social security benefits ssdi and ssi
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SOCIAL SECURITY BENEFITS SSDI and SSI. Overview of Disability Programs SSDI & SSI. Social Security Administration. Insurance program based on quarters of coverage-paid by FICA taxes Not based on financial need - PowerPoint PPT PresentationTRANSCRIPT
SOCIAL SECURITY BENEFITSSSDI and SSI
Social Security Administration
Overview of
Disability Programs
SSDI & SSI
SOCIAL SECURITY DISABILITY--SSDI
• Insurance program based on quarters of coverage-paid by FICA taxes
• Not based on financial need • Earned quarters--$1090=One quarter• Disabled or blind under Social Security rules• 5 month waiting period• Medicare eligible after entitled for 24 months
Spouse Benefits
• Age 62 and married to worker• Any age mothers-worker’s child under age
16• Divorced spouse-married 10 years, age 62
unmarried• Surviving divorced spouse-age 60 married
10yrs can be remarried after age 60• Widow (er) married 9 months age 60• Disabled widow (er) age 50
Child Disability Benefits
• As a child (under 18) auxiliary beneficiary on the record of a parent receiving SSA benefits or deceased-disability not a factor
• As a Disabled Adult Child (over age 18) on the account of a parent
• SSI-as a child whose parents meet the income/resource limits-disability is a factor
SUPPLEMENTAL SECURITY INCOME SSI
• Federal welfare program based on need• Aged, disabled or blind• Be a U.S. citizen or qualified alien• Income/resources of spouse or parents (if
under 18) may affect eligibility• No waiting period• Automatic Medi-cal eligibility in CA• Paid by general taxes not FICA taxes
Disability Definition
• The same for both programs
• Inability to work is key for adults
• Inability to function is key for kids
• Disability must be severe enough to keep adult from doing any substantial work
• Disability must be expected to last 12 months
• ….or result in death
Who decides if you’re disabled?
Non-Disability Factors Disability Factors
•Social Security caseworker•SSI caseworker•Appeals and RepPayee paperwork handled by SSA Office
Medical folder sent to California Department of Social Services: Disability and Adult Services (DDS)
Representative Payees
Who needs one?
•Children
•Drug addicts
•Alcoholics
•Adults who are legally incompetent
•Psychological disorders
Who can be one?
•Parent or family member
•Legal guardian
•A close friend
•Custodian of the person
•Social Service agency
If Your Claim is Approved
• Generally takes 3-5 months to get decision
• SSDI benefits begin with the 6th full month of your disability (waiting period)
• Ex: Disability begins 01/09 and file 02/09 First payment month 07/09 payable in 08/09
• SSI benefits payable month after you file
• SSI review done before first payment
Appeal Process
• Initial claims 32% approval rate• 1st-Reconsideration: Claim sent back to
DDS for another review 8%• 2nd- Hearing: Administrative Law Judge
69% 2007 SSA Statistical Report• 3rd-Appeals Council Review: Judge
reviews ALJ decision• 4th Federal Courts: Civil court action• All have time periods
SSA Medical Benefits
Medicare•Part A-D•Federal program tied to SSDI and age 65•Entitled age 65 or 25th month after disability benefits•Monthly premiums
Medi-Cal•State program Medicaid•California Dept. of Social Services•Tied to SSI•Hawaii separate application•Medi-Cal pays Medicare premiums
SSA WORK INCENTIVES
• Most people with disabilities want to work
• SSA offers a package of work incentives to help them
• Work incentives allow beneficiaries to:
--Test ability to work and
--Gradually become self-supporting
FEARS, MYTHS, AND TRUTHS ABOUT WORK AND DISABILITY BENEFITS
• If I start working my benefits will stop or my income will go down-Fear
• Work incentives allow for continuation of cash benefits for a period of time-Truth
• I can make more money not working-Myth• Going to work will generally increase overall
income-Truth• I can’t work because I’ll lose my Medical
Insurance-Fear• Healthcare (Medicare and Medi-cal) can
continue even if claimant is working-Truth
FEARS, MYTHS, AND TRUTHS ABOUT WORK AND DISABILITY BENEFITS
• I’m afraid that if I go to work and my benefits stop, I’ll get sick again and have a hard time getting back on benefits-Fear
• Expedited Reinstatement can pay up to six months while you wait for decision-Truth
• I can’t get a good paying job-Myth• PASS Program, Ticket to Work and
Community Partners can help you-Truth• I get and SSA check-Myth• SSA benefits are SSDI-Truth
SSDI PRIMARY WORK INCENTIVES
• Trial Work Period
• Extended Period of Eligibility-SGA $980/1640
• Expedited Reinstatement
• Continuation of Medicare
• 301 VR payment
• Ticket to Work
TRIAL WORK PERIOD (TWP)
• Allows claimant to test work ability while still receiving full SSDI for 9 months
TWP• 2009-$700 constitutes a TWP month
• We give you a rolling 5 year period to earn the nine months
• If earning at or above the current SGA level we pay for the tenth month and two additional “grace” months
• Gives beneficiary a trial run on working
LET’S REVIEW THE NUMBERS…
• 9 Trial work months• 3 Grace months• During these
months claimant receives full SSDI check and their wages
EXTENDED PERIOD OF ELIGIBILITY
Starts at end of TWP and extends for 36 months
Claimant whose earnings drop below SGA in any month can get full SSDI payment for that month
Automatic reinstatement if work stops
IRWE
LET’S REVIEW THE NUMBERS…
• 9 Trial work months
• 3 Grace months
• During these months claimant receives full SSDI check and their wages
• 36 Extended period of eligibility—During these months claimant is entitled to the full SSDI check any month wages fall below SGA
EXPEDITED REINSTATEMENT
• Starts at end of EPE and runs for the following 60 months
• Claimant who stopped work due to same disability can be paid while we make a medical decision
• Pay up to six months
LET’S REVIEW THE NUMBERS..
• 9 Trial work months
• 3 Grace months
• 36 months Extended period of eligibility
• 60 months Expedited reinstatement
• 105 months = Almost 9 years that claimant stays connected to SSDI for the cash benefits
• 301 Pmts
CONTINUATION OF MEDICARE
• Starts at end of TWP
• 93 months starting the month after TWP
• 9 month TWP
• 93 months after TWP
• 102 Months of Medicare = 8 ½ years
TICKET TO WORK ACT OF 1999
• Ticket is a voucher to receive rehabilitation or training services from Employment Networks (EN)
• Almost anyone receiving SSDI or SSI disability 18-64
• Does not mean SSA believes claimant is no longer disabled
TICKET PROCESS OVERVIEW
• Ticket received by an SSDI/SSI claimant
• Claimant decides if they want to attempt to return to work and use the ticket
• Claimant contacts MAXIMUS 1-866-968-7842 for information on EN’s
• Claimant selects EN and they agree on an IWP (Individual Work Plan)
MORE TTW ENHANCEMENTS
• The Continuing Disability Review (CDR) process has changed
• Beneficiaries using Ticket will not be selected for a medical CDR
• SSDI/SSI beneficiaries who have received benefits for 24 months No Med CDR Section 111 Protection
• Regularly scheduled CDR’s will continue
SSI Payment Computation
$ 500.00 Social Security- 20.00 General Exclusion$ 480.00 Countable income$ 500.00 Wages- 65.00 Earned Income Exclusion$ 435.00 ÷ 2 = $217.50 Countable incomeTotal C/I $217.50 + $480.00 = $697.50$870.00 - $697.50 = $172.50 SSI
SSI WORK INCENTIVES
• Impairment related work expenses-IRWE
• Blind work expenses BWE
• Earned Income Exclusion
• Plan to Achieve Self Support-PASS
• Property Essential to Self support-PESS
• EXR• Continued Medi-cal
eligibility-1619b $2899 month
• Reinstatement eligibility without new application
• Student Earned income Exclusion
• 301 pmts
SSI WORK INCENTIVE EXAMPLE
• Tom goes back to work at Petco ParkSSI rate CA $935 no countable income $2500 gross wages -$1640 Student Earned Income Exclusion -$85 General & Earned Income Exclusion $775 countable income -$50 IRWE for Drugs -$725 countable income
SSI WORK INCENTIVES
$725 countable income -$362.50 ½ remaining earnings =$362.50 countable income -$100 BWE taxes and lunches at work =$262.50 countable income -$162.50 PASS for books and computer =$100 countable income $935-$100 = $835 SSI + $2500 wages =$3335 Total monthly income
Dealing with Social Security
• Online www.socialsecurity.gov
• Telephone: 1-800-772-1213
• In person
• 8 Branch offices in San Diego County
• Servicing areas
SAN DIEGO SSA OFFICESToll Free 1-800-772-1213
• 1333 Front St San Diego CA 92101 Tel: 619.557.5257• 626 L St. Chula Vista CA 91911 Tel: 619.427.7414• 846 Arnel St El Cajon CA 92020 Tel: 619.440.2943• 2160 S El Camino Real Oceanside CA 92054 Tel: 760.439.8025
• 8505 Aero Drive San Diego CA 92123 Tel: 858.278.1099• 2530 E Plaza Blvd National City CA 91950 Tel: 619.267.1175• 7961 University Ave La Mesa CA 91941 Tel: 619.464.8533• 367 Via Vera Cruz San Marcos CA 92078 Tel: 760.471.2155
QUESTIONS
E-Serviceswww.socialsecurity.gov
• Apply for retirement• Apply for SSDI• Apply for Medicare
Part D• Request a Social
Security statement• COA, telephone #• Replace Medicare
card
• Check status of online application
• Request a proof of income letter
• Get a form 1099/1042S
• Apply for direct deposit
• Retirement Estimator
HOW TO CONTACT THE PASS CADRE
♦ Toll Free 1.888.674.6250 ♦ Local 619.557.6605 ♦ Fax 619.557.5722 ♦ Mailing Address: 1333 Front Street San Diego CA 92101 ♦ PASS Specialist: Patrick Mattis & Peter Prather