Advanced Prostate Cancer
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Financial Planning Questions

I'm 53 and Stage 4, but can't really figure out how to move on to Disability because I can't access my 401K money without penalty until I am 59 1/2 and if I don't have Medicare, I expect health insurance will gobble up most of my income. I'm single and currently working. I plan on continuing to work, both because I'm still able but also for financial reasons. What are you all finding when it comes to making financial decisions at Stage 4?

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Not sure if you know all this but you can apply and receive SSDI (social security disability) which is equal to your social security benefit as if you were at retirement age. Stage 4 is pretty much automatic approval in around 2 months. It can be back-dated to diagnosis up to a year. It will start you on a 2 year wait period to begin Medicare. You can still do some work and make a small amount of money while on SSDI ($1180 per month) It's not a lot, but can help if you can work part time. I've been through this process, so if you need more information you can private message me.

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Thanks Gregg, what did you do for health insurance after you quit working?

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I had purchased health insurance through the exchange before I applied for SSDI and was receiving a premium subsidy because of my income. It was affordable for me, but I also applied for and got VA healthcare because I am a vet. I found out I would not get the premium assistance because I had VA so I dropped my private healthcare insurance. Once I have Medicare, I'll get a supplement and be able to have both again. In the meantime, I may have to purchase private insuarnce again if I can't get the care I want from the VA. The VA is pretty good, although they are somewhat minimalist in their approach which concerns me. So far they have been good and very inexpensive. If I get a private plan again outside the heathcare exchange, the plan would be around $1K per month. I'm hoping I don't need it. But it would be short term so I could do it.

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Ahh, so the part time job would pay for the insurance short term. Interesting. I'm currently thinking that I will try to make it to 59 1/2 so I have access to my 401K funds. I'm castrate resistant but no evidence of mets yet, so I should have 6 years in the tank I would think. Medicare is confusing to me, with all of the Part As, Bs, Cs and Ds. How to decide which to choose? Is Medicare Advantage the way to go?

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Part A is regular medicare. Most everyone gets part B, it is 134 a month, and you need it. Part D is a prescription drug plan if you do not have one already. Would you be able to cobra your current insurance for 2 years if you applied for ssdisability?It takes 2 years after approval to get medicare.It sounds like it would be a sure thing for getting approved being CR. Retirement is nice. You also need a supplemental medigap plan to pay the 20% medicare does not pay.

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I can get COBRA, but it's super expensive I believe. I have a lot more research to do.

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Keep us posted, For Me medicare works great with a secondary, medicare gets the bill reduced substantially then pays 80%, my other policy pays the rest. More power to you if you feel like working.

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Do you mind if I ask which secondary insurance you use?

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I have my wifes teacher insurance as secondary, though I have heard others are good also, I had a Brother in Law with Cancer who had United health as a medigap plan and they covered it all

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When were you diagnosed as Stage 4? I'm guessing you made more than $1180 per month after that point as most would have to just to survive. The Social Security Administration doesn't live in the real world about what you need to make in order to survive. I had to fight with them.

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NEVER join an Advantage plan. Once past the short period in which you can return to traditional Medicare + Medigap, you cannot switch without being medically underwritten for a Medigap policy. You will never get mine with the cancer history. So you will be stuck with the advantage plan, which may not provide you what you need and which may ultimately cost you more. They also restrict access to providers who may you want to see.

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Now, this is the kind of experienced response I was hoping to get here. Those of you who have paved the way and discovered these little gotchas are really helpful. So I think I'll want Medicare Part A, B and D...but not Advantage. Is Medigap something different what I would want?

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You must have a Medigap policy to pay for the percentage of your bills that Medicare doesn’t pay for. You need to read up on Medicare and Medigap. Go to the AARP website and look for info. Also go to the CMS.gov website.

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Forget cms and aarp. Best site is Medicare.gov

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I also found this on people with a disability do not have to pay penalty on early withdrawl of 401k, you still have to pay the tax however, as you would anyway. budgeting.thenest.com/rules...

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Good find.

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Another thing to possibly look at is getting a "loan" from your life insurance (that you will never have to pay back), they have special plans for cancer patients, can read about some here: cancerhorizons.com/financia...

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Check around for other IRA plans that will let you access your money before 59 1/2. Then you can roll your IRA into another plan. I would check with insurance companies.

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Check with the hospital you use to see if there are any financial assistance programs available. Many have funding set aside for those who qualify due to loss of income that help pay out of pocket costs and COBRA premiums. They should have a counselor that you can meet with.

Don't get the idea that Medicare is inexpensive, the cost of Part D coverage when you are on expensive drugs like Xtandi is pretty steep.

Same goes for supplemental coverage when you are under 65.

Medicare website is pretty good at explaining these coverages and showing what they will cost based on your meds and situation.

Ed

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Sorry, I was lucky 😜 I had Medicare and a supplement when diagnosed. Some of the medications have assistance programs depending on your income , my hospital had a financial councilor if needed.

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Hi cfrees,

Do you have a company disability plan through your employer? I worked for SSA for 31 years including 5 years doing medical reviews of disability claims. I know how restrictive their rules are, and how frustrating, and archaic their claims process is.

Dan57 hit the nail on the head about SSA and Medicare. The first requirements for Social Security disability is that you not be performing SGA (Substantial gainful activity), and that you be under a disability that has lasted, or is expected to last, for 12 consecutive months, or result in death. The definition of SGA is slightly different for employees and for self employed persons.

If you are Stage 4 you will meet the 2nd requirement no problem. SSA will not establish your disability for any month in which you are engaging in SGA ($1180 per month in gross wages or performing substantial services if you are self employed) no matter how disabled you are. If you need to keep working at above SGA level in order to meet your living expenses including health insurance premiums and copays, you likely will get denied SSA disability. In fact, if your work and earnings show you are doing SGA, they won’t even do a medical evaluation of your disability. If your earnings below $1180 per month you should be ok.

It often takes them several months to process a disability claim. I would be inclined to file for them at the first point your earnings go below (or are expected to go below) SGA level. That gets you in their system, sets a date for establishing onset of disability under their rules, which in turn determines when you will receive benefits and when Medicare will start, and it preserves your appeal rights.

SSA can not deny you your right to file a claim. If you insist on filing, they have to take and process your claim.

Meanwhile, some of the other options proposed by other members of this group are worth exploring.

Best wishes to you!

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Very good explanation .Thanks

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This has been a really interesting discussion. Thanks for all of your comments. I'll investigate these suggestions. Cheers!

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Article with possible options: bankrate.com/finance/retire...

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Oh, brilliant idea to be able to tap into my 401K for Health insurance premiums to fill the wait for Medicare. Thanks!

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You will never get ONE with....

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I have Kaiser Senior Advantage plan in CA. They have a Medical Financial Assistance program. Okay I am limited to their doctors and etc. but if you qualify they pay for everything. Have been on Xtandi for 7 mo. now. Have paid $0.

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I am 47 an also have stage 4. At this point I am unable to work and am on disability. You cannot work for 6 months before your disability kicks in. That is a long time with no income, but the process is easy and fast as they recognize this as a terminal illness. As the 401k goes you will need to pay taxes but at the time you become disabled the 10% fee they charge for taking out early is waived. I just need a letter from my doctor. Insurance is the tough one, fortunately for myself I am married so I just went on my wife’s. I fear this may cause problems putting this burden on her company, but I may be over thinking it. I was told you had to be disabled For two years for Medicare to kick in and that my disability income was to much to qualify for Medicaid. It has been an eye opener. Retirement at 47 had not been planned for and have 2 kids in college. Fortunately we have decent insurance and my expensive drugs have been free or a $100 copay with my oncologist help. I hope this helps a little.

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It helps a lot actually. Thanks so much!!

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Retired at 53 myself... it’s a blow .. financially cut down as well as disabled..Besides that, we are alive.Your family needs you and you’re going to be here to see them have their own families. Take care..

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