Individuals with serious medical conditions may find that they are no longer able to work and earn a living the same way that they were before their diagnosis. Understanding your disability insurance options can help you replace any lost wages from taking time off from work due to a medical condition.
How Disability Insurance Works with Employment Protections
Disability insurance works in partnership with fair employment laws and leave laws at the local, state, and federal levels. The Family and Medical Leave Act is an example of a federal leave law that allows employees to take time off work and protect their job and sometimes their health insurance coverage.
Employees may also have access to certain employee benefits, such as sick time, vacation time, general paid time off (PTO), policies that allows co-workers to donate their leave hours, and more.
While the FMLA provides job-protected leave, it is unpaid leave. Many people eligible for FMLA leave don’t actually take the leave because they can’t afford to go without income. Disability insurance is one option to get paid.
Understanding Your Disability Insurance Options
Disability insurance benefits are offered by the federal government, some state governments, or through a private insurance company.
Private Disability Insurance
Private insurance companies sell both short-term and long-term disability policies. Short-term policies typically last up to one year, whereas long-term disability insurance policies are usually for medical conditions that last one year or longer.
It is possible to buy these policies directly from an insurance company; however, many people don’t think about purchasing coverage until they have a serious medical condition.
Unfortunately, once someone has a pre-existing medical condition, it is more difficult to get a policy, because insurance companies can use medical underwriting to decide whether or not to insure someone. Additionally, they can choose to charge people more for coverage based on their pre-existing conditions.
Most people get access to a private short-term or long-term private disability insurance plan through their employer as an employee benefit. Employers often pay for the monthly premiums for these plans, so people may forget that they signed up for the coverage when they started their job.
Federal Disability Insurance
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are both federal programs, administered by the Social Security Administration (SSA), that provide financial assistance to people with disabilities.
To qualify for disability benefits from the SSA, you must have a disability within the SSA’s definition of disability. SSA requires that your disability has, or is expected to, last for at least one year or result in death; and you cannot do your current job; and you cannot adjust to a new job. There are differences between the two programs:
Social Security Disability Insurance (SSDI)
You may qualify for SSDI benefits if you are “insured,” meaning that you have worked long enough, recently, and have paid Social Security taxes. The maximum monthly benefit from SSDI, for someone who is not blind, is $3,113 per month in 2021. You can register for a “My SSA” account online to track your eligibility for SSDI, as well as find out how much you would receive from SSDI each month.
There is a full five-month waiting period for SSDI benefits to begin. You will automatically receive health insurance through Medicare after you have received SSDI benefits for 2 years. For more information about Medicare, see our Quick Guide to Medicare. For more information on SSDI, visit www.ssa.gov/pubs/EN-05-10029.pdf.
Supplemental Security Income (SSI)
You may qualify for SSI benefits if: you have a low income and resource (aka: assets) level; and are aged 65+; or blind; or “disabled.” The 2021 federal amount for most people receiving SSI is $794 per month. Most states add a supplemental payment to that amount.
You will receive payments beginning the first full month after becoming disabled. In most states, people eligible for SSI automatically get health insurance through Medicaid. It is possible to receive both SSDI and SSI benefits at the same time. For more information on SSI, visit www.ssa.gov/pubs/EN-05-11000.pdf.
Applying for SSDI and SSI
When applying for SSA disability benefits, it is common for the application process to take a long time. One way to speed up the application process is to see if you qualify for the Compassionate Allowances (CA) program.
This is a list of medical conditions that SSA thinks presumptively qualify for disability benefits. This is not the same thing as automatically qualifying. They will still look to see how your medical condition is impacting your ability to work. If you have a medical condition on the CA list, then it is important to include that in your application, as it will speed up the application process.
Appealing a Denial
Many applications for SSA disability benefits are initially denied. It is important that you appeal that decision, to improve your chances of getting access to the benefits that you need. Be sure to work with your health care team throughout all stages of the appeals process, as they can provide useful information about your medical condition, side effects from treatment, and how those side effects are impacting your ability to work.
For more information on the appeals process, visit www.ssa.gov/pubs/EN-05-10041.pdf. For information about hiring an SSA appeals attorney, see our Quick Guide to Legal Assistance.
State Disability Insurance
California, Hawaii, New Jersey, New York, Puerto Rico, and Rhode Island offer short-term state disability insurance programs. Each state has different eligibility requirements and coverage varies. For example, the maximum amount of time an individual can receive benefits ranges between six to twelve months, depending on the state.
Most state programs are easier to qualify for than the SSDI or SSI. It is also possible to receive both state and federal disability benefits. For more information, see our Quick Guide to State Disability Insurance.
For more information about disability insurance options and how to navigate benefits, as well as other legal and practical issues, visit https://TriageCancer.org.
About the author and Triage Cancer
This post was written by Joanna Fawzy Morales, Esq., a cancer rights attorney, author, speaker, and CEO of Triage Cancer. Ms. Morales has spent more than twenty-five years working on behalf of individuals with cancer. She co-authored the book, Cancer Rights Law, for the American Bar Association. She has presented nearly 1,000 educational seminars on employment, insurance, health care, and advocacy issues for individuals diagnosed with cancer, caregivers, health care professionals, advocates, lawyers, employers, and the general public.
Triage Cancer provides free information about the legal and practical issues that may impact individuals diagnosed with cancer and their caregivers through events, materials, and resources. Triage Cancer also offers CancerFinances.org, a toolkit to help people navigate their finances after a cancer diagnosis.