After the emotional and physical impact of a breast cancer diagnosis, dealing with insurance can be overwhelming. The information in this section may help you understand insurance.
The types of insurance most important for people with breast cancer are:
A health insurance policy is a legal agreement where an insurer gives coverage for some or most of your medical care costs for a certain price.
Learn more about health insurance including how to compare plans, how to maintain coverage if you lose your job, what to do if a claim is denied and more.
Disability insurance pays part of your income if you become too sick to work (any job, not just your current one). Most policies pay about 60 percent of your salary.
Disability can be short-term or long-term, depending on the length of time you are unable to work. Short-term disability is usually less than 6 months.
Private insurance companies offer short-term and long-term disability insurance plans. Some employers provide disability insurance. If you’re employed, check the details of the coverage.
You can also buy disability insurance on your own or add to the coverage your employer provides.
Some people can get long-term disability benefits from the Social Security Administration. Learn more about these benefits below.
If you are buying or choosing disability insurance, check the following:
The Social Security Administration provides monthly payments to people of all ages who:
People with breast cancer (especially those with stage IIIB or stage IIIC breast cancer, or metastatic breast cancer) may qualify for two types of benefits:
Medical eligibility is the same for SSDI and SSI, but each program has its own non-medical criteria.
Social Security Disability Insurance (SSDI) benefits are available for people ages 18-65 who have worked throughout their lives.
SSDI is funded by payroll taxes. You are eligible as long as you have:
SSDI payments depend on your salary and years of work, but most people get about $1,100 per month. You can get an estimate of payments from your local Social Security Administration office. To find an office near you, visit the Social Security Administration's website.
Learn more about SSDI.
Once you get SSDI payments, you are eligible for Medicare 24 months after your breast cancer became “disabling.” This isn't necessarily when you applied for disability benefits, but when your breast cancer kept you from earning income.
If you want to get Medicare, apply as soon as you can. Enrollment can take some time and there's no way to speed up the process.
If you get SSDI payments, your family may also be eligible for some benefits.
The following family members are eligible for up to 50 percent of your monthly SSDI payments. (These payments are in addition to what you get.)
Your household payment limit is about 180 percent of your currently monthly payment. For example, if your SSDI payment is $1,000 per month, then your household payment limit is $1,000 x 1.8 = $1,800 per month.
Supplemental Security Income (SSI) benefits have no work requirements and are available for people of all ages. SSI can be a good option for those who haven’t worked recently, such as a parent who took time off work to raise a family.
However, SSI benefits are for those with the most need, so there are strict income and resource limits. You aren't eligible for SSI if:
If you're eligible for SSI, you can automatically be enrolled in Medicaid in most states.
Unlike SSDI, there are no SSI benefits for family members.
Learn more about SSI.
Learn more about resource limits for SSI.
You can apply for Social Security Disability Insurance (SSDI) online.
With Supplementary Security Income (SSI), part of the application can be done online. However, you will need to go to your local Social Security Administration office to complete the process. To schedule an appointment, call the Social Security Administration toll-free at 1-800-772-1213. (Be sure to make an appointment. If you just show up, there may not be anyone to help you.)
For both applications, the Social Security Administration will need to confirm your breast cancer diagnosis. You don’t need to submit any medical records. However, you’ll need to list the hospitals where you’ve had treatments, as well as the doctors who’ve treated your cancer so the Social Security Administration can contact them.
On your application, give as much detail as you can about your surgery and other treatments (such as radiation therapy, chemotherapy and other medications) and general well-being. This can help your chances of approval.
Apply for SSDI or SSI benefits online.
Find your local Social Security Administration office.
If you have questions about SSDI or SSI, email the Social Security Administration at email@example.com or call them toll-free at 1-800-772-1213.
Long-term care insurance can cover any help needed if you become unable to care for yourself. You may get this care in your own home or in a nursing home.
Long-term care insurance may cover a wide range of services beyond medical care, including:
Long-term care can be expensive.
Most long-term care policies pay a fixed amount for each day you get care (ranging from $50 to hundreds of dollars per day). Daily benefits for at-home care are at the lower end of the range, while nursing home care is the most expensive.
If you are buying a long-term care policy, consider the following:
No insurance plan covers all the costs related to breast cancer care. However, some cover more than others.
In order to plan ahead, it’s important to find out how much of your medical treatment costs you will need to pay. Also, find out what other out-of-pocket costs you'll have to pay.
The next step is to review your current plans to see what coverage you have for each type of insurance.
If you work, start by reviewing the coverage given by your employer. It’s a good idea to meet with someone from the human resources department to go over your questions.
If you don’t work, you may want to talk about your insurance options with a hospital social worker or someone in the hospital financial information office. You can also contact your state or local health department.
When reviewing your insurance plans, be sure to read the policies themselves and not just the marketing brochures that describe them. An insurance policy is a legal contract that describes your rights and responsibilities, as well as those of the insurer. It deserves the same level of attention as any other legal document.
Most hospitals and treatment centers have financial counselors. They can help you with the details of your insurance paperwork and give you an estimate of the cost of your treatment.
Financial counselors can also help you work out a payment plan for the costs you'll have to cover. If you're not able to pay, some places may reduce or wave the costs if you ask.
No matter your income, you may qualify for financial aid from federal or state programs. A financial counselor can help you learn about these programs.
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