Disability Benefits for People With Breast Cancer
You may need to take time off from work if you’ve been diagnosed with breast cancer, either for treatment, recovery, or because side effects make it hard to do your job. If you’re going to be away from work temporarily or for a longer period, it's worth looking into whether you can get disability benefits.
“Most people who need to take time off work because of a cancer diagnosis still need a source of income,” says Joanna Doran, a cancer rights attorney and CEO of Triage Cancer. “So it’s very helpful for them to understand what their disability insurance options are.”
Disability benefits can help to replace lost income while you’re unable to work because of a medical condition, such as cancer. These payments typically replace a percentage of your usual monthly income (for example, 40% to 80%), but not the full amount.
Types of disability benefits you may qualify for
There are several ways to get disability benefits after a breast cancer diagnosis, including from a private insurance plan you purchased previously from an insurance company, coverage through an employer, and some state and federal government programs.
Private disability benefits
In most cases, you can only get private disability insurance benefits after a breast cancer diagnosis if you were already enrolled in a plan beforehand. It can be very difficult to buy a new private disability insurance plan after a cancer diagnosis or recurrence.
People typically buy private short- and long-term disability insurance plans from a private insurance company or broker, or get them through their employer as an employee benefit. If you’re unsure whether you have private disability insurance, it can help to check which plans you may have signed up for in the past, either through your employer or on your own.
“Some people have access to a disability insurance plan through their employer that they have forgotten about because they signed up when they first started working, and their employer pays the premiums,” says Doran. “So we recommend that people review their employee manual or talk to someone who handles employee benefits at work, to find out what they signed up for,” she says.
Private disability plans factor in other disability benefits you may be getting (such as SSDI) when determining your monthly payment amount.
State disability benefits
If you live and work in California, Hawaii, New Jersey, New York, or Rhode Island, you may qualify for a state-sponsored short-term disability insurance program. The eligibility rules vary, but usually require that you’ve earned wages in the state and paid certain payroll deductions for a specific period, and meet criteria related to your medical condition. The programs provide payments for 6 to 12 months, depending on the state.
To find out if you’re eligible, ask a human resources representative at your job or contact your state’s disability insurance agency. Triage Cancer has a guide to each state program that includes contact info for the state agencies.
People who are self-employed may, in some cases, be eligible for state disability benefit programs, but they often need to sign up for coverage before a disability occurs. For example, in California, self-employed people need to have been enrolled in the Disability Insurance Elective Coverage program for at least 6 months to qualify for state disability benefits if they become unable to work.
Federal disability benefits: SSDI, SSI, and VA disability
The federal government has two long-term disability benefit programs for people nationwide who have a medical condition that is expected to last for a year or longer and severely limits their ability to work.
SSDI is for workers who’ve paid a certain amount of taxes on their work-related income and haven’t yet reached full retirement age.
SSI is for people with little or no income or financial resources, whether or not they’ve worked in the past.
Each program has its own eligibility rules, and some people may qualify for both SSDI and SSI at the same time.
Also, people who developed cancer or another illness while serving in the U.S. military or whose illness may have been caused by or made worse by serving in the military may be eligible for VA Disability Benefits.
How disability benefits work
Once you know that you’re eligible for benefits through an insurance plan or state or federal program, you’ll need to file a claim and have it approved before you can start receiving payments.
Disability benefits are either short- or long-term:
Short-term disability provides monthly benefits to people with a medical condition for 3 to 6 months, or for up to 12 months.
Long-term disability provides monthly benefits to people with a medical condition expected to last for an extended period of time (which can vary, depending on the policy or program). SSDI, for example, is for people with a medical condition expected to last a year or longer.
Some people who are taking a few months off from work may file a claim for only short-term disability. Others who need more time away from work may file for short-term disability and then long-term disability, or for long-term disability alone.
Most disability benefit programs and insurance plans require that you were working at or near the time that you file a claim. However, SSI, a federal disability benefit program, doesn’t require a work history.
You may be able to receive payments from more than one disability benefit program or insurance plan at the same time, or from different ones at different points in time while you’re unable to work.
What disability benefits cover
What disability benefits cover can vary greatly depending on the disability program or insurance plan. For instance:
Private short-term disability plans typically pay about 40% to 70% of your weekly salary
Private long-term disability plans typically pay about 60% to 80% of your weekly salary
SSDI pays a monthly benefit, averaging about $1,500, with a maximum of $4,018
SSI pays a monthly benefit, averaging about $750, with a maximum of $967
Because benefit amounts vary so widely, it’s important to check the specific terms of the program or insurance plan you’re applying to.
Filing a claim for disability benefits
In almost all cases, you need to file a claim with a disability program or insurance plan and have it approved before you can start receiving benefits. You’ll need to meet specific eligibility criteria and provide evidence (such as medical records and notes from your doctors) showing that your medical condition is severe enough to prevent you from working.
If your claim is approved, you may still need to wait for days, weeks, or months before you receive your first benefit payment. Many disability programs and insurance plans have a specific “waiting” or “elimination” period between when the qualifying disability began and when you can start receiving payments.
You may be allowed to keep working part-time while receiving disability benefits, but rules vary, and your income may need to stay below a certain amount.
Cost of private disability insurance
Premium rates for private short- and long-term disability insurance plans vary and depend on factors such as your age, health, and the percentage of your income you want to replace.
If you’re purchasing a long-term disability plan on your own (not through an employer who is covering or subsidizing the cost), premiums typically cost about 1% to 3% of your annual income.
If you’ve been diagnosed with breast cancer, purchasing a new private short-term or long-term disability plan may be difficult or very expensive, unless the cancer has been in remission for several years.
Unlike private disability insurance, SSDI and SSI do not require you to be paying premiums at the time you apply for benefits.
Are disability insurance benefits taxed?
Whether disability benefits are taxed depends on the type of benefit and how the premiums were paid. For example, some private disability insurance benefits may be taxable while others are not, and tax rules can vary by state.
The nonprofit Triage Cancer has a detailed guide to understanding which types of disability insurance benefits are taxed by the federal government and by state governments.
Who can help me understand my options for disability benefits?
Researching and applying for disability insurance benefits can be confusing and time-consuming. It’s important to know that there are experts who can help you or a caregiver through the process. For example, you may want to reach out to:
the human resources or benefits representatives, or employee assistance program at your job
a financial navigator, financial counselor, or social worker at the cancer center or hospital where you received cancer treatment
a nonprofit that offers people with cancer free legal and financial navigation services, such as Triage Cancer or the Patient Advocate Foundation
private insurance companies and brokers that you purchased a disability plan from in the past
What can I do if my claim for disability benefits is denied?
If you submit a claim or request for disability benefits and it gets denied, there’s almost always a formal way to appeal that decision. For instance, there are four levels of appeals if you disagree with a decision about your SSDI or SSI benefits. And there are ways to appeal if your claim for private disability insurance benefits was denied.