limits the length of time a group plan insurer can refuse to cover pre-existing health conditions. It also protects personal privacy.

Under HIPAA, you may be able to keep health coverage if you go from one group plan to another. For example, if you change employers, the new group plan must cover a pre-existing medical condition without an exclusion period if:

  • You have had health insurance with no gaps in coverage for longer than 63 days and
  • You have had health insurance for at least the previous 12 months

HIPAA does not protect the coverage provided by individual health plans. If you try to change to a different individual plan, the new insurer can legally turn you down.

Some states have health insurance protection laws that are similar to federal laws. Check to see if your state has laws that can help you get or keep health coverage. Read more about HIPAA protections at hipaa.com.

Disability Income Insurance

Group and individual disability income plans provide benefits if you are not able to work. There are two types of disability policies:

  • Short-term policies pay a weekly income benefit for a short period, such as up to two years.
  • Long-term policies pay income benefits for the time specified by the policy. This could be as long as the rest of a person’s life. It might be up to the age when a person can retire (65 or 67).

Some employers offer short-term disability insurance. The income benefits start soon after you cannot work. They may continue until long-term benefits start. Even if you become unable to work, pay the full insurance premium on time. Keep paying until you get a written notice to stop. If you do not pay, the insurer will cancel your policy.

Long-term benefits continue as long as you are disabled. The insurer will review your case regularly. Benefits will stop if you go back to work. They will also end if a health care provider informs the insurer that you are no longer disabled.

Dealing With Insurance and Benefit Claim Denials

Always look into insurance and benefit claim denials. If you are denied benefits, you may need to appeal the insurer’s decision. An appeal must be filed within the time allowed by the insurer.

You or someone else may have to advocate or fight for your rights. Ask the insurer to answer your questions about the denial decision. Use all of your appeal options. If you believe that a claim denial is unfair, contact an advocacy organization for help such as:

As you go through treatment, you will need to share information with insurers and health care providers. If you are not feeling well enough to do this, ask someone you trust to help. He or she can keep track of insurance applications, claims, payments, denials and appeals. Your health care provider can also refer you to a social worker for help.

If you have questions about an insurance denial, an appeal or your rights, you can contact the Employee Benefits Security Administration. They are part of the U.S. Department of Labor and will offer free, confidential assistance.

Get Moving: Exercising with Limited Mobility

Over 53 million American adults live with some type of disability. However, one in eight live with the most common form of disability which is limited mobility. This is where a person experiences severe difficulty with climbing stairs or walking. If your mobility is severely restricted, exercising may be something you have come to think of as impossible. But exercise can be performed by anyone, including individuals with limited mobility.

Anyone can benefit from exercise

People who experience problems with their joints, issues with their weight, or a serious injury or illness can enjoy the benefits of carrying out regular physical activity. In fact along with the physical benefits, exercise can also help depression, reduce stress and anxiety, boost energy, and improve your sex life and quality of sleep.

Exercise improves cognitive function

Research has shown that there is a significant link between the body and mind when it comes to preventing memory loss. People who get regular exercise reduce their risk of experiencing a drop in their mental function in their later life. This also includes a reduced risk of developing Alzheimer’s or dementia.

You need to get your body moving to help keep your body and brain healthy. But while the challenges caused by restricted mobility may be unavoidable, you should still be able to find an enjoyable and rewarding way to be physically active.

Flexibility exercises

Stretching exercises like yoga are an ideal way to help prevent injury, improve your range of motion and reduce pain and stiffness. Even with very limited mobility in your legs, you can still enjoy the benefits gained from stretches and flexibility exercises. These can significantly help delay or even prevent further muscle atrophy.

Cardiovascular exercises

These exercises will increase your strength and endurance while raising your heart rate. Cycling on an exercise bike, walking, playing tennis or even dancing are great cardiovascular exercises. If your mobility is severely limited then how about swimming and water aerobics? The water will support your body while reducing the risk of any joint or muscle discomfort. It can also feel wonderfully relaxing too.

Strength training exercises

Strength training exercises use resistance such as weights to help you build muscle while also increasing your bone mass. Strength training is also important in helping to improve your balance, crucial in helping to prevent falls. If you have restricted use of your legs, then instead focus on developing your upper body strength. However, if you have issues with your upper body, then focus more on strength training your abs and legs.

Regular exercise may not feel like a priority when your mobility is restricted. However, instead of focusing on your physical limitations, concentrate on finding rewarding fitness activities that you will enjoy. It may feel a challenge to start with, but it will get easier the more you do it and you will feel the physical and emotional benefits in no time.

Qualifying for Disability Benefits with Cancer

Have you been diagnosed with cancer? If so, you might be eligible for financial aid. If so, the Social Security Administration (SSA) might be able to help. The SSA offers monthly financial resources for people with serious illnesses who are unable to work. While a cancer diagnosis does not automatically qualify, thousands of people with cancer are eligible for assistance.

Medically Qualifying for Disability

The SSA will refer to its own medical guide, known colloquially as the Blue Book, when you apply for disability benefits with cancer. The Blue Book contains details on exactly what medical results you’ll need for cancer to qualify. Cancer has different qualifying criteria depending on your specific diagnosis, so there’s no way to know if you’ll qualify without first consulting the Blue Book. Here are a couple of examples on how to qualify:

Prostate Cancer

Prostate cancer is one of the most commonly diagnosed forms of cancer, but the good news it’s highly treatable. Because of how receptive prostate cancer is to treatment, the criteria for qualification for prostate cancer are challenging to meet.

You will qualify for disability benefits with prostate cancer if your cancer has progressed or returned despite one round of anticancer therapy (usually three months’ hormonal therapy or chemotherapy will qualify), OR

Your cancer has spread to an internal organ, OR you have small-cell prostate cancer

Prostate cancer usually has to be Stage IV to qualify, but again, if your cancer has returned despite treatment you may still qualify at a lower stage.

Esophageal Cancer

Esophageal cancer is typically aggressive and challenging to treat, so you’ll actually qualify for Social Security disability benefits with just a diagnosis. Other forms of cancer that qualify with only a diagnosis include:

  • Acute Leukemia
  • Gallbladder cancer
  • Brain Cancer (malignant, not benign tumors)
  • Inflammatory Breast Cancer
  • Liver Cancer
  • Pancreatic Cancer
  • Salivary and Sinonasal Cancers
  • Thyroid Cancer

The entire Blue Book is available online, so you can review the cancer listings with your oncologist to determine if you’ll meet a listing. Typically, if you can meet any one of the following criteria you’ll qualify:

  1. Your cancer is inoperable or untreatable
  2. Your cancer is Stage IV
  3. Your cancer returned despite treatment

Starting Your Application

Applying for benefits is a tedious process, but fortunately you can complete the entire application from the comfort of your own home. Apply online at the SSA’s website—you can even save your progress to be completed at a later date.

If you’d prefer, you can also apply in person at your closest Social Security office. There are over 1,300 offices located across the country. You can schedule an appointment to apply in person by calling the SSA toll free at 1-800-772-1213.

Once approved, you can spend your monthly benefits on medical bills and upcoming treatments, childcare, housing for your family during treatment, food or utility bills, or any other daily living expenses.


Additional Resource:

Social Security Administration: https://www.ssa.gov

Social Security Disability Evaluation: https://www.ssa.gov/disability/professionals/bluebook/

Qualifying Criteria: https://www.disability-benefits-help.org/resources/medical-evidence

The Blue Book: https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

Social Security Disability Application: https://www.ssa.gov/applyfordisability/

Social Security Offices Locator: https://secure.ssa.gov/ICON/main.jsp

Bills Social Security Can Cover: https://www.disability-benefits-help.org/blog/bills-social-security-disability-benefits-cover


This article was provided by Disability Benefits Help (www.disability-benefits-help.org), an independent resource dedicated to helping people across the country receive the disability benefits they need. For more information, feel free to reach out to our team at help@ssd-help.org.