Overview of the Social Security Disability Insurance (SSDI) Work Incentives Karla Bell, Program Manager CHIIP/SDSU Interwork Institute Overview of the Social Security Disability Insurance (SSDI) Work Incentives

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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: (voice); (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

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 Trial Work Period (TWP) Extended Period of Eligibility (EPE) Expedited Reinstatement (EXR) 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 JanFebMarAprMayJunJulAugSepOctNovDec 2008 $0 $675 TWP 1 $715 TWP $0 $415$584$750 TWP $450$0 $670$689$ $650 $675$710$695 $710$0 $1810 TWP 4 $1778 TWP 5 $1825 TWP $718$1975 TWP 7 $2030 TWP 8 $2100 TWP 9 $2100 $2123 Pat--Trial Work Period Example

Extended Period of Eligibility (EPE) The EPE starts the month after the 9 th 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 DoDon’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 $ /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: $ $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 $ She earns $10.00/hour Mary has job coach that works with her 15 hours a month Value of subsidy: $10.00 x 15 = $ 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 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 (voice) (TTY)

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

Resources Disability Benefits 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

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 TTY

Resources Free Medicare Counseling (HICAP)

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