Legislative Priority #2: Metastatic Breast Cancer Access to Care Act

Metastatic Breast Cancer Access to Care Act: Passage of legislation to waive the 24-month waiting period for Medicare and the 5-month waiting period for Social Security Disability Insurance benefits for eligible individuals with metastatic breast cancer.

Background

Individuals diagnosed with metastatic breast cancer automatically qualify for disability benefits from the Social Security Administration (SSA) as long as they apply and meet the SSA’s technical qualification rules. An individual must have been employed within the last ten years and currently be unable to work due to her or his disability in order to earn Social Security disability insurance benefits (SSDI). Once an individual is approved for SSDI, there is a five-month waiting period to begin receiving benefits. Following approval of SSDI, individuals with metastatic breast cancer are eligible for Medicare coverage based on their disability. There is also a waiting period for Medicare coverage, once someone is deemed eligible.

Eligibility for Medicare includes individuals over the age of 65, those with disabilities, and those with two specific diseases, End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS). Individuals under age 65 with disabilities other than ESRD or ALS must have received Social Security Disability Insurance (SSDI) benefits for 24 months before gaining Medicare eligibility. These eligibility rules include individuals diagnosed with metastatic breast cancer.

Metastatic breast cancer is cancer that has spread from the breast to the bones, lungs or other distant parts of the body. 90% of breast cancer deaths are a result of metastatic disease. There are treatments, some of which have extended survival for men and women with metastatic breast cancer. There is no cure.

Federal Precedent for Extended Coverage

The National Breast Cancer Coalition urges Congress to enact legislation to amend the Social Security Act to eliminate waiting periods for disability insurance benefits and Medicare coverage for eligible individuals with metastatic breast cancer.

In 2001, Congress passed a bill to add Amyotrophic Lateral Sclerosis (ALS) as a qualifying condition for automatic Medicare coverage and, in 2020, waived the five-month waiting period for SSDI for individuals with ALS, thus creating a federal precedent. Based on the limited life expectancy of individuals with metastatic disease, an average of 3 years, NBCC believes that both automatic SSDI and Medicare coverage should also apply to metastatic breast cancer patients who qualify.