Federal and State Benefit Programs
Federal and state benefit programs offer help to meet health care and income needs. These programs can help those who can’t work due to cancer, treatment or aftereffects.
Types of federal and state benefit programs:
- Social Security Disability Income (SSDI): This program pays income benefits to people who are disabled. Benefits may also be provided to certain family members. You must have worked and paid Social Security taxes for a certain number of years to qualify.
- Supplemental Security Income (SSI): This program pays income benefits to disabled adults and children who have limited income and resources. Benefits may also be paid to people over age 65 who are not disabled if they meet the financial need requirements.
- Medicare is the federal health insurance program that includes coverage options for prescription medication, doctor services and hospital visits. This program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Medicare services are for people with certain disabilities and for citizens or lawfully admitted residents of the United States who are 65 years of age or older. A portion of the payroll taxes that are paid by employers and employees finances Medicare. It is also partially funded by monthly premiums that are deducted from Social Security checks. Generally, you or your spouse must have worked for at least ten years in Medicare-covered employment to qualify for benefits.
- Medicaid is a partially federally-funded health care program administered by the individual states. Each state sets its own income and disability eligibility requirements and service guidelines. Medicaid does not pay income benefits but sends payments directly to the health care providers, such as doctors and hospitals. Many states extend Medicaid coverage to people who qualify for SSI benefits. However, a number of states use their own eligibility rules for Medicaid and some require a separate application. Contact your state department of health for more information about programs that exist in your area.
The Centers for Medicare & Medicaid website helps you find answers about Medicare and Medicaid. There are online tools to help you compare and find the best Medicare prescription drug plan for your situation. The CMS also provides contact information for all state health departments. You can then contact your state or county Department of Health and Human Services office for help.
Finding Out Your Eligibility
Read about the federal and state programs before you apply for benefits. Learn about the medical requirements that make you eligible for benefits. Here’s who to contact and tools to help:
- U.S. Social Security Administration (SSA).
- Your local Social Security office.
- The Benefit Eligibility Screening Tool.
Applying for Benefits
Apply for benefits as soon as cancer is diagnosed. The process takes an average of 65 days. SSDI benefits generally do not start for about five months after the date you are found to be eligible.
Talk with your health care provider if you can no longer work or do your job duties. Your health care team may have ideas about changes that could help you continue to work. For example, you might ask your employer to change your work hours or some of your job duties for a time.
If your provider believes you should not work for a while, ask him or her to note this in your medical file. Also, try to get a letter from the provider stating this medical opinion. You can include a copy of this letter when you apply for benefits. Take the following steps to apply:
1. Prepare your case. Read about each benefit program. Understand what is required before you apply. This will help you include the documents that are needed such as medical reports.
2. Read the Listing of Impairments from the SSA. Read about what qualifies you as disabled. The SSA website provides good information about the medical proof that is required.
3. Talk with your health care team about applying for disability benefits. Ask them to write down treatment side effects and physical limitations in your medical records. Tell them about your symptoms. Give examples of how this is affecting your work and personal life. Ask that this be noted in your medical records. This information will be important to the SSA as your medical records are reviewed when you apply for benefits. If your provider believes you should not work for a while, ask him or her to give you a note or letter stating why you should not work at this time.
4. Consider your provider’s opinions and recommendations about your ability to work. If you and your provider do not agree, you can seek other medical opinions. To qualify for benefits, proof of your disability is required from a health care provider.
5. Keep good records. Keep track of all letters, bills and claims information. Also, keep notes about discussions between you and your health care team, the insurer and others. Write down dates, names of people and what was said. These records may be useful if there are questions or concerns in the future. Always keep copies of information received from or sent to insurers and benefit programs.
Who Can Help You Apply?
Ask for help if applying for disability benefits seems too difficult. For example, a social worker, friend, loved one or a nonprofit legal services group may be able to help you. You can also contact nonprofit cancer organizations for help with insurance and benefit matters. For example, Livestrong Cancer Navigation Services can guide you through the process of applying for benefits.
You can contact the National Cancer Legal Services Network to locate free legal services to address insurance, employment and financial issues. Also contact Legal Health to get advice and representation.