2014 Red Book

2014 Red Book

Introducing the Red Book 2014

Purpose
of the
Red Book

One of the Social Security Administration’s (SSA) highest priorities is to support the efforts of disabled beneficiaries who want to work by developing policies and services to help them reach their employment goal. The Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs include a number of employment support provisions commonly referred to as work incentives.

The Red Book is a general reference tool designed to provide a working knowledge of these provisions. We write the Red Book primarily for educators, advocates, rehabilitation professionals, and counselors who serve persons with disabilities. We also expect that applicants and beneficiaries will use it as a self-help guide.

The Red Book contains a general description of our disability-related policies. For information specific to your situation regarding eligibility or benefits, you may need to contact us. You will find our contact information on HOW TO REACH SOCIAL SECURITY.The Red Book, including the Spanish language version, is available online at www.socialsecurity.gov/redbook.

 

Purpose of Employment Supports

Congress intended the employment support provisions to provide you with the assistance you need to move from benefit dependency to independence. Employment supports help you to enter, re-enter, or stay in the workforce by protecting your eligibility for cash payments and/or health care until you achieve this goal.

Different rules apply to benefits based on retirement or age. We cover those rules in other publications. Most SSA publications and other public information materials are available at our Internet site, Social Security Online, located at www.socialsecurity.gov.

“Plain Language”

We tried to keep the Red Book clear and brief. We followed “Plain Language” guidelines. We generally use “we,” “us,” and “our” to refer collectively to SSA, the Social Security Act, our regulations, and operating instructions. We use “you” and “your” to refer to the person who is claiming benefits based on disability.

Previous Editions

This 2014 edition replaces all previous editions.

What’s New in 2014?

Automatic Adjustments Effective January 1, 2014

Substantial Gainful Activity (SGA)
The SGA amount for persons with disabilities other than blindness is $1,070 per month in 2014.

For persons who are blind, the amount of earnings that indicate SGA is $1,800 per month in 2014. Details on SGA are on HOW DO WE DEFINE DISABILITY.

Trial Work Period (TWP) Months
The monthly earnings amount that we use to determine if a month counts as a TWP month is $770 per month in 2014. Details on the TWP are on TRIAL WORK PERIOD.

Federal Benefit Rate (FBR)
For 2014, the Supplemental Security Income (SSI) FBR is $721 per month for an eligible individual and $1,082 per month for an eligible couple.

Student Earned-Income Exclusion (SEIE)
For 2014, the amount of earnings that will have no effect on eligibility or benefits for SSI beneficiaries who are students is $7,060 a year. The amount of earnings that we can exclude each month, until we have excluded the maximum for the year, is $1,750 a month. Details on the SEIE are on STUDENT EARNED-INCOME EXCLUSION.

Medicare Part A Hospital Insurance
For 2014, the monthly Medicare Part A Hospital Insurance base premium is $426, and the 45 percent reduced premium is $234.

Medicare Part B Supplemental Medical Insurance

For 2014, the Part B Supplemental Medical Insurance monthly base premium is $104.90. Details on Medicare for Persons with Disabilities Who Work are on SSDI ONLY EMPLOYMENT SUPPORTS.

Medicaid While Working
For 2014, we increased the Medicaid While Working State Threshold Amounts for persons with disabilities. We use yearly state threshold amounts to decide if earnings are high enough to replace SSI and Medicaid benefits. We listed the 2014 amounts for each state on SSI ONLY EMPLOYMENT SUPPORTS.

How to Reach Social Security

Internet Access

Our Internet site, Social Security Online, is located at www.socialsecurity.gov. Most SSA publications and other public information materials are available at this site.Links that may be of interest to the community serving individuals with disabilities:

By Telephone

Call our toll-free number, 1-800-772-1213, between 7 a.m. and 7 p.m., Monday through Friday. If you have a touch-tone telephone, recorded information and services are available 24 hours a day, including weekends and holidays.If you are hearing impaired, call our toll-free TTY/TDD number 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

Find Your
Local Office

If you have a problem or question, try our toll-free telephone number first. Our telephone representatives will either help you or put you in contact with your local office, if needed. Many local telephone directories list local offices under “Social Security”.If you have Internet access, you can find your local office by going to the Social Security Office Locator on our website, Social Security Online, at www.socialsecurity.gov/locator. Enter your postal ZIP code to get the address, telephone number, and directions to your local office.

By Mail

If you have been unable to resolve a problem after calling our toll-free telephone number or after contacting your local office, you may write to the Office of Public Inquiries:

Social Security Administration
Office of Public Inquiries
6401 Security Blvd.
Baltimore, MD 21235-6401

 

Request copies of the Red Book or other SSA Publications

If you want copies of the Red Book or other public information materials, you can:Email: OFSM.OSWM.RQCT.Orders@ssa.gov;
Fax: 410-965-2037;
Phone: 410-965-2039; or
Mail: Social Security Administration
Office of Supply & Warehouse Management
Attn: Requisition and Quality Control Team
2508 Robert M. Ball Building
6401 Security Blvd.
Baltimore, MD 21235-6301We will not ship to Post Office boxes.

How Do We Define Disability?

Our Definition of Disability:
To meet our definition of disability, you must not be able to engage in any substantial gainful activity (SGA) because of a medically-determinable physical or mental impairment(s):

    • That is expected to result in death, or
  • That has lasted or is expected to last for a continuous period of at least 12 months.

NOTE: There is a separate definition of disability for children (under age 18) who are applying for the Supplemental Security Income (SSI) program. A disabled child also qualifies for the SSI employment supports described later in the Red Book.

What is Substantial Gainful Activity (SBA)
We use the term “substantial gainful activity” to describe a level of work activity and earnings.

Work is “substantial” if it involves doing significant physical or mental activities or a combination of both. For work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be SGA.

“Gainful” work activity is:

    • Work performed for pay or profit; or
    • Work of a nature generally performed for pay or profit; or
  • Work intended for profit, whether or not a profit is realized.

We use SGA as one of the factors to decide if you are eligible for disability benefits. If you receive Social Security Disability Insurance (SSDI) benefits, we use SGA to decide if your eligibility for benefits continues after you return to work and complete your Trial Work Period (TWP) (see TRIAL WORK PERIOD). If you receive SSI benefits based on disability, we apply different standards to determine if your eligibility for benefits should continue. For details on how we calculate SSI benefits, see SSI ONLY EMPLOYMENT SUPPORTS.

We do not use SGA as a factor to determine initial eligibility for SSI benefits if you are blind.

How Do We Evaluate Your Activity for SGA Purposes?
We generally use earnings guidelines to evaluate whether your work activity is SGA.

The amount of monthly earnings we consider to be SGA depends on the nature of your disability. The Social Security Act specifies a higher SGA amount for persons who meet the definition of blindness described by the law. For details on our rules about earnings and blindness, see SPECIAL RULES FOR PERSONS WHO ARE BLIND. If your impairment is anything other than blindness, earnings averaging over $1,070 a month (for the year 2014) generally demonstrate SGA. If you are blind, earnings averaging over $1,800 a month (for the year 2014) generally demonstrate SGA for SSDI.

We usually adjust these amounts every year based on increases in the national average wage index

What If You Are Self Employed?
If you are self-employed and your disability is not blindness, the way we evaluate your work activity for SGA purposes will depend on whether we evaluate your work activity before or after you have received SSDI benefits for 24 months and the purpose of the evaluation. We will evaluate your work under The Three Tests or the Countable Income Test to determine if your work activity is SGA, depending on when you worked.

The Three Tests:
We apply three tests to evaluate your work activity when you initially apply for SSDI and before you have received SSDI benefits for 24 months. We will also use the three tests to evaluate your work activity during the re-entitlement period to determine if we can reinstate your benefits in the Extended Period of Eligibility (EPE) (see EXTENDED PERIOD OF ELIGIBILITY). Your self-employment work activity is SGA if:

    • You render significant services to the business, and you had average monthly earnings over the SGA level ($1,070 in 2014); or
    • Your work is comparable to the work of persons without disability in your community engaged in the same or similar businesses; or
  • Your work is worth more than the SGA level earnings in terms of its effects on the business or when com-pared to what you would have to pay an employee to do the work.

The Countable Income Test:
We apply the countable income test if you have received SSDI benefits for at least 24 months. We will only use the countable income test to determine whether you have engaged in SGA and if your disability has ended as a result of that SGA.

We will compare your countable earnings to the SGA earnings guidelines. If your monthly countable earnings average more than $1,070 (in 2014), we will determine that your work is SGA unless there is evidence that you are not rendering significant services in the month. If your monthly countable earnings average less than $1,070, we will decide that your work is not SGA.

If you are self-employed and your disability is blindness, we decide SGA based on whether you have received a substantial income from the business and rendered significant services to the business. We make this determination using your countable earnings. We also use your countable earnings to determine whether your work is SGA and we can reinstate benefits during the EPE (see EXTENDED PERIOD OF ELIGIBILITY).

If you are self-employed, your disability is blindness, and you are age 55 or older, special rules apply. If your earnings demonstrate SGA but your work requires a lower level of skill and ability than the work you did before age 55, or when you became blind, whichever is later, we will suspend, not terminate, your benefits. Your eligibility for SSDI benefits continues indefinitely, and we pay your benefits for any months earnings fall below SGA.

Overview of our disability programs

We manage two programs that provide benefits based on disability or blindness, the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program.

Social Security Disability Insurance
SSDI provides benefits to disabled or blind persons who are “insured” by workers’ contributions to the Social Security trust fund. These contributions are based on your earnings (or those of your spouse or parents) as required by the Federal Insurance Contributions Act (FICA). Title II of the Social Security Act authorizes SSDI benefits. Your dependents may also be eligible for benefits from your earnings record.

Supplemental Security Income Program (SSI)
The SSI program makes cash assistance payments to aged, blind, and disabled persons (including children) who have limited income and resources. The Federal Government funds SSI from general tax revenues. Many states pay a supplemental benefit to persons in addition to their Federal benefits. Some of these states have made arrangements with us to combine their supplemental payment with our Federal SSI payment into one monthly check to you. Other states manage their own programs and make their payments separately. Title XVI of the Social Security Act authorizes SSI benefits.

When You Receive Both SSDI And SSI
We use the term “concurrent” to describe persons who are eligible for disability benefits under both the SSDI and SSI programs. To show how a person’s concurrent benefits would be affected by returning to work, we have provided an example on EXAMPLE OF CONCURRENT BENEFITS WITH EMPLOYEE SUPPORTS.

NOTE: The SSDI and SSI programs share many concepts and terms, however, there are also many very important differences in the rules affecting eligibility and benefit payments. The following table summarizes differences between the SSDI and SSI programs. These differences are important as many persons may apply or be eligible for benefits under both programs.

Comparison Of The SSDI and SSI Disability Programs

SSDI SSI
Source of payments Disability trust fund General tax revenues
Minimum Initial Qualification Requirements
  • Must meet SSA’s disability criteria
  • Must be “insured” due to contributions made to FICA based on your own earnings, or those of your spouse or your parents.
  • Must meet SSA’s disability criteria.
  • Must have limited income and resources.
Health Insurance Coverage Provided Medicare. Consists of hospital insurance (Part A), supplementary medical insurance (Part B), and Medicare Advantage (Part C). Voluntary prescription drug benefits (Part D) are also included. Title XVIII of the Social Security Act authorizes Medicare. Medicaid. A jointly-funded, Federal-State health insurance program for persons with limited income and resources. It covers certain children, and some or all of the aged, blind, and disabled in a state who are eligible to receive federally-assisted income maintenance payments. Title XIX of the Social Security Act authorizes Medicaid. The law gives the states options regarding eligibility under Medicaid.
How do we figure your monthly payment amount?

We base your SSDI monthly payment amount on the worker’s lifetime average earnings covered by Social Security. We may reduce the amount if you receive Workers’ Compensation payments (including Black Lung payments) and/or public disability benefits, for example, certain state and civil service disability benefits. Other income or resources do not affect your payment amount. We usually adjust the monthly payment amount each year to account for cost-of-living changes. We can also pay SSDI monthly benefits to dependents on your record, such as minor children.

To figure your payment amount, we start with the Federal Benefit Rate (FBR). In 2014, the FBR is $721 for a qualified person and $1,082 for a qualified couple. We subtract your countable income from the FBR and then add your state supplement, if any.

We do not count all of the income that you have. The income amount left after we make all the allowable deductions is “countable income”.

The sections on SSI employment supports explain some of the ways that we can exclude income.

We usually adjust the FBR each year to account for cost-of-living changes.

Is a State Supplemental Payment provided? There is no state supplemental payment with the SSDI program. Many states pay some persons who receive SSI an additional amount called a “state supplement”. The amounts and qualifications for these state supplements vary from state to state.

Returning To Work

What Are Your Responsibilities When You Return To Work?
If you receive Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits, you or your representative must promptly report any changes in work activity. You must tell us right away if:

    • You start or stop work;
    • You already reported your work, but your duties, hours, or pay have changed;

You can report changes in your work activity by phone, fax, mail, or in person. Call our toll-free number 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday, or visit your local SSA office. You can find your local office by going to our website at www.socialsecurity.gov.

When you report changes in your work activity, we will give you a receipt to verify that you have properly fulfilled your obligation to report. Keep this receipt with all of your other important papers from Social Security.

When Will We Review Your Disability?
We will review your case periodically to see if your condition has medically improved or if you can perform substantial gainful activity (SGA). We will also review your case if we receive information that you may have medically improved.

If you have received SSDI benefits for at least 24 months, we will not do this review just because you are working.

If you receive SSI benefits, we may review your case if you work and are eligible for Medicaid While Working or if there are changes in your work status. We will not review your case more often than once a year.

We will not perform a review to see if your condition has medically improved while you are using a Ticket to Work (see SSDI AND SSI EMPLOYMENT SUPPORTS). When Will Your Benefits Stop?
If you receive SSDI benefits and we find that you no longer meet the requirements for disability due either to work at the SGA level or medical improvement, we say that your disability “ceased”. If we find that your disability ceased due to work at the SGA level, our decision is effective in the month shown by the evidence. If we find that your disability ceased due to medical improvement, our decision is effective in the month shown by the evidence, or the month we give you written notice, if later. In either case, we pay SSDI benefits for the cessation month and the following 2 months. We call these 3 months the “grace period”.

Your SSDI benefits may continue:

  • If we cease your disability due to your work at the SGA level and then your earnings fall below SGA within the Extended Period of Eligibility (see EXTENDED PERIOD OF ELIGIBILITY), or
  • If we ceased your disability due to medical improvement and you are participating in a program of vocational rehabilitation or similar services (see VOCATIONAL REHABILITATION).

If you receive SSI benefits and we find that you no longer meet the requirements for disability due to medical improvement, we say that your disability “ceased”. Our decision is effective with the month shown by the evidence, or the month we give you written notice, if later. However, your SSI eligibility continues for that month and the following 2 months if you meet all the non-disability-related requirements including the income and resources tests. We call these 3 months the “grace period”.

If we cease your disability due to medical improvement, your SSI benefits may continue if you are participating in a program of vocational rehabilitation or similar services, employment services, or other support services (see VOCATIONAL REHABILITATION.

You are not eligible for an SSI payment for any months you do not meet the non-disability eligibility requirements, for example, the income or resources tests.

 

How Do employment Supports Help?

The employment-support provisions are intended to assist you in your efforts to become self-sufficient through work. Employment supports can help you find a job or start a business, protect your cash and medical benefits while you work, or save money to go to school. If your benefits end because of your work and you have to stop working later, employment supports can make it easy to begin receiving benefits again.

We discuss each employment support on the following pages. You should view all of the employment supports as a total package to fully appreciate the multiple levels of support available to help you achieve your personalized goal of greater economic independence. The following table provides a brief description of the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) employment supports. The last column in the table indicates the page number in the Red Book where you can find a more detailed description of the employment support.

SSDI Employment Supports
The SSDI employment supports provide help over a long period of time to allow you to test your ability to work, or to continue working, and gradually become self-supporting and independent. In general, you have at least 9 years to test your ability to work. This includes full cash payments during the first 12 months of work activity, a 36-month re-entitlement period during the extended period of eligibility, and a 5-year period in which we can start your cash benefits again without a new application (see EXPEDITED REINSTATEMENT). You may continue to have Medicare coverage during this time or even longer.

SSI Employment Supports
The SSI employment supports offer ways for you to continue receiving your SSI checks and/or Medicaid coverage while you work. Some of these provisions can increase your net income to help cover special expenses.

Once you receive SSI, we consider that your disability continues until you medically recover, even if you work. If you cannot receive SSI checks because your earnings are too high, your eligibility for Medicaid may continue while you are working. In most cases, if you lose your job or are unable to continue working, you can begin receiving checks again without filing a new application.

Guide To Employment Supports

Employment Support
(Alphabetically Listed)
How This Employment Support
Can Help You
Blind Work Expenses (BWE) Do you work and receive SSI based on blindness?
Continued Payment Under a Vocational Rehabilitation or Similar Program (Section 301) Has your medical condition improved and are you participating in a vocational rehabilitation or similar program?
Earned Income Exclusion How do we figure your monthly SSI payment amount if you work?
Expedited Reinstatement (EXR) If your benefits ended because you successfully returned to work, can you get benefits again if you stop working?
Extended Period of Eligibility (EPE) How long can you receive SSDI benefits after you return to work?
Impairment-Related Work Expenses (IRWE) Do you pay for items or services related to your disability that you need in order to work?
Medicaid While Working – Section 1619(b) What happens to your Medicaid after you return to work?
Medicare Continuation What happens to your Medicare after you return to work?
Medicare for Persons with Disabilities Who Work What happens if you are no longer eligible for free Medicare Part A because of your work?
Plan to Achieve Self-Support (PASS) Do you want to set aside money to pursue an employment goal?
Property Essential to Self-Support (PESS) Do you receive SSI and own property or resources that are essential to your means of self-support?
Reinstating Eligibility Without a New Application How can you restart your SSI cash payments if you stop working?
Special SSI Payments for Persons Who Work – Section 1619(a) What happens to your SSI cash benefits when your earned income is substantial but you are still disabled?
Special Benefits for Persons Eligible Under Section 1619 Who Enter a Medical Treatment Facility What happens to your SSI payment if you are working, but you have to enter a medical facility?
Subsidy and Special Conditions Do you work and receive SSDI but have extra help on the job or have fewer or simpler tasks than other workers?
Ticket to Work (Ticket or TTW) Do you want assistance to help you return to work?
Trial Work Period (TWP) How can you test your ability to work without losing your SSDI benefits?
Unincurred Business Expenses Do you receive SSDI and are you self-employed?
Unsuccessful Work Attempt (UWA) What happens to your SSDI benefits if you try to return to work but have to stop working or reduce your hours because of your disability?

 

Resources To Assist You Return To Work

You can get information about SSA’s employment support provisions at any of our SSA field offices around the country. You may also call us toll free at 1-800-772-1213, from 7 a.m. to 7 p.m., Monday through Friday.

Work Incentive Liaison (WIL)
Each of our local Social Security offices has a WIL who provides advice and information about our work incentive provisions and employment support programs to individuals with disabilities and outside organizations that serve those with disabilities.

Area Work Incentives Coordinator (AWIC)
AWICs are experienced employment support experts who:

    • Coordinate and/or conduct public outreach on work incentives in their local areas;
    • Provide and/or coordinate and oversee training on SSA’s employment support programs for all personnel at local Social Security offices;
    • Handle sensitive or high profile disability work-issue cases, if necessary; and
  • Monitor the disability work-issue workloads in their areas.

Information on how to contact your local AWIC is available at www.socialsecurity.gov/regions/.

Benefits Planning Query (BPQY)
A BPQY provides information about a beneficiary’s disability cash benefits, health insurance, scheduled continuing disability reviews, representative payee, and work history, as stored in SSA’s electronic records. The BPQY is an important planning tool for a beneficiary, an AWIC, Plan to Achieve Self-Support Specialist, benefits counselor, or other person who may be developing customized services for a disability beneficiary who wants to start working or stay on the job. For instructions on reading and interpreting a BPQY statement as well as details on the components of a BPQY statement, see BPQY Handbook.

We provide BPQYs to beneficiaries, their representative payees and their authorized representatives of record upon request. Beneficiaries can request a BPQY by contacting their local SSA office or by calling SSA’s toll free number, 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. People who are deaf or hard-of-hearing may call our toll-free TTY/TDD number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.

If someone other than the beneficiary, representative payee, or appointed representative (a benefits counselor, for example) wishes to receive a BPQY, they must submit two SSA-3288 forms (Consent for Release of Information) that have been signed by the beneficiary. One is to authorize the release of Social Security records and the other to authorize the release of Internal Revenue Service earnings records. Both releases must contain the beneficiary’s Social Security number or the claim number. Copies of the SSA-3288 are available at http://www.socialsecurity.gov/online/ssa-3288.pdf

Work Incentives Planning and Assistance (WIPA) Projects
WIPA projects are community-based organizations that receive grants from SSA to provide all Social Security and Supplemental Security Income (SSI )disability beneficiaries (including transition-to-work aged youth) with free access to work incentives planning and assistance. Each WIPA project has counselors called Community Work Incentives Coordinators (CWIC) that:

  • Provide work incentives planning and assistance to our beneficiaries with disabilities;
  • Conduct – often in partnership with other community organizations – outreach efforts to those beneficiaries (and their families) who are potentially eligible to participate in Federal or state employment support programs; and
  • Work in cooperation with Federal, state, private agencies and nonprofit organizations that serve beneficiaries with disabilities.

If you are one of the many Social Security Disability Insurance (SSDI) or SSI disability beneficiaries who want to work, a WIPA project can help you understand the employment supports that are available to you and enable you to make informed choices about work.

WIPA services are available in every state, the District of Columbia, and the US Territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. If you want to locate the WIPA organization nearest you, please call 1-866-968-7842 (Voice) or 1-866-833-2967 (TTY). You can also find contact information in our service provider directory on our website at: www.socialsecurity.gov/work.

Work Incentives Seminar (WISE)
WISE feature information to help Social Security disability beneficiaries make the decision to re-enter the workforce or to work for the first time. All WISE take place via free internet-based webinars. The webinar format allows beneficiaries and other interested parties to learn about vital employment resources from Social Security without having to travel to another location.

Some of the webinars are designed to address a broad range of disabilities, while others target people in specific disability categories or age ranges. They may feature various employment service providers, including Social Security approved Employment Networks, State Vocational Rehabilitation Agencies, Protection and Advocacy Services, and WIPA organizations. Some WISE also feature former beneficiaries who have used the Ticket to Work (TTW) program to become employed and offer first-hand accounts of their success.

Beneficiaries and other interested parties may register for scheduled WISE online via our website at www.chooseworkttw.net or by calling the Ticket to Work Help Line at 1-866-YOURTICKET (1-866-968-7842) or for TTY call 1-866-833-2967 Monday through Friday from 8 a.m. – 8 p.m. EST. Archived versions of past events are also available.

Protection and Adocacy for Beneficiaries of Social Security
In every State, U.S. Territory and the Tribal Nations, there is an agency that protects the rights of persons with disabilities. This Protection and Advocacy System administers the SSA-funded PABSS program. Each PABSS agency can:

  • Investigate any complaint you have against an employment network or other service provider that is helping you to return to work;
  • Give you information and advice about vocational rehabilitation and employment services;
  • Tell you about SSA’s work incentives that will help you to return to work;
  • Provide consultation and legal representation to protect your rights in the effort to secure or regain employment; and
  • Help you with problems concerning your individual work plan under the Ticket to Work program.

These services are free to persons receiving SSDI or SSI benefits based on disability or blindness. If you want to locate the PABSS agency nearest you, please call 1-866-968-7842 (Voice) or 1-866-833-2967 (TTY). You can also find contact information in our service provider directory at: www.socialsecurity.gov/work.

Individual Development Accounts(IDA)
If you are working and have limited income, you may be eligible for an IDA through the Temporary Assistance to Needy Families (TANF) program or an Assets for Independence Act (AFIA) grant. An IDA is a trust-like bank account that helps you save your earnings to go to school, buy a home, or start a business. When you make a deposit to the account, a participating non-profit organization matches your deposit. The typical match is one dollar for each dollar that you deposit. The Federal government adds an additional match, limited to $2,000 for an individual or $4,000 for a household over the life of the program (usually five years).

If you have an IDA through TANF or an AFIA grant, we do not count any earnings you deposit into your account, any matching deposits, or any interest earned as Supplemental Security Income (SSI) income or resources. As a result, your SSI benefits may increase.

Note: IDAs that are not federally funded are not exempt from SSI and will be counted under the income and resource rules of SSI.

We do not determine whether you are eligible to have an IDA. For more information about IDAs and to locate a program in your area, visit: www.acf.hhs.gov/programs/ocs/programs/afi.

American Job Centers
American Job Centers (formerly known as One-Stop Career Centers) provide job seekers, with and without disabilities, a variety of tools and services to help them get back to work. Services include training, referrals, career counseling, job listings and other similar employment-related services. Tools, many of which are available on-line, assist job seekers with career exploration, skill assessments (including identifying transferable skills), credential listings, and job openings. Customers can visit a Center in person or connect to the Center’s information through PC or kiosk remote access. Many American Job Centers are also Employment Networks (see EMPLOYMENT NETWORK) and can accept your ticket under the TTW Program. You can locate your closest American Job Center at www.servicelocator.org.

Job Accommodation Network (JAN)
JAN provides free, expert, and confidential guidance on workplace accommodations and disability employment issues to help people with disabilities enhance their employability. JAN consultants offer one-on-one guidance on workplace accommodations, the Americans with Disabilities Act and related legislation, and self-employment options for people with disabilities. Assistance is available both over the phone and online. You can contact JAN by phone at 800-526-7234 (Voice) or 877-781-9304 (TTY). The JAN website (www.AskJAN.org) is a rich source of information that makes a chat service available and features the Searchable Online Accommodation Resource.

Federal Employment Of People With Disabilities
The Federal Government’s Office of Personnel Management (OPM) has a special hiring authority for hiring workers with disabilities that have certain significant physical, psychiatric, or mental disabilities. These are also known as targeted disabilities. For more information see the OPM Web site at: www.opm.gov/disability/index.asp.

AmeriCorps
AmeriCorps is a national network of service programs that engage Americans to meet the nation’s needs in priority areas like disaster services, economic opportunity, education, environmental stewardship, healthy futures, and veterans and military families. We exclude the stipend that AmeriCorps members receive in the determination of SSI benefits. For Social Security Disability Insurance recipients, the income exclusion only applies to the AmeriCorps VISTA program. For more information, go to the AmeriCorps website at www.americorps.gov.

 

SSDI and SSI employment Supports

Subsidy and Special Conditions )SSDI and SSI Eligible)

When do we consider Subsidies and Special conditions? We consider the existence of subsidies and/or special conditions when we make an substantial gainful activity (SGA) decision. We use only earnings that represent the real value of the work you perform to decide if your work is at the SGA level.
What is a subsidy? A “subsidy” is support provided by your employer that may result in your receiving more pay than the actual value of the services you perform.
What are special conditions? “Special conditions” refers to support and on the job assistance provided by your employer, or by someone other than your employer, for example, a vocational rehabilitation agency. Because of this support, you may receive more pay than the actual value of the services you perform.
How can you tell if a subsidy or a special condition applies to you? A subsidy or special condition may exist if:
    • You receive more supervision than other workers doing the same or a similar job for the same pay; or
    • You have fewer or simpler tasks to complete than other workers doing the same job for the same pay; or
    • You are given additional or longer paid breaks than other workers doing the same job for the same pay; or
    • You have a job coach or mentor who helps you perform some of your work

Do subsidies or special conditions affect my SSI payments?

No, we do not consider subsidies or special conditions when we figure your SSI payment amount.
Unsuccessful Work Attempt (UWA) (SSDI and SSI Eligible)

What is a UWA? A UWA is an effort to do substantial work, in employment or self-employment, which you stopped or reduced to below the substantial gainful activity (SGA) level after a short time (6 months or less) because of:

What is the benefit of a UWA if you receive Social Security Disability Insurance? When we make a SGA decision to determine if your disability continues or ceases because of your work, we do not count your earnings during a UWA.
Can a UWA occur during the Extended Period of Eligibility (EPE)? Yes. During the EPE (see EPE), we consider a UWA as part of our SGA decision for months up to and including the month we decide your disability has ceased.
Can a UWA occur during the Trial Work Period (TWP)? No. We do not consider a UWA during the TWP (see TWP) or after we decide that your disability has ceased.

Does a UWA affect your monthly Supplemental Security Income (SSI) payment?

For SSI, we only consider a UWA at the time you file an initial claim. After that, we do not consider a UWA in figuring your SSI payment.


Impairment-Related Work Expenses (IRWE) (SSDI and SSI Eligible)

How can IRWE help you? We deduct the cost of certain impairment-related items and services that you need to work from your gross earnings when we decide if your work is substantial gainful activity (SGA). It does not matter if you also use these items and services for non-work activities.
When will we deduct your IRWE? We deduct IRWE for SGA purposes when:

  • The item(s) or service(s) enables you to work;
  • You need the item(s) or service(s) because of a physical or mental impairment;
  • You pay for the item(s) or service(s) and are not reimbursed by another source such as Medicare, Medicaid, or a private insurance carrier;
  • The cost is “reasonable”, that is, it represents the standard charge for the item or service in your community.
How do we use IRWE to figure your Supplemental Security Income (SSI) monthly payments? If you receive SSI benefits, we will exclude IRWE from your earned income when we figure your monthly payment amount if you meet the requirements above and you paid the expense in a month that you received earned income or performed work while you used the IRWE.
Can IRWE be deducted during a non-work month? Generally, you must be working in the month you pay for an IRWE. However in certain situations, we can deduct IRWE amounts for expenses you pay before you start or after you stop work.
What types of expenses are deductible? The following table outlines the types of expenses that are deductible as IRWE.

Examples Of Deductible and Non-Deductible IRWE(SSDI and SSI Eligible)

TYPE OF EXPENSE IRWE DEDUCTIBLE NOT DEDUCTIBLE
Transportation Costs The cost of structural or operational modifications to your vehicle that you need to travel to work, even if you also use the vehicle for non-work purposes. The cost of driver assistance or taxicabs you need because of your disability rather than the lack of public transportation.Mileage expenses at a rate determined by us for an approved vehicle and limited to travel to and from work. The cost of your vehicle whether modified or not.The costs of modifications to your vehicle that are not directly related to your impairment or critical to the operation of your vehicle, for example, paint or pin striping.Your travel expenses related to obtaining medical items or services.
Attendant Care Services Services performed in the work setting.Services performed to help you prepare for work, the trip to and from work, and after work; for example, bathing, dressing, cooking, and eating. Services that incidentally also benefit your family, for example, meals shared by you and your family. Services performed by your family member for a cash fee where he/she suffers an economic loss by reducing or ending his/her work to help you, for example, if your spouse must reduce his or her work hours to help you get ready for work. Services performed on non-workdays or help with shopping or general housekeeping, for example, cleaning and laundry.Services performed for someone else in your family, for example, babysitting. Services performed by your family member for payment “in-kind”, for example, room and board.Services performed by your family member for a cash fee where he/she suffers no economic loss. This includes services provided by your non-working spouse.
Medical Devices Deductible devices include wheelchairs, dialysis equipment, pacemakers, respirators, traction equipment, and braces. Any device you do not use for a medical purpose.
Prosthesis Artificial hip, artificial replacement of an arm, leg, or other parts of the body. Any prosthetic device that is primarily for cosmetic purpose.
Residential Modifications If you are employed outside of home, modifications to the exterior of your house that permit access to the street or to transportation; for example:

  • Exterior ramps
  • Railings
  • Pathways

If you are self-employed at home, modifications made inside your home in order to create a workspace to accommodate your impairment. This includes enlarging a doorway into an office or workroom and/or modifying office space to accommodate your dexterity challenges

If you are employed outside of home, modifications to the interior of your house.If you are self-employed at home, cannot deduct any modification-related expenses that you will deduct as a business expense when determining SGA.
Routine Drugs & Routine Medical Services Regularly prescribed medical treatment or therapy that is necessary to control your disabling condition, even if control is not achieved. This includes, but is not limited to:

  • Anti-convulsant drugs
  • Anti-depressant medication
  • Psychotropic medication
  • Blood level monitoring
  • Radiation treatment
  • Chemotherapy
  • Corrective surgery for spinal disorders
  • Counseling, mental health and therapy services
  • Your physician’s fee relating to these services.
Drugs and/or medical services used for your minor physical or mental health problems, for example:

  • Routine physical examinations
  • Allergy treatments
  • Dental examinations
  • Optician services.
Diagnostic Procedures Procedures related to the control, treatment, or evaluation of your disabling condition; for example, brain scans, and electroencephalograms. Procedures not related to your disabling condition, for example, allergy testing.
Non-Medical Appliances & Devices In unusual circumstances, devices or appliances that are essential for the control of your disabling condition either at home or at work; for example, an electric air cleaner if you have severe respiratory disease. Your physician must verify this need. Devices you use at home or at the office that are not ordinarily for medical purposes and for which your doctor has not verified a medical work-related need. These include:

  • Portable room heaters
  • Air conditioners
  • Dehumidifiers
  • Humidifiers
Other Items & Services Expendable medical supplies; for example, incontinence pads, elastic stockings, and catheters. The cost of a service animal including food, licenses, and veterinary services. An exercise bicycle or other device you use for physical fitness, unless verified as necessary by your physician. Health insurance premiums.

Plans To Archieve Self-Support (PASS) (SSDI and SSI Eligible)

How can a PASS help you? A PASS allows you to set aside other income besides your Supplemental Security Income (SSI) and/or resources for a specified period of time so that you may pursue a work goal that will reduce or eliminate the SSI or Social Security Disability Insurance (SSDI) benefits you currently receive. For example, if you receive SSDI, wages, or other income, you could set aside some of that money to pay expenses for education, vocational training, or starting a business as long as the expenses are related to achieving your work goal.We do not count the income that you set aside under your PASS when we figure your SSI payment amount. We do not count the resources that you set aside under your PASS when we determine your initial and continuing eligibility for SSI.A PASS can help you establish or maintain SSI eligibility and may increase your SSI payment amount. For example, if you receive $800 per month in SSDI, you have too much income to be eligible for SSI. But if you otherwise qualify for SSI and have a work goal, you could use some of your SSDI to pay for PASS expenses to help you reach your work goal. Because we would not count the portion of your SSDI you are using toward your PASS, this could reduce your countable income enough so you could be eligible for SSI.In addition, other agencies may not count income that SSA has excluded for a PASS when they determine your eligibility for housing assistance or the Supplemental Nutrition assistance Program (food stamps).
Who can have a PASS? If you receive SSI or could qualify for SSI after setting aside income or resources so that you may pursue a work goal, you could benefit from a PASS.
What are the requirements for a PASS? Your Pass must:

    • Be designed especially for you;
    • Be in writing. We prefer that you use our form, the SSA-545-BK. . You can get copies of the PASS form, SSA-545-BK, at your local office, from any PASS Expert, or from our website at www.socialsecurity.gov/online/ssa-545.html;
    • Have a specific work goal that you are capable of performing;
    • Have a specific timeframe for reaching your goal;
    • Show what income you receive (other than your SSI payments) and/or resources you have that you will use to reach your goal;
    • Show how you will use your income and resources to reach your work goal;
    • Show how the money you set aside will be kept separate from other funds;
    • Be approved by us; and
  • Be reviewed periodically by us to assure your plan is actually helping you make progress towards your work goal.

Who Can Help You Set Up A Plan To Acheive Self-Suppost (PASS)? (SSDI and SSI Eligible)

Anyone may help you with your PASS; for example, vocational counselors, social workers, benefit specialists or employers. We will evaluate the plan and decide if it is acceptable. We can also help you put your plans in writing.SSA has specially-trained employees (PASS Specialists) that work with the PASS program. When you submit a written PASS proposal to a PASS Specialist, he or she will review it to:

    • Make sure the work goal is reasonable;
    • Make sure that you need the items and services listed on the PASS application to reach the work goal;
    • Make sure the expenses are reasonably priced; and
  • Work with you to make any needed changes.

The following Internet site provides a map that you can use to locate the PASS Cadre for your area. www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm.

Where can you get more information about a PASS? You can get a PASS Specialist’s telephone number by calling our toll-free number 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday or visit our website at: www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm.You can ask for a pamphlet entitled Working While Disabled — A Plan for Achieving Self-Support (SSA Publication No. 05-11017). It is also available online at www.socialsecurity.gov/pubs/EN-05-11017.pdf. You can also get a copy from your local office or by calling our toll-free number 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday.

Examples Of A PASS (SSDI and SSI Eligible)

A Sample PASS (SSI ONLY)

Example 1 – Wages Being Excluded under an approved PASS

    • Billy wants to go to school to become a social worker.
    • Billy works part time and earns $665 per month.
    • We figure Billy’s countable income using the earned income formula (See SSI ONLY EMPLOYMENT SUPPORTS)
      $665 – $20 = $645 – $65 = $580
      $580 / 2= $290 in countable income.
    • Billy’s earned income reduces his SSI benefit of $721 by $290 per month to $431.
    • He agrees to spend the $290 in countable income on his education and we approve a PASS.
  • We set aside this income and his SSI increases by $290/month for the PASS timeframe. Billy receives $721 in SSI benefits, and has $290 to use for approved PASS expenses.

A Sample PASS (SSDI ONLY)

Example 2 – SSDI Being Excluded under an approved PASS

    • Maria wants to go to school and become a paralegal.
    • She receives $800 in SSDI benefits
      • Maria’s employment goal needs to be expected to generate enough income to eliminate SSDI. (Have expected earnings over $1,070 per month SGA for 2014)
      • Maria determines she needs $780 per month for tuition, books, and school supplies. We can exclude up to $780 per month in SSDI income. This represents the full amount of Maria’s SSDI payment after deduction of the SSI general exclusion. This will make Maria eligible for the full SSI payment ($721 for 2014).
  • Maria must use the SSI payment of $721 for living expenses and use the PASS funds of $780 for approved plan expenses.

 

Ticket To Work (TTW) (SSDI and SSI Eligible)

What is a Ticket? The TTW Program is an innovative program for persons with disabilities who want to work and participate in planning their employment. The TTW Program increases your available choices when obtaining employment services, vocational rehabilitation (VR) services, and other support services you may need to get or keep a job. It is a free and voluntary service. You can use the Ticket if you choose, but there is no penalty for not using it. You might not be subject to a continuing disability review while you are using your Ticket.
How can I take part in the Ticket Program? This program is available in all 50 states and 10 United States Territories. Many Social Security Disability Insurance and Supplemental Security Income disability beneficiaries are eligible to obtain services from a state VR agency or another approved provider of their choice. We call these approved providers “Employment Networks.” Employment Networks (ENs) are private organizations or government agencies that have agreed to work with Social Security to provide employment services to beneficiaries with disabilities. You can participate in the program by contacting an EN or by calling the Ticket Call Center at the number below. For a list of approved ENs, please visit www.socialsecurity.gov/work.

Where do I get more information?

For more information on the TTW Program, including a list of approved ENs, call 1-866-YOURTICKET (1-866-968-7842) or for TTY call 1-866-833-2967 between 8 a.m. to 8 p.m. Eastern time (Monday through Friday).You can find information about the TTW Program online at www.socialsecurity.gov/work.

Continued Payment Under A Vocational Rehabilitation Program Or Similar Program (Section 301) SSDI and SSi Eligible)

How do I qualify for continued payment under Section 301? If we find that you are no longer disabled due to medical improvement, your benefit payments usually stop. However, if you are participating in an appropriate program of vocational rehabilitation (VR) or similar services, your benefits may continue until your participation in the program ends.To qualify for continued payments under Section 301:

    • You must be participating in an appropriate program of the VR or similar services that began before your disability ends under our rules; and
  • We must review your program and decide that your continued participation in the program will increase the likelihood of your permanent removal from the disability benefit rolls.

What is an appropriate program of the VR or similar services?

Here are some examples of appropriate programs:

    • The Ticket to Work; or
    • A Vocational Rehabilitation Agency using an individualized plan for employment (IPE); or
    • Support services using an individualized written employment plan; or
    • A Plan to Achieve Self-Support (PASS); or
  • An individualized education program (IEP) for an individual age 18 through 21.

How long may my benefits continue?

Under Section 301, your benefits may continue until you:

    • Complete your program; or
    • Your participation in the program stops; or
  • We decide that your continued participation in the program will not increase the likelihood of your permanent removal from the disability benefit rolls.

Expedited Reinstatement (EXR) (SSDI and SSI Eligible)

What is EXR? EXR is a safety net for people who successfully return to work and lose their entitlement to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits and payments. If your cash payments ended because of your work and earnings, and you stop work within 5 years of when your benefits ended, you may be able to have your benefits started again right away through a request for EXR.
How does EXR help you? If you have stopped receiving benefits due to your work, we may be able to restart them again. The EXR provision allows you to receive up to 6 months of temporary cash benefits while we conduct a medical review to decide if we can reinstate your benefits. You may also be eligible for Medicare and/or Medicaid during this provisional benefit period.
Who can we reinstate? You are eligible to request EXR if you meet all the following requirements:

    • Your previous entitlement to SSDI benefits terminated due to performance of substantial gainful activity (SGA); or your previous SSI disability/blindness eligibility terminated because of excess earned income or a combination of earned and unearned income;
    • You are not performing SGA in the month you apply for EXR;
    • You are unable to work at the SGA level due to your medical condition;
    • Your current medical impairment(s) is the same as, or related to, your original disabling impairment(s); and
  • You request EXR within 5 years from the month your benefits stopped.

What happens after my request for reinstatement is approved?

The month we reinstate your disability payments begins your initial reinstatement period (IRP). The IRP can last for 24 months (not necessarily consecutive), and ends when you have received 24 months of payable benefits. If you receive SSDI benefits, we can pay you for any month during the IRP that your earnings are not substantial gainful activity (SGA) (see SGA). If you receive SSI benefits, the normal income counting rules apply (see SSI ONLY EMPLOYMENT SUPPORTS).

When is a month not counted as a payable month?

If you receive SSDI, any month you perform SGA, or did not receive a payment due to any of the following reasons:

    • prisoner suspense
    • sanction penalty
    • deportation
    • alien outside of the United States
  • failure to provide a Social Security Number

If you receive SSI, any month a payment is not due based on the normal payment and computation rules (excess income or resources) is not considered a payable month. However, months of eligibility under 1619(b) (see MEDICAID WHILE WORKING) or months in which your entire check is withheld to recover an overpayment, are counted as payable months.

When is the IRP completed? The IRP is completed when you have received a total of 24-months (not necessarily consecutive) of payable benefits.

What happens after completion of the IRP?

If you receive SSDI benefits, you are entitled to:

    • a new 60-month period to file an EXR request if your reinstated benefits are terminated due to SGA; and

 

SSDI only employment Supports

 

Trial Work Period (TWP) (SSDI eligible)

How does the TWP help you? The TWP allows you to test your ability to work for at least 9 months. During your TWP, you will receive full Social Security Disability Insurance (SSDI) benefits regardless of how high your earnings might be as long as you report your work activity and you have a disabling impairment.
When does the TWP start? Your TWP starts when you begin working and performing “services”. In 2014, we consider your work to be services for the TWP if your gross earnings are more than $770 a month, or if you work more than 80 hours in self-employment in a month. Your TWP cannot begin until the first month you are entitled to SSDI benefits, or the month you file for benefits, whichever is later.
How long does the TWP last? The TWP continues until you accumulate 9 TWP service months (not necessarily consecutive) within a rolling 60-month period.

What happens when you complete your TWP?

After you complete your TWP, you begin your Extended Period of Eligibility (EPE) (see EPE. During the EPE, we evaluate your work and earnings to decide if you can work at the substantial gainful activity (SGA) level (see SGA).
What else do you need to know about the TWP?
    • You are not eligible for disability benefits or a TWP if you work at the SGA level within 12 months of the start of your impairment(s) and before we approve your claim for disability benefits. This is because your impairment does not meet our definition of disability (see HOW DO WE DEFINE DISABILITY).
    • We can consider medical evidence that might demonstrate your medical recovery at any time. Therefore, it is possible for your benefits to stop due to your medical recovery before the end of your TWP.
    • We will not conduct a continuing disability review if you are participating in the Ticket to Work program and you are using your Ticket (see TICKET TO WORK).
  • Unsuccessful Work Attempts do not apply during the TWP (see UWA).

Usually, we adjust the dollar amount of TWP “services” each year based on the national average wage index.

Does the TWP apply to Supplemental Security Income (SSI)?

No. A TWP does not apply to the SSI program.

Extended Period of Eligibility (EPE) (SSDI eligible)

What is the EPE? The EPE begins the month after the Trial Work Period (TWP) ends, even if you are not working that month. The first 36 months of the EPE is the re-entitlement period.
How does the EPE help you? During the 36-month re-entitlement period, you get benefits for all months your earnings or work activities are below the substantial gainful activity (SGA) level as long as you continue to have a disabling impairment. We suspend cash benefits for months your earnings are over the SGA level. If your earnings fall below the SGA level in the re-entitlement period, we can start your benefits again. (This is a different rule than Expedited Reinstatement (EXR) that we describe on EXPIDITED REINSTATEMENT.)
What happens the first time you work above SGA? The first time that you work above SGA in the EPE, we will decide that you no longer meet the requirements for disability due to work, and we say that your disability ”ceased”. We will pay benefits for the month your disability ceased and the following 2 months. We call this the grace period. If your earnings fall below SGA and you are still in the 36-month re-entitlement period, we can restart your benefits without a new application.
Can you continue to receive benefits after the 36-month re-entitlement period ends? If you are not working above SGA and are eligible for a benefit payment for the 37th month of the EPE, you will continue to receive benefits until you:

    • Work a month at the SGA level, or
  • Medically recover.

What happens if you work after the re-entitlement period ends?

Your benefits will end if you work above SGA after the 36-month re-entitlement period. However you may be able to start your benefits again if you stop work within the next 5 years (see EXR on EXPIDITED REINSTATEMENT.)

Do you get an EPE under Supplemental Security Income?

No. The EPE applies only to persons who receive Social Security Disability Insurance cash benefits.

Unincurred Business Expenses (Self-Employment) (SSDI eligible)

What are unincurred business expenses? “Unincurred Business Expenses” are contributions made by others to your self-employment business effort. For example, if the state vocational rehabilitation agency gives you a computer for your business, or a friend works for your business as unpaid help, these are “unincurred business expenses”.We generally follow the Internal Revenue Service (IRS) rules to figure your net earnings from self-employment. The IRS only allows you to deduct expenses you actually paid or incurred debt. When we make a substantial gainful activity decision, we also deduct unincurred business expenses from your net earnings because we want an accurate measure of the value of your work.

What qualifies as an unincurred business expense?

For an item or service to qualify as an unincurred business expense:

  • It must be an item or service that the IRS would allow as a legitimate business expense if you had paid for it.

Do unincurred business expenses affect your Supplemental Security Income (SSI) payments?

No. We do not deduct unincurred business expenses from earnings when we figure your SSI payment amount.

Continuation of Medicare Coverage (SSDI eligible)

What is Continuation of Medicare Coverage?

Most persons with disabilities who work will continue to receive at least 93 consecutive months of Hospital Insurance (Part A); Supplemental Medical Insurance (Part B), if enrolled; and Prescription Drug coverage (Part D), if enrolled, after the 9-month Trial Work Period (TWP). You do not pay a premium for Part A. Although cash benefits may cease due to work, you have the assurance of continued health insurance. (93 months is 7 years and 9 months.)
When does this start? The 93 months start the month after the last month of your TWP.
How do you qualify? You must already have Medicare and be working at substantial gainful activity, but not be medically improved.

Medicare for Persons with Disabilities Who Work (SSDI eligible)

Can you buy Medicare coverage? Yes. After premium-free Medicare coverage ends due to work, you can buy continued Medicare coverage, as long as you remain medically disabled. If you have limited income and resources you may be eligible for state assistance with these costs under various Medicare Savings Programs. Your state Health and Human Services agency makes the determination about whether you qualify for this help.

Who is eligible to buy Medicare coverage?

You are eligible to buy Medicare coverage if:

    • You are not yet age 65; and
    • You continue to have a disabling impairment; and
  • Your Medicare stopped due to work.

What kind of Medicare coverage can you buy?

Premium Hospital Insurance (Part A) is available at the same monthly cost that uninsured eligible retired beneficiaries pay. If you have less than 30 quarters of coverage, the premium is $426 in 2014. However, you may qualify for a reduction in this premium (see below).Premium Supplemental Medical Insurance (Part B) is available at $104.90 per month in 2014.You can buy Part A separately without Part B. You cannot buy Part B unless you also buy Part A. Premium Prescription Drug coverage (Part D) is also available.

Do you qualify for a reduction in your monthly Part A premium?

You may qualify for a 45 percent reduction in the monthly amount of your premium for Part A. You qualify for the reduced premium of $234 in 2014 if you:

    • Have 30 or more quarters of coverage on your earnings record; or
    • Have been married for at least 1 year to a worker with 30 or more quarters of coverage; or
    • Were married for at least 1 year to a deceased worker with 30 or more quarters of coverage; or
  • Are divorced, after at least 10 years of marriage, from a worker who had 30 or more quarters of coverage at the time the divorce became final.
When can you enroll? You may enroll:

    • During your initial enrollment period (the month you are notified about the end of your premium-free health insurance and the following 7 months); or
    • During the annual general enrollment period (January 1 through March 31 of each year); or
  • During a special enrollment period. You can enroll at any time while you are working, covered under an employer group health plan, still have a disabling impairment, or during the 8-month period that begins with the first full month after your employment or group health plan coverage ends, whichever occurs first.

For Part D, you may enroll (or change plans) during the annual coordinated election period (October 15 through December 7 of each year). The effective date for the enrollment is January 1 of the upcoming year. There also will be special enrollment periods for some situations.

How does it work with an employer’s group health plan? Generally, if you purchase Part A and maintain your employer group health plan, Medicare will be your primary payer if you are working. Your group health plan would become a secondary payer.
When does the state pay premiums for Medicare? States are required to pay Part A premiums for some working persons with disabilities. You qualify if you:

    • Are eligible to enroll in Medicare Part A for persons with disabilities who work; and
    • Meet certain income and resource standards; and
    • Apply for assistance with your state Medicaid agency; and
  • Are ineligible for Medicaid on any other basis.

Note: Persons with disabilities who work should contact their state health and human services agency for information. See HELP WITH MEDICARE PART A PREMIUMS.

SSDI at a Glance – What Happens When You Go to Work (SSDI eligible)
Social Security Disability Insurance (SSDI) employment supports can help you protect your cash and medical benefits while you work. When your benefits end because of your work and you have to stop working later, employment supports can make it easy to begin receiving benefits again. You should view all of the SSDI employment supports as a total package to fully appreciate the multiple levels of support available to help you achieve your goal of greater economic independence.

 

Beginning the Process – The Trial Work Period (TWP) Your TWP is a time when you can test your ability to work. During your TWP, we pay you disability payments no matter how much you earn. Details on the TWP are on TWP.Your TWP is a time when you can test your ability to work. During your TWP, we pay you disability payments no matter how much you earn. Details on the TWP are on page 28.How it works:

    • Lasts for 9 months
    • The 9 months do not have to be in a row
  • Must take place within 60 months (5 years)

For 2014, the monthly earnings amount that we use to determine if a month counts as a TWP month is $770 per month. The 2014 self-employment earnings or activity that we use to determine if a month counts as a TWP month is $770 per month or 80 hours per month.

The Next Step– The Extended Period of Eligibility (EPE) Your EPE starts the month after your TWP ends. Details on the EPE are on EPE.How it works:After your TWP ends, you get a 36-month EPE. Whether we can pay you during this period depends on how much you work and earn.During your EPE:

    • We can pay you for any month your work and earnings are not at a substantial gainful activity (SGA) level, and
  • We can pay you for the first month that your work and earnings are substantial and for the next 2 months

Your benefits will terminate if your work is substantial in any month after your EPE ends.

Your Safety Net-Expedited Reinstatement (EXR) EXR is your safety net if your cash benefits end because of your work. If you make less money or you have to stop working because of your disability, we may be able to restart your benefits right away if

    • You stop working above the SGA level, and
    • Your disability is the same as or related to your current disability, and
  • You make your request within 5 years of when your benefits end.

Details on EXR are on EXR.

What About Medicare If your disability payments stop because of your work, the Medicare coverage you have can continue if your disability still meets our rules. It can continue for at least 93 months after your TWP ends. Details on Continuation of Medicare Coverage are on CONTINUATION OF MEDICARE COVERAGE.

 

SSI only employment Supports

Earned Income Exclusion (SSI eligible)

Do we count all your earned income when we figure your Supplemental Security Income (SSI) payment? We do not count the first $65 of the earnings you receive in a month, plus one-half of the remaining earnings. This means that we count less than one-half of your earnings when we figure your SSI payment amount.We apply this exclusion in addition to the $20 general income exclusion. We apply the $20 general income exclusion first to any unearned income that you may receive.The following table shows two examples of how we apply the general income exclusion and the earned income exclusions.

Examples of the Earned Income Exclusion (SSI eligible)
Examples of the Earned Income Exclusion

Situation 1
Ed receives $361 SSDI each month,
wages of $289 each month,
and no other income.
$ 361
SSDI
-20
General income exclusion
$ 341
Countable unearned income
$ 289
Earned income
-65
Earned income exclusion
$ 224
-112
½ remaining earnings
$ 112
Countable earned income
$ 341
Countable unearned income
+112
Countable earned income
$ 453
Total countable income
$ 721
2014 Federal Benefit Rate
-453
Total countable income
$ 258
SSI payment
Available income:
$ 361
SSDI
+289
Earned income
+268
SSI
$ 918
Total Monthly Income
Situation 2
Ed receives wages of $450 each month,
no SSDI, and $13 of unearned income
from another source.
$ 0
SSDI
$ 13
Other unearned income
-20
General income exclusion
$ (7)
Remaining general income exclusion
$ 450
Earned income
-7
Remaining general income exclusion
$ 443
-65
Earned income exclusion
$ 378
-189
½ remaining earnings
$ 189
Countable earned income
$721
2014 Federal Benefit Rate
-189
Total countable income
$ 532
SSI payment
Available income:
$ 450
Earned income
+13
Other unearned income
+532
SSI
$ 995
Total Monthly Income

Student Earned Income Exclusion (SSI eligible)

How does the SEIE help you? If you are under age 22 and regularly attending school, we do not count up to $1,750 of earned income per month when we figure your Supplemental Security Income payment amount. The maximum yearly exclusion is $7,060. These amounts are for the year 2014; we usually adjust these figures each year based on the cost-of-living.
What is the definition of “regularly attending school?” “Regularly attending school” means that you take one or more courses of study and attend classes:

    • In a college or university for at least 8 hours a week; or
    • In grades 7-12 for at least 12 hours a week; or
    • In a training course to prepare for employment for at least 12 hours a week (15 hours a week if the course involves shop practice); or
  • For less time than indicated above for reasons beyond the student’s control, such as illness.
Does home schooling qualify? If you are home-taught, you may be considered “regularly attending school” if:

    • You are instructed in grades 7-12 for at least 12 hours a week; and
  • The instruction is in accordance with a home school law of the state or other jurisdiction in which you reside.

If you are home-taught because of a disability, you may be considered “regularly attending school” by:

    • Studying a course or courses given by a school (grades 7-12), college, university or government agency; and
  • Having a home visitor or tutor who directs the study.
How do we apply the income exclusion? We apply the SEIE before the general income exclusion or the earned income exclusion.

Property Essential to Self-Support (PESS) (SSI eligible)

How does PESS help you? We do not count some resources that are essential to your means of self-support when we decide your continuing eligibility for Supplemental Security Income.
What is not counted? We do not count your property if you use it in a trade or business (for example, inventory or goods) or personal property you use for work as an employee (for example, tools or equipment). Other use of the item(s) does not matter.We do not count up to $6,000 of equity value of non-business property that you use to produce goods or services essential to daily activities. An example is land you use to produce vegetables or livestock solely for consumption by your household.We do not count up to $6,000 of the equity value of non-business income-producing property if the property yields an annual rate of return of at least 6 percent. An example is a rental property.You must be using the property we are excluding under the PESS provision for your self-support activities. If you are not currently using this property because of circumstances beyond your control, you must expect to start using it again within a reasonable period of time, usually 12 months.
What type of resources do not qualify as PESS? We do not consider liquid resources, for example, stocks, bonds, or notes as PESS, unless you use them as part of a trade or business.

Special SSI Payments for Persons Who Work – Section 1619(a) (SSI eligible)

What is Section 1619(a)? You can receive Supplemental Security Income (SSI) cash payments even when your earned income (gross wages and/or net earnings from self-employment) is at the substantial gainful activity (SGA) level. This provision eliminates the need for the trial work period or extended period of eligibility under SSI.
How do you qualify? To qualify, you must:

    • Have been eligible for an SSI payment for at least 1 month before you begin working at the SGA level; and
    • Still be disabled; and
  • Meet all other eligibility rules, including the income and resource tests.
How does it work? Your eligibility for SSI will continue for as long as you meet the basic eligibility requirements and the income and resource tests. We will continue to figure your SSI payment amount in the same way as before. If your state provides Medicaid to persons on SSI, you will continue to be eligible for Medicaid.
Do you need to apply? You do not need to file a special application. Just keep us up to date on your work activity.

Reinstating SSI Eligibility Without a New Application (SSI eligible)

How does it help you? If you have been ineligible for Supplemental Security Income (SSI) payments due to your work, you may be able to restart your SSI cash payments again at any time without a new application.If you have been ineligible for SSI and/or Medicaid for any reason other than work or medical recovery, you may be able to restart your SSI cash payment and/or Medicaid coverage within 12 months without a new application. When your situation changes, contact us and ask about how you can restart your SSI benefits and/or Medicaid.If your cash payment and Medicaid benefits ended because of your earned income, or a combination of earned and unearned income, and you stop work within 5 years of when your benefits ended, we may be able to start your benefits again under Expedited Reinstatement (see EXPEDITED REINSTATEMENT).

Special Benefits If You Are Eligible Under 1619 and Enter a Medical Facility (SSI eligible)

How does it help you? If you are working and eligible under section 1619, you may receive a Supplemental Security Income (SSI) cash benefit for up to 2 months while in a Medicaid facility or a public medical or psychiatric facility.
What happens if you enter a Medicaid facility? Usually, if you enter a Medicaid facility where Medicaid pays more than 50 percent of the cost of care, your SSI payment is limited to $30 per month, plus any state supplement, minus any countable income. However, if you enter a Medicaid facility while you are eligible under section 1619, we will figure your benefit using the full Federal Benefit Rate for up to 2 months.
What happens if you enter a public medical or psychiatric facility? Usually, if you are in a public medical or psychiatric facility, you are not eligible to receive an SSI payment. However, if you enter a public medical or psychiatric facility while you are eligible under section 1619, your SSI cash benefits may continue for up to 2 months. For this provision to apply, the facility must enter an agreement with us that will allow you to keep all of your SSI payment.

Medicaid While Working– Section 1619(b) (SSI eligible)

How does it help you? After you return to work, your Medicaid coverage can continue, even if your earnings (alone or in combination with your other income) become too high for a Supplemental Security Income (SSI) cash payment.
How do you qualify? To qualify, you must meet all of the following qualifications:

    • Were eligible for an SSI cash payment for at least 1 month;
    • Would be eligible for cash payment except for earnings;
    • Still be disabled;
    • Still meet all other eligibility rules, including the resources test;
    • Need Medicaid in order to work; and
    • Have gross earned income that is insufficient to replace SSI, Medicaid, and any publicly funded attendant care. (See following “threshold amount” discussion.)

The “threshold amount” is the measure that we use to decide whether your earnings are high enough to replace your SSI and Medicaid benefits. Your threshold amount is based on:

    • The amount of earnings that would cause your SSI cash payments to stop in your state; and
  • The average annual per capita Medicaid expenditure for your state.

If your gross earnings are higher than the threshold amount for your state (see following chart), you may still be eligible if you have:

    • Publicly funded attendant or personal care; or
  • Medical expenses above the state per capita amount.
Do all states use the same Medicaid eligibility rules? Most states use our SSI eligibility rules to determine Medicaid eligibility. However, the following states use their own eligibility rules for Medicaid that are different from our SSI eligibility rules:

Connecticut Minnesota Ohio
Hawaii Missouri Oklahoma
Illinois New Hampshire Virginia
Indiana North Dakota

If you live in one of these states, you will continue to be eligible for Medicaid under section 1619(a) or 1619(b) if you were eligible for Medicaid in the month before you became eligible for section 1619.

2014 State Threshold Amounts for Persons with Disabilities (SSI eligible)

STATE THRESHOLD STATE THRESHOLD
Alabama $26,420 Montana $30,227
Alaska $56,786 Nebraska $37,894
Arizona $35,773 Nevada $30,841
Arkansas $30,482 New Hampshire $38,505
California $36,928 New Jersey $34,405
Colorado $34,055 New Mexico $33,349
Connecticut $68,340 New York $44,657
Delaware $40,447 North Carolina $34,424
District of Columbia $39,833 North Dakota $43,582
Florida $30,750 Ohio $36,063
Georgia $28,820 Oklahoma $30,252
Hawaii $36,713 Oregon $32,725
Idaho $40,196 Pennsylvania $35,897
Illinois $27,829 Rhode Island $34,452
Indiana $37,010 South Carolina $30,142
Iowa $32,338 South Dakota $36,599
Kansas $34,584 Tennessee $36,313
Kentucky $29,725 Texas $33,407
Louisiana $31,235 Utah $34,103
Maine $32,411 Vermont $38,783
Maryland $41,746 Virginia $33,862
Massachusetts $39,730 Washington $29,683
Michigan $34,260 West Virginia $30,531
Minnesota $51,268 Wisconsin $33,361
Mississippi $28,499 Wyoming $36,447
Missouri $36,140 N. Mariana Islands $18,324

2014 States with Separate Threshold Amounts for Blind Persons(SSI eligible)

STATE THRESHOLD
California $38,248
Iowa $32,866
Massachusetts $40,579
Nevada $33,464

 

Special Rules For Persons Who Are Blind

What do you mean by special rules for persons who are blind? Employment supports, in general, are special rules that help you return to work or work for the first time. Congress included language in the law specifically to make it easier for persons who are blind to go to work. These special rules apply only to persons who are blind.
How do we define blindness? Blindness is central visual acuity of 20/200 or less in the better eye with best correction, or a limitation in the field of vision in the better eye so that the widest diameter of the visual field subtends an angle of 20 degrees or less.
Do the same conditions of blindness apply in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)? No. Under SSDI, this condition has to have lasted or be expected to last at least 12 months. There is no duration requirement for blindness under SSI.
What employment supports are available only to persons who are blind? Blind work expenses are available if you receive SSI based on blindness (see BWE).

How We Apply Substantial Gainful Activity (SGA) Under SSDI to Persons Who Are Blind

How do we determine SGA for blind SSDI beneficiaries who work? For the year 2014, if you are blind, average monthly earnings over $1,800 will ordinarily demonstrate that you are performing SGA. This is higher than the current guideline for non-blind disabled workers. We generally change the SGA level for beneficiaries who are blind every year to reflect changes in general wage levels.

REMINDER: If you are blind, you may use any or all of the deductions from earnings that apply to the SGA decision.

How do we apply SGA to blindSSDI beneficiaries who are self-employed? We decide if work activity is SGA for self-employed persons who are blind solely on their earnings. We do not look at time spent in the business or services rendered as we do for non-blind self-employed persons.
How do we determine SGA for SSDI beneficiaries who are blind andage 55 or older? Special rules apply after your 55th birthday. If your earnings demonstrate SGA but your work requires a lower level of skill and ability than the work you did before age 55 or when you became blind, whichever is later, we will suspend, not terminate, your benefits. Your eligibility for SSDI benefits continues indefinitely, and we pay your benefits for any month earnings fall below SGA.
Does SGA apply to persons who are blind under SSI? No. If you meet the medical definition of blindness, we do not use SGA as a factor to determine your SSI eligibility. Your SSI eligibility continues until you medically recover, or your eligibility ends because of a non-disability-related reason. See COMPARISON OF MONTHLY SSI PAYMENT WITH BWE VERSUS IRWE for an explanation of how we figure your SSI payment amount.

Blind Work Expenses (BWE) (SSI eligible)

How do BWE help you? We do not count any earned income that you use to meet expenses that you need to earn that income when we decide if you are eligible for Supplemental Security Income (SSI), and figure your payment amount. To qualify you must be eligible for SSI based on blindness.

How is BWE different than impairment-related work expenses (IRWE)?

The BWE items do not have to be related to your blindness. When we figure your SSI payment amount, we treat BWE items differently than IRWE. We do it this way because it always results in a higher SSI payment amount for you. The table below shows how your monthly payment would be affected by BWE versus IRWE.
Examples of BWE
  • Service animal expenses
  • Transportation to and from work
  • Federal, state, and local income taxes
  • Social Security taxes
  • Attendant care services
  • Visual and sensory aids
  • Translation of materials into Braille
  • Professional association fees, and
  • Union dues.

Comparison of Monthly SSI Payment With BWE Versus IRWE

With $40 BWE With $40 IRWE
$361 — Earned Income $361 — Earned Income
-20 — General Income Exclusion -20 — General Income Exclusion
$341 $341
-65 — Earned Income Exclusion -65 — Earned Income Exclusion
$276 $276
-138 — 1/2 Remaining Earnings -40 — Impairment Related Work Expenses
$138 $236
-40 — Blind Work Expenses -118 — 1/2 Remaining Earnings
$ 98 — Countable Income $118 — Countable Income
$721 — 2014 Federal Benefit Rate $721 — 2014 Federal Benefit Rate
-40 — Blind Work Expenses -118 — Blind Work Expenses
$623 — SSI Payment $603 — SSI Payment

Accommodations for Persons Who Are Blind or Visually Impaired

We recognize our duty to inform you of your rights and responsibilities under our programs.
Website We make every reasonable effort to maintain the accessibility of our websites:

Letters We offer the following delivery options for most of our letters and other communications:

  • Standard print notice by first class mail
  • Standard print notice by certified mail
  • Standard print notice by first class mail and a follow-up call to read the notice within five business days of the date of the notice;
  • Standard print notice and Braille by first class mail;
  • Standard print notice and a compact disc (CD) that contains a Microsoft Word file by first class mail. The Word CD should work with most screen readers but not in an audio CD player.
  • Standard print notice and large print (18-point font) notice by first class mail; or
  • Standard print notice and an audio CD by first class mail. The audio CD should work in most CD players

Please visit our website at www.socialsecurity.gov/notices to request one of the options listed above. You may also call us toll-free at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office.If none of the options listed above work for you, please call us toll-free at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office to request another accommodation.

Publications are available in alternate formats This book, The Red Book, and some other publications are available in alternative media. You can get some of these materials in Braille, audiocassette tape, disk, or enlarged print form. You can find a list of the publications available in alternate formats on our website at: www.socialsecurity.gov/pubs/alt-pubs.html.You may order these publications while you are online, or you may contact our Braille Services Team by telephone at: 410-965-6414, or 410-965-6408, or by fax at 410-965-6413. TTY users may call 1-800-325-0778.

Additional Help WIth Health Care For Persons with Disabilities

 

Medicaid Buy-In for Working Persons with Disabilities

How does it help you? Your state may allow you to buy Medicaid if you are disabled and no longer entitled to free Medicaid because you returned to work.
How do you qualify? You may qualify if you:

  • Meet the definition of “disabled” under the Social Security Act; and
  • Would be eligible for Supplemental Security Income (SSI) payments if it were not for your earnings.

If you are not an SSI recipient, your state decides if you are disabled. Your state will not consider whether you are working when it makes that decision.

How can you get more information? Contact your state Medical Assistance office. Call 1-800-MEDICARE to get their telephone number. (TTY users call 1-877-486-2048.) Ask about the Medicaid buy-in program.

Help with Medicare Part A Premiums

How does it help you? If you are under age 65, disabled, and no longer entitled to free Medicare Hospital Insurance Part A because you successfully returned to work, you may be eligible for a program that helps pay your Medicare Part A monthly premium.
How do you qualify? To be eligible for this help, you must:

  • Continue to have a disabling impairment; and
  • Sign up for Premium Hospital Insurance (Part A); and
  • Have limited income; and
  • Have limited resources; and
  • Not already be eligible for Medicaid.
For more information To find out more about this program, contact your state Medical Assistance office. Call 1-800-MEDICARE to get their telephone number. (TTY users call 1-877-486-2048.) Ask about Medicare for Qualified Disabled and Working Persons.

Affordable Care Act (ACA)
Need health insurance or know someone who does? Thanks to the Affordable Care Act, more Americans now qualify to get coverage that fits their needs and budgets. Visit the Health Insurance Marketplace at www.HealthCare.gov or call 1-800-318-2596 to get more information. If you are deaf or hard of hearing, you may call TTY 1-855-889-4325. Please note, Medicare is not part of the Health Insurance Marketplace. If you are a Medicare beneficiary, you do not have to replace your Medicare coverage with Marketplace coverage.

 

Example of concurrent benefits with Employment Supports

Many persons are eligible for benefits under both the Social Security Disability Insurance (SSDI) and Supplemental Security Income (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 SSDI benefits and 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.

March 2004 Tom’s SSI benefits begin the month after he filed his application. He is eligible for $564 per month (the FBR in 2004). Tom also becomes eligible for Medicaid.
August 2004 Tom’s SSDI benefits begin. This is the month after Tom completed his 5-month waiting period. The 5 months began the first full month after Tom’s approved onset date of February 14, 2004. The 5 months were March, April, May, June, and July 2004. Tom is eligible to receive SSDI benefits beginning August 2004. His monthly benefit amount is $300 which reduces his SSI to $284:$300 SSDI – $20 general income exclusion = $280 countable unearned income$564 FBR – $280 countable unearned income = $284 SSI payment

 

Tom qualifies for Medicare.

August 2006 Tom qualifies for Medicare after 24 months of entitlement to SSDI benefits. Medicare Hospital Insurance (Part A) is premium-free; Medicare Supplementary Medical Insurance (Part B) is optional but there is a premium. Tom’s state pays his Part B premium for him because he is eligible for SSI and has been covered by Medicaid since March 2004. Tom now has both Medicare and Medicaid. Medicare is the primary payer and Medicaid is the secondary payer.

 

Tom wants to work.

December 2008 Tom contacts his local Social Security office on December 7, 2008, to learn how a job will affect his SSDI, SSI, and health insurance benefits. Tom is a certified auto mechanic, and a local car dealership has offered him a job.

 

Tom returns to work.

January 2009 Tom begins work at the car dealership. The dealership pays him $1,600 a month.

 

How Tom’s work affects his SSDI benefits.

January 2009 Tom’s trial work period (TWP) begins. During the TWP, Tom can continue to receive full SSDI benefits for at least 9 months regardless of the amount of his earnings. Each month that Tom earns over $700 in 2009 ($770 in 2014) will count as a TWP service month. His TWP ends with the 9th TWP service month in a rolling 60-month period.
September 2009 Tom provides pay stubs showing his steady work activity since January 2009. We determine Tom’s TWP months are January, February, March, April, May, June, July, August, and September 2009. Tom completes his TWP in September 2009.
October 2009 Tom’s extended period of eligibility (EPE) begins the month after his TWP ended. For the next 36 months (through September 2012), Tom will be paid benefits for any month he does not work over the substantial gainful activity (SGA) level. We refer to this 36-month period of time as the re-entitlement period.

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 determine if his earnings are SGA as follows:

$1,600 wages – $200 employer subsidy – $350 IRWE = $1,050 monthly 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.

January 2010 We stop Tom’s SSDI benefits. Tom does not meet our requirements in October 2009 because we determined he was engaging in SGA. We can pay Tom for the month of cessation and the 2 following months. We refer to these 3 months as the “grace period”. Tom’s grace period months are October, November, and December 2009.For any month that Tom’s earning fall below the SGA limit during his 36-month re-entitlement period, we can restart his benefits without a new application. If we restart Tom’s benefits during the re-entitlement 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?

October 2012 Tom’s entitlement will terminate if his work activity continues at over the SGA level. This is the first month after the end of the 36-month EPE. Tom’s entitlement may stop earlier than October 2012 if he no longer meets our disability requirements.

 

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.

January 2009 Tom’s income for January 2009 through December 2009 is SSDI of $300 per month and wages of $1,600 per month. Because Tom’s monthly income does not change, the calculation will be the same for all months in 2009.First, we figure his countable unearned income by subtracting the $20 general income exclusion from his SSDI:$300 SSDI – $20 = $280 countable unearned income Next, we calculate his countable earned income by first subtracting the $65 earned income exclusion from his wages:$1,600 – $65 = $1,535From this amount, we deduct the $350 IRWE for the taxi transportation:$1,535 – $350 IRWE = $1,185

Note: Tom’s subsidy is not an earned income exclusion for SSI; subsidy applies only to the SSDI SGA determination. This means we cannot subtract the $200 monthly subsidy when we figure his SSI payment and eligibility. However, the IRWE deduction applies to both the SSDI SGA and SSI payment determinations.

The second step in figuring Tom’s earned income is to divide this result by 2:

$1,185 ÷ 2 = $592.50 countable earned income

We now add the countable unearned income and the countable earned income to determine total countable income:

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

Finally, we subtract the total countable income from the SSI FBR to determine SSI eligibility and payment amount:

$674 (FBR in January 2009) – $872.50 countable income = $0 SSI payment

Tom will not receive SSI payments for January 2009 through December 2009 because of his SSDI benefits and monthly earnings. However, he is still 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 2010 as long as he works over the SGA level.

January 2010 Tom reports that he received a pay increase to $1,900 per month beginning in January. His IRWE has increased to $400 per month. Tom’s only income is his wages since he is not receiving an SSDI payment. Here is how we figure his SSI eligibility and payment amount for January 2010.We subtract both the general income exclusion and earned income exclusion from monthly earnings:$1,900 wages – $20 general income exclusion – $65 earned income exclusion = $1,815$1,815 – $400 IRWE = $1,415 ÷ 2 = $707.50 countable earned income$674 (FBR in January 2010) – $707.50 countable income = $0 SSI payment Tom is not eligible for any SSI payment unless his earnings or IRWE change.

 

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 (which ended September 2009) 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.


Summary of Example with Concurrent Benefits

Date Event
03/04 SSI benefits and Medicaid start
08/04 SSDI benefits start
08/06 Medicare starts
01/09 Work starts
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

 

Demonstration Projects Update

 

SSA conducts numerous research and demonstration projects to study ways to improve services to our current and future beneficiaries. These projects can lead to ways to better serve persons with disabilities, as well as potentially changing program rules to allow for better coordination among other federal and state programs.

 

Benefit Offset National Demonstration (BOND)
BOND tests a $1 reduction in benefits for every $2 in earnings over substantial gainful activity (SGA) levels, in combination with benefits counseling, with the goal of helping beneficiaries with disabilities return-to-work. The demonstration allows beneficiaries to face this gradual reduction in their benefits, eliminating the abrupt loss of cash benefits. We began a pilot of BOND in January 2011 and full implementation began in late April 2011. A final report is due in 2017.

 

Youth Transition Demonstration (YTD)
We designed the YTD project to further the goal of increasing employment of persons with disabilities. The YTD focuses on youths ages 14-25 who receive Supplemental Security Income, SSDI, or childhood disability benefits, or who are at heightened risk of becoming eligible for such benefits. YTD sites develop service delivery systems and partnerships with Federal, State, and local entities to assist youth with disabilities to successfully transition from school, which may include post-secondary education, to employment and economic self-sufficiency. All six of the random assignment sites have completed YTD services. The 12-month impact reports for all of the sites have been posted and can be found at www.socialsecurity.gov/disabilityresearch/interimreports.html. The 24-month impact reports for all of the sites have been posted and can be found at www.socialsecurity.gov/disabilityresearch/documents/YTD%20Final.pdf

 

Current Events
To keep up with the latest developments and get information about local contacts, visit our Internet website at: www.socialsecurity.gov/disabilityresearch. This site provides information on major activities such as our demonstration projects work incentive policies, and other relevant resources. You can also sign up to get e-mail notices when we post updates.

 

Glossary

Area Work Incentive Coordinator (AWIC) An AWIC is an experienced employment support expert who:

  • Coordinates and conducts public outreach on work incentives in his or her local area; and
  • Provides, coordinates and oversees training on our employment support programs for all personnel at our local offices.
Benefit Planning Query (BPQY) The BPQY is an important planning tool for disability beneficiaries or any person who may be developing customized services for a disability beneficiary who wants to start working or stay on the job. The BPQY provides current information about your disability cash benefits, health insurance, scheduled continuing disability reviews, representative payee, and work history, as stored in our electronic records.
Blind Work Expenses
(BWE)
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. Common examples of BWE include state and federal payroll taxes, and money spent for meals at work.
Break-Even
Point
The dollar amount of total income (after we apply all applicable deductions) that will reduce the SSI payment to zero for a particular case. Your break-even point depends on your earned and unearned income, living arrangements, applicable income exclusions, and state supplement, if any.
Childhood Disability Benefits (CDB) A person disabled before age 22 may be eligible for child’s benefits if a parent is deceased or starts receiving retirement or disability benefits.The adult child—including an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild-must be unmarried, age 18 or older, and have a disability that started before age 22.Also referred to as “disabled adult child (DAC) benefits”.
Continuation of Medicare
Coverage
If your benefits stop because you are working you can receive at least 93 consecutive months of Medicare coverage after your trial work period (TWP). This provision allows your health insurance to continue even after your benefits have stopped.
Continuing Disability Review (CDR) Our process of obtaining complete current information about your condition to decide if your SSDI or SSI benefits should continue.
Countable Income 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.
Countable Income Test One of the tests we may use to evaluate self-employment income if you have received SSDI benefits for 24 months.
Employment Network (EN) An EN is a qualified public or private organization under contract with us to coordinate and deliver employment services, vocational rehabilitation services, or other support services to beneficiaries who are participating in the Ticket to Work program.
Expedited Reinstatement (EXR) A safety net if your cash benefits end because of your work. You may request reinstatement of your benefits within five years of when they ended if you stop working at the substantial gainful activity (SGA) level because of your impairment. You may get up to six months of provisional (temporary) benefits while we make a decision on your request.
Extended Period of Eligibility (EPE) A consecutive 36-month period that follows your TWP. During your EPE, you may still receive payments depending on how much you work and earn. We can pay you disability benefits during your EPE if:

  • your condition is still disabling, and
  • your work is not SGA.

Your benefits will end if your work is substantial after the end of your EPE.

Federal Benefit Rate (FBR) The basic benefits standards used in computing the amount of your federal SSI payments. Benefit levels differ for individuals and couples living in households and for persons in Medicaid institutions. Federal benefit rates may be increased annually to reflect increases in the cost of living.
Impairment-Related Work Expenses
(IRWE)
When we make a SGA decision, we can deduct the cost of items and services that you pay out of pocket and that you need to work because of your impairment. Some examples are: medicines, co-pays, service animals, counseling services, and attendant care services. 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.
Initial Reinstatement Period (IRP) Your IRP begins with the first month that we reinstate your disability payments. The IRP can last for 24 months (not necessarily consecutive), and ends when you have received 24 months of payable benefits. If you receive SSDI benefits, we can pay you for any month during the IRP that your work and earnings are not SGA. If you receive SSI benefits, the normal income counting rules apply.

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

 

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

Medicaid Protection for Persons with Disabilities Who Work

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

  • have earnings that are too high to qualify for SSI under current rules; and
  • 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 persons when they lose coverage due to medical improvement, but who still have a medically determinable severe impairment.

Medical Improvement Expected

If we approve your claim for disability benefits, we may also decide that we expect your disabling impairment(s) to improve. If so, we will schedule your case for a future review in less than three years.
Medicare Health insurance program for eligible disabled persons and persons age 65 or older usually consisting of:

  • Hospital Insurance under Medicare (Part A)
  • Supplemental Medical Insurance under Medicare (Part B); and
  • Voluntary prescription drug coverage with a Prescription Drug Provider (PDP) (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 Persons with Disabilities Who Work If you are disabled and you return to work, you can buy continued Medicare coverage when your premium-free Medicare ends due to work activity. States are required to help you pay the hospital insurance premiums if you have limited income and resources but are not eligible for Medicaid.
Plan to Achieve Self-Support (PASS) Under an approved PASS, you may set aside income and resources over a reasonable time that will enable you to reach a work goal to become financially self-supporting. You can use the income and resources that you set aside to obtain training or education, purchase 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 (PESS)

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

Protection and Advocacy for Beneficiaries for Social Security (PABSS)

In every State, U.S. Territory and the Tribal Nations, there is an agency that protects the rights of persons with disabilities. This Protection and Advocacy System administers the SSA-funded PABSS program.
Resources Resources are anything you own. For example, bank accounts, stocks, business assets, real estate property, or personal property that you can use for your support and maintenance are considered resources. We do not count all of your resources; i.e., life insurance policies, when we decide if you are eligible for SSI benefits.

Social Security Disability Insurance (SSDI)

SSDI provides benefits to disabled or blind persons who are insured by workers contributions to the Social Security trust fund. These contributions are based on your earnings (or those of your spouse or parents). Your dependents may also be eligible for benefits from your earnings record.Social Security Disability Insurance is authorized under title II of the Social Security Act.

Student Earned Income Exclusion (SEIE)

If you are under age 22 and regularly attending school, the SEIE allows you to have some of your earnings excluded from your income. We usually adjust the amounts we can exclude each year based on the cost-of living.

Subsidies and Special Conditions

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 an SGA decision.

Substantial Gainful Activity (SGA)

We will evaluate your work activity if you are applying for or receiving disability benefits under SSDI, or if you are applying for benefits because of a disability (other than blindness) under SSI. Under both programs, we generally use earnings guidelines to evaluate your work activity to decide whether your work is substantial, and whether we may consider you disabled under the law.

Supplemental Security Income (SSI)

The SSI program makes cash assistance payments to aged, blind, and disabled persons (including children) who have limited income and resources.Supplemental Security Income program is authorized under title XVI of the Social Security Act
SSI Income SSI income is:

  • Earned income – money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, royalties and honoraria received for services; and
  • Unearned income – money received from all other sources; for example, gifts, interest, pensions, Social Security, and veteran’s benefits. 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).
The Three Tests We may use these tests to evaluate self-employment income when you initially apply for SSDI, and before you have received SSDI benefits for 24 months. We also use the three tests to determine if we can reinstate your benefits when we evaluate your work activity in the EPE.
Ticket to Work (TTW) The TTW Program is for SSI or SSDI beneficiaries who want to work and participate in planning their employment. Participation in the TTW program increases your available choices when obtaining employment services, vocational rehabilitation services, and other support services you may need to get or keep a job. It is a free and voluntary service. When you participate in the TTW program, you are using your ticket. You might not be subject to a continuing disability review while you are using your Ticket.
Trial Work Period (TWP) The TWP lets you test your ability to work or run a business for at least nine (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 for example, free rent, donated supplies, or unpaid help from friends or family members. If you are self-employed, we deduct unincurred business expenses from earnings when we make an SGA decision.
Unsuccessful Work Attempt (UWA) An UWA is 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 (six months or less) because of your impairment, or the removal of special conditions related to your impairment that were essential to your work. We do not count earnings during a UWA when we make an SGA decision.
Vocational Rehabilitation (VR) The VR program is a public program administered by a State VR agency in each State or U.S. territory to help people with physical or mental disabilities become gainfully employed.
Work Incentives Planning and Assistance (WIPA) Projects WIPA projects are community-based organizations that receive grants from SSA to provide all Social Security and Supplemental Security Income (SSI )disability beneficiaries (including transition-to-work aged youth) with free access to work incentives planning and assistance. Community Work Incentives Coordinators (CWIC) are professionals who work for WIPAs, meet with beneficiaries, and provide important information about your benefits and how working would affect your SSA income and health care.
Work Incentives Seminars Events (WISE) A free, internet-based seminar that gives Social Security disability beneficiaries information they need to make a decision about going back to work or working for the first time. WISE feature various employment support service providers, such as Vocational Rehabilitation, Protection and Advocacy Services and Employment Networks. Some WISE address a broad range of disabilities, while others target people in specific disability categories or age ranges. WISE information may be accessed 24-hours per day at your convenience.

 


Social Security Administration
SSA Pub. No. 64-030
ICN 436900
January 2014
Developed by:
Social Security Administration
Office of Retirement and Disability Policy

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