Overview of the Social Security Disability Insurance (SSDI) Work Incentives

Karla Bell, Program ManagerCHIIP/SDSU Interwork Institute

Overview of the Social Security Disability Insurance (SSDI) Work Incentives

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Getting Started

Overview

Social Security Disability Benefits

Work Incentives for SSDI

Tools, Skills and Resources for benefits and employment planning

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

Social Security Disability Benefit Programs

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 average monthly SSDI payment in 2012 is $1111

No 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)

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 (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 $675TWP

1

$715TWP

2

2009 $0 $0 $0 $0 $0 $0 $0 $0 $0 $415 $584 $750TWP

3

2010 $450 $0 $0 $0 $0 $0 $0 $0 $0 $670 $689 $692

2011 $650 $650 $675 $710 $695 $695 $710 $0 $0 $1810TWP

4

$1778TWP

5

$1825TWP

6

2012 $718 $1975TWP

7

$2030TWP

8

$2100TWP

9

$2100 $2100 $2100 $2123 $2123 $2123 $2123 $2123

Pat--Trial Work Period Example

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 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 listen to their concerns

Do refer them to the right resources: Work Incentives Planning and Assistance Project (WIPA) for benefits planning

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 during EPE as part of SGA decision

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 Subsidy and IRWE can be used

If 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 discriminationhttp://www.disabilityrightsca.org/

800-776-5746TTY 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

kbell@interwork.sdsu.edu

www.talentknowsnolimits.info

www.tknlyouth.org

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