Thinking About Work
Glossary of Benefits Terms
Terms below are listed in alphabetical order by topic.
Affordable Care Act – Enacted to increase the quality and affordability of health insurance across the states for all. People of low income may be eligible for a subsidy (like a discount) for health insurance both on the cost of the insurance and out of pocket expenses like co-pays and deductibles. Typically you have choices of different plans. You can take the subsidy on you monthly payments or as a tax deduction all at once. It is one more way that persons with disabilities who do not otherwise have health insurance can obtain it. People with pre-existing conditions cannot be denied insurance coverage, and all people not covered by another health insurance plan such as an Employer’s plan, Medicare or Medicaid, will need to enroll or pay a penalty. There are very few exceptions to this.
Benefits Specialists – Experts who have been trained to have working knowledge of Social Security benefits and work incentives; Medical Benefits. Certified Benefit Specialists will also know information about food, housing and other benefits.
Disabled Adult Child – A dependent child aged 18 or older whose disability began before age 22 (son,daughter, or eligible grandchild of a retired, deceased, or disabled worker who was/is entitled to Social Security benefits.)
Dual Eligibility: Medicare and Medicaid – Some individuals are eligible for both Medicaid and Medicare at the same time. A person may be on Medicaid due to disability and/or low income but on Medicare because s/he has been on Social Security Disability Insurance for at least two years. There are some new specialized services for the “dual eligible“ beneficiaries who have especially challenging disabilities.
Extended Period of Eligibility (EPE) – This is the period of time (36 months) after the 9 month of Trial Work have finished. The SSDI beneficiary is allowed to work during this period and earn up to $1090. gross income a month, which is SGA in 2015 per month or less without loss of benefits. If the work income is at or over $1090. gross income a month from work, they would lose their SSDI benefit for that month. When the EPE is over, the very first time the person earns SGA, their SSDI case can close and their SSDI cash benefit stop.
Impairment Related Work Expenses (IRWE) – This is an incentive which requires the worker to document disability related expenses (which allow them to work to) Social Security. Social Security then reduces the amount they are taking out of your check because of wages. Examples of IRWE costs are medicine, medical supplies, medical devices, service animals, bandages and syringes. Out–of–pocket medical services such as doctor’s visits and out–of–pocket expenses for transportation might be examples of IRWE depending on circumstances
Individual Development Account – This is an asset building tool designed to enable low-income families to save towards a targeted amount usually used for building assets in the form of home ownership, post-secondary education and small business ownership. This is not a Social Security Program but is usually a matching of government and private funds that match the worker’s savings account. IDA has been available in 17 states and Washington D.C.
Medicaid – A joint federal and state health insurance program that helps low-income individuals or families pay for the costs associated with medical and custodial care, provided they qualify. Although largely funded by the federal government, Medicaid is run by the state so coverage and options may vary. See also Affordable Health Care Act.
Medicaid Buy-In – Some states have programs that allow persons who are disabled and working to purchase low cost Medicaid policies with rates based on their income.
Medicaid 1619 b Benefits – This option is for SSI recipients who have earnings too high for a SSI cash payment. They can be eligible if they meet certain income and disability requirements, and continue to need Medicaid. SSA decides whether a person’s earnings are high enough to replace his/her SSI and Medicaid benefits. This amount is based on the amount of earnings which would cause SSI cash payments to stop in the person’s State and average Medicaid expenses in that State.
Medicare – The insurance program that offers hospital coverage (Part A) and optional supplemental medical coverage (Part B) to Social Security Disability beneficiaries 24 months after eligibility for benefits has been established. It also includes Medicare Advantage option (Part C), which provides the ability to participate in private plans, and prescription coverage (Part D).
Medicare Buy In Programs – Also known as Medicare Savings Programs, help reduce out of pocket expenses for people of low income. There are three separate components: in general, Qualified Medicare Beneficiary (QMB): Pays for Medicare Part A and B premiums, deductibles and have no coinsurance or copayment for Medicare-covered services co-insurances or copays. Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare’s Part B premium. And Qualifying Individual (QI) Program: Pays for Medicare’s Part B premium. All of these programs qualify a person for Extra Help in paying for Medicare Part D costs.
Plan to Achieve Self Support (PASS) – Lets a disabled individual set aside money outside of the asset and resource limits (s/he owns not needed) to pay for items or services needed to achieve a specific work goal. As Social Security reduces the SSI when a person works, in a PASS plan the reduction is set aside in a dedicated account to fund the PASS. The applicant develops a written plan to document what training, items, or services they need to reach a specific work goal. A PASS can include supplies to start a business, school expenses, equipment and tools, transportation, uniforms and other items or services you need to reach the employment goal. The person writes a plan outlining the expenses incurred to reach the vocational goal. Social Security usually requires the plan is signed off by a Certified Rehabilitation Counselor. There is an ultimate goal of reducing or eliminating the Social Security benefits by working. It is designed for SSI recipients but at times it can be used for SSDI beneficiaries if the person is able to become eligible for an SSI benefit. In this case, the SSDI benefit is used to fund the PASS. (not needed work related expenses are extensive enough).
Substantial Gainful Activity (SGA) – the amount of work income earned in any month that Social Security considers to be significant earnings. It is used to determine whether the individual is eligible to receive the SSDI disability benefit during the Extended Period of Eligibility; and to establish that an individual, after completing the Trial Work Period and Extended Period of Eligibility, has successfully returned to work and is no longer eligible for cash benefits. The SGA level in 2015 is $1090. This amount can change every January 1st, depending on the federal cost of living increase or decrease.
Social Security Disability Insurance (SSDI) – Social Security pays disability benefits if you have worked long enough, paid into the Social Security system. You also must have a medical/psychiatric condition that has prevented you from working or is expected to last at least 12 months or result in death.
Supplemental Security Income (SSI) – a federal program funded by tax revenues (not Social Security) for low income disabled, aged and blind persons. The amount received each month depends on your living situation, the state where you live and other factors. The federal amount stays consistent across states, but each individual state can choose to issue a State Supplemental Payment (SSP).There are asset and resource limits.
Ticket to Work – Is provided via a letter (the “Ticket”) from Social Security letting beneficiaries know that they can apply for vocational rehabilitative services to help them return to work. They do this by using a person or agency on the Social Security approved list. These providers are called Employment Networks (EN’s). If someone chooses to do this, they keep their Medicaid or Medicare throughout the process.
Trial Work Period – a (one time) period of 9 (not necessarily consecutive) months in which a Social Security Disability Insurance (SSDI) beneficiary may test his or her ability to work, get their full SSDI benefits, regardless of work earnings, and still be considered disabled. A month of Trial Work counts toward your nine months if you make more than $780 (gross income a month in 2015) or if you work more than 80 hours per month in self-employment. At the end of the Trial Work Period, Social Security determines if you are earning “SGA”.
Work Incentives Planning & Assistance Projects (WIPAs) – Provide free benefits counseling to Social Security disability beneficiaries to help them make informed choices about work. WIPA projects offer a range of services to help you understand your options if you choose to pursue work. WIPAs are staffed by Community Work Incentive Coordinators, certified by Social Security, who provide in-depth counseling about working, earning more money, and how working may affect your benefits.