PowerPoint Outline (MS Word Format) - Interwork Institute

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Nov 20, 2013 (3 years and 8 months ago)

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Slide 1

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

Karla Bell, Program Manager

CHIIP/SDSU Interwork Institute


Slide 2

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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 Prog
rams

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


Slide 5

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.o
rg/news/news_1685.htm

A Community Work Incentives Coordinator (WIPA projects) will request a BPQY
for you as part of benefits counseling


Slide 6

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 o
f 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


Slide 7

3 Types of SSDI benefits

S
SDI

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


Slide 8

SSDI Benefits

SSDI provides cash benefits aft
er 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 reso
urce limit


Slide 9

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)


Slide 10

SSDI Work Incentives

•SSDI Work incentives have structured time periods

•The Tri
al 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 entitl
ement

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 W
ork month used was November 2008. He used two in 2008 and
one in 2009

for some seas
onal 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 9
th

Trial Work Period month.


Slide 14

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


Slide 15

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


Slide 16

Extended Peri
od 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 suspe
nded

If earnings drop below SGA, checks can restart without a new application


Slide 17

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


Slide 18

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 wor
k

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


Slide 19

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 Expe
nses (IRWE)

Subsidy or Special Conditions

Unsuccessful Work Attempt (UWA)

Income Averaging


Slide 21

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 impa
irment related item or service


Slide 22

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


Slide 23

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 prov
ided 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 r
educe 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


Slide 26

Unsuccessful Work Attempt (UWA)

Attempted SGA level work in employment or self
-
employment

Work stopped or was redu
ced 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


Slide 27

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



Slide 28

What Happens to SSDI After the EPE?

Safety net of being a
ble 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 t
he circumstance

Beneficiary should seek advice from local SSA office when making that decision


Slide 30

Expedited Reinstatement (EXR)

Allows individuals who were terminated from SSDI due to
work
to get their
benefits back again in an expedited manner with
out having to re
-
apply


Slide 31

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 revie
w 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 n
ew 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


Slide 33

Private Insurance

You can have Medi
-
Cal, Medicare, and/or private health insurance at the same
time

If you have insurance from your empl
oyer, 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
rev
iews 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


Slide 35

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
me
eting 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


Slide 36

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
pa
yee 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


Slide 37

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 b
y Community Work Incentives Coordinators (CWIC)

For SSI, and SSDI recipients ages 18
-
64

https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate


Slide 38

Resources

Area Work Incentiv
es 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


Slide 39

Resources

Free Medicare Counseling (HICAP)

1
-
800
-
434
-
0222

http://www.cahealthadvocates.org/HICAP/




Slide 40

Questions

You are
welcome
to contact

Karla Bell at:

619
-
594
-
5381

kbell@interwork.sdsu.edu


www.talentknowsnolimits.info

www.tknlyouth.org


Slide 41

Question and Answer

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Slide 42

Survey
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