2008 Red Book

EXAMPLE OF CONCURRENT BENEFITS AND EMPLOYMENT SUPPORTS

Many individuals are eligible for benefits under both the SSDI and SSI programs at the same time. We use the term “concurrent” when individuals are eligible for benefits under both programs. Below we describe how an individual’s concurrent benefits would be affected by his return to work.

Tom filed an application for Social Security Disability Insurance (SSDI) benefits and Supplemental Security Income (SSI) on February 27, 2002. His medical condition caused him to stop work beginning February 14, 2002. We call this date his “alleged onset date” of disability.

Tom was approved for disability benefits.

Tom received an award letter on June 06, 2002 stating he was approved for disability benefits with his onset date of February 14, 2002.

For SSDI benefit purposes, Tom completed a 5-month waiting period before becoming eligible for SSDI benefits. The 5 months began the first full month Tom was approved for disability. In Tom’s case, the 5 months were March, April, May, June, and July. Tom was eligible to receive SSDI benefits beginning August 2002.

For SSI benefit purposes, Tom was eligible to receive SSI benefits beginning March 2002.

Tom qualified for health insurance.

After Tom completed a 24-month waiting period for Medicare coverage, Tom qualified for Medicare beginning August 1, 2004. Medicare Hospital Insurance (Part A) is premium-free; Medicare Supplemental Medical Insurance (Part B) is optional, but there is a premium. Since Tom is eligible for SSI, he has been covered by Medicaid, and the State pays the Part B premium for him. Since Tom has both Medicare and Medicaid coverage, Medicare is the primary payer and Medicaid the secondary.

Tom wanted to work.

Tom contacted his local office in December 2006 to learn more about his benefits, specifically how a recent job offer will affect his SSDI, SSI, and health insurance benefits. Tom is certified as an auto mechanic, and a local car dealership offered him a job.

Tom returned to work.

Tom began work at the car dealership in January 2007. The dealership paid him $1,600 a month. If Tom’s medical condition is expected to improve we may start a medical review at any time to determine if he still meets the disability requirements.

Tom is working in his trial work period (TWP).

Tom is eligible for a trial work period (TWP). During the TWP, Tom can continue receiving full SSDI benefits for at least 9 months regardless of the amount of his earnings. Each month that Tom earns over $640 in 2007 ($670 in 2008) will count as a trial work period service month. His TWP ends with the 9th month of service in a rolling 60-month period.

Tom reported to us that he is earning $1,600 a month beginning January 2007 and provided his pay stubs showing the steady work activity from January 2007 through October 2007. We determined that Tom has completed his trial work period. TWP months were January, February, March, April, May, June, July, August, and September 2007.

Tom completed his TWP and is now eligible for an extended period of eligibility (EPE).

Tom has completed his TWP. His EPE begins with the first month after the TWP. The first month of Tom’s EPE is October 2007. For the next 36 months (through September 2010), Tom will be paid benefits if he is not working over the substantial gainful activity (SGA) level. We refer to this 36-month period of time as the reentitlement period. During these 36 months, benefits can be reinstated based on Tom’s level of work activity. The SGA level for 2007 was $900 per month for non-blind individuals ($940 in 2008).

Is Tom performing SGA?

We know from his pay stubs that Tom is receiving $1,600 a month in wages. Tom is taking a taxi to and from work at a cost of $350 per month and brings the receipts into the Social Security office. We confirm with Tom’s treating physician that Tom’s condition prevents him from driving. Crowded situations, such as in public transportation, aggravate his condition. Since Tom is paying for the transportation, and there is a medical need for him to take a taxi to and from work, we can deduct the cost of his transportation expenses as Impairment Related Work Expenses (IRWE).

Tom mentioned during our discussion that he is only able to complete four car repairs a day compared to his co-workers who complete an average of 6-8 car repairs a day. Tom believes he is paid the same salary as his fellow co-workers. If this is the case, Tom’s employer may be subsidizing his wages. We contacted the employer and learn that the employer is paying Tom $1,600 a month, the same rate as experienced employees who produce 6-8 repairs a day. The employer pays Tom the same rate as the experienced employees because he is aware of Tom’s disability and understands it takes him longer to complete tasks. The employer calculates the service Tom provides is worth $1,300 a month.

Based on this information we calculated Tom’s SGA earnings. With the $300 subsidy, the value of his services is $1,300 a month. We deduct the $350 for his IRWE from $1,300 to determine that his earnings are $950 a month. This is over the monthly SGA level for 2007, so for the first month of his EPE, Tom is engaging in substantial gainful activity.

How does Tom’s SGA level work activity affect his benefits in the EPE?

If we determine that a beneficiary engages in SGA in the Extended Period of Eligibility, we cease benefits with that month. A beneficiary can be paid for the month of cessation and the two following months. We refer to this as the “grace period.”

Tom’s month of cessation was October 2007, but we paid him for October and the two following months (November and December 2007.)

If Tom’s earnings fall below the SGA limit, benefits can be reinstated without filing an application if Tom is still in his 36-month reentitlement period.

If Tom is re-entitled to benefits during the 36-month reentitlement period, he can continue  to collect benefits if his work activity is below the SGA limit, even after the 36-month  re-entitlement period ends.

Will Tom’s entitlement to SSDI terminate?

If Tom’s work activity continues at over the SGA level, his entitlement to SSDI will terminate the first month after the end of the 36-month EPE. Tom’s entitlement would terminate October 2010.

Tom’s entitlement may stop earlier than October of 2010 if he no longer meets our disability requirements.

Will Tom continue to have Medicare coverage?

If Tom continues to work above the SGA level and no longer receives his SSDI payment, his Medicare coverage will continue for at least 93 months after his TWP period as long as he continues to have a disabling impairment (has not medically improved). Tom’s Medicare coverage would end on June 30, 2015, and would terminate on July 1, 2015.

Tom can then choose to purchase Premium Medicare Hospital Insurance coverage (Part A). If he purchases Part A, he can then purchase Part B. Since Tom has earned at least 30 quarters of coverage, he can qualify for the reduced Part A rate. Tom’s Medicare Insurance (Part A and B) premiums will be based on the rates in 2015, the year his premium free coverage ends.

If Tom decides to purchase Medicare coverage in 2015, he will have to file an application with Social Security, and we will conduct a medical continuing disability review. After the medical review, if we determine that Tom’s medical condition has not improved, he can purchase Medicare coverage.

At age 65, if he still has Medicare it will automatically convert to Medicare under the Aged provisions.

How does Tom’s work activity affect his SSI benefit?

Unlike SSDI, SGA is not an issue after a person becomes eligible for SSI. It is only considered when initially filing for SSI disability benefits, unless the disability is blindness. Therefore, if an SSI beneficiary returns to work, we determine whether the individual continues to meet the non-disability requirements, including income and resources. (TWP and EPE apply only to SSDI, not SSI.) For Tom, we will determine the effect of his $1,600 earnings on his SSI eligibility and payment amount on a month by month basis.

Tom is receiving $300 SSDI monthly for January 2007 through December 2007 and has monthly wages of $1,600 beginning January 2007. We start by calculating his SSI payment for January 2007. In this case, since his monthly income does not change, the calculation will be the same for all months of 2007.

First, we subtract the $20 general income exclusion from his SSDI:

$300 SSDI - $20 = $280 countable unearned income

Then, we subtract the $65 earned income exclusion from his wages:

$1,600 - $65 = $1,535 earned income

Next, we deduct the $350 IRWE for the taxi transportation from the earned income:

$1,535 - $350 IRWE = $1,185.00

(Note: Subsidy is not an SSI earned income exclusion; it only applies to SGA. This means we cannot subtract the $300 per month subsidy that was used in determining SGA for SSDI entitlement. However, IRWE applies to both SGA and SSI income.)

Then divide the result by 2, the second step in the earned income exclusion:

$1,185.00 ÷ 2 = $592.50 countable earned income

Then, add the countable unearned income to the countable earned income to determine countable income.

$280 countable unearned income + $592.50 countable earned income = $872.50 countable income.

We subtract the countable income from the SSI Federal Benefit Rate (FBR) to determine SSI eligibility and payment amount.

$603 FBR in January 2007 - $872.50 countable income = no SSI payment

(Note: He might be due an SSI payment if he lives in a state that combines its supplemental payment with the Federal payment, and the combined monthly payment exceeds his countable income.)

Tom will not receive SSI payments for January 2007 through December 2007 because of his monthly earnings and his SSDI benefits. However, he will still be eligible for SSI and Medicaid While Working (under section 1619(b) of the Social Security Act), as long as his earnings remain under his state’s threshold amount, he needs the Medicaid coverage, and he continues to be eligible for SSI except for his earnings.

Tom will not receive SSDI benefits beginning January 2008 for as long as he works over the SGA level. In January 2008, Tom reports that he received a pay increase to $1,800 per month beginning January 2008. His IRWE expenses have increased to $400 per month. Below is an explanation of how we figure his SSI eligibility and payment amount for January 2008:

Subtract both the general income exclusion and earned income exclusion from Tom’s monthly wages since he does not have any “unearned income.”

$1,800 monthly wages - $20 general income exclusion - $65 earned income exclusion = $1,715

$1,715 - $400 IRWE = $1,315 ÷ 2 = $657.50 countable earned income

$637.00 FBR for January 2008 - $657.50 countable income = no SSI payment. (He does not live in a state that has arranged with us to combine the state supplement with the Federal payment.)

Tom remains ineligible for any SSI payment unless his earnings or IRWE change. His Medicaid will continue as long as his earnings are below his state’s threshold amount, he needs Medicaid coverage, and he would be eligible for SSI payments except for his earnings. During this time, he is eligible for an SSI payment for any month that his countable income decreases to below the FBR amount. When Tom’s earnings exceed the state threshold amount, his Medicaid will end. However, he may then be eligible to buy-into Medicaid if he resides in a state that has the optional Medicaid buy-in program.

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SUMMARY OF CONCURRENT BENEFITS AND EMPLOYMENT SUPPORTS — EXAMPLE TIMELINE

• SSI and Medicaid start 3/02.
• SSDI benefits start 8/02.
• Medicare begins 8/04 after 24 months. Medicare is primary payer, and Medicaid is secondary.
• Begins work 1/07. Earned income stops SSI.
• 9 month TWP is 1/07 through 9/07. SSDI continues.
• EPE begins 10/07. Working at SGA.
• SSDI ceases due to SGA in 10/07.
• Benefits paid for 10/07, 11/07 & 12/07.
• Working at SGA but below SSI state threshold amount; Medicaid continues.
• Last month of EPE is 9/10.
• SSDI termination month is 10/10.
• Extended Medicare continues if still disabled.
• Medicaid ends when earnings above SSI state threshold amount.
• Extended Medicare terminates 7/1/15.
• If still working and disability continues, may be able to purchase Premium HI and/or buy into Medicaid.
• If no longer working and disability continues, may file for EXR within 5 years of 10/10 termination month (until 9/15).

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