Financing a Transplant

Care Following a Transplant

Common funding sources to help with the costs of recovering from a transplant include:

Note: This information is only a brief summary and is not intended to provide complete information. Ask your transplant financial team and your insurance provider or employee benefits officer for the latest information or help.

Vocational Rehabilitation

Vocational rehabilitation provides assistance to individuals who cannot return to work after an injury or illness. It helps individuals achieve suitable employment or enhance their ability to function independently at home and in the community. Federal and state governments fund each state's department of vocational rehabilitation, which, depending on the individual, may provide the following types of services:

  • evaluation to determine job skills, abilities and attitudes, which includes medical, psychological and vocational testing
  • development of an individualized rehabilitation plan, including long-range vocational goals, intermediate objectives to achieve vocational goals, the process for evaluating progress, rehabilitation equipment, client assistance (including financial services) and post-employment services
  • vocational rehabilitation training and assistance, including training in the activities of daily living, physical and occupational therapy, use of physical aids or devices, such as artificial limbs or wheelchairs and skills training for the specific type of work (classroom instruction, individual tutoring and simulated work)
  • job-seeking skills, such as preparing a résumé or handling job interviews
  • placement with an employer and/or on-the-job training
  • services to help your family adjust to your disability
  • transportation to rehabilitation activities

Eligibility Requirements

You may be eligible if:

  • You have a physical or mental condition that makes it difficult for you to work.
  • You would be able to return to work after receiving rehabilitation.
  • You need these services to be able to prepare for, start or maintain gainful employment.

Applying for Vocational Rehabilitation

You must complete an application and be evaluated for eligibility. You should start rehabilitation as soon as possible, after you are discharged from the hospital to protect your disability coverage. Your transplant social worker can help you apply or you can contact the agency yourself.

Social Security Coverage for the Disabled

The Social Security Administration's two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), are for individuals whose medical conditions prevent them from working. Both of these programs should be used as a move towards improving your economic condition.

Social Security Disability Insurance (SSDI)

  • covers individuals who are working and paying Social Security taxes
  • can be collected while you are involved in an approved rehabilitation program

Supplemental Security Income (SSI)

  • makes monthly payments to disabled individuals with few assets and low incomes
  • requires no waiting period

Eligibility Requirements

If you are eligible for SSDI or SSI, you may receive benefits until you are able to work again on a regular basis. Certain members of your family may also qualify for benefits.

Under this program:

  • You must file a formal application.
  • You must be unable to perform any work for which you are qualified.
  • Your disability must be expected to last at least a year or result in death.
  • You must have earned enough work credits when you were able to work (SSDI only).
  • You may file an appeal if you are turned down the first time you apply, but believe that you qualify.

Applying for Disability

Even if another insurer or government agency has ruled that you are disabled, you must still meet Social Security requirements in order to receive Social Security benefits. Contact the Social Security Administration at (800) 772-1213 or your transplant financial team to apply for these programs. It is also important to consider the following points when applying:

  • Apply as soon as you become disabled.
  • You may apply by telephone, mail or in person at any Social Security office.
  • Ask your social worker for help in applying.
  • You cannot collect benefits until your sixth full month of disability.
  • You may be able to qualify retroactively (dating back to the disabling event).
  • During the 60 to 90 day claims process, Social Security will be gathering your medical information and assessing your ability to work.
  • If you meet the initial requirements for disability, the Social Security office will send your application to your state's Disability Determination Service for a formal evaluation.
  • Reviewers will gather information from your doctors about your medical condition, history and treatment, as well as your ability to perform normal work activities.
  • You may need to take a physical examination for further assessment.
  • If additional testing is required, Social Security will pay for these expenses.
  • You will receive written notice about your claim.

Review Periods and Termination of Benefits

Your case will be reviewed periodically to see if you are still disabled. Your benefits will end if:

  • you work on a regular basis and earn an average of $500 or more a month; or
  • your medical condition improves and you are no longer considered disabled (unless you are in a vocational rehabilitation program).

Work Incentives

In effort to help you move from dependency on benefits to self-sufficiency, work incentives protect your entitlement to cash payments and/or Medicaid or Medicare protection, until you can support yourself. Also, because you can still receive Social Security benefits if you attempt to work, it is important to call your Social Security Administrator and ask about work incentives and how they affect your benefits. The following points will provide you with a basic overview of work incentives:

  • You may work for up to nine "trial" months (when your earnings are more than $200 in one month) over a five-year period. After nine trial months, Social Security will evaluate your work.
  • Generally, if your earnings average $500 a month or less, you will continue to receive benefits.
  • If you earn more than $500 a month on average, you will receive benefits for three more months.
  • If you are still defined as disabled, you may receive a monthly benefit for any month that your earnings fall below $500, for up to 36 months.
  • You must make Social Security aware of any special expenses you must pay in order to work. These expenses will be subtracted from your earnings to calculate your monthly earnings. These expenses include things like medications, travel costs related to your job, and some medical costs.

Americans with Disabilities Act

The Americans with Disabilities Act (ADA) of 1990 prohibits discrimination against people with disabilities who wish to work. The Act applies to private companies, state and local governments and employment agencies and labor unions that employ 15 or more workers for more than 20 weeks, but does not cover all employers. The ADA specifically excludes drug and alcohol abuse among the disabilities it covers, but it does protect those who have stopped using illegal drugs and have enrolled in or completed a drug rehabilitation program.

Eligibility Requirements

To be protected under the ADA, you must:

  • have a physical or mental impairment that restricts one or more major life activities; and
  • be able to perform the essential functions of your current job or a job that your are seeking, either with or without "reasonable" accommodations from your employer.

Employer Responsibilities

Reasonable Accommodations

Employers are required to make reasonable accommodations for disabled workers, such as:

  • changing work schedules as necessary
  • providing restructured job duties and/or reassigning disabled workers to other positions
  • improving access to work facilities for disabled persons
  • constructing new devices (such as a wheelchair ramp) or modifying existing ones to assist disabled workers, and
  • modifying job examinations, training materials or policies as appropriate
Exceptions

If you have not made your employer aware of your disability, they will be under obligation to accommodate you. Also, employers may not have to provide an accommodation if they can prove it would pose an undue hardship to the business.

Patient Rights

Although pre-employment drug testing is allowed, ADA regulations do not allow an employer to take a medical examination before you are considered for employment. However, the Act does allow a routine medical examination after a job offer has been made and before employment begins for all new employees.

In a job interview, you may only be asked about your disability if the company can prove that the questions relate directly to the necessities of the job and meet certain other considerations.

Filing a Claim

To report a potential ADA violation, contact your local Equal Employment Opportunity Commission office, listed under "United States Government" in the telephone book. By law, an employer cannot retaliate against anyone filing a claim or participating in an investigation.




This web site is intended solely for the purpose of electronically providing the public with general health-related information and convenient access to the data resources. UNOS is not affiliated with any one product nor does UNOS assume responsibility for any error, omissions or other discrepancies.
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