2008 Red Book

If you are blind, we do not count any earned income that you use to meet expenses in earning that income when we decide your SSI eligibility and payment amount.

The dollar amount of total income that will (after applicable deductions are applied) reduce the SSI payment to zero in a given set of case facts. Your break-even point depends on your earned and unearned income, living arrangements, applicable income exclusions, and state supplement, if any.

Continuing Disability Review
(SSDI and SSI)

Our process of obtaining complete current information about your condition to decide if your SSDI and/or SSI benefits should continue.

You can receive at least 93 consecutive months of Medicare hospital and supplemental medical insurance after the trial work period. This provision allows health insurance to continue when you go to work and are engaging in SGA.

The amount of money left after we have subtracted all available deductions from your total income. We use this amount to decide your SSI eligibility and payment amounts.

One of the tests we may use to evaluate self-employment income if the individual has received SSDI benefits for 24 months.

Qualified individuals may request reinstatement of benefits, within 5 years of benefits having stopped, without having to file a new application. Up to 6 months of provisional benefits are available while we make a decision on the request.

During the 36 consecutive months following the trial work period, if you qualify, we may restart your SSDI benefits without a new application, disability determination, or waiting period.

We deduct the cost of items and services that you need to work because of your impairment; for example, attendant care services and medical devices, when we decide if you are engaging in SGA. It does not matter if you also need the items for normal daily activities. We can usually deduct the cost of these same items from earned income to figure your SSI payment.

SSI income is:

• Earned income – money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, and some royalties and honoraria; and


• Unearned income – money received from all other sources; for example, gifts, interest, Social Security, veteran’s benefits, and pensions. Unearned income also includes “in-kind income” (food or shelter) and “deemed income” (some of the income of a spouse, parent, or sponsor of an alien).

Medicaid (Medi-Cal in California, AHCCS in Arizona) (SSI)

Medical coverage provided to a person by the state title XIX program.

A state may provide Medicaid coverage for individuals with disabilities who:

• have earnings that are too high to qualify under current rules;
• are at least 16, but less than 65 years of age; and
• meet state resource and income limits.

A state may also provide Medicaid coverage to these individuals when they lose coverage due to medical improvement, but still have a medically determinable severe impairment.

Medical Improvement Expected
(SSDI and SSI)

When we decide you have a disabling impairment, we also decide that the disabling impairment(s) may improve; we document that your case will need a future review.

Health insurance program for eligible disabled individuals and individuals age 65 or older usually consisting of:

• Hospital Insurance under Medicare (Part A);
• Supplementary Medical Insurance under Medicare (Part B); and
• Voluntary prescription drug coverage with a Prescription Drug Provider (PDP) under Part D.

Low-income beneficiaries with Medicare can get Extra Help paying their prescription drug coverage premiums by filing an application with SSA. More information is available at: www.socialsecurity.gov/prescriptionhelp/.

Medicare for Individuals With Disabilities Who Work (SSDI)

Some individuals with disabilities who have returned to work can buy continued Medicare coverage when their premium-free Medicare ends due to work activity. States are required to help pay the hospital insurance premiums for some working individuals with disabilities.

Under an approved PASS, you may set aside income and/or resources over a reasonable time period that will enable you to reach a work goal to become financially self-supporting. You then can use the income and resources that you set aside to obtain occupational training or education, purchase occupational equipment, establish a business, etc. We do not count the income and resources that you set aside under a PASS when we decide SSI eligibility and payment amount.

Property Essential to Self-Support (SSI)

We do not count some or all of certain property necessary for self-support when we apply the SSI resources test.

Resources (SSI)

Resources are anything you own; for example, a bank account, stocks, business assets, real property, or personal property that you can use for your support and maintenance. We do not count all your resources when we decide your SSI eligibility.

Substantial Gainful Activity (SSDI and SSI)

We evaluate the work activity of individuals claiming or receiving disability benefits under SSDI, and/or claiming benefits because of a disability (other than blindness) under SSI. Under both programs, we use earnings guidelines to evaluate your work activity to decide whether the work activity is substantial gainful activity, and whether we may consider you disabled under the law. While this is only one of the tests used to decide if you are disabled, it is a critical first step in the disability evaluation.

SSDI

Social Security Disability Insurance authorized under title II of the Social Security Act.

SSI

Supplemental Security Income program authorized under title XVI of the Social Security Act.

Subsidy and Special Conditions
(SSDI and SSI)

Supports you receive on the job that may result in more pay than the actual value of the work you perform. We use only the actual value of the work you perform when we make a SGA decision.

The Three
Tests (SSDI)

One of the tests we may use to evaluate self-employment income when an individual initially applies for SSDI and prior to the individual’s receiving SSDI benefits for 24 months. The three tests are also used when evaluating work activity in the reentitlement period after benefits have ended due to SGA.

The trial work period is an incentive for the personal rehabilitation efforts of SSDI beneficiaries who work. The trial work period lets you test your ability to work or run a business for at least 9 months and receive full SSDI benefits, if you report your work activity and your impairment does not improve.

Unincurred Business Expenses

Support contributed to your self-employment effort by someone else. If you are self-employed, we deduct unincurred business expenses from earnings when we make a SGA decision.

Unsuccessful Work Attempt

An effort to do substantial work (in employment or self-employment) that you stopped or reduced to below the SGA level after a short time (6 months or less). This change must have resulted because of your impairment, or the removal of special conditions related to your impairment that was essential to the further performance of your work. We do not count earnings during an unsuccessful work attempt when we make an SGA decision.