Overview of the Social Security Disability Insurance (SSDI) Work Incentives
Slide 1
Overview of the Social Security Disability Insurance (SSDI) Work Incentives
Karla Bell, Program Manager
CHIIP/SDSU Interwork Institute
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Getting Started
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Slide 3
Overview
Social Security Disability Benefits
Work Incentives for SSDI
Tools, Skills and Resources for benefits and employment planning
Slide 4
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 incentives vary greatly between SSDI and SSI
Know what type of benefit you receive and what work incentives apply
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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:
A Community Work Incentives Coordinator (WIPA projects) will request a BPQY for you as part of benefits counseling
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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
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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
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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 average monthly SSDI payment in 2012 is $1111
No resource limit
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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)
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SSDI Work Incentives
•SSDI Work incentives have structured time periods
•The Trial Work Period, Extended Period of Eligibility 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
Slide 11
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
Slide 12
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
Slide 13
Pat-Trial Work Period (TWP) Example
Pat’s Trial work months are not all consecutive but are spread out over 5 years. His first Trial Work month used was November 2008. He used two in 2008 and one in 2009 for some seasonal work and in October of 2011 he was ready to return to work and increase his hours and earnings so he completed his Trial Work Period in 2012 and April 2012 was his 9th Trial Work Period month.
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Extended Period of Eligibility (EPE)
The EPEstarts 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
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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
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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
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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
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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
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SGA Do’s and Don’ts
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 listen to their concerns
Do refer them to the right resources: Work Incentives Planning and Assistance Project (WIPA) for benefits planning
Follow-up!
Slide 20
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
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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
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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
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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
Slide 24
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
Slide 25
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
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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 during EPE as part of SGA decision
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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
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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
Subsidy and IRWE can be used
If earnings are over SGA, SSDI benefits terminate
Slide 29
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
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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
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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
Slide 32
Extended Medicare Coverage
Medicare coverage uninterrupted during Trial Work Period (TWP)
Continuation of Medicare: Medicare coverage continues for 93 consecutive months after the end of the TWP
Medicare for Persons with Disabilities who Work: Medicare coverage can continue with premium payment
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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
Slide 34
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
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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)
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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 ( and local benefits planners.
These tools, rules and skills can result in timely and improved customer service with benefit programs
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Resources
Disability Benefits 101
SSA Red Book-Guide to Work Incentives
Work Incentives Planning and Assistance (WIPA) Projects
Free benefits counseling by Community Work Incentives Coordinators (CWIC)
For SSI, and SSDI recipients ages 18-64
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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
Disability Rights California
Protection and Advocacy for Beneficiaries of Social Security (PABSS)
Assistance with appeals, overpayments, problems with Employment Networks, workplace discrimination
800-776-5746
TTY 800-719-5798
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Resources
Free Medicare Counseling (HICAP)
1-800-434-0222
Slide 40
Questions
You are welcome to contact
Karla Bell at:
619-594-5381
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