COVID-19 Insurance and Financial Issues for People With Breast Cancer

Jamie DePolo: Hello. As always, thanks for listening. Our guest is Joanna Morales, a cancer rights attorney, author, speaker, and CEO of Triage Cancer, a national nonprofit organization connecting people to cancer-survivorship education through educational events, a speakers’ bureau, and online materials and resources. Joanna has spent more than 24 years working on behalf of people with cancer, including 5 as an adjunct professor of law at Loyola Law School teaching a seminar in cancer-rights law, and 8 at the John Wayne Cancer Institute’s Psychosocial Care Program and Positive Appearance Center.

Today, Joanna joins us to talk about some of the financial and insurance issues that people with cancer are facing in the wake of the COVID-19 pandemic. And I do want to point out that the information we’re discussing is current as of April 10, 2020, the day we’re recording this podcast.

Joanna, welcome to the podcast.

Joanna Morales: Thank you for having me.

Jamie DePolo: So, this information is really important. We’ve been getting a lot of questions about it. So, I want to start with talking about some of the paid sick leave and Family Medical Leave Act updates that took effect on April 2 and I believe last until December 31 of this year. Could you sort of explain these new laws and especially how they affect the unemployment program?

Joanna Morales: Sure. So, there’s actually a couple different pieces to that. Congress has been very busy over the last couple of weeks in providing new benefits to employees and others, and they showed up in some different laws. And after a law gets passed, it’s up to federal agencies, and sometimes states, to implement those laws. The way that they get implemented and the details get worked out are through regulations.

So, we have a lot of different agencies who are passing regulations or issuing regulations — so, the Department of Labor, the IRS — and this information is kind of coming fast and furious right now. But there’s really three different key benefits related to employment. There’s a new paid sick leave benefit, there’s a new Family and Medical Leave Act benefit, and then there’s a new unemployment benefit.

If we break those down a little bit, the paid sick leave program is something totally new. So, we don’t have federally required paid sick leave. If someone has access to paid sick time at their work, that’s because the employer provides it or because they live in a city or one of the handful of states that have paid sick leave. But this is a new benefit in addition to anything that exists through your employer or through a state program.

So, now, through this new paid sick leave program, employees can take 80 hours of paid sick leave, so effectively 2 work weeks of sick leave, and you don’t have to have worked there a certain period of time in order to take this leave. So it really applies to right after your first day of employment, and you’re allowed to take that time off if you’re unable to work or tele-work because you’re subject to a government quarantine or isolation order, if you’ve been advised to self-quarantine from a healthcare professional, or if you potentially have symptoms of COVID-19 and you are seeking a medical diagnosis. So, you’re going to the doctor to get tested, for example, or you can take that time off if you’re caring for someone who’s in one of those situations.

If you are doing any of those things and using that paid sick leave, you get 100% of your pay. But if you need to take time off to care for an individual who can’t work because of one of those situations, or if you need to take time off work because you need to care for a child whose school has closed or whose regular caregiver is unavailable specifically because of the coronavirus, then you only actually get to take that time off with two-thirds your rate of pay.

There’s a lot of details to this, and we do have written-out information on these topics on our website at TriageCancer.org. But what we know, when a law gets passed, really, the devil is in the details, so that people can actually figure out whether or not these laws apply to them and then how to use them.

Jamie DePolo: Got it. And you mentioned two other pieces.

Joanna Morales: Yes. So, that’s the paid sick leave program.

Jamie DePolo: Okay.

Joanna Morales: The Family and Medical Leave Act program is for any employee who has been on payroll for at least 30 days — so that’s very different from the regular FMLA, where you have to work for the employer for 12 months before you can take FMLA leave. You can take 12 weeks of leave under the new Family and Medical Leave Act program. The first 2 weeks are unpaid, and the rest of the 10 weeks are paid at two-thirds the rate of your regular pay.

But there is a cap on the pay. So, you actually only get paid a maximum of $200 a day, or $10,000 over that 12-week period of time. So, basically, if you make $25 an hour or less, you’re getting paid.

What is important to know about this new Family and Medical Leave Act program, I think particularly for the cancer community, is that if you’ve taken time off under the original FMLA and you’ve used up your full 12 weeks during your 12-month period of time, then you can’t take this additional leave. So, it’s really kind of replacing the FMLA. It's not adding an additional 12 weeks of leave to the FMLA.

Jamie DePolo: Okay, very good to know.

Joanna Morales: So, for people who’ve already used up their leave, yeah. So, we’re getting that question quite a bit.

Jamie DePolo: Sure.

Joanna Morales: But on the flip side, if you’ve only used 4 weeks of leave under the FMLA so far, then you could still take 8 more weeks during your year period under this new program. So, you could actually get paid for a period of that time.

Jamie DePolo: Got it. Okay, and the last piece?

Joanna Morales: So, the last piece is actually about unemployment. But before I get there, for just a minute, I want to clarify something interesting. So, they originally in the law said that these two new benefits, the paid sick leave and the Family and Medical Leave Act program, would be from April 2 through December 31 of 2020. But in the regulations, they actually did it retroactively to April 1. So, as of April 1, employees could actually start taking these benefits.

Jamie DePolo: Interesting. Okay, good to know.

Joanna Morales: So, the Coronavirus Aid Relief and Economic Security Act, otherwise known as the CARES Act, provided some new unemployment benefits for the many people who are having to file for unemployment because they can no longer work. Now, states provide unemployment insurance already. There’s a lot of difference in the rules and the amount of the weekly benefit that you would get each week, but this federal law adds additional benefits to what states already provide.

So, the first thing it does is it adds an extra $600 a week on top of whatever you get as a state amount, but that $600 only lasts for 4 months, up until July 31 of 2020. Now, those benefits might not start right away because states are still trying to implement this new benefit, but the delays are expected. But you will get retroactive pay back to the beginning of April.

In addition to adding the $600 a week, it also adds a 13-week extension of regular state unemployment insurance benefits for a total of 39 weeks that you can receive unemployment insurance.

And then it did something entirely new for individuals who are freelancers or independent contractors or self-employed and other groups of people who usually aren’t eligible for unemployment insurance. So, it adds a benefit for them as well. And it actually goes back retroactively to January 27, when we started to see changes in the economy. And so people can apply now and say that they were unemployed beginning that early.

So, for anyone who thinks they’re eligible for unemployment insurance, they can contact their state unemployment insurance agency, and that information is on our website, on our state resources page.

Jamie DePolo: Okay. I do have one question about this unemployment, this is separate from the lump sum amount for people who make below a certain income that was also part of the CARES Act? Is that correct?

Joanna Morales: Exactly. So, this is just for individuals who can no longer work because maybe their employer closed or went out of business or they were let go by their employer. So, this is just specific to unemployment insurance.

The CARES Act also created a cash-assistance program for all U.S. residents. So, that is an amount of $1,200 for each individual adult who has an income up to $75,000.

But it’s important to know that it’s adjusted gross income. So, if you actually look at your tax form, if you’ve filed your taxes, it’s line 8B of your taxes. So, it’s not necessarily your gross income, it’s your adjusted gross income. So, we don’t want people to assume they don’t qualify.

And then there’s $1,200 per adult in that income group. So, if you’re a couple, you get $2,400 if you have an income up to $150,000, and then you also get $500 for each qualifying child age 16 or under. So, it’s important to know, if you have a 17-year-old in the house, you’re probably not going to get the $500 for that child.

Also, it gets phased out. So, as your income goes up, you can still potentially get financial assistance, but the amount goes down. So, you’d get less than that $1,200.

Jamie DePolo: Now, do we know yet when those checks might be starting to hit people’s accounts? I’ve heard a couple different things. One is that if you file your taxes online and the government has your bank account information, that money is going to get to you faster. If you have to wait for a paper check from the government, it’s going to take longer, because the government can only write a certain number of paper checks per month. Is that correct?

Joanna Morales: Well, it is correct that if you normally pay your taxes and the IRS has your bank account information on file, then they can direct deposit that check to you. And that’s definitely going to come a lot faster than if they have to issue a paper check. We’re expecting that the direct deposits happen during the month of April [Editor’s Note: Direct deposits were delivered on April 15.]. They’ve indicated that they want all the hard-copy checks to go out by May, but again, we don’t have a sense of what that actually is going to look like.

But according to the law, you’re supposed to get a paper notice in the mail not later than a few weeks after your payment has actually been sent. So, they’ll send you mail saying your payment is in the mail and how much that payment is going to be.

Jamie DePolo: Okay. Okay.

Joanna Morales: Now, for anyone who doesn’t normally file their taxes — so, for example, social security retirement and disability benefit recipients who don’t normally make enough money to file taxes — they’re still going to qualify for that $1,200 payment, and it’s going to be direct-deposited into the account where they normally get those benefits. I think that’s particularly relevant for the cancer community.

Jamie DePolo: Certainly. And I know a lot of people now have questions about their health insurance if they’ve been laid off. So, if you could talk about that, about the COBRA, the coordination of care and how that is affected, say, if you’ve been furloughed or laid off, and it’s not clear that your company is going to open again, like if you worked for a restaurant.

Joanna Morales: So, anytime you lose your employer-sponsored health insurance, where you’re leaving a job or you’re losing a job, COBRA is the federal law that allows you to keep the same health insurance coverage you had through your employer for an additional period of time. Typically, if you’re losing your job or you leave your job, you get to keep COBRA coverage for 18 months. If you’re, for example, a young adult aging out of your parents’ health insurance plan, you could keep COBRA for 36 months. So, the length of time you get to keep COBRA depends on why you qualify for it, but COBRA as a federal law only applies to employers with 20 or more employees.

If you work for a smaller employer, you may be in a state that has a state COBRA law. And the state COBRA laws typically pick up employers with two to 19 employees, but the length of time you get to keep COBRA coverage varies widely. So, if you’re in Georgia, for example, you might only get COBRA for 3 months, whereas if you’re in California, you can keep COBRA for 36 months under the state law.

Now, COBRA is just one of the many options you might have if you’re losing your employer plan, and I mention these other options because COBRA can be expensive. You have to pay the full amount of the premium that your employer was paying for that coverage. So, oftentimes I say you don’t appreciate what your employer pays for health insurance until you have to write that check yourself, and that can be prohibitively expensive for someone, especially if they’re not working and don’t have any income coming in.

So, in addition to COBRA, there’s also the ability to see if you want to buy a plan in your state health insurance marketplace. Now, in most states, the marketplaces are closed for enrollment for 2020, but losing your employer-sponsored health insurance coverage actually gives you a special enrollment period for 60 days to buy a plan in the marketplace. And because someone’s income level could be significantly lower if they just lost their job, you might actually qualify for financial assistance to get that plan through the marketplace.

Marketplace plans might be coverage that is as good or better than what the employer plan was offering, and might actually be less expensive than COBRA. But you don’t really know until you go and take a look at what your options are, and then you have to do some math to compare those options. We have a lot of tools on the Triage Cancer website on how to pick a health insurance plan and how to minimize the costs of coverage.

Jamie DePolo: Excellent, because I’ve been reading some stories where people were buying plans that they thought were one thing and then they turned out to just only cover a few things. So, I think the information on your website is going to be really helpful to a lot of people to make sure they pick the proper plan.

Joanna Morales: Yes. We definitely want people to be careful before making choices, because those short-term health insurance plans can deny people coverage if they have a preexisting condition, can charge them more because of that preexisting condition, and can even exclude whole categories of care. So, you might think you’re buying a full-scope health insurance plan, and then it turns out it doesn’t cover chemotherapy or prescription drugs. And so we want people to have good information before they make those choices, and we do have a lot of content on our website about how to do that.

We also have information on Medicaid, which is the other option that someone might qualify for in their state if they don’t have a high income level because they’ve lost their job. In some states that have expanded Medicaid under the Affordable Care Act, Medicaid might be a good option for getting health insurance coverage.

And I do also just want to mention that even if someone is currently uninsured, not just because they’ve lost their employer coverage, there are 11 states and DC that have reopened their state marketplaces. So, you don’t have to have a special enrollment period. You can go now to your state marketplace and sign up for coverage if you’re currently uninsured.

Jamie DePolo: Okay. Very good to know. I’m curious, too, if someone is currently in cancer treatment, say, receiving chemotherapy or radiation, and they’ve lost their job, which means they’ve lost their employer-sponsored health insurance, and they’re looking to sign up for a new plan, I know sometimes you have to wait to receive any benefits. Is that being changed because of the pandemic?

Joanna Morales: Do you mean, do they have to wait for benefit through a new employer?

Jamie DePolo: Or from the new plan, I guess. Say if they became unemployed because of COVID-19, they signed up for a new plan, say, through a state health insurance marketplace. Is there any lag time from when they can get coverage, if that makes sense?

Joanna Morales: Yes, absolutely. So, there’s no waiting period to have to get coverage, but when your coverage begins depends on when you apply. So, in some states, if you sign up in the first half of a month, your coverage will begin the first day of the next month. But if you sign up the 16th day to the last day of the month, your coverage won’t begin until the first day of the following month. So, if you sign up on the 16th, for example, it might actually be 45 days till your coverage begins.

Now, some states, especially the ones that have reopened marketplaces, are handling this a little bit differently. So, for example, up until a couple of days ago, even if you signed up for coverage on April 4, they were going to retroactively have your coverage begin on April 1. So, when your coverage actually begins is going to depend on what state you’re in, and if you’re signing up for a marketplace plan.

With Medicaid, when you sign up for Medicaid, your coverage begins typically within a month of when you sign up. But in some states there’s retroactive coverage up to 3 months. So, care maybe that you received 2 weeks ago could potentially be covered by Medicaid. Some states have eliminated retroactive coverage, so again, it’s going to be a little bit different depending on where you live.

Jamie DePolo: Okay. So, it’s important that people figure that out, especially if they’re in the midst of treatment, say, if they’re scheduled for 6 more weeks of radiation, because you really don’t want to pause that unless you have to to figure out if it’s going to be covered.

Joanna Morales: Exactly. You also want to make sure that if you know or you think you’re about to lose coverage that you look at your options now, so that you can make some decisions so that you have a seamless transition of coverage.

Talk to your providers about what your options are. So, what are the possibilities for rescheduling treatment, obviously only if appropriate, given their health opinions, but looking at that. And having conversations, because if you are proactive and have those conversations ahead of time, there may be ways to work around those issues.

Jamie DePolo: Okay. Now, I’ve read a lot of information about tax-filing deadlines have been pushed back, companies are extending grace periods for student loan repayments. So, could you talk a little bit about some of the most important aspects of those things, especially for people with cancer?

Joanna Morales: While there’s a lot of challenges that people are facing, there’s a lot of solutions being proposed.

So, the tax-filing deadline, which is usually April 15, has been extended to July 15. First it was just that you still had to pay your taxes on April 15, but you could wait to file. Now, they’ve pushed both requirements back to July 15.

There’s programs to help with utilities. So, companies have said they’re not going to cancel service because of someone’s inability to pay. They’re waiving late fees. Some states have told utility companies that they can’t cancel coverage if someone can’t afford it.

But there are also financial companies that are doing things. So, there are banks and loan companies that are offering programs to support their customers, everything from if you’re having challenges paying your car loan, or your credit card, or a personal loan, they’re re-working out payment plans. There are lots of mortgage options. So, the U.S. Department of Housing and Urban Development, or HUD, suspended foreclosures and evictions of homeowners that have FHA loans.

If you have a Fannie Mae or Freddie Mac loan, you’re also under that protection. If you rent, and you live in a building that actually has one of those loans, you’re also protected from eviction.

So, I think, really, what I would say is, if you’re having any trouble making payments on any of your bills, how important it is to talk to the companies that you have accounts with and ask them about your options. Don’t just ignore your bills, because there may be options to help you deal with your bills. And then, on top of that, there’s also financial assistance programs that are available.

And specifically with respect to student loans, if you are a federal student loan-borrower, right now you’re automatically being placed in what’s called administrative forbearance, which basically means you can stop making your monthly payment until September 20 of this year. You can make payments if you want to, but they’re basically, at no interest, putting a pause on those loans. Now, if you have another type of student loan, you need to contact your specific servicer to see what options they’re offering.

Jamie DePolo: Okay. Okay. That's all very good to know, and I guess it kind of emphasizes the importance of what you said before, is communicating with your various lenders and let them know what’s going on with you.

That also sparked a question. I had read something online that was advising people, if you have automatic payments for various things — say your phone, your internet, your credit card — that you should stop those. And I was wondering if you had heard that, and if so, why that might be recommended?

Joanna Morales: Well, I think if you’re having trouble making those payments, you should definitely stop them, because otherwise that money is going to continue to come out of your account. But again, you don’t just want to stop them and not communicate with your companies that you have accounts with, because then that is going to have an impact. Now, it’s important to know that these companies are being bombarded at the moment, so calling them is probably... you’re going to have to wait to get to actually talk to someone, but lots of companies are doing automatic things.

So, for example, Wells Fargo, if you were in the middle of a foreclosure or an eviction or a repossession of your car at the time all of this started to happen, they’ve automatically suspended those actions. And they have specific phone lines for certain things, like if you want to suspend your mortgage payments for 90 days, there’s a specific phone line for that. But I would recommend that people also look at their options for contacting their creditor companies online if you have internet access, because that is often the fastest way to get access to some of these repayment options.

Jamie DePolo: Okay. I live in New Jersey, and I have several friends who have filed for unemployment, and they were telling me that they’ve opened up more online things, but for the initial few days, you couldn’t even get through online because so many people were applying. So, I guess the bottom line is, people have to be patient.

Joanna Morales: Very much so, and persistent, too. Don’t give up just because it’s hard to get a hold of someone. I’ve even heard companies recommend that you get online at 3 a.m. to fill out their application for some of these repayment options. And that sounds a little bit painful, but if that’s the easiest way to get through, that might be a good tip.

Jamie DePolo: Okay. Good to know. Now, we’ve talked about a whole lot of things, and I’m sure there are probably a whole lot more things we could talk about. But to kind of wrap up, if someone has been diagnosed with cancer, what are the three or four most important things you would want them to know right now about finances and insurance? Like, what really do they need to be thinking about?

Joanna Morales: I think the most important things for people to be thinking about are, if you’re having trouble paying your bills — and I think a cancer diagnosis causes financial challenges on its own, but in the current environment, there are likely to be additional challenges. If you’re having trouble paying any of your bills, it’s so important to not ignore them, but to proactively contact the companies that you have accounts with and find out your options for postponing payments, for rescheduling payments, for changing payment plans, maybe even changing interest rates on some accounts. I think companies are very willing to work with their customers right now, and many of them have assistance programs.

And with respect to insurance, it’s the same thing. If you have questions about your insurance coverage, communicate with your providers. If you are concerned about getting or keeping your health insurance, there are lots of options that are available to people, and it’s important that you actually look at all of your options and that you do some math to compare your options, because once you make a choice, you might be stuck with that choice for the rest of the year.

For example, if you choose COBRA if you’re losing your employer coverage and then you decide in a couple of months that COBRA is too expensive, you can’t then move to a marketplace plan in the middle of the year. You’re going to have to wait until the next open enrollment period, and that coverage wouldn’t begin until January. So it’s important to investigate all of your options and make an educated decision so that you don’t get stuck in certain circumstances.

Jamie DePolo: Excellent. Joanna, thank you so much. This is such valuable information. I really appreciate your time.

Joanna Morales: Thank you for having me, and I recommend to anyone visiting TriageCancer.org for details about all the things that we talked about and more.