Transcript PowerPoint - Interwork Institute

Overview of the
Social Security
Disability
Insurance
(SSDI) Work
Incentives
Karla
Bell,ofProgram
Overview
the Social Security
Manager
Disability Insurance (SSDI)
CHIIP/SDSU
Interwork
Work Incentives
Institute
Getting Started
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Overview
 Social
 Work
Security Disability Benefits
Incentives for SSDI
 Tools,
Skills and Resources for benefits and
employment planning
Social Security
Disability Benefit
Programs
 Two
different types of disability benefits:
 Social Security Disability Insurance (SSDI)
 Supplemental Security Income (SSI)
 If
you receive both SSDI and SSI = “Concurrent
Beneficiary”
 Work
 Know
incentives vary greatly between SSDI and SSI
what type of benefit you receive and what work
incentives apply
How do I find out
what benefits I
receive?

Benefits Planning Query (BPQY)
 A brief report with details about your SSDI and/or
SSI benefits, health coverage and work and
earnings history
 Request from your local Social Security Office
 Call the Social Security Administration (SSA) at:
800-772-1213 (voice); 800-325-0778 (TTY)
 Learn more about the BPQY on Disability
Benefits 101:
http://ca.db101.org/news/news_1685.htm
 A Community Work Incentives Coordinator
(WIPA projects) will request a BPQY for you as
part of benefits counseling
Social Security’s
Definition of Disability

To be eligible, Social Security’s definition of disability must be met:
 “the inability to engage in any substantial gainful activity by
reason of any medically determinable physical or mental
impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period of
not less than 12 months.”

Individual must have a disability which can be documented by a
qualified medical examiner — meet a certain level of disability

Individuals must either not be working at time of application, or if
working must have countable earnings of less than SGA level
 Substantial Gainful Activity (SGA):
 2012 Amount = $1010/month or $1690 for blind individuals

For SSDI, the SGA limit on countable earned income applies at
initial application and forever onwards
3 Types of SSDI
benefits

SSDI
 Insured status on own work record
 Number of credits needed to qualify depends on age of disability
onset

Childhood Disability Benefits (CDB)
 18 years of age or older
 Disabled by SSA’s definition before age 22; and,
 Child of an insured worker who is either disabled, retired or
deceased

Disabled Widow(er)s Benefits (DWB)
 Paid to surviving spouse of insured former worker – worker
must be deceased
 Individual must be at least 50 years old and disabled
SSDI Benefits
 SSDI
provides cash benefits after a 5 month waiting
period (no 5 month waiting period for Childhood
Disability Benefits)
 Medicare
health insurance after a 2 year waiting period
 Monthly
payment depends on average lifetime
earnings
 The
 No
average monthly SSDI payment in 2012 is $1111
resource limit
How Work Affects
SSDI

SSDI counts income when it is EARNED, not when it is PAID

Benefits are not gradually reduced – Benefits are paid in full or not at all

The SGA test remains in effect indefinitely for SSDI

People who work but never engage in SGA will NOT lose cash benefits or
Medicare unless medically recovered

Earned income doesn’t affect the SSDI payment until it reaches a certain
level (SGA)

When earnings do reach a level of SGA, IRWEs and Subsidy can be used to
reduce the income that SSA counts

Other work rules allow a beneficiary to try work for a period of time with no
effect on their benefits (Trial Work Period, Unsuccessful Work Attempt)
SSDI Work
Incentives
•SSDI Work incentives have structured time periods
•The TWP, EPE and Expedited Reinstatement work incentives are
only available once per period of disability
•The TWP and EPE may have been used years ago and the person
may not realize it
Trial
Work
Period
(TWP)
Extended
Period of
Eligibility
(EPE)
Expedited
Reinstatement
(EXR)
Trial Work Period
(TWP)
 Allows
you to test work for at least 9 months
while receiving full SSDI benefits (must
continue to have a disability)
 No
limit to earnings during TWP
 2012
Trial Work Period Amount:
 $720 gross earnings or
 80 hours/month in self-employment
 No
special TWP amount for blind persons
Trial Work Period
(TWP)

Lasts until you complete 9 months (not necessarily
consecutive) of work within a rolling 60-consecutive
month period

No other work incentives apply during the TWP

Only one TWP per period of entitlement

Only Social Security can determine if any TWP months
have been used or are available

Social Security cannot provide accurate information
about use of TWP months if work has not been
reported or reported work has not been processed
Trial Work
Period Work Period Example
Pat--Trial
(TWP) Example
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2008
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$675
TWP
1
$715
TWP
2
2009
$0
$0
$0
$0
$0
$0
$0
$0
$0
$415
$584
$750
TWP
3
2010
$450
$0
$0
$0
$0
$0
$0
$0
$0
$670
$689
$692
2011
$650
$650
$675
$710
$695
$695
$710
$0
$0
$1810
TWP
4
$1778
TWP
5
$1825
TWP
6
2012
$718
$1975
TWP
7
$2030
TWP
8
$2100
TWP
9
$2100
$2100
$2100
$2123
$2123
$2123
$2123
$2123
Extended Period of
Eligibility (EPE)
The EPE starts the month after the 9th Trial
Work month is used
The EPE lasts for 36 consecutive months
whether the individual is working or not
Substantial Gainful Activity (SGA) applies
 2012
SGA Amount = $1010/month or $1690 for
blind individuals
Pat — Extended
Period of Eligibility

Pat’s Trial Work Period ended in April of 2012

Extended Period of Eligibility starts in May 2012

Extended Period of Eligibility ends in April 2015

Pat’s EPE months start and end no matter if he is
working or not and no matter how much he is
earning
Extended Period of
Eligibility (EPE)
 Any
month earnings are below SGA, individual is
eligible to receive their full SSDI check
 Any
month earnings are above SGA, individual is
not eligible to receive SSDI check in that month
 If
earnings are above SGA, the check is
suspended
 If
earnings drop below SGA, checks can restart
without a new application
Grace Period
 After
the TWP ends the Grace Period
provides you 3 more months of SSDI
payments if you are doing sustained
SGA level work
 The
three month grace period may
occur within the EPE or after the EPE
has ended
SGA and the Value of
Work
 SGA is
not just a number, it is a decision
 If
gross monthly earnings are over SGA this
triggers the start of a process
 Social
Security will consider the value of your work
 SSA will
apply other work incentives to determine a
person’s countable income and then compare it to
the current SGA level for the year
SGA Do’s and Don’ts
Do
 Do
listen to their
concerns
refer them to the
right resources: Work
Incentives Planning and
Assistance Project
(WIPA) for benefits
planning
Don’t

Don’t make presumptions
that just because
earnings are over SGA
that they will lose their
SSDI check

Don’t give benefits advice
no matter how well
meaning

Don’t tell someone to quit
their job or tell them to
“Keep earnings below
SGA”
 Do
 Follow-up!
Tools for the SGA
Decision
When determining if the value of someone’s work
represents SGA, Social Security Claims
Representatives have four basic tools at their disposal:

Impairment Related Work Expenses (IRWE)

Subsidy or Special Conditions

Unsuccessful Work Attempt (UWA)

Income Averaging
Impairment Related
Work Expenses
(IRWE)

IRWE expenses are subtracted from a person’s
earnings, reducing countable income which may keep
earnings below SGA

Item or service enables you to work

Need item/service because of disabling impairment

You paid the cost and are not reimbursed

The cost is reasonable

You paid the expense in a month that you received
earned income or performed work while you used the
impairment related item or service
Impairment Related
Work Expenses
(IRWE)

Must be approved by Social Security

Save receipts to provide as proof

Examples:
 Expendable medical supplies
 Vitamin supplements
 Service animal costs
 Prescription co-pays
 Cost of cab, special bus or driver if person cannot use
public transportation
IRWE Example

Pat is blind and earns $2100.00/month in 2012

He pays $150 per month for a note taker

He also pays $300/month for service dog
expenses

Pat’s countable income is:

$2100 - $450 IRWEs = $1650 countable income

2012 SGA for blind individuals = $1690

Pat will continue to get his SSDI check because
his countable earnings are under SGA
Subsidy and Special
Conditions

Sometimes a person’s disability results in the need for extra
assistance, a reduced production rate, frequent breaks, or
fewer job duties than co-workers in a similar job

Subsidy:
 Support provided by your employer

Special Conditions:
 Support that is provided by someone other than your
employer (i.e., Department of Rehabilitation, job coach)

As a result of this support, you may be receiving more pay
than actual value of services you perform

Social Security assigns a dollar value to that support which
can reduce gross wages
Subsidy Example

Mary monthly earnings are $1100.00

She earns $10.00/hour

Mary has job coach that works with her 15 hours a month

Value of subsidy:
 $10.00 x 15 = $150.00

Countable earnings:

$1100 wages - $150 job coach subsidy = $950 countable
wages

$950 countable wages is less than 2012 SGA amount of $1010

Mary’s work does not represent SGA
Unsuccessful Work
Attempt (UWA)
 Attempted
SGA level work in employment or
self-employment
 Work
stopped or was reduced to below SGA
after a short time (6 months or less) because
of:


Impairment
Removal of special conditions
 Considered
decision
during EPE as part of SGA
Averaging
 When
earnings vary, Social Security may
average earnings:
 Earnings fluctuate above and below SGA
 UWA is not applicable
 Often occurs for people who earn an hourly
wage and have work hours that vary each
month
 Does
not apply during TWP or after Grace
Period has been used
What Happens to
SSDI After the EPE?
 Safety
net of being able to go on and off SSDI
without a new application ends
 SSDI
can continue indefinitely if:
 Continue to meet SSA’s definition of disability
 Countable earnings are below Substantial
Gainful Activity

 If
Subsidy and IRWE can be used
earnings are over SGA, SSDI benefits
terminate
Choices After Benefits
Terminate Due to
Work
 Person
may be able to use Expedited
Reinstatement
OR
 Person
can file a new claim if earnings are
below SGA
 Either
may be better, depending on the
circumstance
 Beneficiary
should seek advice from local SSA
office when making that decision
Expedited
Reinstatement
(EXR)
Allows individuals who were
terminated from SSDI due to work
to get their benefits back again in
an expedited manner without
having to re-apply
Expedited
Reinstatement
(EXR)

Request EXR within 5 years of termination

Person must currently be unable to perform SGA due to the same or a
related disability to the one for which benefits were previously paid

Medical review uses medical improvement standard -- which is an easier
test than the one used at initial application
 Person isn’t proving that they are disabled, but that disability still exists
at same level of severity

Eligible for up to 6 months provisional benefits while a decision is pending
 If it is determined that medical improvement has occurred and
reinstatement is denied, Social Security usually does not ask the person
to pay the provisional payments back

Once reinstated, individual is eligible to receive a new TWP/EPE after
receiving 24 months of benefit payments
Extended Medicare
Coverage
Medicare coverage uninterrupted during Trial
Work Period (TWP)
 Continuation
of Medicare: Medicare coverage
continues for at least 93 consecutive months
after the end of the TWP
 Medicare
for Persons with Disabilities who
Work: Medicare coverage can continue with
premium payment
Private Insurance
 You
can have Medi-Cal, Medicare, and/or
private health insurance at the same time
 If
you have insurance from your employer, this
insurance will pay first, followed by Medicare,
and then Medi-Cal will pay any medical
expenses left over
Ticket to Work and
Self-Sufficiency
Program

Available to all SSI and SSDI beneficiaries in cash status, ages 18-64

You can place your ticket with an Employment Network (EN) or State
Vocational Rehabilitation -- get free employment services

Your choice to use your Ticket or not and who you take it to

Regularly scheduled medical reviews are waived during active
participation (work reviews still occur)

Individual and EN work together to create an IWP (individual work plan)

When the individual reaches certain employment income levels, the
Employment Network is paid

Goal of the program is to reduce reliance on disability benefits through
employment that can move you towards financial independence
Ticket to Work
 You
can contact all Employment Networks that
serve your area to find one that is right for you
 You
can change Employment Networks if the
one you are working with is not meeting your
goals & needs
Ticket Hotline: M – F 8:00 AM - 8:00 PM EST
866-968-7842 (voice)
866-833-2967 (TTY)
www.chooseworkttw.net
Benefits Planning Tools,
Skills and Resources
for Results

The Benefits Binder: your notebook and log of phone calls,
office visits, and names of service staff you contact. File original
paycheck stubs, government letters and receipts here.

Reporting Requirements: Who is responsible, when? If you
have a payee, the payee is responsible to report changes to
Social Security. If not, it’s the beneficiary. Report income and
other life changes timely

Know your appeal rights. A Notice of Action explains them.

Utilize Benefits Planning Tools and Resources: Disability
Benefits 101 website (www.db101.org), and local benefits
planners.
These tools, rules and skills can result in timely and improved
customer service with benefit programs
Resources

Disability Benefits 101
www.disabilitybenefits101.org

SSA Red Book-Guide to Work Incentives
www.ssa.gov/redbook

Work Incentives Planning and Assistance (WIPA) Projects

Free benefits counseling by Community Work Incentives
Coordinators (CWIC)

For SSI, and SSDI recipients ages 18-64
https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate
Resources
Area Work Incentives Coordinators (AWIC)
 Social Security’s work incentives experts
 Help SSI and SSDI beneficiaries who are having trouble getting
accurate information and application of work incentives at local
SSA offices
www.ssa.gov/sf/awic.htm
Disability Rights California
 Protection and Advocacy for Beneficiaries of Social Security
(PABSS)
 Assistance with appeals, overpayments, problems with
Employment Networks, workplace discrimination
http://www.disabilityrightsca.org/
800-776-5746
TTY 800-719-5798
Resources
Free Medicare Counseling (HICAP)
1-800-434-0222
http://www.cahealthadvocates.org/HICAP/
Questions
You are welcome to contact
Karla Bell at:
619-594-5381
[email protected]
www.talentknowsnolimits.info
www.tknlyouth.org
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