In the United States, many people with cancers—including multiple myeloma—who can no longer work apply for Social Security Disability Insurance (SSDI) to replace lost income.
If you’ve been diagnosed with cancer, e.g. multiple myeloma, you may be wondering whether you qualify for SSDI. Before applying, it’s important to understand a few key factors. Always follow the official guidance from the Social Security Administration (SSA) (ssa.gov) or consult a professional, since the SSA has very specific rules for what counts as a “Disability.”
1. Who Qualifies for SSDI?
You may qualify if you have:
- A disability or blindness, and
- Enough work history under Social Security.
2. What Medical Conditions Count as a Disability?
- SSA requires that your condition must prevent you from working for at least one year or be expected to result in death.
- The SSA maintains a detailed Listing of Impairments (Disability Evaluation Under Social Security) (also called the “Blue Book”).
For cancer, please see: Disability Evaluation Under Social Security / Adult Listings (Part A)/ Section 13.00 Cancer – Adult.
- Multiple Myeloma is specifically listed under Section 13.07, with these requirements:
- A. Failure to respond or progressive disease following initial treatment, OR
- B. Bone marrow or stem cell transplantation → Considered a disability for at least 12 months after transplantation. After that, SSA evaluates any residual impairments.
3. How Much Work History Do You Need?
- SSDI eligibility requires sufficient work credits.
- In general, you need 40 credits, with 20 earned in the last 10 years (the 20/40 Rule).
- Younger workers may qualify with fewer credits.
4. How SSA Decides If You Have a Qualifying Disability
SSA uses a 5-step evaluation process:
- Are you currently working?
- Is your condition severe?
- Is your condition on the official disability list?
- Can you still do the work you did previously?
- Can you do other types of work?
For more details, please check: SSA – Disability Evaluation Process.
5. Health Insurance Options for Individuals With Cancer
🔹 A. If You Already Have Health Insurance
- Employer or Group Health Plan
- ✅ Best option: keep it. Group coverage cannot deny or drop you due to a cancer diagnosis.
- COBRA allows continuation for 18–36 months if employment ends.
- Individual / ACA Marketplace Plan (Affordable Care Act)
- Insurers cannot deny coverage or charge more for pre-existing conditions.
- Enrollment possible during open enrollment or qualifying life events.
- Choose a plan with a strong oncology network and comprehensive drug coverage.
🔹 B. If You Are Uninsured and Newly Diagnosed
- ACA Marketplace Plan
- The main path to comprehensive coverage.
- Look for Silver or higher-tier plans to reduce out-of-pocket costs.
- Medicaid (low-income)
- Covers hospital, oncology, and prescriptions.
- Eligibility varies by state.
- Medicare (age 65+ or disabled)
- Part A & B: Hospital and outpatient treatment.
- Part D: Prescription coverage.
- Medigap or Medicare Advantage: Helps reduce out-of-pocket costs.
- Note: Medicare Advantage plans may have network restrictions, so check oncology access.
🔹 C. Supplemental / Alternative Coverage
- Cancer-Specific or Critical Illness Insurance
- ❌ Not available once diagnosed. Must be purchased beforehand.
- Short-Term Health Plans
- ❌ Typically exclude pre-existing conditions. Not suitable.
🔹 D. Practical Considerations
- Cancer Center Access → Ensure your plan includes NCI-designated centers and oncologists.
- Prescription Drug Costs → Multiple myeloma treatments (e.g., Revlimid, Darzalex) are expensive. Check drug formulary coverage.
- Out-of-Pocket Maximum (MOOP) → Choose the lowest MOOP you can afford, since cancer care almost always reaches this limit.
✅ Summary
- If employed → Keep employer coverage or use COBRA.
- If uninsured → Enroll in an ACA Marketplace plan or Medicaid (if eligible).
- If 65+ or disabled → Medicare with Medigap or Advantage is the best route.
- Cancer-only or short-term policies are not available after diagnosis, so comprehensive health insurance is the only realistic choice.
6. Important Notes
- SSDI → Retirement Conversion
- SSDI benefits automatically convert to retirement benefits at full retirement age.
- The benefit amount does not change.
- Medicare After SSDI
- Individuals receiving SSDI are automatically enrolled in Medicare after 24 months of disability entitlement, regardless of age.
- A welcome package arrives 3 months before coverage begins.
- Part B is optional (you may decline if not needed).
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