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2012 Red Book(En Español) |
EXAMPLE OF CONCURRENT BENEFITS WITH EMPLOYMENT SUPPORTSMany persons are eligible for benefits under both the SSDI and SSI programs at the same time. We use the term “concurrent” when persons are eligible for benefits under both programs. Below we describe how a return to work may affect a person’s concurrent benefits.
Tom files applications for Social Security Disability Insurance (SSDI) benefits and Supplemental Security Income (SSI) on February 27, 2004. His medical condition caused him to stop work beginning February 14, 2004. We call this date his “alleged onset date” of disability. Tom was approved for disability benefits.Tom receives an award letter on June 7, 2004, stating he is approved for disability benefits with his alleged onset date of February 14, 2004.
Tom qualifies for Medicare.
Tom wants to work.
Tom returns to work.
How Tom’s work affects his SSDI benefits.
Is Tom performing SGA?We know from Tom’s pay stubs that he receives $1,600 a month in wages. Tom tells us that he is able to complete only 4 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 contact the employer and learn that the employer is paying Tom $1,600 a month, the same rate as experienced employees who complete 6-8 repairs a day. The employer pays Tom the same rate as the experienced employees because he knows about Tom’s disability and understands it takes him longer to complete tasks. The employer calculates that the actual worth of Tom’s services is $1,400 a month. This means that Tom has a monthly subsidy of $200, which is the difference between what he is paid ($1,600) and what his employer says his services are worth ($1,400). Tom takes a taxi to and from work and provides receipts which show this cost is $350 per month. Tom’s treating physician confirms that his condition prevents him from driving. He cannot take public transportation because crowded situations aggravate his condition. Since Tom pays for his work transportation and there is a medical need for him to take a taxi, we can deduct the cost of his transportation expenses as Impairment-Related Work Expenses (IRWE). We use Tom’s subsidy and IRWE to calculate his SGA earnings as follows: $1,600 wages -$200 employer subsidy -$350 IRWE = $1,050 SGA earnings $1,050 is over the monthly SGA level for 2009 of $980, so Tom is engaging in SGA in the first month of his EPE, October 2009. Tom’s SGA level work activity affects his benefits in the EPE.
Will Tom’s entitlement to SSDI terminate?
How does Tom’s work activity affect his SSI benefit?SGA rules are different for SSI. For SSI disability benefits, we only consider SGA when the initial claim is filed (unless the disability is blindness, then we do not consider SGA at all). We do not consider SGA after a person becomes eligible for SSI. However, we must determine whether the person continues to meet the non-disability requirements, including income and resources. We determine the effect of Tom’s earnings on his SSI eligibility and payment amount on a month-by-month basis.
Will Tom continue to have Medicaid?Medicaid will continue as long as Tom’s earnings are below his state’s threshold amount, he needs the Medicaid coverage, and he continues to be eligible for SSI except for his earnings. During this time, he is eligible for an SSI payment for any month that his countable income is under 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. Will Tom continue to have Medicare?Tom will no longer receive SSDI payments, but his Medicare coverage will continue for at least 93 months after his TWP period (which ended 9/09) as long as he continues to have a disabling impairment (has not medically improved). Tom’s Medicare coverage will terminate on July 1, 2017. Tom could then choose to purchase Premium Medicare Hospital Insurance coverage (Part A). If he purchases Part A, he can purchase Part B. He can qualify for the Part A reduced rate since he has earned at least 30 quarters of coverage. We will base Tom’s Medicare Insurance (Parts A and B) premiums on the rates in 2017, the year his premium-free coverage ends. Tom will have to file an application with Social Security if he decides to purchase Medicare coverage in 2017. He will also have to undergo a medical continuing disability review. Tom can purchase Medicare coverage if we determine that his medical condition has not improved after conducting this review. If Tom still has Medicare when he turns age 65, it will automatically convert to Medicare under the Aged provisions.
|
Date | Event |
03/04 | SSI benefits and Medicaid start |
08/04 | SSDI benefits start |
08/06 | Medicare starts |
01/09 | Starts work |
TWP begins | |
SSI stops due to earnings | |
09/09 | TWP ends |
10/09 | EPE begins |
Work at SGA continues | |
SSDI benefits cease, grace months | |
for payment are 10/09-12/09 | |
01/10 | SSDI benefits stop |
09/12 | EPE ends |
Extended Medicare begins | |
10/12 | SSDI termination month |
Medicaid ends if earnings are over state | |
threshold amount | |
07/17 | Extended Medicare stops |
May be able to purchase Premium HI | |
and/or buy into Medicaid | |
09/17 | Last month to file for EXR if no longer working |
and still disabled |
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