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Social Security Disability and Medicare

Living with an advanced breast cancer (ABC) diagnosis is challenging. It’s difficult enough to balance your personal life and financial needs when you are well. But supporting yourself financially during an illness is even harder.

Medical care for ABC can be expensive. Not everyone works after getting a diagnosis. Whether or not your work is a personal decision. The decision to not work can be based on your:

  • Financial situation
  • Physical needs
  • Mental health
  • Emotional needs

You may continue to work (or start working) after an ABC diagnosis, or you may choose to stop. If you have ABC and cannot work, you may qualify for disability benefits through the U.S. Social Security Administration. These benefits include financial help and health insurance, both extremely needed by people with ABC.

What is social security disability income (SSDI)?

Social Security Disability Income (SSDI) is a federal benefit. It is paid to people who have worked some in the recent past, but who are no longer able to work. Once you are approved, SSDI gives you a regular income. For some, an approval may lead to health insurance from Medicare or Medicaid.

Many working people have Social Security taken out of their paychecks. This is also called FICA. As this money is taken out, you earn work credits. People who have earned enough work credits are eligible to apply for SSDI. You earn up to four credits a year if you work full-time or part-time.

You need between 20 to 40 credits to qualify for SSDI. A part of your credits must be earned in the last 10 years. The rest can be carried over from previous decades. If you haven’t worked in over 10 years, you may not qualify for SSDI.

If you are self-employed and pay self-employment taxes, you are still eligible for SSDI.

You can check your work credits to find out if you qualify for SSDI and how much your payments would be. Contact the Social Security Administration online at www.ssa.gov or call 1-800-772-1213. Ask for a form called SSA-7005 (Request for Social Security Statement).1-3

What is a disability?

The Social Security Administration defines a disability as a condition that prevents you from working because of a medical or physical ailment. The health condition must be:

  • Life-altering, or
  • Will impact you for at least the next 12 months.

This means that to qualify for disability income, you must not be working. If you are approved for disability income and start working, your support will be taken away. If you apply for disability while still working, you will not get approved.

The Social Security Administration uses a resource called the Blue Book to decide which conditions count as disabilities.2,3

Receiving approval and benefits

People with major health conditions, such as ABC, may qualify for the Compassionate Allowances program. The Compassionate Allowance program speeds up the approval process. In general, an SSDI application may take 3 to 4 months or more to process. A Compassionate Allowance application may take as little as 10 days.

All applications must have correct medical documents with them in order to be approved. Documentation may include:

  • Notes from your healthcare provider
  • Copies of imaging studies (MRIs or ultrasounds)
  • Surgery reports
  • Other medical details about your health

Your healthcare provider may be able to help you get all the documents you need. You can also find help filing a disability application from a friend, family member, or social worker.

It is important to remember that once your application is seen and approved, you will still need to wait. You will start getting checks 6 months after you are declared disabled. Your disability date will depend on the medical documents and your work history.

Another important issue to consider is health insurance. When you qualify for SSDI you also become eligible for Medicare, a government health insurance program. You must wait 2 years before you can get the Medicare benefit. This waiting period applies to all disabling conditions, even those with advanced disease. This can be frustrating to navigate for those with ABC.

If your SSDI application was denied, you can always appeal the decision or reapply. Many applications are approved during the appeal process.

You can apply for SSDI anytime. If you want to keep working after your diagnosis or during treatment and decide later that you are unable, you can always apply later. There is no one time limit to claiming SSDI as long as you are not working at the time of application.1,4,5

What is the difference between SSDI and SSI?

SSI is a different Social Security program called Social Security Income (SSI). It is not the same as SSDI. SSI is determined based on income and financial need rather than time worked. People who have not earned enough work credits to qualify for SSDI can pursue SSI if they need help. Individuals on SSI qualify for Medicaid right away, another government insurance program.1,4

  1. Social Security Disability Income for People with Cancer. American Cancer Society. Available at: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/social-security-disability-income-for-people-with-cancer.html. Published 5/13/19. Accessed 10/12/19.
  2. Disability Evaluation Under Social Security. Social Security Administration. Available at: https://www.ssa.gov/disability/professionals/bluebook/general-info.htm. Accessed 10/12/19.
  3. R Benefits Planner: Disability, How You Qualify. Social Security Administration. Available at: https://www.ssa.gov/planners/disability/qualify.html. Accessed 10/12/19.
  4. Metastatic Breast Cancer Guide. Patient Advocate Foundation. Available at: https://www.patientadvocate.org/wp-content/uploads/Metastatic-Breast-Cancer-Guide.pdf. Accessed October 12, 2019.
  5. Compassionate Allowances. Social Security Administration. Available at: https://www.ssa.gov/compassionateallowances/. Accessed 10/12/19.

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