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Rep. Andrew Garbarino, R-N.Y. (Photo: Franmarie Metzler/House Creative Services)

Life Health > Health Insurance > Medicare Planning

Bill Could Help Clients With Breast Cancer Get Quick Medicare Access

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What You Need to Know

  • Rep. Andrew Garbarino, R-N.Y., introduced the bill, and Rep. Kathy Castor, D-Florida, is the co-sponsor.
  • A version introduced in the 117th Congress had 240 House co-sponsors 29 co-sponsors for a companion bill in the Senate.
  • One potential obstacle: Concerns about fair treatment for people with other serious health problems.

House members have brought back a bill that could help clients with metastatic breast cancer get quick access to Medicare and Social Security disability insurance.

H.R. 549, the Metastatic Breast Cancer Access to Care Act bill, would exempt people with breast cancer that has spread from the usual waiting periods for SSDI income benefits and enrollment in Medicare.

Rep. Andrew Garbarino, R-N.Y., introduced the bill. He overcame the current friction between Republicans and Democrats in the House and listed Rep. Kathy Castor, D-Fla., as a co-sponsor.

What It Means

If H.R. 549 becomes law — or even comes up for discussion at a House hearing — conversations about it could be a way to get clients interested in hearing about the limitations of the Social Security disability insurance program and the availability of commercial disability insurance.

The History

The version of the bill on the agenda for the 118th Congress is similar to care access bills introduced in the 115th, 116th and 117th congresses. It has support from the National Breast Cancer Coalition and other patient support groups.

H.R. 3183, the House version introduced in the 117th Congress, had 240 co-sponsors. A Senate companion bill, S. 1312, had 29 co-sponsors.

The new version is under the jurisdiction of the House Ways and Means Committee.

Disability Benefits Waiting Periods

Under normal SSDI program rules, applicants determined to be seriously disabled qualify for Medicare benefits after a five-month waiting period and Social Security income benefits after a two-year waiting period.

The program uses the waiting periods to hold costs down, by keeping people with relatively short-term impairments from using the benefits.

Former President Donald Trump signed S. 578, a bill that created the ALS Disability Insurance Access Act of 2019 and gave people with amyotrophic lateral sclerosis quick access to Medicare and SSDI benefits, in December 2020.

The Social Security Administration, which handles Medicare enrollee services, implemented the ALS waiting period elimination requirement in August 2021, without putting the change regulation through a public comment period.

The agency hinted at concerns about how callers with other serious conditions might react in a May 2022 Program Operations Manual System update.

“If you receive questions about why the 24-month waiver does not cover other impairments, explain that currently the law only applies to individuals diagnosed with ALS,” SSA tells members of the enrollee services team in a manual update section on handling inquiries. “Do not attempt to explain why other impairments are not included.”

Compassionate Allowances

The Social Security Administration has a program, the Compassionate Allowances program, that speeds up the application process for SSDI applicants with some very serious conditions, such as metastatic cancer.

The Compassionate Allowance program does not eliminate the normal Medicare benefits waiting periods. In some cases, the SSA counts the time an applicant was disabled before filing for benefits in decisions about whether the applicant has completed the waiting period.

(Image: Adobe Stock)


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