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 Federal Benefit Rate [FBR] in 2004). Tom also becomes eligible for Medicaid.|
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.
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.
Tom begins work at the car dealership. The dealership pays him $1,600 a month.
How Tom’s work affects his SSDI benefits.
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 ($810 in 2016) 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.|
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.
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?
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.
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 = $1,535
From this amount, we deduct the $350 IRWE for the taxi transportation:
$1,535 - $350 IRWE = $1,185
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.
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
|03/04||SSI benefits and Medicaid start|
|08/04||SSDI benefits start|
|SSI stops due to earnings|
|Work at SGA continues|
|SSDI benefits cease, grace months|
|for payment are 10/09-12/09|
|01/10||SSDI benefits stop|
|Extended Medicare begins|
|10/12||SSDI termination month|
|Medicaid ends if earnings are over state|
|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|