Disability resources?

[Jennedy]

Hi all, I have been on short term disability due to my pneumonitis. I am scheduled to go back to work 11/2. I am in IT and currently WFH due to Covid so not a problem. But this has got me trying to plan for when I am no longer able to work. I currently carry the health insurance for my husband and I.  I have been trying to determine if I am on LTD what my health care coverage would be. But I can't figure out how "they" determine if I am unable to work. 

Any thoughts or websites to go to? I looked at SSDI. But I need to get it all approved through work. 

Thanks

Jenny

[LexieCat]

Hi, Jen,

I just went through the disability routine, myself. I have STD and LTD through my job, which also requires me to apply for STD through the State of NJ (we are required to contribute through payroll deductions). I also applied for SSDI.

SSDI has expedited disability processing for Stage IV lung cancer--you're basically automatically approved. I'm not sure how old you are, but the benefit for SSDI is basically the same as your full retirement benefit if you retired at your full retirement age. I have another 2.5 years before I hit full retirement age but applying for SSDI gave me an extra $500 a month over what I'd get retiring right now. Also, when you get disability (SSDI) you qualify for Medicare in 2 years, I believe (I will be 65 next year so I qualify even sooner).

So that's one route to health insurance. (I don't have to worry because I get my healthcare through my retirement as a government employee before my current job.)

After 26 weeks of STD through my job, mine will automatically convert to LTD. That gets reduced by my SSDI benefit, but it continues till I reach full retirement age, at which point it stops and I get only SSDI (which converts to retirement benefit).

As for continuation of your healthcare if you are out on LTD, I think you will have to check with your HR department or your employee handbook. Worst case scenario, you should qualify for COBRA until Medicare kicks in. 

I did a lot of googling and researching before I felt comfortable applying. But Social Security considers me disabled from the date of my Stage IV diagnosis, in July, even though I didn't start treatment/stop working until September. There's a 5-month waiting period, so I won't actually see a SSDI check until February, but at least that front-end time gets counted as part of the 5 months. 

[Judy M2]

COBRA can be expensive. Obamacare (Affordable Care Act) can be a reasonable alternative pending Medicare eligibility. You can go on your state's website or call to find the right plan for you and calculate your premium. 

Once you're eligible for Medicare (Part A), remember that you'd also need a Medicare supplement (Part B.) and prescription coverage (Part D) to get complete coverage. Premiums apply for all parts, unless you get a Medicare Advantage plan that includes Parts B and D plus some other benefits.  Lots to learn. 

[Lisa Haines]

LexCat provided you some great information and 'll share a little more, based on my expereince.

I am actually on SSDI myself and have been for well over 2 years now so I also do have Medicare A.  At this point I did not opt into part B yet because my husband is still employed and we are both under 65 and his insurance is primary and  in our situation we are not required to opt into part B until he retires and does not have a group plan.  There is no point in me paying the premium for Part B and then a supplement and then Part D as long as he works.  I am allowed to defer my part B without penalty, as long as he works and has a group plan.  If that were not the case and you opt into Part B late you may have to pay penalties so you have to be very careful with that and make sure that you meet the requirements for not enrolling right away. 

 I know at some point when he's closer to retiring we will move to Medicare ABD and and a supplement to make sure I have full coverage.  Right now we're better off with his plan and also eligible to stay with his HSA which we could not have if he had Medicare.

As far as your employer group health plan you may have to look at the employee handbook or talk to someone in your human resources department to figure out exactly how it works with insurance if you go on to long-term disability etc. It can vary greatly by employee and employee size larger group employees are required to offer more programs than our small companies that don't meet their requirements under the federal rules.

Insurance can definitely be very confusing and very expensive so it's really great that you are looking to all this now.  The  social security website has a wealth of information on SSDI and SSI and you can even apply online, if and when you need to do so you can even start the application and just not submit it until you are ready.  Here is a link to the site -- https://www.ssa.gov/benefits/disability/

Stage IV lung cancer is expedited for approval but keep in mind that you do not get benefits for the first 6 months and the start date of disability is the last day that you're able to work. It's good if you do have other programs where you can maintain income. When I had to go on SSDI I was working for a very small company and we did not have short or long-term disability so I went 6 months without any income, it was definitely a big adjustment at the time.

Best wishes,

   Lisa

 

 

[LexieCat]

11 hours ago, Lisa Haines said:

Stage IV lung cancer is expedited for approval but keep in mind that you do not get benefits for the first 6 months and the start date of disability is the last day that you're able to work.

 

 

In my case (and I'd assume this is true for everyone with Stage IV LC), they started the 5-month waiting period as of my date of diagnosis in July, rather than when I started treatment/stopped working. They count by calendar months, and when you get a check it's for the previous month's benefit. So how it works for me is the waiting period is August, September, October, November, December. I get benefits for January, but the check for that doesn't go out till February. 

I believe it's considered problematic if you continue working too long (as in, several months--I forget how long) after your disability date. For me, the bottom line is that I was having to struggle to do my job (which requires intense legal analysis), so I didn't feel I was able to do what my employer hired me to do, even with accommodations. It was just too difficult/stressful to try. I limped along for a week or so after my first infusion and concluded it was just impossible to make it work.

[Babs]

Hi,

This is an interesting thread.  I was on STD through my employer and decided to retire in February.  I had a recurrence in June and am now considered stage IV.  Does anybody know if I would be eligible for SSDI if I retired?

Babs

[Tom Galli]

If you are not Stage IV, this might help in understanding SSI disability applications.

Stay the course.

Tom

[LexieCat]

Babs, when you say you retired in February, do you mean you went on Social Security? Or did you retire without applying for SS? 

My impression is that if you've already begun receiving SS retirement benefits you can't then switch to SSDI. You MIGHT be able to cancel your retirement and pay back any SS benefits you've received and then apply for disability--you might have to contact Social Security (or talk to a disability attorney) to find out. As I said, the main benefit to SSDI is that your benefits will permanently be at the full retirement amount (as opposed to the reduced benefit if you retire early). So whether it's worth it for you to do that depends on your age and how much you'd get at your full retirement age, as well as how much you'd have to pay back, etc. Remember--you've got that 5-month waiting period where you get no benefits for SSDI, too, which factors into the mix.

*ETA* See post below--apparently it IS possible to switch benefits.

I'm no expert here--it's just that I researched a lot of this stuff relatively recently. 

[Babs]

No, I haven’t yet applied for SS.  I just retired from my job.  I am 62 years old, so maybe something I should check into? 

[Rower Michelle]

Hi Jenny 
I asked the same question two years ago. The disability process isn't well documented and you've gotten very helpful advice.  We had the same situation, my husband was on my employer sponsored policy.  This is what we did: 

1. I used my employer's Short Term Disability which lasted for six months. As a condition for LTD I had to apply for SSD

2. I filed for SSD five months after my Stage IV diagnosis, so that I would be immediately be  approved without having to wait for benefits.   

3. At the six month mark of my diagnosis,  my employer terminated my position and we elected to pay for COBRA.  Yes, its' expensive, but the out not pocket was almost zero, so it was better than anything offered on the exchange which had super high premiums,  deductibles and copays.  The total out of pocket expenses was still less on COBRA for us. 

4.  My employer has a COBRA extension for disability, BUT here is the catch.  I had to be approved by SSD within 90 days of starting COBRA coverage.  We got the SSD approval to the employer in about 40 day.   We received a 11 month extension to COBRA for both us us, so COBRA coverage would continue for a total of 29 months.  We paid the normal COBRA premium up to 18 months and at the 19th month, the COBRA carrier can increase the premium by an additional 50% (which in our case they did!).  We are now 21 months on COBRA, and aside from the outrageously high premium, the other problem we have encountered is there is no employer procedure for maintaining the disability extension and we've been accidentally disenrolled from health coverage three times.   If you get a COBRA extension, you will need to continue to verify your medical coverage to avoid claim denials.  

5. The 29 month COBRA extension is enough time to get me to Medicare through SSD which is 24 months of receiving SSD benefits.   I am still on the LTD plan from my employer.  

6. Then we had to assess how to obtain insurance for my husband since he is under 65.   After looking at everything available (including some of the alternatives like MediShare), my husband took a part time job at UPS.  We found this really hard to believe, however for part time employees with 9 months of service there are FULL benefits, not crappy ones either.  We just got the enrollment information and my cancer care will be covered at 100%.  There is NO employee contribution for health insurance either!    We've since learned that there are a lot of people in the county that got to work for UPS part time  just for the excellent benefit coverage.

Human Resources was of some help, however, the best resource was the case manager at the disability insurance company.  She knew all the rules, timeframes and the correct order of the administrative hoops.   

Keep us posted!

Michelle  

[Jennedy]

Thank you all for your suggestions. I read through everything I could find on our HR site, plans and guides.  I have spoken to people from Cigna (the administer of the disability), Anthem, and HR. I confirmed that my health benefits continue through LTD just like they do during short term. 👏My hope is to continue working until spring. (Bonus payouts in February).  

I believe I read that I had 1 year from date of diagnosis to apply. That was June 2020. Sounds like I need to get everything together and apply. 

FYI - I will turn 62 in December. The difference in the disability benefit vs. Taking early SS retirement is almost $800/month. I am Stage IV. 

I have been putting this off but now I feel like this is the right thing to do. 

@Rower Michellegreat news about the UPS insurance. I know how you struggled with the COBRA.

[LexieCat]

3 hours ago, Babs said:

No, I haven’t yet applied for SS.  I just retired from my job.  I am 62 years old, so maybe something I should check into? 

I sure would, if I were you. I retired from my County position in 2011, so I have a defined pension benefit I've been collecting all this time. With my current job, on top of the pension, my income is high enough that my take-home pay is a pittance. For me, the main purpose in continuing to work was to afford some fun things and also to build up some additional retirement savings (403(b)). 

My original plan, before the Stage IV diagnosis, was to hold off on Social Security till I hit 70, if at all possible, to max out my benefit. Although I'm hopeful I will respond well to treatment and that I'll be a long-term survivor, I also know that realistically, I'm less likely to have to fund a very long retirement. 

So for me, getting a benefit equivalent to my full retirement benefit made sense. I get more money now, when I can use it, and even if I'm one of the fortunate long-timers I'll have a higher ongoing Social Security benefit. 

Everybody's situation and considerations are different--this was just my thought process and reasoning. For me, SSDI made sense. Plus, if you're 62 now, you will qualify for Medicare a year earlier than you otherwise would, if that does you any good.

 

[LexieCat]

Apparently it IS possible to get SSDI after already receiving retirement benefits. Here's a good explanation from the AARP website: https://www.aarp.org/retirement/social-security/questions-answers/retirement-to-disability/.

It occurs to me that it might be good to have a forum here related to employment, insurance, and disability issues. These things come up for a lot of people and it might be nice to collect the threads in one place. 

Admins?