Tom begins working in his trial
work period (TWP).
|
During the TWP, Tom
can continue receiving full SSDI benefits for at least
9 months regardless of the amount of his earnings.
Each month that Tom earns over $700 in 2009 will count
as a trial work period service month. His TWP ends
with the 9th month of service in a rolling 60-month
period. |
| Tom completed his TWP and is now eligible for
an extended
period of eligibility (EPE). |
Tom has completed his TWP. His EPE
begins with the first month after the TWP. |
| Is Tom performing substantial
gainful activity (SGA)? |
SSA knows that Tom is paid $1,600
a month. But Tom is taking a taxi to and from work at
a cost of $350 per month. Tom’s physician confirms that
Tom’s condition prevents him from driving. Crowded situations,
such as in public transportation, aggravate his condition.
Since Tom is paying for the transportation, and there
is a medical need for him to take a taxi to and from
work, SSA can deduct the
cost of his transportation expenses as Impairment Related
Work Expenses (IRWE). |
| Is the employer also subsidizing Tom in some way? |
Tom is able to complete 4 car repairs
a day. The employer pays Tom $1,600 a month, the same
rate as employees who produce 6-8 repairs a day. The
employer does this because he is aware of Tom’s disability
and understands it takes him longer to complete tasks.
The employer calculates the service Tom provides is worth
$1,400 a month. So yes, there is an employer subsidy, and
this can also be subtracted from
countable earnings. |
| How does Tom’s SGA level work activity affect his benefits
in the EPE? |
In the first month of the EPE
SSA determines if an individual is engaging in SGA.
If yes, SSA will cease benefits with that month. A beneficiary can be paid for the
month of cessation and the two following months, known
as the “grace period.”
If Tom’s earnings fall below the SGA limit, benefits
can be reinstated without filing an application if
Tom is still in his 36-month reentitlement period.
If Tom is re-entitled to benefits during the 36-month
reentitlement 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? |
If Tom continues to work at the same
level, with his work activity constantly over the SGA
limit, Tom’s entitlement to SSDI will terminate the first
month after the end of the 36-month EPE. |
| Will Tom continue to have Medicare coverage? |
If Tom continues to work above
the SGA level and no longer receives his SSDI payment,
he can continue to have Medicare
coverage for at least
an additional 93 months after his TWP period. This
is as long as he continues to have a disabling impairment
(has not medically improved).
Tom can then choose to purchase Premium Medicare Hospital
Insurance coverage (Part A). If he purchases Part A,
he can then purchase Part B. Since Tom has earned at
least 30 quarters of coverage, he can qualify for the
reduced Part A rate.
If Tom decides to purchase Medicare coverage in 2014,
he will have to file an application with Social Security,
and we will conduct a medical continuing disability
review. After the medical review, if we determine that
Tom’s medical condition has not improved, he can purchase
Medicare coverage. If Tom’s employer offers him a Group
Health Plan, Medicare could be either the primary or
secondary payer. |
| How does Tom’s work activity affect his SSI benefit? |
Unlike SSDI, SGA is not an issue
after a person becomes eligible for SSI. It is only
considered when initially filing for SSI disability
benefits, unless the disability is blindness. Therefore,
if an SSI beneficiary returns to work, SSA determines
whether the individual continues to meet the non-disability
requirements, including income and resources. (TWP
and EPE apply only to SSDI, not SSI.) For Tom, we will
determine the effect of his $1,600 earnings on his
SSI eligibility and payment amount on a month by month
basis.
Tom is receiving $300 SSDI monthly for January
through December and has monthly wages of $1,600
beginning January.
SSA starts by calculating his SSI payment for January. In this case, since his monthly income does not
change, the calculation will be the same for all months
of the year. Follow the steps below. It's a bit complicated,
but this is how it works! |
| First, SSA subtracts the $20 general income exclusion
from his SSDI. |
$300 SSDI -
$20 = $280 countable unearned income |
| Then, subtract the $65 earned income exclusion from
his wages. |
$1,600 - $65 = $1,535 earned
income |
| Next, deduct the $350 IRWE from the earned income and
divide the result by 2 -- the second step in the earned
income exclusion. (**Note: Subsidy
is not a SSI earned income exclusion; it only applies to
SGA. This means we cannot subtract the $300 per month subsidy
that was used in determining SGA for SSDI entitlement.
However, IRWE applies to both SGA and SSI income.)) |
$1,535 - $350 IRWE = $1,185.00 ÷
2 = $592.50 countable earned income |
| Then, add the countable unearned income to the countable
earned income to determine countable income. |
$280 countable unearned income +
$592.50 countable earned income = $872.50 countable income. |
| Subtract the countable income from the SSI Federal
Benefit Rate (FBR) to determine SSI eligibility and payment
amount. |
$637 in
January 2009 - $872.50 countable income = no SSI payment. (Note:
He might be due an SSI payment if he lives in a state
that combines its supplemental payment with the Federal
payment, and the combined monthly payment exceeds his
countable income.) |
| SSI Results |
Tom will not receive SSI payments
for January through December because of his
monthly earnings and his SSDI benefits. However, he will
still be 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. |
| SSDO Results |
Tom will not receive SSDI benefits
beginning January for as long as he works over the
SGA level. |
