Losing Your Health Insurance Coverage? Get the Details on Changes to Special Enrollment Periods.

You may qualify for a special enrollment period (SEP) to buy coverage through the Changes-to-Special-EnrollmentACA’s health insurance Marketplaces, if you experience a life-changing event that results in a loss of coverage, such as:

  • losing your employer based coverage,
  • aging out of your parent’s health insurance coverage, or
  • moving to a new state.

During a SEP you have 60 days to shop for, and buy, new health insurance coverage in the Marketplace. You may also add family members to your coverage during a SEP, if you get married, or give birth to or adopt a child.

Recently, the rules around special enrollment have changed by the Department of Health and Human Services (HHS) and there are a few extra steps that you now have to take.

On June 23, 2017, HealthCare.gov began requiring applicants to submit additional information to conduct a pre-enrollment verification of eligibility for a SEP. What this means, is that once you pick a plan the Marketplace will “pend” your enrollment and you will have 30 days to submit documents to confirm your SEP eligibility before you can begin using your coverage. When you submit an application on HealthCare.gov, you will get a notice with a list of documents you can send to provide this confirmation.

As soon as your SEP is verified, the Marketplace will send your information to the health insurance company you chose and your coverage will start based on when your SEP started and when you picked your plan. In some cases, this will be retroactive.

For more information and to see a copy of the various notices you may receive, visit the CMS Center for Consumer Information and Insurance Oversight website.

Senate’s Efforts to ‘Repeal & Replace’ Stall…For Now

This week the Senate’s efforts to repeal and replace the Affordable Care Act (ACA) Time For Plan Bhave stalled, for now. Yesterday, Senate Majority Leader Mitch McConnell said that he was not going to move forward with a vote on the Senate’s health care reform proposal called the Better Care Reconciliation Act (BCRA). This announcement came after two more (for a total of four) Republican Senators publicly declared that they would not support the bill. The four Senators are: Rand Paul (KY), Susan Collins (ME), Jerry Moran (KS), and Mike Lee (UT).

In response, McConnell suggested that the Senate would instead vote on a “repeal only” version of a bill to dismantle the ACA and that they would deal with replacing it later. They would give themselves two years to “deal with it,” as the repeal would not take effect for two years, which would also be after the next midterm election.

A true “repeal” of the ACA means that it would be like the ACA never existed, including the elimination of all of the ACA’s consumer protections, Medicaid expansion, some Medicare benefits, individual and employer mandates, and taxes. A similar bill was passed in 2015, but President Obama vetoed it.  That bill was scored by the Congressional Budget Office in 2015, and it found that between 30 and 32 million people would lose access to health insurance coverage.

However, just hours after this decision to move forward with a repeal vote was announced, three Republican Senators (Shelley Moore Capito (WV), Susan Collins (ME) and Lisa Murkowski (AK)) said they would not vote for a bill that would irresponsibly take away coverage from millions of Americans, with no alternative.  Their opposition to a repeal vote with no alternative means that it would be unlikely to pass if all Senate Democrats opposed the bill as well.

The President has also announced his support for a full repeal vote, suggesting that he will just “let Obamacare fail.” Unfortunately, we just don’t know what that means.  It could mean that all federal agencies simply stop enforcing the consumer protections created in the law. It may also mean that the Department of Health and Human Services will stop paying for Americans to receive financial assistance to purchase health insurance.

After a meeting at the White House today, Leader McConnell has declared that he will call for a procedural vote to allow Senators to debate and offer amendments on the BCRA.  Without further negotiating it is likely that the Senate will have to go back to the drawing board and come up with other proposals. Many have suggested that the Senate should go back to holding open hearings on these issues and to work together, in bipartisan efforts to improve our health care system. We will have to wait and see.  Unfortunately, we are now only 3.5 months away from the start of open enrollment for 2018, and there is so much uncertainty.

One thing does seem certain, the efforts to provide accessible, affordable health care for all Americans must continue. If this is an issue that concerns you, you can keep talking to your elected officials about how important access to quality, affordable health insurance coverage is to the cancer community.

Do You Need Health Insurance Now?

If you do not have health insurance coverage, you can apply for Medicaid at any time if eligible, or buy a policy through the State Health Insurance Marketplaces if you qualify for a special enrollment period.

  • For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar.
  • If you aren’t sure what your health insurance options are or want to understand more about health insurance, visit CancerFinances.org.

Stay tuned to our blog, as we will continue to share ongoing developments in efforts to change our health care system.

Uncertainty puts Marketplace Financial Assistance in Jeopardy

A recent study found that the average family in America spends 10.1% percent of the family’s income just on health insurance premiums and deductibles. So it’s no wonder Marketplace-Financial-Assistance-Jeopardythat many Americans need a little help purchasing health insurance coverage. The Patient Protection and Affordable Care Act (ACA) made financial assistance available for people who buy health insurance in the marketplaces, based on their income level. However, due to uncertainty in politics, as well as policy and legislative changes, that financial assistance may be in jeopardy.

There are two different types of financial assistance in the marketplaces:

  • Premium tax credits reduce the amount that people pay for their monthly premiums to have health insurance.
  • Cost-sharing subsidies, also known as cost-sharing reductions, help to lower deductibles, co-payments and co-insurance. The way that cost-sharing subsides work is that the insurance company reduces what they charge individuals and, in turn, the insurance companies are reimbursed by the federal government.

Since the beginning of the year, uncertainty has put these financial assistance options in jeopardy. The new presidential administration had suggested that they were going to eliminate the cost-sharing reductions and that they would repeal the ACA, which would eliminate the premium tax credits, as well.

While health insurance companies are accustomed to dealing with uncertainty, like not knowing how many people will get sick during a given year, it is unusual for politics to create such uncertainly in the health insurance market.

Specifically, the uncertainty that will have the greatest impact is the fact that there has not be a clear decision from the President or Congress on if they are going to continue funding the cost-sharing reduction payments to insurance companies, and whether the individual mandate will be strictly enforced. The individual mandate was designed to insure that individuals do not wait to purchase insurance once they are sick. The IRS has already indicated that they will not strictly enforce the mandate moving forward.

Oliver Wyman, an actuarial consultant, states that these sort of ambiguities are new to actuaries who are in charge of setting the rates, and actuaries are predicting that 2018 insurance premiums are expected to increase between 28 and 40%.

Ultimately, the uncertainty around cost-sharing reduction payments, and the lack of enforcement of the individual mandate is projected to be responsible for the bulk of premium increases for 2018 and has already led some insurers to pull out of the marketplaces in some states, to avoid having to deal with the uncertainty.

This uncertainly, along with the current proposals for health care reform being discussed in the U.S. Senate, have the potentially to significantly impact the cancer community.

Stay tuned to our blog for the latest updates on proposed changes to our health care system.

Senate Health Care Proposal – Take 2 

Yesterday, the U.S. Senate released its revised proposal to overhaul health insurance in Senate Health Care ProposalAmerica.  Unfortunately, this new version of the Better Care Reconciliation Act (BCRA-2) would still cause significant harm to the cancer community.

For clarity, here we will focus just on the changes to the Republican proposal that we will refer to as BCRA-2.  Read more about the first version of BCRA.

The major provisions to take note of in this new version include:

  1. Cutting the Medicaid program so significantly that 15 million fewer people would have coverage, according to the Congressional Budget Office.
  2. Allowing insurers to sell plans with bare-bones coverage (“junk insurance”), as long as they also sell at least one policy that meets the ACA’s requirements. The concern is that by allowing individuals to purchase this less adequate, but cheaper coverage, healthier people would gravitate towards these plans, and people with pre-existing conditions would stay in marketplace plans, which would result in an unbalanced risk pool, and higher premiums for people buying marketplace plans. In addition, it would lead to higher medical debt for individuals buying junk insurance if they need medical care and find out that they only have bare-bones coverage. This was exactly a problem that the ACA was trying to address by creating minimum standards of coverage for plans being sold.
  3. Allocating $45 billion to deal with opioid abuse, a clear concession to two Republican Senators’ request.
  4. Adding $70 billion to help states stabilize their insurance marketplace.
  5. Keeping an ACA provision that places a 3.8% net tax on investment income and a 0.9% payroll tax on individuals making more than $200,000 annually.

While the BCRA-2 does contain some minimal improvements from the Senate’s original version, it ads changes that would be more harmful to the cancer community and others with pre-existing medical conditions. And, the overall impact of this proposal is still detrimental to most Americans.

Next Steps

In order for the bill to pass the Senate, the Republican Leadership need 51 votes in support.  There are 52 Republican Senators and 48 Democratic and Independent Senators. If there is a 50-50 tie, the tie can be broken by a vote from the Vice President of the United States, who is a Republican.

Moderate Senator Susan Collins (R-ME), has announced she wouldn’t support a procedural motion to allow debate on the bill. Conservative Senator Rand Paul (R-KY) also is unlikely to support the bill due to the fact that it doesn’t completely repeal the ACA. Therefore, Republicans can only afford to lose one more vote, if they want to pass the BCRA-2. Three other moderate Republicans have expressed serious concerns about this legislation: Dean Heller (R-NV), Shelley Moore Capito (R-WV), and Rob Portman (R-OH).  Senate Majority Leader Mitch McConnell has indicated that he wants a vote on BCRA as early as next week.

Do You Need Health Insurance Now?

If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces if you qualify for a special enrollment period.

  • For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar.
  • If you aren’t sure what your health insurance options are or want to understand more about health insurance, visit CancerFinances.org.

 What You Can Do

  • Contact your U.S. Senators and share your health care concerns, by calling (844) 257-6227. Even if you’ve called before, please call again. Even if you know how your Senators will vote, please call to share your thoughts.
  • To find your elected officials or learn more about becoming an advocate, visit our Advocacy resource page. You can also find the Facebook and Twitter handles for the current members of Congress here.

 Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available, about this issue that affects all of us.

Is a Reverse Mortgage Right for You?

by Kristi Sullivan, CFP

Chances are high that when I mention the idea of a reverse mortgage to clients, I’ll be Reverse Mortgagemet with a very sour expression. I think this is because of the impression that these instruments are expensive and that you give up ownership of your home to use them.

Now I am no expert in these products, but for clients who have most of their net worth tied up in their homes, finding a way to use that equity to pay bills is a must.

Reverse Mortgage Basics

Here are some reverse mortgage basics:

  • Reverse mortgages are also known as home equity conversion mortgages (HECM) and are administered by the FHA.
  • You enter an arrangement with the lender to take money out of your home based on the amount of equity you have and your age.
  • You don’t have to have earned income to qualify.
  • You keep the ownership of your house until the last occupant dies or moves out.
  • You can receive the income from home equity in a variety of ways: For a specific time period, as a credit line to use as needed, or for your lifetime or the time that you or your spouse occupy the home.
  • When you pass away or move from the home, whatever equity is left after the debt and fees are paid will pass back to you (if living) or to your estate. (For related reading, see: How Does a Reverse Mortgage Work?)

An HECM is different than a home equity loan or line of credit. With a traditional home equity loan, you have to pay back the principal and interest over time. With a reverse mortgage, your house actually pays you.

Benefits of a Reverse Mortgage

Brainiacs who are way smarter than me have been modeling the use of a reverse mortgage in retirement planning. The numbers show that using home equity for income, especially when retirement investments are down, can lengthen the time your nest egg will last. Wade Pfau has been doing research on the use of reverse mortgages in retirement income plans and says there are two big benefits:

  1. Using a reverse mortgage early in retirement can reduce the stress of market volatility on the invested portfolio by allowing people to live off of their home equity rather than selling investments when values in their accounts are down.
  2. The second benefit is that opening a reverse mortgage now (especially with current low interest rates) can allow for the principal that you can borrow against to grow for a longer time.

Not everyone can get a reverse mortgage. You must be at least 62 years old, live in a single-family or two-to-four-unit home, and there is a limit to how much mortgage debt can be against the home at the time you apply for the HECM. (For related reading, see: The Reverse Mortgage: A Retirement Tool.)

This is not for everyone. Some downsides are:

  • The closing costs and fees on reverse mortgages are more expensive than conventional loans.
  • You may be tempted to spend your home equity on dumb stuff instead of using it prudently.
  • You still must have enough income or savings to maintain the home and pay property taxes and insurance.
  • There are people out there selling reverse mortgages who may not have your best interest at heart. Investigate and get several quotes before deciding on who to use for a reverse mortgage. (For related reading, see: Beware of These Reverse Mortgage Scams.)

If you are feeling your retirement income is too tight and you meet the eligibility requirements, using your home equity through a home equity conversion mortgage may be worth investigating.

Check out more from Wade Pfau in this Forbes article. For more information, you can also call National Council on Aging at (800) 510-0301.

This post originally appeared at Investopedia on March 3, 2017. 

Senate Delays Health Care Vote, But Our Work Is Not Done

On Friday we shared details about the Senate health care bill, and in the last few days there have been new developments. Senate-Delays-Health-Care-Vote-Post

First, the Congressional Budget Office (CBO) released its report on the Senate health care proposal and unfortunately the news is still alarming.The CBO estimates that under the Senate’s version of the Better Care Reconciliation Act (BCRA) 22 million Americans would be uninsured by 2026.

Second, the Senate changed their proposal and added additional provisions that would make it harder for people to get insurance. For example, the proposal now includes a requirement that if someone has a gap in health insurance coverage of more than 63 days, they would have to wait six months before they could purchase insurance.

Since last Thursday, many Senators and Governors have expressed a concern that the vote on BCRA was being rushed and shared their concerns with Senate Leadership. The proposal is also opposed by health care groups, professional associations, and many in the cancer community. Because of these concerns and opposition, Senate Leadership have postponed the vote, which will no longer happen this week.  However, a vote could be scheduled at any time so our work is not done.

It is vital to continue talking to your elected officials about how BCRA would impact you and your communities.  This week, Senators and Members of Congress will head home to their local districts. You can call their offices and ask to have a meeting (although keep in mind that their schedules may already be full), but if you are out celebrating the 4th of July and you see your elected officials in your community, don’t be afraid to talk to them!

Here are a few easy ways to make your voice heard, even if you aren’t able to see your elected officials in-person:

  1. Contact your U.S. Senators and share your health care concerns, by calling (844) 257-6227. Even if you’ve called before, please call again. Even if you know how your Senators will vote, please call to share your thoughts. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resource page.
  2. Use social media. Our friends at Justice in Aging have created this wonderful social media kit. You can also find the Facebook and Twitter handles for the current members of Congress here.
  3. Contact your state Governors and express your concerns. They have a powerful voice in this process as well.

As always, stay tuned.  Will continue to provide updates as more information becomes available, about this issue that affects all of us.

U.S. Senate Proposes Health Care Changes

Another Step BackwardsYesterday, the U.S. Senate released the “Better Care Reconciliation Act (BCRA) of 2017,” containing their proposed changes to our health care system and the Patient Protection and Affordable Care Act (ACA). The language we have now is still being referred to as a ‘discussion draft,’ which means that it has not been officially introduced in the Senate. This bill would replace the text of the American Health Care Act (H.R. 1628), that was passed by the U.S. House of Representatives last month.  Additionally, this proposal has not been scored by the Congressional Budget Office (CBO), which is expected to release a score on Monday or Tuesday of next week.  That score will provide an estimated analysis of how much the bill will cost and how many people will lose coverage.

Senate Leadership are planning to hold a vote on this bill by the end of next week, leaving only a few days for the members of the Senate to review these proposed health care changes.  At this time, there is no plan to hold any committee hearings about this bill.

What’s Included

The bill is 142 pages long, so we are still working to digest its full ramifications, but we did want to highlight some things we know will have an impact on the cancer community.

              Consumer Protections

Certain consumer protections in the ACA remain unchanged by the BCRA, such as prohibiting health insurers from denying coverage or charging someone more for coverage based on a pre-existing condition, the ability for children under the age 26 to stay on their parent’s plan, and 90-day maximums for waiting periods for employer-sponsored plans.

However, other protections for people who have pre-existing conditions would be weakened. The BCRA sets up a system where states are incentivized with $2 billion to apply for a waiver. These waivers would give states the ability to redefine essential health benefits (EHB) and to change or reduce other coverage standards. This means that plans may no longer be required to cover services like prescription drugs, hospitalization, or mental health care.  Additionally, while current law prohibits insurance companies from placing annual or lifetime dollar limits on EHBs, they are allow to impose these limits on anything else.  So if, for example, a state chooses to not include prescription drugs as an EHB, plans could impose lifetime and annual limits on prescription drugs.

              Financial Assistance

Currently, there are two types of financial assistance options available to help people access plans sold through the ACA’s health insurance marketplaces: 1) premium tax credits, which lower monthly premiums based on income; 2) cost-sharing subsidies, sometimes referred to as cost-sharing reductions, which lower deductibles, co-payments, and co-insurance payments.

The way that cost-sharing subsides work is that the insurance company reduces what they charge individuals and in turn they are reimbursed by the federal government.  The BCRA would only keep the federal governments’ reimbursements back to the insurance companies for 2018 and 2019.  Eliminating these reimbursements for 2020 makes it more likely that insurance companies will pull out of state marketplaces, reducing choice for consumers and likely increasing costs for everyone.

The BCRA would also change the eligibility requirements for premium tax credits.  Currently, these credits are available to anyone purchasing a plan in the marketplaces who have a household income level between 138% and 400% of the federal poverty level (FPL).  In dollar amounts that is equal to an individual whose income is between $16,642 and $47,520. The BCRA is proposing cutting the tax credits so that they are only available to people with incomes up to 350% of the FPL ($42,210) starting in 2020.

In addition to having a low enough household income level, an individual must spend 9.5% of their income on health insurance premiums in order to get a tax credit. The BCRA is proposing that this amount be tiered based on age. For example, a 60-year-old with an income between 300 and 350% of the FPL would have to spend 16.2% of their household income on premiums before becoming eligible for a tax credit, while a 28-year-old would only have to pay 4.3%.

Current law also restricts insurance companies to only being able to charge older Americans up to three times more for their private health insurance. For example, a 64-year-old can only be charged a maximum of three times more than a 21-year-old in the same location. The BCRA is proposing to increase that age ratio to allow insurance companies to charge up to five times more for older Americans.

These changes would make it harder for everyone to purchase insurance in the marketplace, and would certainly impose a greater burden on older Americans.

              Individual and Employer Mandates

The BCRA would effectively eliminate the requirement for Americans to have health insurance by making the penalty $0.  It would also effectively eliminate the requirement for mid-sized and large employers to pay a penalty if they don’t provide health insurance to their employees, by making the penalty $0. The concern with these eliminations is that the money collected through the penalties help pay for some of the financial assistance people receive to purchase plans in the marketplaces.

              Medicaid

Under the ACA, states were given the opportunity to expand their Medicaid programs by adding a new category of eligibility for anyone with a household income under 138% of the FPL.  As part of this expansion the federal government would reimburse states for the costs of adding these newly eligible individuals to their Medicaid programs.  The BCRA would begin to reduce federal reimbursements at the end of 2020, over a three year period (from 2021 to 2023).  However, eight states have a ‘trigger clause,’ which means that if the federal funding falls below the rates promised in the ACA, the expansion in that state is eliminated immediately. The following states have a trigger clause: Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington.

The BCRA is proposing significant cuts to the traditional Medicaid program, as well.  These cuts will unequivocally impact a substantial number of Americans:

  • Medicaid covers nearly 75 million people in the U.S., including children, people with disabilities, pregnant women, and seniors.
  • Approximately 25% of the U.S. population obtains health care coverage through Medicaid.
  • Medicaid covers 49% of all births in the U.S.
  • Medicaid covers 39% of all children and 76% of children in poverty.
  • The number of people on Medicaid in the U.S. is equivalent to the populations of these states combined: AK, HI, OR, NV, ID, UT, MT, WY, CO, NM, ND, SD, NE, KS, OK, MN, IA, AR, LA, MS, AL, KY, WV, SC, DE, CT, RI, NH, VT, and ME.

In addition to funding cuts, it would move the Medicaid program to a block grant system where states would receive a fixed amount of money per enrollee and if that money runs out during the year, states would have to decide whether to cut enrollment, cut coverage, raising taxes, or all three. This prior blog post provides some additional information about how block grants work.

The BCRA also proposes adding work requirements as a condition of receiving Medicaid. While work requirements may seem like a reasonable condition to gaining access to Medicaid, they may negatively impact certain populations. For example, individuals who are in cancer treatment and are unable to work, but don’t meet the very strict eligibility requirements for Social Security Disability benefits. The proposed language in the BCRA, does not provide a definition of disability, which further confuses the issue.

Next Steps

Shortly after release yesterday, four Republican U.S. Senators [Sens. Rand Paul (KY), Ted Cruz (TX), Ron Johnson (WI), and Mike Lee (UT)] announced their opposition to the bill, arguing that it should go further to repeal the ACA and further cut financial support for access to health insurance coverage.

In order for the bill to pass the Senate, the Republican Leadership need 51 votes in support.  There are 52 Republican Senators and 48 Democratic and Independent Senators. If there is a 50-50 tie, the tie can be broken by a vote from the Vice President of the United States, who is a Republican.

This suggests that in order to pass the bill, Senate leadership will need to make further changes.  However, making further cuts to our health care system may cause some moderate Republicans to pull their support for the bill. There are a number of Republican Senators who have expressed concerned over the cuts to Medicaid, such as Senator Shelley Moore Capito, who represents West Virginia, where 42% of all children in the state are covered by Medicaid.

Do You Need Health Insurance Now?

If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces if you qualify for a special enrollment period.

  • For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar.
  • If you aren’t sure what your health insurance options are or want to understand more about health insurance, visit CancerFinances.org.

 What You Can Do

  • Contact your U.S. Senators and share your health care concerns, by calling (844) 257-6227. Even if you’ve called before, please call again. Even if you know how your Senators will vote, please call to share your thoughts.
  • To find your elected officials or learn more about becoming an advocate, visit our Advocacy resource page. You can also find the Facebook and Twitter handles for the current members of Congress here.

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available, about this issue that affects all of us.

The Numbers Don’t Lie: The AHCA Will Cost Us

The Congressional Budget Office has released its “score” of the American Health Care The AHCA Will CostAct (AHCA) and the bottom line is that the AHCA will cost the cancer community greatly.

The Congressional Budget Office (CBO) is a non-partisan agency that is tasked with analyzing proposed legislation to determine its financial impact.  Most recently the CBO analyzed the House passed bill designed to make major changes to the Affordable Care Act (ACA). The CBO concluded that while the bill would reduce the overall federal deficit by $199 billion over a 10 year period, it would do so at the cost of Americans.

The biggest savings would come from cutting Medicaid, a programs that provides coverage to individuals with low incomes and disabilities.  The second largest cost savings would come from reducing the financial assistance that is currently available to many people who purchase individual health insurance through the ACA Marketplaces.

As a result of these changes, the report estimates that by 2026, 23 million Americans would be without health insurance. The CBO also notes that the AHCA could mean some Americans would buy policies that don’t cover “major medical risks.” The CBO doesn’t consider those individuals to be insured due to the policies’ inadequate coverage.

According to the CBO, under the AHCA “it would become more difficult for less healthy people (including people with preexisting medical conditions) in [some] states to purchase insurance because their premiums would continue to increase rapidly.”  Additionally, the AHCA would result in higher premiums for older, less healthy Americans.

Although none of this information is unexpected, the CBO report confirms our beliefs that the AHCA would undoubtedly harm the cancer community.  But remember the AHCA is not law yet! The Senate has to pass a bill, the two versions have to be reconciled, and then the President has to sign it into law.  So there is still time to act!

Contact your Senators, go to town halls being hosted by your elected officials, and educate yourself on how this law could really impact you.

Stay tuned to this blog as we will provide updates as more information becomes available.  Also, please join us on June 21, 2017 for a free webinar – An Update to Our Health Care System.  It is open to all and we are providing free CEUs for health care professionals. Register today!

Taking Time Off: How laws work together

Often the ways that federal laws, state laws, and employer policies work together are like puzzle pieces fitting together.  Except that everyone’s puzzle is going to look a little different, depending on which laws apply to you, which state you live in, and what benefits are offered by your employer.

When you are thinking about taking time off work, you may have multiple options or puzzle pieces available to you.  In fact, many patients ask us, “Can I use my sick time, then my vacation time, and then my FMLA, and then I also have a short-term disability policy at work. Can I string them all out to cover all the time that I need to be away from work because of my cancer treatment?” And the answer is, it depends.

First, the FMLA can work with paid leave options and disability insurance.

Family and Medical Leave Act (FMLA): the FMLA is a federal law that provides eligible employees with up to 12 weeks of unpaid, but job protected leave, per year. For more information about the FMLA, read Triage Cancer’s Quick Guide to the FMLA.

Paid Time Off (PTO): Your employer may give you vacation days, sick days, or maybe just a general bank of PTO hours for you to use for vacation or sick leave. If you are not familiar with what your employer offers, contact your human resources representative or review your employee manual.

Disability Insurance: If you have to take some time off because of a medical condition, or have determined you are unable to work at all, the next thing you have to understand, is how you might be able to replace your lost wages. That is where disability insurance comes into play. Disability insurance benefits can be purchased directly from a private insurance company, or can be offered by an employer, some state governments, or the federal government. Get more, customized information about disability insurance at http://cancerfinances.org, or check out Triage Cancer’s Quick Guide to Disability Insurance

Finding out if you have any or all these options available to you, is the first step in the process.  Figuring out how they can work together is the next step.

Case Study #1: Jane has 3 weeks of vacation, 3 weeks of sick time, her employer is covered by the FMLA, and her employer offers a short-term disability insurance policy that last up to 12 months.  Jane thinks that she will need to be out of work for 12 weeks. What are Jane’s options?
How laws work togther CS1

As shown in the picture above, Jane can use all of her benefits together, concurrently.  In fact, her employer can require her to substitute the unpaid leave under the FMLA, with any paid leave that she has (e.g., her sick time hours). But, if her employer doesn’t require her to do that, and she still wants to, her employer must allow her to:

  1. Take her 12 weeks off work under the FMLA, which provides her with job protection and maintains her health insurance
  2. For the first 3 weeks that she is off, she is paid by her vacation days
  3. For the next 3 weeks that she is off, she is paid by her sick time
  4. And, for the final 6 weeks, she is paid a portion of her salary by her short-term disability policy.

Using these benefits together allows Jane to maintain her income, while also protecting her job and access to health insurance coverage.

If Jane prefers to string out her sick time, vacation time, then use her FMLA and short-term disability benefits, she may be able to do that, but only if her employer allows her to. However, Jane should know that just taking sick time or vacation time, or receiving short-term disability benefits does not protect her job.  In this situation, it is the FMLA that is providing the job protection.

Second, the FMLA and the ADA can work together to give you access to time off from work because of your medical condition.

Americans with Disabilities (ADA): The ADA is a federal law that provides eligible employees with disabilities protection from discrimination in the workplace, as well as access to reasonable accommodations. Reasonable accommodations can be anything from modifications in schedule, workplace environment, use of technology, telecommuting, and more. Employers are required to accommodate eligible individuals. For more information about the ADA, read Triage Cancer’s Quick Guide to the ADA. For more information about reasonable accommodations, read Triage Cancer’s Quick Guide to Reasonable Accommodations. Note, the ADA only applies to private employers with 15 or more employees, as well as state or local governments. If you work for a smaller employer, you may be covered by your state’s fair employment law.

If you have used up your 12 weeks of FMLA leave during a 12 month period, you may be eligible for additional time off as a reasonable accommodation under the ADA. However, court cases have suggested that additional time off as a reasonable accommodation will only be considered reasonable if the request for additional leave is for a definite period of time. How long is considered reasonable will depend on your job responsibilities and your workplace.

Case Study #2: Mark has 3 weeks of vacation, 3 weeks of sick time, his employer is covered by the FMLA, and his employer offers a short-term disability insurance policy that last up to 12 months.  Mark thinks that he will need to be out of work for 15 weeks. What are Mark’s options?

How laws work togther CS2

As shown in the picture above, Mark can use all of his benefits together, concurrently.  If he wants to, his employer must allow him to:

  1. Take his 12 weeks off work under the FMLA, which provides him with job protection and maintains his health insurance
  2. Take the remaining 3 weeks off work as a reasonable accommodation under the ADA. which provides him with job protection
  3. For the first 3 weeks that he is off, he is paid by his vacation days
  4. For the next 3 weeks that he is off, he is paid by his sick time
  5. And, for the final 9 weeks, he is paid a portion of his salary by his short-term disability policy.

Using these benefits together allows Mark to maintain him income, while also protecting his job and access to health insurance coverage.

As you can see, there are lots of details to using these laws and benefits. It is crucial to learn about all of your options before making decisions about taking time off from work, to ensure that you are making educated decisions, and putting together the best puzzle for you.

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