We are 144,793 members in 73 forums discussing 114,637 topics.

Help with Abbreviations

All TopicsForum: Employment, Insurance, and Other Financial Issues → Topic: Stage IV and Medicare

Topic: Stage IV and Medicare

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Jun 14, 2011 03:07PM, edited Jun 14, 2011 10:30PM by MaryNY

MaryNY wrote:

My friend was diagnosed with triple-negative breast cancer three years ago. She lost her job about a year later. Her unemployment benefits have run out at around the same time she had surgery for mets to the lungs. As she was recovering from that, she was diagnosed with brain mets, for which she has also had surgery. She is fortunate in that she still has insurance but has no income and her savings are depleted. She needs to pay rent, utlities, doctors co-pays, transporation to and from frequent doctor/hospital appts and doesn't know where to turn.

I thought I read somewhere that Stage IV breast cancer patients automatically qualify for Medicare. Is that true? Or is there something about qualifying for social security disability first? Not sure if the process varies from state to state but this is in NY.

I'm not sure how she is managing to cover her rent payments at the moment, I think her family may be helping. I was wondering if anyone of have any suggestions on that end too. Like how difficult is it to qualify for Section 8 housing. 

Log in to post a reply

Posts 1 - 25 (25 total)

Log in to post a reply

Jun 14, 2011 03:12PM MaryNY wrote:

I posted this topic earlier but then realized that the subject line made it look like a begging letter, but couldn't figure out how to revise that so deleted the post instead.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 04:27PM reesie wrote:

I don't know about the Medicare wait without SSDI but I understand qualification is 24 months from qualifying for SSDI It sounds like she would qualify immediately for SSDI and be eligible for retroactive benefits. If you go to www.SSA.gov you should be able to get some info.

Marie - It's A Great Day To Be Alive. Dx 10/29/2010 ER+/PR+, HER2- Stage IV mets to bones, liver, lungs, skin, pleural effusions

Log in to post a reply

Jun 14, 2011 04:44PM, edited Jun 14, 2011 04:48PM by nurse-ann

Hi:

I can only tell you how it worked for me.  I became disable (by SSA's definition) two years ago - May 1st.  They contacted me around the end of 2010 to ask if I wanted part b deducted from my benefits.  The same happened with my brother.  You are eligible for Medicare 2 years after becoming disabled.

I edited the post to add that my reason for disability is stage IV.

Dx 11/18/2006, ILC, 5cm, Stage IV, Grade 2, 15/16 nodes, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 06:04PM MaryNY wrote:

My friend's lesions in her lungs showed up about a year ago, I think. But Stage IV was probably confirmed more recently when they did the lung surgery. I did look at the SSA.gov site earlier but found it hard to figure out.

So she has to qualify for disability first, right? and that might or might not be retroactive. And she would only be eligible for Medicare two years after the date established for the date of disability?

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 06:13PM blondiex46 wrote:

Tell her to apply and you have to wait 6 months from the diagnoses before you can collect.  As far as insurance she might qualify for MA now but I am a part of the Healthy women Breast cancer and cervical program

http://www.familyplanningplus.org/services/healthy-woman/

that is the one for New York, I am in PA and get it.....any questions let me know!!

Original 8/96 - 1cm, chemo, rads. Recurrence..9/09...Mets to lungs, chest wall, lymph nodes under arm & chest, cervical & lumbar spine, ribs, hip. Femera, Falsodex, Zometa, Xeloda, Gemzar, Taxotere, Adriamycin moving to Havalen

Dx 9/1/2009, 3cm, Stage IV, ER+/PR-, HER2-
Log in to post a reply

Jun 14, 2011 06:14PM scuttlers wrote:

Mary, there is a thread with lots of answers to your questions on the Stage IV forum, I just bumped it up so it should show in recent discussions.

Your friend can fill the request for SSDI in line. My whole process took less than two weeks from application to approval. Yes, there is a wait for Medicare, but in the wait there is also money coming in which really helps.

The SS office will also check to see if she qualifies for SSI in addition to the SSDI, which could qualify her for Medicaid possibly (or the low income need based which applies in her state).

My favorite side effect of treatments is BEING ALIVE!

Dx 2/4/2009, IBC, 6cm+, Stage IV, Grade 3, 11/17 nodes, mets, ER+/PR-, HER2+
Log in to post a reply

Jun 14, 2011 06:15PM nurse-ann wrote:

That's my experience but also look at the financial requirements for Medicaid in her state.  My brother was able to be on Medicaid until Medicare was available to him two years after becoming disabled - now he has both. 

Dx 11/18/2006, ILC, 5cm, Stage IV, Grade 2, 15/16 nodes, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 06:33PM 37antiques wrote:

Hi Mary! 

Your friend needs to apply for SSDI, she can do it online, and then they will call her.  If you need help with this, I am very good at this whole process and can try to guide you if you need it.  It does take time, the sooner you get everything together the quicker it goes.  It would be best if she told her doctors that she is doing this, so they will be prepared and have all of the documents on hand to submit for her.

After 2 years of SSDI, Medicare kicks in.  Yes, there is a premium they deduct.  However, since you are in NY, if she has SSDI and goes to the office of the Aging (no matter the age, she is now considered disabled), they will help her with that and become an advocate for anything she needs, and they can especailly help with the prescription plans, which can be a huge headache.

But it sounds like she needs immediate help, instead of waiting two years. If you need help or guidance, please feel free to PM me, I am in NY and am unfortunately, very familiar with what she can do right now.  There is housing assistance, medical care, a lot of things that she can qualify for easily since she has no income, but again, you have to have all of the paperwork ready to go.

I hope this helps, and if I can help you at all, please let me know.

IDC DCIS & Mets

Dx 2/27/2007, IDC, 1cm, Stage IV, Grade 3, 0/0 nodes, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 08:34PM cycle-path wrote:

Regarding Section 8 housing: I don't know how difficult it is to qualify, but I do know the waiting list to actually GET the housing after you qualify can be rather long. So it's something to look into right away. I believe you have to apply through your local city or county housing authority.

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
Log in to post a reply

Jun 14, 2011 08:38PM bcincolorado wrote:

I can tell you for many people with SSDI claims you are often denied to start off with.  I knew someone who applied and was approved right away but many have to get a lawyer and do an appeal.  For this person the SSDI payments did not start (they were not eligible) until they had not been able to work for a year.  Then it took 6 months more before they were eligible for Medicare payments.

Dx 8/2009, IDC, 2cm, Stage II, Grade 1, 0/2 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 09:24PM reesie wrote:

I understand Stage IV is an automatic approval if you have the required work history, and are not working. I believe it even qualifies for expedited processing.

Marie - It's A Great Day To Be Alive. Dx 10/29/2010 ER+/PR+, HER2- Stage IV mets to bones, liver, lungs, skin, pleural effusions

Log in to post a reply

Jun 14, 2011 09:41PM MaryNY wrote:

Thank you all so much for the suggestions. I'm looking at the SSA.gov site now.

Is there any downside she should know about in applying for SSDI? I think she won't want to go through the process if it involves a lot of hassle.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 14, 2011 09:43PM MaryNY wrote:

Reesie: is that automatic approval for SSDI or Medicare? I believed she's worked all her adult life until she was laid off two years ago, but she's only worked a couple of days over the last two years and is not currently employed.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 02:57PM, edited Jun 19, 2011 02:58PM by Chickadee

There is a very good chance that your friend will be eligible for significant back pay to the date of disability which appears to be a couple years ago.  It's a shame that she didn't apply sooner but that's not the issue now.

Stage IV cancer is typically automatic approval once all documentation has been verified.  The approval by the state's disability determination office is expedited based on "Compassionate Allowance".  She can submit her path reports herself to her local SS Office.  Payments are supposed to start 6 months from the last day of work or the established date of disability.  That makes me think your friend would get assistance sooner rather than later.  In any event they will back date benefits to the date of disability and that would be the day she had to leave work due to her disability.

Medicare follows two years from the date of disability as well.

Clearly your friend should either call the SSA or visit her local office.  Having as much information with her when she goes will help the SSA figure out all the timelines for her.

The hassle surely would be worth it in her situation.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 03:15PM MaryNY wrote:

Chickadee: I'm not sure about the backdating. She didn't lose her job because of her disability, she was one of many laid off by her company. I think she had finished treatment at the time. She did collect unemployment benefits through early this year. To claim that you do have to certify that you are ready, willing and able to work, so it might not be feasible for her to now say that she was disabled. Not sure. It would be rough if she was told, yes you can disability and we'll back pay you, but we want all the unemployment benefits repaid as you weren't able to work.

I printed out a lot of material but she was too tired to meet up last week. When we spoke on the phone, she said she didn't want to deal with it now and that she'd really want to see a lawyer to do something like that. I don't want to push her. I'm not sure how I'd feel if I had to admit I was disabled. I think she also feels too physically tired to deal with it now. 

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 04:01PM ebann wrote:

Ok this is how it worked for me. I applied for SSDI and send in the application. Once they received it they sent me a letter that they did received it and it would take 3 to 6 months for approval. I called to let them know that I received it and that I am stage 4 from breast cancer. (IBC) They then told me I would have an answer in a week. So in a week I was called and told me that I was approved. They also told me it would be retroactive from the time of diagnosis. They are 6 months behind and they is when I will start receiving payments faithfully. Then once you are approved from SSDI then you may apply for medicare if you do not have any insurance at that time. I am sure your friend will be taken care of she just needs to take action. She does not need to worry about being declined. When she sends in her stuff to SSDI she needs to get the documentation of her diagnosis and the proper  wording for her approval. You should find this online on the SSDI gov page. As far as housing for section 8 the waiting list is at least 2 to 3 year wait. I hope you found this to be helpful. Now it is just a matter of time figuring out what to do before she gets her check from SSDI.

Blessings, Elizabeth

Elizabeth (EB Ann)

Dx 4/10/2008, IBC, 6cm+, Stage IV, Grade 3, 3/16 nodes, mets, ER-/PR-, HER2-
Log in to post a reply

Jun 19, 2011 04:15PM reesie wrote:

On the stage iv board there's a thread called how many stage iv ladies are getting ss disabolity orsomething like that. You should look at that tread you might get some answers there too.

Marie - It's A Great Day To Be Alive. Dx 10/29/2010 ER+/PR+, HER2- Stage IV mets to bones, liver, lungs, skin, pleural effusions

Log in to post a reply

Jun 19, 2011 04:46PM Chickadee wrote:

I think your friend sounds deeply depressed.  It may be difficult to encourage her to follow up on any of this.  If only we could wish away the dark clouds instead of waste precious energy fighting them off so we can take care of ourselves and our business.

MaryNY, you are a wonderful friend and she is lucky to have you.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 05:32PM MaryNY wrote:

ebann: so you were approved within a week? When you say retroactive to time of diagnosis -- would that be when Stage IV was confirmed? (My friend would initially have been Stage II with Stage IV prob only confirmed this year.) So there is no payment for the first six months following diagnosis? or is it that they do pay retroactively but not until six months has elapsed?

reesie: yes, I'll look at that other thread.

chickadee: hard for me to tell but I don't believe she's depressed, just tired. She feels her energy is precious and wants to spare it for the things she enjoys doing.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 06:06PM 37antiques wrote:

Mary,

It is retroactive either to the time of DX or the date of application, so either way it is important to start it.  Even if you just start online and get some things in there, that would be the date.  Payment starts on the 6th month, they do not pay for the first 5.  You must have worked and earned enough credits in your lifetime to be eligible, that usually works out to a year and a half.  For instance, my husband was approved and payments came in on the 6th month, within a month the back payment came in, from the date of disability discounted for the first 5 months.  Prior to getting any regular payments, he was eligible to get SSI payments as soon as it was processed.  My BIL is terminal, his application was approved pretty quickly, and his full payments started right away, with no back pay and no wait for the 6th month.  Every year they send out a statement a couple months before your birthday, if she knows where hers is, it will tell you how much she is eligible for every month.

IDC DCIS & Mets

Dx 2/27/2007, IDC, 1cm, Stage IV, Grade 3, 0/0 nodes, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 06:19PM Alpal wrote:

You must have earned a certain amount of credits in the last 10 years. If you quit work 10 years ago, even if you worked continuosly for 30 years prior to that, you would not be eligible. It sounds like she probably worked 8 out of the last 10 years, so that should be fine. She will NOT need an attorney. Her Stage IV diagnosis will automatically qualify her if she has the credits. Since she hasn't worked for 2 years, I'd guess they would date her disability from the day she was diagnosed Stage IV. Or the last day she signed the unemployment paper saying she was able to work, if that was after her Stage IV diagnosis. Depending on that date, she may receive backpay. No income questions will even be asked for SSDI. She may qualify for Medicaid, but that is dependent on household income. She will automatically qualify for Medicare after 2 years of SSDI - Medicare is not income dependent.

This is her money and I hope you encourage her to take advantage of it. Because of her Stage IV diagnosis, it really will not be a hassle at all.

Allison

Dx 7/2008, IDC, Stage IV, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 08:16PM MaryNY wrote:

Thank you all. This is all good information to know even if I find it hard to persuade her to apply. Once someone qualifies for disability (that's SSDI right?), does everyone get the same amount?

I just pulled out my Social Security Statement dated Dec 2010 (I never looked closely at this before) and it says:

Disability: You have earned enough credits to qualify for benefits. If you become disabled right now, your payment would be about $1,318 a month.

I don't have a long earning history in the US as I just moved here in the 90s, so maybe that affects the amount and others get more than this.

Anyway, even if my friend just got a similar amount, at least it would cover her rent.

As for Medicaid, would having savings in an IRA or 401k disqualify her? If she was eligible, how would the coverage compare with regular insurance on the open market? Is it likely that all the same doctors would be covered?

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 08:21PM Chickadee wrote:

The amount she will receive is based on her earnings history....so to answer your question, no everyone gets different amounts.  I have a 40 year work history and will receive more than you do for your shorter work history.  

SSI and Medicaid are income/asset dependent.  If she has savings over $2000(I think) she will not qualify.  

SSDI is not income dependent and your savings/assets are not part of the decision.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 08:33PM Alpal wrote:

Mary - don't know whether this applies, but if she has dependent children, they would also receive a check if she was approved for SSDI. I think - but you need to check this out - that she would be able to withdraw IRA and 401-K funds without tax penalty because of her Stage IV status. Also, Stage IV would qualify her for forgiveness of federal student loans.

Allison

Dx 7/2008, IDC, Stage IV, mets, ER+/PR+, HER2-
Log in to post a reply

Jun 19, 2011 08:34PM MaryNY wrote:

$2,000 is very low. I'm guessing she wouldn't qualify then.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4

Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-