“You have cancer.” Now what?

by Aditi Narayan, MSW; LIVESTRONG Program Manager

When Ana heard the words “you have cancer” at the age of 23, she was in shock.  She told her parents right away. Her mother wanted to know whether she could still have children after treatment for cervical cancer.  Her father wanted her to get a second opinion.  Her friends wanted to know how they could support her.  Ana wanted to know whether she would live and how much having cancer would cost – financially, physically, and emotionally.

Her doctor told her about the side effects of the recommended treatments, but Ana left the appointment with more questions than answers about the myriad ways cancer would affect her for the rest of her life.

Do I have to tell my coworkers? How much time will I have to take off of work? Can I drive myself to chemotherapy or will someone else have to take me? How much will this cost? Can I afford this?

Unfortunately, Ana’s story is all too common among the more than 15.5 million people affected by cancer in the United States. While your health care team focuses on your medical needs, LIVESTRONG focuses on you, not the disease. Our free, personalized and confidential one-on-one navigation services can help with financial or insurance counseling, education on diagnosis and treatment options, access to discounted fertility preservation services, emotional support, clinical trial matching, and more. We can also help you and your family find essential resources to assist with daily practical issues. Our services are available via phone and online from 8:30am-5pm ET Mondays-Thursdays, and from 8:30am-4pm ET on Fridays. Call 1-855-220-7777 or go online at LIVESTRONG.org/CancerSupport to connect with a navigator today.

Iram, Brain Cancer Survivor and a former LIVESTRONG Navigation client

Iram, Brain Cancer Survivor and a former LIVESTRONG Navigation client

Recognizing that you and your loved ones may want to look for information on your own prior to or instead of contacting a navigator, we created an extensive suite of helpful articles, videos, and tools. Explore this information at LIVESTRONG.org/WeCanHelp.

Within one week of her call with her LIVESTRONG Navigator, Ana

  • Had a better understanding of her cancer diagnosis, the recommended treatment and the potential side effects;
  • She had received free medications to start the process of freezing her eggs at a discounted price;
  • She had scheduled an appointment with another oncologist to get a second opinion after learning her insurance would cover it;
  • She had discussed her financial options with her case manager so she wouldn’t feel overwhelmed with medical bills;
  • She had signed up for an online support group her case manager found for her to learn about ways she could take care of herself during and after treatment; and
  • By using LIVESTRONG Rally to mobilize her support network, she knew which of her family members and friends would be taking her to chemotherapy and bringing her meals for the next two weeks.

By connecting Ana with the resources she needed, LIVESTRONG saved Ana thousands of dollars in fertility preservation and stimulation medication costs, and also saved her the hours and energy it would have taken her to identify these resources and contact them. Contact us to learn about how we can help you today.

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Since 2004, LIVESTRONG Cancer Navigation has helped over 115,000 people like Ana and Iram navigate their cancer at no cost in English and Spanish by being a central hub of cancer support services.

ADA and FMLA: How Laws Work Together

Regardless of the type of job you have, if you need to take time off work because of ADA and FMLAyour cancer diagnosis and treatment, you should learn about your employment rights. More people are familiar with the Family and Medical Leave Act (FMLA), which is the federal law that allows eligible employees to take time off work because of their own serious medical condition or to care for a spouse, child, or parent. The FMLA provides 12 weeks of unpaid leave, per year.

Most people don’t think about the Americans with Disabilities Act (ADA) as a way to take time off work. But they should. The ADA requires employers to provide eligible employees with reasonable accommodations in the workplace. A reasonable accommodation can include changes to work schedules, telecommuting, or even extended leave from work.

Now the FMLA and the ADA can actually work together.

For example, meet Jane. Jane has been undergoing cancer treatment. She has taken time off from work under the FMLA.  She has almost used all 12 weeks of her FMLA leave and her doctor has not yet released her to return to work. She is concerned that she will lose her job if she tells her employer she will not be able to return to work when her 12 weeks of FMLA leave are up.  It is possible that if Jane is also eligible for protection under the ADA, that she could ask for additional time off as a reasonable accommodation under the ADA, if it does not pose an undue hardship on the employer.

However, ADA case law has suggested that additional time off from work will only be considered a reasonable accommodation if the length of additional leave is for a definite period of time. Some recent cases have also shown that employers shouldn’t have rigid leave rules, but be more flexible with leave decisions on a case-by-case basis.

So, if Jane gets to the end of her FMLA leave and she calls her employer and says, “I would like more time off from work as a reasonable accommodation, but I don’t know when I will be able to return”- that is unlikely to be seen as a reasonable accommodation.  But, if Jane calls her employer and says, “I would like three more weeks off work as a reasonable accommodation, because my doctor has released me to come back to work in 3 weeks” – that is more likely to be seen as a reasonable accommodation.

Before making decisions about working through treatment or taking time off work, it is important to get the facts and learn about your options, so that you can make educated decisions about what will work for you.

For more information about your employment rights, visit: http://TriageCancer.org/employment or read our employment-related blogs.

Lymphedema Basics

What is it?

Lymphedema is an abnormal collection of high-protein fluid just beneath the skin. This swelling, or edema, occurs most commonly in the arm or leg, but can also occur in other parts of the body.  The collection of the high-protein fluid attracts more fluid to the region thus increasing swelling.  It also can cause your body to have an inflammatory reaction resulting in scar tissue called fibrosis in the affected area. The presence of fibrosis makes it even more difficult for the excess fluid to be eliminated from the area.  All this fluid prevents the delivery of oxygen and essential nutrients to the area, which then can delay wound healing, create an environment for bacteria to grow, and increase the risk of infections in or below the skin.

Primary lymphedema is a hereditary condition.  Cancer patients are at risk of secondary lymphedema.  Secondary lymphedema is caused by the damage of lymph vessels or the removal of lymph nodes.  In cancer treatment, lymph nodes are removed when a tumor is removed to determine the spread of the cancer. Lymphedema is a chronic condition that cannot be cured, but it can be treated.

What are the symptoms?

The earliest symptoms of lymphedema can include achy, heavy limbs, a tingling in the limbs and maybe even some minor swelling that comes and goes. It is very important that these symptoms are not ignored and that you report them to your healthcare team right away. The earlier you treat lymphedema, the greater the chance of preventing it from becoming a larger, more severe condition.

What is the treatment?

Treatment of lymphedema is called complete decongestive therapy (CDT) and it is broken up into 2 stages: in clinic care and maintenance. The maintenance phase means applying the same treatment techniques to yourself, in your own home.  CMT is a non-invasive therapy that includes:

  • Manual lymph drainage (MLD) – This combines the gentle stretching of skin and deep breathing to reroute lymphatic fluid around the blocked areas
  • Compression bandages
  • Compression garments
  • Special exercises
  • Skin care – Those who suffer from lymphedema are at a greater risk of catching an infection from the bacteria that lives on our skin. Cleansing with low PH soap and using a low PH moisturizer are essential to managing lymphedema

Is lymphedema treatment covered by insurance?

If you have private health insurance, maybe. Coverage for the treatment of lymphedema gets very confusing because those treatments are bandages and garments and not medications.  The ACA (Affordable Care Act) requires all Marketplace plans to cover 10 general categories: (1) ambulatory patient services, (2) emergency services, (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services which includes behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices,(8) laboratory services, (9) preventive and wellness services and chronic disease management; and, (10) pediatric services, including oral and vision care.  The problem is that states are allowed to determine the definition of these categories.  Some states, like California, Louisiana, North Carolina and Virginia have laws that improve the coverage of compression supplies.  Some other states have legislation pending.  Bottom line, you need to call your insurance company and ask them very specific questions about lymphedema treatment coverage.

If you have Medicare, the coverage answer is generally no. Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in the Medicare statute. The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does.  Right now there is a bill before Congress called The Lymphedema Treatment Act (HR1608 and S2373). This bill was first introduced in 2010, and has been reintroduced since then.  It has gathered more and more support over the years, but it is still a bill and not a law.

Lymphedema is very real and uncomfortable risk for cancer patients.  There are resources out there, like the National Lymphedema Network.  Educate yourself before your cancer treatment begins so you can be vigilant in recognizing the early symptoms of lymphedema.  Early treatment makes a difference.

ACA ‘Repeal and Replace’ Bill Unveiled

Repeal and Replace BilLate yesterday evening, a bill was introduced in Congress to repeal and replace the
Patient Protection and Affordable Care Act (ACA or Obamacare).  Prior to the actual introduction of this piece of legislation, there was a lot of speculation about what would be included, and although a version was just released, the House of Representatives is expected to begin considering the legislation in the relevant committees this week.  This is very fast moving compared with other legislation.

The bill is significantly shorter than the ACA and has been named “The American Health Care Act.”

If passed, the law would make several significant changes to our health care system.  For example, the bill would:

  • Eliminate the current requirement that most Americans have health insurance or pay a penalty.
  • Eliminate the current requirement for large employers (50+ employees) to pay a penalty if they do not provide adequate and affordable health insurance to their employees.
  • Require that people have “continuous coverage” or else they could be charged a 30% higher premium. Starting with open enrollment for 2019 insurance plans, anyone who has gone more than 63 days without coverage during the previous 12 months will be assessed a 30% late-enrollment surcharge on top of their base premium.
  • Eliminate the current system of financial assistance to purchase individual health insurance that is based on income and household size. Instead the law would provide tax credits based on age, rather than income. Those under 30 would receive $2,000 per year, up to those over 60, who would receive $4,000 per year. Only individuals earning up to $75,000 a year and married couples filing jointly earning up to $150,000 a year for would be eligible for the full credit. It is estimated that many people currently receiving financial assistance would see a 50% cut in the assistance that they receive under this new law.
  • Change the funding structure of the Medicaid system (i.e., to a per capita payment). This means that each state will receive a set amount of money each year. If states run out of money during the year, they will either have to limit enrollment, limit coverage, or both. This system might end up looking like the failed High Risk Pool structure we had prior to the ACA.
  • Increases the amount that insurance companies can charge older Americans for their health insurance from a 3:1 ratio to 5:1 ratio. Currently, insurance companies cannot charge a 64 year old more than 3 times what it charges a 21 year old. This bill would change that to 5 times what a 21 year old is charged, making health care that much more expensive for older Americans.
  • Eliminate several of the taxes (e.g., the medical device tax, the tanning tax, a tax on high earners, etc.) created by the ACA that were designed to help pay for the financial assistance provisions and expansion of coverage.

The bill does not repeal the protections for people with pre-existing conditions and allowing young adults to stay on their parent’s policy until they turn 26, but also doesn’t address some of the gaps in coverage. For example, the bill does not address the cost of prescription drugs or how much insurance companies can increase rates year to year.

So, while some protections from the ACA will survive, it is anticipated that if this bill passes, many of the 20 million Americans that gained coverage under the ACA will be negatively impacted. For the cancer community, passage of this bill could mean an increased likelihood of facing financial ruin due to a diagnosis.

Of course very few bills are ever passed exactly as they are introduced, so there will still likely be more changes.  Additionally, even if this bill is passed by the House of Representatives, it still has to pass the Senate, and be signed by the President.

Stay tuned for more updates.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  2. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at org/blog/share-your-aca-story.

When Adult Children Get Sick, It May Be Hard For Parents To Get Information

When Sean Meyers was in a car accident on a November evening three years ago, he was flown by air ambulance to the emergency department at Inova Fairfax Hospital, in Northern Virginia. With his arm broken in four places, a busted knee and severe bruising to his upper body, Meyers, 29, was admitted to the hospital. While badly hurt, his injuries didn’t seem life threatening.

When his car went off the road, Meyers had been on his way to visit his parents, who live nearby in Sterling. They rushed to the hospital that night to wait for news and to be available if Sean or the hospital staff needed anything. But beyond the barest details, no one from the hospital talked with them about their son’s condition or care, not that night nor during the next 10 days while he was hospitalized.

“All the time he was there, the hospital staff was very curt with us,” said Sam Meyers, Sean’s dad. “We couldn’t understand why we were being ignored.”

After leaving the hospital, Sean moved into his parents’ spare bedroom temporarily to continue his recovery. About a week later, he was in their kitchen one evening with his girlfriend when suddenly he collapsed. He was rushed to the nearest hospital, where he died. An autopsy revealed that he had several blood clots as well as an enlarged heart.

For Sean’s parents, the results were particularly wrenching because there’s a history of blood clots on his mother’s side of the family. How much did the hospital staff know?

“It might have saved his life if they’d talked to us,” Sam Meyers said.

A spokeswoman for Inova Fairfax said, “We cannot comment on specific patients or cases.” But she noted that information about a patient’s care can be shared in a number of circumstances.

These days, when people think about patient privacy problems, it’s usually because someone’s medical record has been breached and information has been released without their consent. But issues can also arise when patient information isn’t shared with family and friends, either because medical staff decide to withhold it or patients themselves choose to restrict who can receive information about their care.

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) established rules to protect the privacy of patients’ health information while setting standards for hospitals, doctors, insurers and others sharing health care information.

Stepped-up enforcement in recent years and increased penalties for improper disclosure of patient information under HIPAA may lead hospitals and others to err on the side of caution, said Jane Hyatt Thorpe, an associate professor at George Washington University’s department of health policy and an expert on patient privacy.

“For a provider who’s uncertain about what information a provider may or may not be able to share, the easiest and safest route is to say no,” she said.

However, the law is actually quite permissive about providers disclosing information to family members and others who are involved in a patient’s care, said Thorpe.

“If the physician thinks it’s in [the] patient’s best interest to share information with mom or dad or whatever, they may do so,” she said.

They may also decide not to share information, however.

Generally, if a patient is unconscious and unable to give permission to discuss his medical information, a doctor may share details about his health with family and friends. But even if the patient is alert and able to make a choice, a health care provider can use discretion in deciding how much to tell family and friends.

Dr. Wanda Filer, president of the American Academy of Family Physicians, recalled a patient who was an HIV-positive sex worker who didn’t want his family to know about his health, even as he was dying. She honored his wishes. “The family was left in the dark,” she said.

State laws may be more restrictive than HIPAA, requiring patient permission to disclose information to others, said Elizabeth Gray, a research scientist at George Washington University’s department of health policy. However, Virginia law generally follows HIPAA on disclosures, said Gray.

In Sean Meyers’ case, there are unanswered questions. For example, “we don’t know what the patient actually said to the providers,” said Filer.

“HIPAA does allow information to be shared with family or friends based on the patient’s wishes or, if the patient cannot make his/her wishes known, then based on the family member’s or friend’s involvement in the patient’s care,” the spokeswoman for Inova said. The health system’s privacy policy states that it may disclose a patient’s medical information to a friend or family member as permitted under HIPAA and provides details about how to request a form to restrict such disclosures.

There’s no surefire way to avoid lapses in communication or ensure that providers get all the relevant information about a patient’s health. Most smartphones today allow people to store health care information that can be accessed by emergency personnel, said Joy Pritts, a privacy consultant who is a former chief privacy officer in the Office of the National Coordinator for Health Information Technology at the federal Department of Health and Human Resources. In addition to listing allergies and other health concerns, people could state their wishes about disclosing their health information.

In the case of adult children, it may be useful for the child to carry a signed document that authorizes health care providers to disclose and discuss health care information with the parents for a set period of time, said Pritts.

It’s no guarantee, but if a provider is on the fence about disclosing information, “it might help,” said Thorpe.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

What do you have to disclose to an employer?

disclose to an employerMany individuals decide to work through cancer treatment or return to work, while still managing side effects of cancer treatment with medications.  Trying to figure out what has to be disclosed to employers or potential employers is a common concern for individuals.  For more general information about disclosure and privacy, check out our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

In this blog we wanted to focus on the issue of disclosing medications to an employer.  As with most situations there has to be a balance between the interests of the employer and those of the employee.  An employee may have a legitimate desire to keep the medications they are taking confidential.  An employer may have a legitimate need to know what medications its employees are taking. For example, a school probably wouldn’t want their school bus drivers taking prescription pain medications that would hinder their ability to drive. So, what does the law allow?

The Americans with Disabilities Act (ADA) protects the privacy of medical information of eligible individuals in the workplace. The ADA includes specific rules about how much information about your medical condition you have to share with an employer or potential employer, and when.

Under the ADA, employers cannot require blanket disclosure of prescription medications being taken by all employees. However, there are some exceptions based on where you are in the hiring process and the particular type of job you do.

Prior to receiving an employment offer, potential employers are not legally allowed to ask any questions about your medical condition or general health. After a job offer has been made, employers are allowed to ask you questions about your health history or to complete a medical exam, but only if they would be required of anyone entering a similar job. Furthermore, employers are not allowed to take back the job offer based on the results of a medical exam, unless the results show that you cannot perform the essential functions of that job, with or without a reasonable accommodation.

Once you are working for an employer, you can only be asked to complete a medical exam or questions about your health history, when it is “job-related and consistent with business necessity” or if there is a “direct threat.”

The Equal Employment and Opportunities Commission (EEOC), the federal agency that enforces the ADA, has issued guidelines providing some additional information on these exceptions. In these guidelines, the EEOC uses the example of a police officer. Because there is a significant safety risk involved with a police officer using certain prescription medications, an employer may be able to demonstrate that asking a police officer about his/her prescription drug use is consistent with business necessity. On the other hand, it probably isn’t reasonable to ask a firefighter, who acts in a purely administrative role, about her medications.

Unfortunately, the EEOC doesn’t provide a list of other occupations that would fall within this exception of being “job-related and consistent with business necessity.” So it is unclear, for example, if a nurse or construction worker who operates heavy machinery would have to disclose his/her use of morphine.

The EEOC does point out that there are other laws that might apply to certain employees, such as interstate bus and truck drivers, airline pilots and flight attendants, and mine workers.

If you have access to an Employee Assistance Program (EAP) at work, and you contact an EAP counselor, the counselor may ask you questions about your medical conditions, but only if the counselor: 1) does not work for or on behalf of the employer; 2) is obligated to shield any information the employee reveals from decision makers; and 3) has no power to affect employment decisions.

Resources:

Choosing to share information about your medical condition and the laws that protect your privacy or require disclosure can seem complicated.

For more information about the ADA, visit www.eeoc.gov or read our Quick Guide to the ADA.

For information about disclosure and privacy, read our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

A Model for All Children’s Hospitals

Sadly, adults are not the only ones touched by cancer.  Kids get cancer, too.  While only triage-cancer-blog-school-reentry1% of all cancer in the United States is found in kids under the age of 15, in 2016 that means 10,380 children.  Childhood cancer has been on the rise for the past few decades.  However there is some good news out there.  Because of major treatment advances in recent decades, more than 80% of children with cancer now survive 5 years or more.

Thankfully, now we need to talk about how children transition from treatment back to school.  There is a lot of discussion about adults returning to work after taking time off to deal with a cancer diagnosis.  We talk about the normalcy, the sense of the purpose, and the chance to socialize that work may bring.  Well, for these kids, returning to school can mean exactly the same thing.  And it also comes with its own degree of challenges.  Thanks to Stony Brook Children’s School Intervention and Re-Entry Program, there is now a model of how to help children transition from treatment to school.

The School Intervention and Re-Entry Team is made up of physicians, nurses, child life specialists, and educational liaisons who work with school personnel including teachers, school nurses, counselors, social workers, psychologists and other staff members in a joint effort to ease the child’s return to the classroom. This is a service that is free to all Stony Brook Children’s patients. Some of the services they provide include:

  • Presentations to the school faculty regarding a patient’s illness and treatment
  • Classroom presentations to the patient’s peers
  • Acting as a liaison between the hospital and the school
  • Arranging for home instruction
  • Advocating for appropriate educational service
  • Attending 504 and CSE/IEP meetings
  • Providing medical documentation to schools
  • Facilitating neuropsychological evaluations and/or other educational testing services
  • Holding ongoing phone consultation regarding school issues, placement, curriculum, accommodations, and other educational services

The program’s services don’t stop at high school either.  This year, they were able to offer a workshop specifically for students with cancer and blood disorders who are transitioning to college. The workshop was designed to educate these students as well as their siblings, parents and school personnel about their unique needs, and to empower this special population of students to realize their academic goals. There was also an expo with representatives from many regional colleges available to speak individually with students and families about their schools, programs, and services.

We recognize that all children are not being treated at Stony Brook Children’s.  But if you are a parent of a child with cancer, you are used to being an advocate for your child.  Let Stony Brooks Children’s School Intervention and Re-Entry Program be a model you advocate for at your child’s hospital.  After all, we all want our children to be healthy and successful in everything they do.

An Update to Cancer Exposure at Camp Lejeune

Cancer Exposure at Camp LejuneIn February of 2016, we notified you that the Department of Veterans Affairs (VA) has acknowledged that exposure to Camp Lejeune’s contaminated drinking water increases your risk for cancer and other medical conditions. Now the rules that will allow potentially thousands of veterans stationed at the base — or surviving spouses — to receive automatic disability benefits if they have been diagnosed with one of eight diseases, have been finalized.

If you or your spouse were stationed at Camp Lejeune for at least 30 cumulative days, between August 1, 1953, and December 31, 1987, and you have been diagnosed with adult leukemia, aplastic anemia, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin’s lymphoma or Parkinson’s disease, you could be eligible for Disability Benefits from the VA. You will have to submit evidence of the diagnosis and service information.

Please be aware, according to the VA, it is currently taking about 133 days to process Disability Claims.

Getting Back to Work: SSI Employment Support Programs

money-ssiSupplemental Security Income (SSI) pays cash benefits to eligible, low-income individuals who are 65 or older, or have a disability, or who are blind.  SSI is run by the Social Security Administration. There is no requirement to pay into the Social Security retirement system before you can receive SSI benefits, which is different from Social Security Disability Insurance (SSDI).  View our Quick Guide on Disability Insurance for more information.

One thing that both SSI and SSDI have in common is a system of support programs to help you get back to a well-paying job when your medical condition no longer keeps you from working. Please see our blog on SSDI Employment Supports for information on the Ticket to Work Program, which is available to both SSDI and SSI recipients.

In this blog, we would like to share a brief overview of SSI specific employment supports that help determine how much your benefit will be when you try to return to work:

Earned Income Exclusion

The first $65 of the earnings you receive in a month, plus one-half of the remaining earnings will not be counted when determining your benefit amount. This means that they count less than one-half of your earned income when they figure your SSI benefit amount.

Section 1619 – Special SSI Payments for People Who Work

You can still be eligible for SSI and Medicaid while working (under section 1619(b) of the Social Security Act) as long as your earnings remain under your state’s threshold amount, you need the Medicaid coverage, and you continue to be eligible for SSI except for your earnings (meaning you still have a disability).  After you return to work, your Medicaid coverage can continue, even if your earnings (alone or in combination with your other income) become too high for a SSI cash payment.

Reinstating SSI Benefits without a New Application

If you lose your eligibility for SSI because of your work situation, you may be able to restart your SSI benefits again at any time within 5 years, without a new application.  Basically this means if you lose your job or take a pay cut, but are still disabled, your SSI payments will resume immediately.

If you have been ineligible for SSI and/or Medicaid for any reason other than work or medical recovery, you may be able to restart your SSI cash payment and/or Medicaid coverage within 12 months without a new application.

Student Earned Income Exclusion

If you are under the age of 22 and regularly attending school, they don’t count up to $1,780 of your earned income when figuring your SSI benefit.

Property Essential to Self-Support (PESS)

They do not count some resources that are essential to your means of self-support when they decide if you are still eligible for SSI.  For example, they don’t count up to $6,000 of the equity value of a non-business rental property, if that property has an annual rate of return of at least 6%.

For more information about the detailed rules surrounding working while receiving SSI benefits, please visit https://www.ssa.gov/redbook.

This can be very confusing information, so for a complete overview of the entire SSI program go to https://www.ssa.gov/ssi/text-understanding-ssi.htm. You can also call the Social Security Administration at 800-772-1213 or visit your local Social Security office for assistance.

Understanding your options can help you get back to work and get back to normal.

Getting Back to Work: SSDI Employment Supports

triage-cancer-blog-return-to-workReturning to work after being out because of a serious medical condition can be a scary prospect.  It usually takes a person quite a long time to get approved for SSDI benefits, so the thought of giving up those benefits is alarming if you are not 100% sure you’re ready to work.  The Social Security Administration understands that fear, and has you covered, with what they call “employment supports.”

This is a quick overview of SSDI employment supports and how they work together:

Step 1. The Trial Work Period (TWP)

This is an opportunity for you to test your ability to work, during which time you will continue to receive SSDI payments, no matter how much you earn as long as you still have a disability and are reporting your work to the SSA.  The details:

  • The TWP lasts for 9 months
  • The 9 months do not have to be in a row
  • The 9 months must take place within a 60 month timeframe

Step 2. The Extended Period of Eligibility (EPE)

This period begins the month after your TWP ends.  So, if you’ve worked and received benefits for 9 months, on your 10th month you would be in your EPE.  This means you might be eligible for another 36 months of benefits depending on how much you are earning. This one is a little trickier:

  • During your EPE, you will receive benefits for any month you work and your earnings are not considered a substantial gainful activity (SGA).
  • During your EPE there is a grace period. Meaning, if you suddenly get a raise or get more hours at work and your earnings are considered substantial, you will receive benefits for that month and the following 2 months.
  • Your benefits will end if your earnings are substantial in any month after the EPE ends.

Step 3. Expedited Reinstatement (EXR)

Step 3 only comes into play if you have returned to work and your SSDI benefits have ended because your earnings are considered substantial.  EXR is a safety net, meaning it’s there for you when everything is going great, you’re back to work, and then all of a sudden your medical condition flairs up.  The details:

  • If your benefits ended within the last 5 years due to an increase in your earnings, but you still have your original medical condition, you do not have to reapply for benefits.
  • Instead, you will receive 6 months of temporary benefits while your case goes under medical review. Also, if you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Please visit www.ssa.gov/redbook/documents/TheRedBook2016.pdf to get a full understanding of the rules surrounding going back to work.