Benefits 101Benefits 101

Jill WalterJill Walter

Nick IshamNick Isham

2012 Legislative Days 2012 Legislative Days TrainingTraining

Purpose of presentationPurpose of presentation

Understand SSI and SSDI basicsUnderstand SSI and SSDI basics Be able to explain that there are Be able to explain that there are

work incentives to debunk the MYTH!work incentives to debunk the MYTH!

MYTHMYTH

You will lose your benefits and health You will lose your benefits and health insurance if you work.insurance if you work.

SSDI vs. SSISSDI vs. SSITitle IITitle II SSDISSDI

RetirementRetirement DACDAC

Based on work history, Based on work history, FICA paid.FICA paid.

Comes with Medicare.Comes with Medicare.

Title XVITitle XVI SSISSI

Needs based, have little Needs based, have little or no income and or no income and resources. resources.

Comes with Medicaid.Comes with Medicaid.

SSDI: Social Security Disability SSDI: Social Security Disability InsuranceInsurance

Must have a permanent condition that Must have a permanent condition that prevents working.prevents working.

Must have paid FICA taxes during employmentMust have paid FICA taxes during employment Entitled to benefits in one of 3 waysEntitled to benefits in one of 3 ways

Disability Insurance Benefits (DIB)Disability Insurance Benefits (DIB) Disabled Widow Benefits (DWB)Disabled Widow Benefits (DWB) Childhood Disability Benefits – also called DACChildhood Disability Benefits – also called DAC

24 month wait for Medicare24 month wait for Medicare

SSI: Supplemental Security SSI: Supplemental Security IncomeIncome

A financial and medical benefit available for A financial and medical benefit available for people who meet income and asset limits.people who meet income and asset limits.

Asset LimitsAsset LimitsIndividual: $2,000Individual: $2,000

Couple: $3,000Couple: $3,000

Who have a disability or have a child with a Who have a disability or have a child with a disabilitydisability

Or are at least 65 years old or are blindOr are at least 65 years old or are blind

SSISSI

Federal Benefit Rate (FBR) for 2012 Federal Benefit Rate (FBR) for 2012 is $698is $698

Eligible for WI State Supplement of Eligible for WI State Supplement of $83.78 if receiving any amount of SSI$83.78 if receiving any amount of SSI

In WI, automatically enrolled in In WI, automatically enrolled in Medicaid.Medicaid.

Concurrent BeneficiariesConcurrent Beneficiaries

Receiving Title II and Title XVIReceiving Title II and Title XVI Two separate checks a monthTwo separate checks a month Title II must be under $698Title II must be under $698 Convenient for a PASS planConvenient for a PASS plan

Work IncentivesWork Incentives

MYTH: Start working, you lose your MYTH: Start working, you lose your benefits.benefits.

SSA program that allows people SSA program that allows people receiving Title II or XVI to work and receiving Title II or XVI to work and still receive payments and health still receive payments and health benefits.benefits.

Series of safety nets.Series of safety nets. Some apply just to Title II, some to Some apply just to Title II, some to

Title XVI, some to both.Title XVI, some to both.

Work Incentives for Title IIWork Incentives for Title II

Trial Work Period (TWP): 9 months of Trial Work Period (TWP): 9 months of unlimited earnings.unlimited earnings. TWP = $720 in 2012TWP = $720 in 2012 Continue full SSDI paymentsContinue full SSDI payments Does not have to be used consecutively – 5 Does not have to be used consecutively – 5

year rolling period.year rolling period.

Work Incentives for Title IIWork Incentives for Title II

Substantial Gainful Activity (Substantial Gainful Activity (SGASGA): the way ): the way SSA measures work that is significant, SSA measures work that is significant, productive and will sustain you.productive and will sustain you.

In 2012 SGA=$1,010/month of countable In 2012 SGA=$1,010/month of countable incomeincome

CessationCessation – the first month of earnings – the first month of earnings considered SGA after the TWP, followed by considered SGA after the TWP, followed by 2 Grace Period months.2 Grace Period months.

Work Incentives for Title IIWork Incentives for Title II

Extended Period of Eligibility Extended Period of Eligibility (EPE(EPE): 36-month ): 36-month period in which a person can receive their SSDI period in which a person can receive their SSDI payment any month their earnings are below payment any month their earnings are below SGA.SGA.

The number of times a person’s SSDI payments The number of times a person’s SSDI payments stop and start is not limited during the EPE.stop and start is not limited during the EPE.

Starts the month after TWP ends.Starts the month after TWP ends.

The first time a person earns over SGA after the The first time a person earns over SGA after the EPE, their benefits would be terminated.EPE, their benefits would be terminated.

BOND National BOND National Demonstration ProjectDemonstration Project

An additional SSDI work incentive meant An additional SSDI work incentive meant to increase work activity for beneficiary's.to increase work activity for beneficiary's.

BOND randomly assign individuals who BOND randomly assign individuals who are entitled to SSDI.are entitled to SSDI.

SSA is piloting this project that runs until SSA is piloting this project that runs until September of 2017.September of 2017.

BOND gives a gradual reduction with a BOND gives a gradual reduction with a 2/1 offset on earnings.2/1 offset on earnings.

BOND Offset ExampleBOND Offset Example

If working 30 hours at $10.50/hour making If working 30 hours at $10.50/hour making $1,354.50 a month.$1,354.50 a month.

SSA would subtract the current SGA SSA would subtract the current SGA amount $1,010.00(1354.50-1010 = 344.50)amount $1,010.00(1354.50-1010 = 344.50)

Then take half of this amount Then take half of this amount (344.50/2=172.25) from your current SSDI (344.50/2=172.25) from your current SSDI cash payment.cash payment.

So your SSDI payment is reduced by So your SSDI payment is reduced by $172.25, but your earnings are $1,354.50. $172.25, but your earnings are $1,354.50.

Work Incentives for Title IIWork Incentives for Title II

Options after terminationOptions after termination Expedited Reinstatement (Expedited Reinstatement (EXREXR))

Reapply for Title II benefitsReapply for Title II benefits

Work Incentives to reduce your Work Incentives to reduce your earned income under SGAearned income under SGA

Subsidy and Special Conditions:Subsidy and Special Conditions: Job Job coach, extra support, coach, extra support, accommodationsaccommodations

Impairment Related Work Expenses Impairment Related Work Expenses (IRWEs):(IRWEs): Out of pocket expenses Out of pocket expenses related to your disability and needed related to your disability and needed for employment.for employment.

Extended Period of Medicare Extended Period of Medicare Coverage (EPMC)Coverage (EPMC)

Remain eligible for Medicare coverage Remain eligible for Medicare coverage after no longer eligible for SSDI after no longer eligible for SSDI paymentspayments

Eligibility for Eligibility for at leastat least 93 months 93 months starting the month after TWP.starting the month after TWP.

Ineligibility for SSDI must be due to Ineligibility for SSDI must be due to earning at SGA level, not due to earning at SGA level, not due to medical improvement.medical improvement.

MedicareMedicare

Part A – Hospital Insurance.Part A – Hospital Insurance.

Part B – Supplemental Medical Part B – Supplemental Medical Insurance.Insurance.

Part D – Prescription Drug Coverage.Part D – Prescription Drug Coverage.

Basic SSI CalculationBasic SSI Calculation

Unearned income - $20 (General Income Exclusion)= Countable Unearned income - $20 (General Income Exclusion)= Countable Unearned Unearned IncomeIncome

Gross Earned Income - $65 (Earned Income Exclusion)Gross Earned Income - $65 (Earned Income Exclusion) = Countable = Countable Earned 2 Earned 2 Income Income

Countable Unearned + Countable Earned = Total Countable IncomeCountable Unearned + Countable Earned = Total Countable Income

698 (FBR) – Total Countable Income = 698 (FBR) – Total Countable Income = SSI PAYMENTSSI PAYMENT

Break Even PointBreak Even Point

Without unearned Without unearned incomeincome

(FBR x 2) +65 + 20 = (FBR x 2) +65 + 20 = BEPBEP

The BEP for someone The BEP for someone receiving just SSI is receiving just SSI is

$1,481$1,481

With unearned incomeWith unearned income

UnearnedUnearned

-20-20 CountedCounted

UnearnedUnearned

FBRFBR

- - Counted UnearnedCounted Unearned

remainderremainder

(remainder x 2) +65 = BEP(remainder x 2) +65 = BEP

SSI calculation in reverse

SSI Calculation 2012SSI Calculation 2012

Work Incentives for SSIWork Incentives for SSI

Student Earned Income Exclusion (SEIE)Student Earned Income Exclusion (SEIE): : AAllows students to exclude earnings from llows students to exclude earnings from income in calculating SSI payment.income in calculating SSI payment.

Earn up to $1,700/month before their SSI Earn up to $1,700/month before their SSI check is reduced.check is reduced.

Only $6,840/year can be excluded.Only $6,840/year can be excluded. IRWEsIRWEs: SSA will deduct $1 of countable : SSA will deduct $1 of countable

income for every $2 spent out-of-pocket on income for every $2 spent out-of-pocket on an IRWE. This results in the SSI payment an IRWE. This results in the SSI payment increasing.increasing.

Work Incentives for SSIWork Incentives for SSI

Plan to Achieve Self-Support (PASS):Plan to Achieve Self-Support (PASS): AAllows people to set aside money into a llows people to set aside money into a PASS account to achieve a vocational goal.PASS account to achieve a vocational goal.

Need to be receiving SSI or became Need to be receiving SSI or became ineligible for SSI due to other income.ineligible for SSI due to other income.

The other monthly income (Title II or The other monthly income (Title II or earned income) is put into the PASS earned income) is put into the PASS account, not counted in SSI calculation account, not counted in SSI calculation and thus increasing your SSI payment.and thus increasing your SSI payment.

1619(b)1619(b)Continuing Medicaid coverage after SSI Continuing Medicaid coverage after SSI

ineligibility due to earningsineligibility due to earnings Have been eligible for an SSI cash payment Have been eligible for an SSI cash payment

for at least 1 month; for at least 1 month; Still meet the disability requirement; and Still meet the disability requirement; and Still meet all other non-disability SSI Still meet all other non-disability SSI

requirements; and requirements; and Need Medicaid benefits to continue to work; Need Medicaid benefits to continue to work;

and and Have gross earnings that are insufficient to Have gross earnings that are insufficient to

replace SSI, Medicaid and publicly funded replace SSI, Medicaid and publicly funded attendant care services. attendant care services.