Taking FMLA Leave During the Holidays

The Family & Medical Leave Act (FMLA) allows eligible employees to take up to 12 FMLA-During-Holidaysweeks of unpaid, job-protected leave, per year.  How this 12 weeks of time off gets counted by employers is a frequent question that we receive.  Figuring this out can be especially confusing if your FMLA leave takes place over the holiday season, where there are usually a number of paid company holidays. So, when trying to calculate your time off when taking FMLA leave during the holidays, this is how it breaks down:

  • If your company pays for 1 day of a company holiday (like Thanksgiving, for example), but you take the other 4 days off during that week as well, the entire week (5 days) would count towards your 12 weeks of FMLA leave.
  • However, if you work at least 1 day that week, your paid company holiday will not count towards your FMLA leave. For example, if you work Monday but then take the rest of the week off (which includes 1 day of a paid company holiday on Thursday), then only Tuesday, Wednesday, and Friday will count against your FMLA leave.
  • If your company shuts down for 1 or more weeks (e.g., the week between Christmas and New Year’s), that time will not be counted against your FMLA.

Knowing how paid holidays interact with the FMLA is the best way to ensure you make the most of your FMLA leave. For more information on the FMLA, including who is an “eligible employee” and how the FMLA works with other benefits, visit our website and read our FMLA Quick Guides. And, we hope that you have a happy and healthy holiday season!

FAQs About Social Security Survivors Benefits

Today we are pleased to share some very useful information from the Social Security Administration about the right of survivors to collect a loved ones’ Social Security benefits.

  1. Who can get Social Security survivors benefits and how do I apply?

Response: When you die, members of your family could be eligible for benefits based on your earnings. You and your children also may be able to get benefits if your deceased spouse or former spouse worked long enough under Social Security.

  1. Who can get survivors benefits?

Response: Widows and Widowers
A widow or widower can receive benefits

  • at age 60 or older.
  • at age 50 or older if disabled.
  • at any age if she or he takes care of a child of the deceased who is younger than age 16 or disabled.

Divorced Widows and Widowers
A divorced widow or widower can receive benefits

  • at age 60 or older if the marriage to the deceased lasted at least 10 years.
  • at age 50 or older if disabled and the marriage to the deceased lasted at least 10 years.
  • at any age if she or he takes care of a child of the deceased who is younger than age 16 or disabled.

Unmarried children
Unmarried children can receive benefits if they are:

  • younger than age 18 (or up to age 19 if they are attending elementary or secondary school full time);
  • any age and were disabled before age 22 and remain disabled.

Under certain circumstances, benefits also can be paid to stepchildren, grandchildren, stepgrandchildren or adopted children.

Dependent parents
Parents age 62 or older who received at least one-half support from the deceased can receive benefits.

One-time lump sum death payment
A one-time payment of $255 can be made only to a spouse or child if they meet certain requirements. Survivors must apply for this payment within two years of the date of death.

  1. How do I apply doe Survivors Benefits?

Response: You cannot apply for survivors benefits online. To report a death or apply for survivors benefits, please

  1. Where can I find more information about Survivors Benefits?

Response: You can find more information about Survivors benefits by accessing the following links: Survivors Planner: How You Apply For Survivors Benefits
Survivors Planner: If You Are The Worker’s Widow Or Widower
Survivors Benefits
Social Security Survivors Benefits: Protection You And Your Family Can Count On

  1. What Should I do when someone dies?

Response: Notify Social Security as soon as possible when someone getting benefits dies. In most cases, the funeral director will report the person’s death to Social Security. Give the funeral director the deceased’s Social Security number so he or she can report the death.

See How Social Security Can Help You When A Family Member Dies for more information.

  1. How much do survivors get in benefits?

Response: We base survivors benefits on the amount the deceased worker earned during his or her lifetime.

See Survivors Planner: How Much Would Your Benefit Be? for more information.

  1. Who can get a lump-sum death benefit?

 Response:  We may pay a lump-sum death benefit of $255 to:

  • A spouse who was living with the deceased person at the time of death; or
  • A spouse or a child who, in the month of death, is eligible for a Social Security benefit based on the deceased person’s record.

More Information

Survivors Planner: A Special Lump-Sum Death Payment

Information You Need To Apply For Lump Sum Death Benefit – Form SSA-8

     8. Can Social Security payments go to the estates of deceased beneficiaries?

Response: A deceased beneficiary may have been due a Social Security payment at the time of death. We may pay amounts due a deceased beneficiary to a family member or legal representative of the estate.

See Claim For Amounts Due In The Case Of Deceased Beneficiary – Form SSA-1724 for more information.

 

Genetics, Genomics & Liquid Biopsies: How Do They Apply to You

Genetic Testing vs. Genomic Testing

We all know that our DNA can be very useful in figuring out what part of the world our Genetics Genomicsancestors hail from, but can understanding our DNA really help in the treatment of cancer? For more and more of us the answer is yes.  Thanks to the advances in genetic and genomic testing, doctors are able to offer targeted therapies based on the results of these tests.  But what the difference between genetics and genomics?

  • Genetics is the study of heredity (genes that you inherited from your parents)
  • Genomics is the study of genes and their functions

Genetic testing detects hereditary alterations in DNA, while genomic testing detects acquired (over the course of a lifetime) alterations in DNA.

Some of the common mutations we’ve heard about, like BRCA1 and BRCA2 are examples of genetic mutations (germline mutations). These genetic mutations are passed on from parent to child, and increase an individual’s chance of developing certain types of cancers. For example, if you have a BRCA1 mutation, you have a higher risk of developing, breast, ovarian, pancreatic, and prostate cancer.

In addition to genetic testing, there are now genomic tests that can look at certain tumors and identify which therapies might work better against those tumors. These are called targeted therapies. For example, there is now a genomic test that can look at the tissue of an ovarian tumor to detect BRCA mutation types that may benefit from a targeted therapy called a PARP inhibitor.

All genetic or genomic testing is done by analyzing a biopsy.  Traditionally this has meant a tissue biopsy.  Unfortunately, not all tumors are easy or comfortable to access for a biopsy.  Often tissue biopsies mean invasive procedures like surgery, which isn’t always an option because of poor health or the location of the tumor.  Thankfully there is a new hope: Liquid Biopsies.

What are Liquid Biopsies?

Liquid biopsies are blood tests that are analyzed to assess mutations and other changes in a tumor’s DNA. This is possible, because tumors continually shed dead cells into the blood stream.

On June 1, 2016, the FDA approved the first liquid biopsy test for use in cancer treatment. The test detects key mutations in the EGFR gene that makes patients with advanced non-small cell lung cancer candidates for a specific treatment option. Previously, tumor specimens were used to detect these mutations.

At this point, these tests may be most valuable to patients with advanced stage cancer. They can be used to monitor changes over time and direct treatments when tumors recur or progress. Eventually, liquid biopsies may be able to help direct care for patients with earlier-stage cancer or help monitor disease progression in people with precancerous lesions. Scientists caution that more research is needed before liquid biopsies are used routinely in cancer care, but this is an area of intense study, so the future looks bright. The scientific advances in genetic and genomic testing as well as liquid biopsies are allowing cancer patients to benefit from this new era of precision medicine.

For more information about genetics and genomics, watch our webinar recording.

Six Key Things You Need to Know During Open Enrollment

Open enrollment for plans sold in the Marketplaces started yesterday and we have Six Key Things to Know Open Enrollmentbeen hearing that there is still a lot of confusion. As a reminder, open enrollment is the time of year consumers can shop for a new plan or make changes to existing plans. For Marketplace and Medicare plans the plan won’t start until January 1, 2018. Employer plans may have different start dates, so check with your employer. Here are six key things you need to know during open enrollment:

  1. Health insurance can be confusing.
    1. Make sure you understand the key terms used in your health insurance policy. Watch our new video – Triage Cancer Presents: Health Insurance Basics to learn more. This information is useful regardless of where you get your health insurance coverage.
  2. Financial assistance still exists for most people who purchase plans in the marketplace.
    1. For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.
    2. Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.
  3. Individuals shopping for insurance (regardless of where they get it – Medicare, employers, private companies), should be sure to do the math when comparing options!
    1. Often times we only look at the monthly premium of a plan. However, to accurately determine what a plan with cost you for the year, you have to do the math! Assuming that a consumer will reach their out-of-pocket maximum during the year, the way to do the math is to multiply the monthly premium by 12, then add that amount to the plan’s out-of-pocket maximum. You may be surprised to find that the bronze plan may not be your most affordable option.
    2. Consumers should also look at the network of doctors and hospitals, the other costs (e.g., co-payments, deductibles, etc.), and prescription drug coverage.
    3. For more information on how to pick a plan watch our webinar, Choosing Wisely: How to Pick an Insurance Plan or visit CancerFinances.org.
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit http://medicare.gov for more information about plan options.
  5. Be wary of short-term health insurance plans.
    1. These plans may look attractive based on their low cost, but they are not considered creditable coverage and when they end, consumers typically aren’t eligible for a special enrollment period to buy a plan in the Marketplaces, which could leave them with a gap in coverage. Additionally, they do not have to include the consumer protections in the ACA and may be able to charge people with cancer more, or exclude covering cancer treatments.
  6. Open enrollment dates may vary depending on where you live.
    1. The federally run Marketplace will be open from November 1 – December 15; however, some states have extended their open enrollment periods.
    2. There are also some extensions available for people who were affected by the recent hurricanes. (see the link above)

Making the Most of Ticket to Work

Tai Prohaska, MPH
Manager of Strategic Alliances, Allsup

If you had to stop working due to cancer, and were awarded Social Security Disability Ticket to WorkInsurance (SSDI), you could benefit from Social Security’s Ticket to Work program. Research shows that the longer a person is detached from the labor force, the less likely it is they will return to work. If and when you are medically able to try some kind of work, this program makes it easier for you to test whether you are ready to work, without the fear of losing your SSDI and Medicare benefits.

Many people are able to earn much more through work earnings than they receive in SSDI benefits, and those earnings go toward your future Social Security retirement benefits.  In addition, there are important personal rewards, including retrieving an important part of who you are through your work, discovering purpose in your day and belonging with others, and providing vital security for your future.

To make the most of the program, it helps to understand these Ticket to Work basics:

  • Employment Networks (ENs). More than 600 ENs across the U.S. offer a range of free support services through the Ticket program. Some ENs serve specific populations, while others provide specialized support services. You can click here to search for an EN. You can also visit Allsup Employment Services, which supports individuals with exploring their interests, understanding their skills, and pursuing their employment options. Once employed, they provide support to address issues such as improving energy and stamina for a full-time job, discussing job accommodations with employers and complying with Social Security’s reporting processes, to protect benefits for the long-term.
  • Trial Work Period (TWP). You can keep your SSDI cash benefits while testing your ability to work for nine months.  You have a safety net where you can test your ability to work again and receive your full SSDI benefits in addition to your job earnings.
  • Extended Period of Eligibility (EPE).  After Your TWP ends, you will get full SSDI benefits for the first three months of this 36-month period in addition to your job earnings. After that, you are eligible to receive SSDI benefits for any month your job earnings drop below substantial gainful activity (SGA).  In 2017, SGA is $1,170 for non-blind individuals and $1,950 for blind individuals.
  • Continuing Medicare Coverage. After your TWP ends, your Medicare coverage continues for up to 93 consecutive months. You still receive coverage during this time even if your SSDI payments end.
  • Expedited Reinstatement of Benefits.  If you become unable to work again within five years after your EPE ends, you can request to have your SSDI benefits restarted without filing a new application.
  • Continuing Disability Review (CDR) Protection. Social Security periodically reviews disability claims to determine if you still qualify as disabled.  As part of the Ticket to Work program, you are exempt from medical CDR and your status remains unchanged.

If you are ready and medically able to return to work, taking advantage of the Ticket to Work program can help prepare you for success. To learn more, visit https://choosework.ssa.gov.

Clarifying Open Enrollment

There has been a lot of confusion about open enrollment for health insurance coverage in the news and on social media and we want to clarify some things and share some news:

  1. Open enrollment to buy coverage for 2018 through the State Health Insurance Marketplaces has been cut from 12 weeks to just 6 weeks, running from November 1 to December 31. However, there are some additional things you need to know:
    1. If you live in one of the states below, your state may have decided to keep open enrollment open longer:
      • California – November 1 to January 31
      • Colorado – November 1 to January 12
      • D.C. – November 1 to January 31
      • Massachusetts – November 1 to January 31
      • Minnesota – November 1 to January 14
      • Washington – November 1 to January 1
    2. If you were affected by Hurricanes Harvey, Irma, or Maria, you also have access special enrollment periods, which extends the time you have to get coverage in 2017 or enroll in coverage for 2018.
      • Group A:
        • Timing: The date of the SEP qualifying event through December 31, 2017.
        • Eligibility: Individuals who experienced an SEP qualifying event between 60 days prior to the start date of the incident period and December 31, 2017 and reside, or resided at the time of the hurricane, in any of the counties declared as meeting the level of “individual assistance” or “public assistance” by FEMA.
        • What to do: Contact the Marketplace Call Center at 1-800-318-2596.
      • Group B:
        • Timing: December 16, 2017 through December 31, 2017.
        • Eligibility: Individuals who reside in or move from areas affected by a hurricane in 2017, who are applying for 2018 coverage.
        • What to do: Contact the Marketplace Call Center at 1-800-318-2596 to request an enrollment after December 15, 2017.
  1. Medicare open enrollment occurs each year for people to enroll or switch Medicare plans and prescription drug plans. Medicare open enrollment runs from October 15 to December 7, but the Centers for Medicare & Medicaid Services have announced a special enrollment period to give people more time to enroll due to the recent hurricanes.
    1. Timing: From the start of the incident period through December 31, 2017.
    2. Eligibility: Individuals who reside, or resided at the start of the incident period, in an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or a major disaster; individuals who do not live in the affected areas but rely on friends or family members who live in the affected areas for help making health care decisions.
    3. What to do: Contact 1-800-MEDICARE to access the special enrollment period. Click here for more information.

Remember, with both Medicare and Marketplace plans, when you sign up for coverage in open enrollment, you coverage won’t actually start before January 1, 2018.

If you need coverage now, visit CancerFinances.org or watch our webinar recording on how to pick a health insurance plan, to see if you have other options.

Health Care in the News: Keeping Down Costs

  1. Cost-Sharing Reductions: On Thursday, 10/12, the President announced the discontinuation of cost-sharing reduction payments (CSRs) for health insurers that sell plans in the state Health Insurance Marketplaces.
    • For those who choose to buy health insurance coverage through the marketplaces, they may be eligible for 2 types of financial assistance: 1) premium tax credits; and 2) cost-sharing reductions. Premium tax credits reduce your monthly premium payment for whichever plan you choose to buy in the marketplace. Cost-sharing reductions are a requirement in the ACA, that insurance companies lower the cost of deductibles, co-payments, and co-insurance amounts on silver level plans, based on your income level. The cost-sharing reductions are provided by the insurance company, but are reimbursed by the federal government.
    • Since taking office, the President has indicated that he might end the CSRs. His lack of a definitive decision creative uncertainty for insurance companies in determining their rates for plans sold in the marketplace for 2018. This uncertainty actually cause may insurers across the country to choose not to sell plans in the marketplace for 2018, which ultimately reduces competition and increases rates for the plans that are sold in the marketplace. Some companies decided to continue to sell their plans, but increased their rates, to cover the loss of the CSR payments from the federal government.
    • It now falls on Congress to fund the CSR payments for 2018 and beyond. There is currently a proposal being discussed in the Senate to fund the CSR payments for two years, but it includes other changes (see below).
    • On Wednesday, 10/18, eighteen states filed a temporary restraining order to force the President to continue funding the CSR payments.

Alexander-Murray-Keeping-Costs-Down

  1. Alexander-Murray Legislation: On Wednesday, 10/18, in response to the President’s decision to end the CSR payments, U.S. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached a bipartisan compromise that is an important first step to stabilize health insurance markets and provide states more flexibility, while maintaining important patient protections.
    • They have proposed bi-partisan legislation, which will likely keep health insurance costs lower for consumers. This legislation is supported by nearly 30 cancer organizations representing patients, physicians, nurses, and social workers, because cancer patients and survivors need access to quality, affordable health insurance. However, there are some political compromises included in this bill.
    • This bill funds the CSR payments through 2019 and restores some of the funding that was previously cut by the President, for outreach and education about open enrollment and health insurance options.
    • This bill also takes some steps to expand access to catastrophic health insurance plans, which could allow more people to afford health insurance, but there is also serious concern about the limited coverage included in these plans. It also allows states flexibility to waive some of the ACA requirements for plans sold through the marketplace. Again, while it may expand access, there are some questions about the coverage included in those plans.
    • At this time, it is unclear if there are enough votes to pass this legislation. If you would like to share your opinion or experience, you can contact your U.S. Senators by calling: 844-257-6227.
  1. Executive Order: On Thursday, 10/12, the President also signed an Executive Order, which allows insurance companies to sell policies across state lines and to sell cheaper policies with less coverage than currently required under the ACA. The challenge with this proposal is that:
    • It allows insurance companies to avoid state health consumer protections.
    • It also creates a situation where people can buy minimal health insurance coverage, but if they are diagnosed with a serious medical condition like cancer, then they find out that those policies don’t cover needed medical care, like chemotherapy.
    • The Executive Order requires federal agencies to draft regulations, share the draft for public comments, and then release final regulations on these changes.

As these events unfold, Triage Cancer will continue to provide updates on these changes and how they may have an impact on the cancer community. Stay tuned.

Balance Billing: What You Need to Know

In order to avoid unexpected medical bills, it is important to know how your health plan Balance Billingworks and how a practice referred to “balance billing” can affect you. Most plans have a specific network of doctors and facilities that their members can use for their medical care. To be a part of a plan’s network, these doctors and facilities contract with the plan and agree to accept a specific rate for their services under the plan. These doctors and facilities are considered “in-network.” Doctors and facilities that don’t have a contracted relationship with an insurer are considered “out-of-network.”

The main difference between in-network and out-of-network healthcare providers is that in-network healthcare providers work with your insurance company to provide negotiated (discounted) rates, while out-of-network providers do not agree to discounted rates. For example:

You visit an in-network doctor and the total charge is $250. The doctor and your plan have negotiated a $75 discount. The plan then pays the doctor $140 (which they have agreed is the “allowed amount” for the doctor to receive). You then have to pay the remaining $35.

But, if you visit an out-of-network doctor and the total charge is $250 and there is no negotiated discount. The plan pays the doctor $140, but you’ll be responsible for the entire remainder, which is $110.

The latter part of the example regarding out-of-network doctors is an example of “balance billing.” Balance billing occurs when out-of-network doctors and facilities bill patients for the difference between a billed charge and a health plan’s allowed amount. However, this type of balance billing is typically not allowed when:

  • you have Medicare and you’re using a healthcare provider that accepts Medicare assignment;
  • you have Medicaid and your provider has an agreement with Medicaid; or
  • your doctor or facility has a contract with your health plan (in-network) and is billing you more than your plan’s contract allows.

Patients can also face balance billing when they receive care from a provider they did not know was out-of-network. For example:

You are going to have surgery at a hospital.  Both your surgeon and the hospital are in your plan’s network.  But during the surgery you need anesthesia so that you are not awake. The person who gives you the anesthesia, the anesthesiologist, whom you did not choose, is not in-network. A few weeks later you receive a large bill from the anesthesiologist, who was not covered by your plan. 

This is another example of balance billing, or “surprise billing.” Patients who think that they are being careful to only visit in-network providers are often surprised by these bills. Another example of when this often happens is when your doctor sends your blood to an out-of-network lab for testing. You can avoid this by asking your doctor to make sure they are using an in-network lab for your plan.

These situations can leave patients with huge medical bills that they are unable to pay, and can even lead to bankruptcy.

Some states have tried to protect patients from balance billing. For example, on July 1, a California law went into effect that says, if you have a non-emergency service and visit an in-network facility (like a hospital or a lab), you will only be responsible for your in-network share of the cost even if you’re seen by an out-of-network provider.

This is a giant step in terms of healthcare and patient care, as a recent Consumers Union survey found that nearly 1 in 4 Californians who visited a hospital or had surgery in the past two years were charged an out-of-network cost when they thought the provider was in-network.

In addition to knowing how to use your plan, you also need to make sure that you understand what type of plan you have. Because, the California law does not cover employer-sponsored plans that are self-insured. To find out of your plan in self-insured, you can call the number on your insurance card, or talk to your employer’s human resources representative.

New York and Florida also have comprehensive state laws to protect patients from balance billing. But there are a total of 21 states that have laws that deal with balance billing. To check if your state has a law protecting you from balance billing, visit Triage Cancer’s Chart of State Laws.

If you think you are being balance billed, there may be steps that you can take to deal with the bill.

10 Ways Medicaid Affects Us All

Medicaid was created in 1965 as a program for the poor. Today, it helps 74 million people — more than 1 of every 5 people in the U.S. You or someone you know likely benefits.

rollinggraphic_piecharts

Sources: George Washington University study/Women’s Health Issues journal, The Kaiser Family Foundation

Big School Booster

Medicaid paid for nearly $4 billion in school-based health care services in 2015.

Dependent Children

Medicaid aimed, at its start, to insure healthy children and pregnant women. Children are still the largest demographic group served. How Medicaid coverage breaks down:

rollinggraphic_whoiscovered3

Where The Money Goes

But a look at who benefits from Medicaid spending shows a different story.

rollinggraphic_whobenefits3

Sustaining Livelihoods

About 60 percent of non-disabled Medicaid adult enrollees have a job.

 

 

rollinggraphic_enrollment21

Coverage Forecast

Most Medicaid enrollees churn in and out of the program every few years, depending on their circumstances. Odds are 1 in 4 you might need this safety net one day.

The article in its entirety can be found here. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation

 

Volunteering While on FMLA – Risking Your Job?

We often get questions about what an individual is allowed to do while on leave under Volunteering-on-FMLAthe FMLA. For example, can you engage in contract work, work a second job, or volunteer on FMLA leave? Like many issues around work and cancer, there isn’t a one-size fits all answer.

The Family and Medical Leave Act (FMLA) is a federal law that allows eligible employees to take time off from work, for up to 12 weeks, because their own serious medical condition prevents them from working, or to act as a caregiver for a seriously ill spouse, child, or parent.

To be eligible for FMLA leave, individuals must have worked at their place of employment for a minimum of 12 months, and worked over 1,250 hours, in the last 12 months. Also, private employers must have more than 50 employees in order to be covered by the FMLA. For more information about the FMLA, take a look at our Quick Guide.

The FMLA does not expressly prohibit individuals from working another job while on FMLA leave (sometimes referred to as moonlighting, but we also know that many people regularly work more than one job). “Employers with established policies regarding outside employment while on paid or unpaid leave may uniformly apply those policies to employees on FMLA leave. Otherwise, the employer may not restrict your activities.” Keep in mind, some states may have laws that might impact an employee’s ability to work other jobs while on leave.

If you are taking time off under the FMLA because a medical condition keeps you from working, and you chose to volunteer or work another job while on FMLA, and your employer finds out, they are allowed to ask questions regarding your responsibilities and your ability to work. Employers may question your responsibilities at you other job, to ensure that they are not similar to what you do while working for them. Therefore, it may be in your best interest to check with your employer about their policies around working another job or volunteering while out on FMLA leave.

For more information, visit https://www.dol.gov/whd/regs/compliance/1421.htm.