Your Legal Rights if You Become Seriously Ill

If you or someone you love is diagnosed with a serious ailment, such as cancer, heart failure or some other chronic or life-threatening disease, it's easy to become so consumed with the reality of a medical condition that you overlook important legal issues that may arise.

Most people know the importance of a will or trust, which provides for someone's estate after death, and an "advance directive" that appoints a person to make medical decisions on a patient's behalf in case the patient becomes unable to do so.

However, there are other important legal concerns for ill people, and often they are shrouded in myths that create unnecessary worry and confusion. The most common legal myths facing patients - and the facts you need to know...

Myth: You will lose your health insurance if you change employers while you have a serious illness.

Fact: The federal Health Insurance Portability and Accountability Act (HIPAA) allows you to move from one health plan to another without being excluded due to a preexisting medical condition, such as cancer, heart disease, etc.

Medicare, which covers Americans age 65 and older (as well as people of any age who meet Social Security disability requirements), cannot be revoked because of a serious illness. People have the option of enrolling in traditional Medicare or a Medicare Advantage plan, which is basically a medical HMO.

The same applies to people who are covered by Medicaid, the federal-state program for low-income Americans. For more information, contact the Centers for Medicare & Medicaid at 800-633-4227 or uww.cms.gov.

Another little-known fact: Some employers will request that a representative from their health insurance provider come to your workplace to explain coverage. This usually happens if an employer provides more than one health insurance option, or as a part of the open enrollment period when an employee can change from one plan to another. In other cases, your company's human resources department may offer guidance.

Myth: If you are unable to work because of a serious illness, you will lose your job.

Fact: The Americans with Disabilities Act (ADA) is a federal law that applies to employers with 15 or more employees. A person is protected by the ADA if he/she has a physical or mental impairment that substantially limits a major life function. To qualify, a person must be able to perform the essential functions of the job, with reasonable accommodation, if necessary (which must be provided by the employer as long as it does not create any undue hardship for the employer).

Examples: Extended periods of leave time, job restructuring and part-time work schedules.

Important: It is your choice whether to disclose your medical condition to your employer. If you do not require some type of accommodation, you are not obligated to disclose your illness. Some employees are concerned that if they tell their employers they have cancer, they will be treated differently and will face discrimination. However, you cannot claim discrimination if your employer was never told about your medical condition.

Another little-known fact: The Family and Medical Leave Act is a federal law that allows an employee to take up to 12 weeks of unpaid medical leave during any 12-month period without losing his job or health insurance coverage. It applies to employers with 50 or more employees, and the employee must have worked at the company for at least one year (and at least 1,250 hours in that year).

This type of leave can be tailored to the needs of your treatment.

Example: You can take all 12 weeks at once ... or mornings off for radiation ... or Fridays off for chemo. This leave can be used for an employee's own serious illness or that of a parent, child or spouse.

When on leave, people are usually looking for ways to cover their monthly expenses. Some states have a state disability insurance program that provides a portion of one's salary, usually for a maximum of one year.

Another option is payments under short-term or long-term disability insurance. Not every employer offers this type of insurance.

Suggestion: If your employer does not offer disability insurance, you may want to purchase it privately.

Caution: Once you are diagnosed, it may be difficult to purchase private disability insurance. Contact an insurance agent who can explore options that might be available.

Myth: If you don't have health insurance when you're diagnosed with a serious illness, no insurer will cover you.

Fact: Many states have a high-risk pool that covers people who can't qualify for individual insurance and don't have access to group insurance, Medicare or Medicaid. These offerings vary from state to state, and premiums may be high. Also, depending on the state where you live, there may be other options available.

Another little-known fact: Some states have additional protections. The Breast and Cervical Cancer Treatment Program, administered by the states, pays for the treatment of uninsured women with breast or cervical cancer if they meet certain requirements. Some states may have coverage for men with prostate cancer.

The specific details of coverage do vary from state to state. Check with the Department of Insurance in your state about all of the above.

Myth: If you lose income because of a serious illness, you won't be able to pay your bills.

Fact: The short-term disability insurance offered by some states can help. Social Security benefits might be available if you can demonstrate that you are disabled by a physical or a mental impairment that is expected to last 12 months or longer.

Social Security Disability Insurance is based on a person's work history. Supplemental Security Income is based on a person's assets and resources. For more information, contact the Social Security Administration at 800-772-1213.

Important: There is a six-month waiting period before you are eligible to receive Social Security benefits. Apply for benefits as soon as it is determined that you are going to be disabled for at least 12 months.

Another little-known fact: Many people know that it's often possible to save on health insurance by electing coverage under a spouse's health insurance plan. However, many people don't know that HIPAA protection also applies to this situation, so a preexisting medical condition cannot legally preclude you from starting health coverage under your spouse's employer provided plan.

Also, some people may be eligible for lower utility and telephone bills, because their income has decreased.