Returning to Work: Questions and Answers for People Receiving SSI and/or SSDI

WORK AND SOCIAL SECURITY

Q IF I GO BACK TO WORK WHILE RECEIVING EITHER SSDI OR SSI BENEFITS, DO I HAVE TO TELL SOCIAL SECURITY?

A Yes. You should always report your earnings to the Social Security Administration (SSA), and you should talk to a claims representative before you start working, so you will know what and when you have to report. Keep a copy of any pay stubs you submit and a record of when you reported the earnings to SSA.

Q I AM ON SSDI. IF I GO BACK TO WORK, WILL I LOSE ALL OF MY SSDI BENEFITS?

A No. Or at least not right away. You can receive your entire SSDI check during your "trial work period." Your trial work period is nine months long. Any month you earn more than $530 will be counted as one of the nine months of your trial work period. Note: On January 1, 2001, the Trial Work Period amount rose from $200 a month to $530 a month. Any months worked before January 1, 2001, the trial work period amount is $200. The nine months donít have to be all at the same time. Social Security will count any months you work in a five year period as part of the trial work period.

Once you have accumulated 9 months of trial work, then Social Security will start looking at months in which you make more than $740, as of January 1, 2001. If you earn more than $740 per month, Social Security will consider that "substantial gainful activity." Note: On January 1, 2001, the $740 a month rose from $700 a month. Earnings in any month between July 1, 2022 and January 2001, substantial gainful activity is $700 a month. On July 1, 1999, the $700 figure rose from $500. Earnings in any month before July 1, 2022 will be have to fall below the $500 level in order to not count as substantial gainful activity.

Q WILL I LOSE MY SSDI BENEFITS AT THE END OF MY TRIAL WORK PERIOD?

A You will be able to keep your SSDI benefits for 3 more months after your trial work period ends. Then, if you continue working and make more than $700 a month, your SSDI check will stop. Note: On January 1, 2001, the $740 figure rose from $700.

Q CAN I GET MY SSDI CHECK BACK AGAIN IF I LOSE MY JOB AFTER THE TRIAL WORK PERIOD?

A It depends on whether Social Security thinks you are still disabled. During the three months after your trial work period, Social Security will look at your medical records to see if your health has improved enough that you are no longer considered disabled. If Social Security finds that you are still disabled, then you will be covered under what Social Security calls an "Extended Period of Eligibility" for the next 36 months. You will automatically be eligible for your SSDI check in any month during the Extended Period of Eligibility in which your earnings drop below $740.

Note: On January 1, 2001, the $740 a month figure rose from $700.

On the other hand, if Social Security looks at your medical records and decides that they show "medical improvement" then they will send you a notice saying that they no longer consider you disabled. Then the only way you will be able to get your SSDI benefits back will be by appealing (and winning) or applying all over again.

Q SO DOES THAT MEAN THAT JUST BY GOING BACK TO WORK SOCIAL SECURITY IS GOING TO ASSUME THAT I AM NOT DISABLED AND TERMINATE MY BENEFITS?

A No. Social Security will assume that you are still disabled. They canít use the fact that youíre working to prove otherwise. But they can (and will) look at your medical records to decide if you are still disabled. Some people will clearly still be disabled. However, if you have improved so that you really are functioning a lot better, then there is a real risk that Social Security might conclude that your condition has medically improved and you are no longer disabled under their rules.

Q DO ALL OF MY EARNINGS COUNT TOWARD THE $530 OR $740 LIMITS, OR ARE THERE SOME DEDUCTIONS?

A Social Security counts the gross monthly wages you earn only for the Trial Work Period months. For months after the ninth month of the Trial Work Period, SSA recognizes certain expenses that can be deducted from gross monthly wages to reduce monthly income below the substantial gainful activity level.

  1. Subsidies: If your employer pays you and you are not really doing the work that would be required of you, (because your employer wants to be nice to you) your "earnings" could be
    considered as a subsidy and the money would not be counted as income.
  2. Business related expenses: self-employed persons can deduct the reasonable cost of business-related expenses from monthly gross earnings.
  3. Impairment Related Work Expenses (IRWEs): these are expenses that are necessary to go to work and stay on the job. These include most drugs and medical services. IRWEs can also include items such as personal attendant care, medical or prosthetic devices, residential modifications and special transportation (such as cab fare). All IRWEs can be deducted from gross monthly earnings to get below the $740 a month SGA. SSA must approve any IRWEs deductions.

 

Note: On January 1, 2001, the $740 figure rose from $700.

Example:
You earn $950 a month in gross wages. Because of your disability, you must take medication to allow you to get to and perform your job. This expense costs you $300 a month out of your pocket. Your countable wages for SSA purposes are therefore $650 ($950 minus the $300 prescription costs). Since your countable wages are less than $740 per month, your SSDI benefits will continue.
$950 (gross monthly earnings)
- $300 (cab fare)
$650 (countable wages)

Q I RECEIVE SSI INSTEAD OF SSDI. DO I STILL HAVE A 9 MONTH TRIAL WORK PERIOD?

A No. The Trial Work Period only applies to people who get SSDI. Your SSI check will be affected as soon as you go back to work. But you may still be able to keep some of your SSI check, even if you work more than 9 months.

Q WHAT WILL HAPPEN TO MY SSI CHECK IF I GO BACK TO WORK?

A SSI is called a "means-tested" program. It is only available to people who have little or no income or assets. As your income goes up, your SSI check goes down, or ends altogether. But Social Security wants people on SSI to work, so they donít count some of the money you earn when they are calculating how big your SSI check will be. Social Security calls income you earn from employment or self-employment Earned Income.

The first $20 of any earned or unearned income you have is subtracted. In addition, SSA subtracts $65 plus 50% of the remaining earned income. This is called the earned income disregard.

Q IF I QUIT OR LOSE MY JOB, HOW SOON CAN MY SSI BENEFITS START AGAIN?

A If you lose your job within 12 months after your SSI benefits were stopped because your earnings were too high, and you are still disabled, your SSI benefits would start again without a new application. If you work for more than 12 months after your SSI or Medicaid stopped and then lose your job, you may need to reapply for SSI.

Q DOES THIS MEAN I CAN EARN AS MUCH AS I WANT AND STILL RECEIVE SSI?

A No. Once your earned income is roughly twice the monthly SSI benefit rate, plus the $85 in disregards, you will no longer be eligible for SSI. In 2001, this figure is $1,244 per month--or higher if you have business-related expenses or Impairment Related Work Expenses (IRWEs).

Example:
You receive $530 from SSI (in 2001).
You go back to work and earn $600 a month in gross wages.
SSA will subtract the first $85 of the $600 to get $515.
Then SSA subtracts 50% of the remainder (50% of 515) to get $257.50.
Then SSA subtracts the $257.50 from the $530 SSI benefit to get $272.50, which is how much you can get in SSI. Thus you have earnings of $600 from your employment, and SSI benefits of $242.50, for a total monthly income of $872.50.
You have improved your monthly income by $372.50 by going to work.

Remember, if you have a subsidy, business related expenses, or IRWEs, you would deduct them from your gross wages before you subtract the income disregard of $85, and then take 50% of the remainder. That gives you a larger SSI benefit.

Q WHAT IS A "PASS" PLAN THAT I HAVE HEARD ABOUT?

A The Plan for Achieving Self Support (PASS) program allows disabled SSI and SSDI beneficiaries to receive SSI by excluding from their SSI eligibility and benefit calculations any income or resources used to pursue a work goal. Anyone interested in pursuing a PASS must submit an application to their local SSA office (there is an application form that is not mandatory to submit, but you are advised to use it), and the PASS must be approved by SSA before your income and resources will be excluded. You should have someone familiar with PASS help you with your application.

Q I RECEIVE BOTH SSDI AND SSI BENEFITS. WHICH WORK INCENTIVES APPLY TO ME?

A Unfortunately, both programs have different rules, and both apply to you. For example, you will have a 9 month trial work period for SSDI, and if you are earning over $740 a month after 12 months, you will lose your SSDI benefits, but you could have some SSI benefits after the 9 months if your earnings are low enough. Note: On January 1, 2001, the $740 figure rose from $700. It is more likely that you will lose your SSI benefits first, though, since your SSI benefits probably do not amount to much of your total benefits.

 

HEALTH INSURANCE

Even though you're feeling better, there is probably no issue more important than knowing that your medical expenses will be covered even if you go back to work. Right now your health care expenses may be covered by Medicare or Medicaid, or both. This chapter discusses how each of those programs may be affected if you return to work, and what your alternatives are.

Q WHAT SHOULD I LOOK FOR IN A WORK HEALTH INSURANCE PLAN?

A When you look for a job, look for one with a good health insurance plan. A good plan should cover your doctor and hospital bills with little or no deductible or co-payment, it should cover your prescriptions, and it shouldn't have a waiting period for pre-existing conditions. You'd also like to have the option of choosing a plan that's not an HMO so that you can keep your existing doctors and not have to worry about getting approval from someone every time you need a specialist.

Q WHERE ARE JOBS WITH GOOD HEALTH INSURANCE?

A Large employers are more likely to have plans that don't exclude pre-existing conditions. Large
employers may also be more likely to offer several plans so you don't have to be in an HMO. Most full-time government jobs have good health insurance. Most unionized employers and many not-for-profits offer good health insurance. But there are also many small companies that offer good health insurance plans, and many large ones that only offer a bare-bones HMO plan.

Q HOW DO I FIND OUT WHAT KIND OF INSURANCE A PROSPECTIVE EMPLOYER
OFFERS?

A You probably won't make a good impression in an interview if you spend a lot of time asking about health insurance. But it's all right to ask about fringe benefits generally and when you actually get an offer, by all means ask for a detailed description of the salary and benefit package.

Q WHAT IF THE EMPLOYER'S HEALTH INSURANCE PLAN WON'T COVER
PRE-EXISTING CONDITIONS?


A Exclusions for pre-existing conditions can be a serious problem for people with disabilities who go back to work. Recently, however, the Health Insurance Portability and Accountability Act of 1996 (_HIPAA_) made it much harder for group health insurance companies to refuse to cover pre-existing conditions. The new rules apply to any employer that has at least two employees in its group plan.

HIPAA says that the longest any employer can exclude a pre-existing condition is 12 months. More importantly, HIPAA says that if you already had group health insurance for at least 12 months, (or 18 months if you are joining your group plan late), then when you switch jobs, or start a new one, your new health insurance has to cover your pre-existing condition right away. Even people who have been on Medicaid or Medicare have some protection under HIPAA. If your new job has a pre-existing condition limitation, and your employer says it applies to you, check with an attorney to find out if HIPAA can help you.

There is one other important thing you need to know about HIPAA. First, if you have a break of more than 63 days in your present insurance, then you can't count the months before the break toward your pre-existing exclusion period. This can be a problem for people on Medicaid who start doing temporary or part-time work, or start back to work in some other job without health insurance.

Q WILL I BE ABLE TO KEEP MY MEDICARE COVERAGE IF I GO BACK TO WORK?

A If you have Medicare, you will probably be able to keep your Medicare coverage after you return to work. You will keep your Medicare for at least the first 12 months you work. Then, if you are still considered disabled, you will be able to keep your Medicare if you continue to work.
Starting on October 1, 2000, for the first eight and one-half years after you return to work, your Part A (hospitalization) coverage will be free. (This includes the Trial Work Period). You'll only pay for the Part B coverage which is probably now being deducted from your Social Security check. After the eight and one-half years, you can continue to buy Medicare coverage if you are still disabled, although then you would have to pay both Part A and Part B premiums.

As you know, Medicare doesn't cover prescription drugs. Unless you've got some way to pay for your prescriptions, Medicare alone won't be enough to assure you access to all the health care you need as a person with a disability.

Q CAN I KEEP MY MEDICAID BENEFITS IF I GO BACK TO WORK?

A If you get SSI now, you probably also have a Medicaid card which you use at the doctor's office, for hospitalizations, and to buy your prescriptions. It's very hard to keep your Medicaid when you return to work, because the income limits for Medicaid in Illinois are so low.
There are two groups of people who now get SSI and who can keep Medicaid when they go back to work. If you earn over $740 per month, but under $1,244 per month, you should still get a small SSI check every month after Social Security makes adjustments for your earnings. People who work and make over $740 per month and still get an SSI check can continue their Medicaid under a special program called 1619(a).

It works this way: when you earn over $740 a month in gross earnings, and report it, SSA will automatically put you in the 1619 program, although you should contact SSA to confirm this. SSA will use the earned income disregards and exclusions (discussed in the chapter about SSDI and SSI) to determine the amount of SSI benefit. SSA should also notify the Department of Human Services that you are on the 1619 program. The Department of Human Services should continue your Medicaid eligibility without a spenddown.

Very few people in Illinois get their Medicaid under the 1619a program, but it's an important benefit for low-income workers. If you are working and getting an SSI check, be sure that your local Medicaid office is continuing your benefits. (You should contact an attorney if the Department of Human Services puts you in a spenddown or terminates your Medicaid coverage.)
There are also a few people who can make up to approximately $23,271 and keep their Medicaid. If you have been on SSI and Medicaid, and are still seriously disabled even though you're working, Social Security can put you on a special list that will let you keep your Medicaid benefits without a spenddown. This program is called 1619(b). To be eligible for continued Medicaid coverage under 1619(b) you must meet the following conditions:

If you think you might be eligible, tell the Social Security worker to evaluate you for "1619(b)" benefits. Your Medicaid benefits should not be terminated by the Department of Human Services until Social Security makes the 1619(b) determination.

Q CAN I BUY MY OWN HEALTH INSURANCE IF I CAN'T QUALIFY FOR A GROUP POLICY?

A Individual health insurance policies will be expensive and hard to find for people with disabilities. The State of Illinois offers a health insurance plan, called I-CHIP (Illinois Comprehensive Health Insurance Plan) for people who cannot buy other health insurance. I-CHIP has a variety of plans, with a wide range of deductible amounts. It also offers a plan for people on Medicare that includes prescription drug coverage.

There are two major problems with I-CHIP insurance. First, for most people, it includes a six-month exclusion for pre-existing conditions. That means that your pre-existing conditions would not be covered for the first six months. The exclusion doesn't apply to people who have been on another group health insurance program for at least 18 months and haven't had a break of insurance more than 63 days long. So if you are just now losing your COBRA insurance, you may qualify for I-CHIP without the six-month exclusion.

The second problem with I-CHIP is that it can be expensive. For people living in the Chicago area, monthly premiums for a single man run $141 to $1269, depending on your age, whether you elect the PPO policy, and the amount of your annual deductible. The Medicare prescription drug policy that most people choose costs $111 per month for a man under age 30 living in the Chicago area. Still, these costs are inexpensive compared to the costs of some prescription drug treatment. If you can afford the premiums, and have no other source of insurance, I-CHIP may give you the coverage you need to return to work.


GOING BACK TO WORK Ė DISCRIMINATION IN THE WORKPLACE

If you go back to work, you may be concerned that you will be discriminated against because of your status as a person with a disability, or you may need some accommodation in order to go back to work. The Americans with Disabilities Act (ADA) makes it unlawful to discriminate in employment against a qualified individual with a disability if the person can perform the essential functions of the job with or without a reasonable accommodation. The ADA makes it unlawful to discriminate in all employment practices, including:

Q WHAT IS CONSIDERED A DISABILITY UNDER THE ADA?

A Under the ADA, a person has a disability if they have a physical or mental impairment that
substantially limits a major life activity.

Q WHAT DOES THE ADA MEAN BY "QUALIFIED"?

A A qualified individual must satisfy the job requirements for educational background, employment experience, skills, licenses, and any other qualification standards that are job related. The ADA does not interfere with an employer's right to hire the best qualified applicant. The ADA does not impose any affirmative action obligations.

Q HOW ARE ESSENTIAL FUNCTIONS DETERMINED?

A Essential functions are the basic job duties that an employee must be able to perform. Factors to consider are:

Q WHAT IS A REASONABLE ACCOMMODATION?

A A reasonable accommodation is any change or adjustment to a job or work environment that permits a qualified applicant or employee with a disability to participate in the job application process or to do the job successfully and that does not create undue hardship to the employer.
For example, reasonable accommodations may include:

Q HOW DO I GET AN ACCOMMODATION?

A If you need an accommodation, you must request one. It is not up to the employer to try to anticipate or assume that you need one.

Q WHEN DOES A REASONABLE ACCOMMODATION BECOME AN UNDUE HARDSHIP?

A Undue hardship means that an accommodation would be unduly costly, extensive, disruptive, or would fundamentally alter the nature or operation of the business. Among the factors to be considered are the cost, the employer's size, financial resources and the nature and structure of its operation.

Q MUST I DISCLOSE MY HEALTH STATUS TO MY EMPLOYER?

A No. Unless you need a reasonable accommodation to perform the essential functions of the job, it is not necessary to disclose your health condition.

Q CAN THE EMPLOYER ASK QUESTIONS ABOUT MY HEALTH OR REQUIRE A MEDICAL EXAMINATION AS A CONDITION OF EMPLOYMENT?

A NO! It is unlawful to ask an applicant whether he or she is disabled or to require the applicant to take a medical examination before making a job offer.

After a job offer is made, you may be required to have a medical examination but only if everyone else who will be working in the job category also must have an examination. A job offer may be conditioned on the results of the medical exam. If you are not hired because a medical examination reveals your disability, the employer must be able to show that the reasons for exclusion are job related and necessary for the conduct of their business. They must also be able to show that there was no reasonable accommodation available that would make it possible for you to do the job.

Q IF MY EMPLOYER KNOWS ABOUT MY DISABILITY, WILL MY COWORKERS KNOW?

A They shouldn't know if you don't tell them. The results of all medical examination or information from inquiries about a disability must be kept confidential by your employer and maintained in separate medical files. In addition, if you have HIV for example, the AIDS Confidentiality Act prohibits anyone from disclosing your status without your consent.

 

THE FAMILY AND MEDICAL LEAVE ACT

The Family and Medical Leave Act of 1993 (FMLA) entitles eligible employees to take reasonable leave for medical reasons, for the birth or adoption of a child, or for the care of a child, spouse, or parent who has a serious health condition. The Act requires covered employers to provide up to 12 weeks of leave per year.

Q WHO IS COVERED?

A In general, any employer who employs 50 or more employees is covered. Any employee who has been employed an average of 25 hours per week for at least 12 months is eligible.

Q WHAT NOTICE MUST I PROVIDE BEFORE TAKING LEAVE?

A An employee must provide at least 30 days advance notice before FMLA leave is to begin if the need for the leave is foreseeable. If 30 days notice is not workable, notice must be given as soon as practicable--generally at least two daysí notice.

Q DO I HAVE TO DISCLOSE MY OR MY FAMILY MEMBER'S MEDICAL CONDITION?

A Probably. An employer may require that a request for leave under FMLA be supported by certification issued by the employee's health care provider.

Q WILL I GET PAID DURING MY LEAVE?

A No, unless your company has a paid leave policy or a short-term disability plan.

Q WHAT ABOUT MY HEALTH INSURANCE DURING MY LEAVE?

A During any leave under the Act, an employer must maintain your health coverage under any group health plan. An employee is obligated to pay health plan premiums while on leave ONLY to the same extent as when not on leave.

Q DO I HAVE TO TAKE MY LEAVE ALL AT ONCE?

A Often, leave will be taken in large segments of time or the full 12 weeks. However, when medically necessary, leave may be taken on an intermittent or reduced schedule basis. This may include periods of an hour or several days at a time.

 

OTHER FINANCIAL ISSUES FOR PEOPLE RETURNING TO WORK

Many people's financial situations change dramatically when they become disabled and can no longer work. You may be collecting long-term disability insurance from a former employer. You may have unpaid bills or have recently filed for bankruptcy. This section addresses these financial issues for people who are now returning to work.

Q I GET LONG TERM DISABILITY BENEFITS FROM MY COMPANY. WILL I LOSE THEM IF I GO BACK TO WORK?

A Every long term disability policy is different. Some say that all of your benefits end if you go back to work. If your policy says that, you should be very sure of yourself and your ability to work before you give up those benefits. But many policies now include provisions that encourage you to go back to work. They may allow you to work part-time without losing your benefits. They may keep your eligibility status active, so that you have a period to "try out" work before you lose your benefits. They may provide that if you go back to work you'll get benefits in any month in which your income drops below a certain level.

The only way to know what your plan allows is to read it carefully. If you are at all uncertain about what your plan allows, be sure to consult with an attorney or someone at the plan office before you make a change that may cause you to lose these benefits.

Q I GOT BEHIND ON MY BILLS WHEN I HAD TO QUIT WORK. WILL I HAVE TO START PAYING ON ALL THOSE OLD DEBTS AGAIN?

A People who are very ill often have debts. You may owe money for uncovered medical expenses, school loans, car loans, credit cards, utility bills, health club memberships, or any other expense. When you were ill, and your only income was Social Security, you may have been advised that you were "judgment proof" and may have written to your creditors telling them that you could not pay. Or you may have already been declared bankrupt so that your debts were wiped out.

If you go back to work, you will no longer be judgment proof. If your creditors go to court and get a judgment against you they can garnish your paycheck or your bank account. There are laws limiting how much money a creditor can take out of your paycheck. If you make less than $213 a week after taxes, then your creditors cannot garnish your paycheck. If you make more than that, however, they can take up to 15% of every paycheck. So if you make $300 per week after taxes, your creditors can garnish $45 every week, or about $180 per month.

If going back to work means that you will suddenly be faced with lots of old bills you cannot pay, then this might be a good time to consider filing for bankruptcy. There are two forms of bankruptcy--Chapter 7, which wipes out all of your old debts, and Chapter 13, which creates a plan for paying off some or all of your old debts. If you are considering filing for bankruptcy you will have to see an attorney to help decide which form is right for you and represent you in bankruptcy court.

If you have already filed for bankruptcy, then you probably know that you can't file a second Chapter 7 bankruptcy for six years. If there are now other people you owe money to, then returning to work means that you have to be prepared to pay those bills.
Chapter 13 bankruptcy is available to people who have filed either Chapter 7 or Chapter 13
bankruptcy in the past.

Checklist
This checklist should remind you of some of the important issues you need to consider when you return to work. This checklist is strictly a practical one. It does not deal with issues such as job satisfaction, possible job-related stress, or your personal health issues. Often, of course, these factors may be more important to you as you make your decision than the practical factors described here.


RESOURCES

Social Security Administration (applications, appeals, reporting work)
Contact your closest office or call (800) 772-1213; TTY (800) 325-0778
Illinois Department of Human Services (processes Medicaid applications, income reporting, and appeals)

Contact your local office or call (800) 720-4166

Illinois Comprehensive Health Insurance Plan (I-CHIP)
(800) 367-6410

SSI Coalition (to discuss SSI/SSDI representation, including assistance on Return to Work issues or to get speakers on SSI/SSDI issues or Return to Work issues)

(312) 223-9600; TTY (800) 427-0766

 

FOR PEOPLE WITH HIV:

Illinois AIDS Drug Assistance Program (ADAP) -
(800) 825-3518

Illinois Department of Public Health, AIDS Activity Section (to get help paying COBRA premiums)
(800) 825-3518

AIDS Legal Council of Chicago (legal assistance on issues related to your HIV status, including any of the topics discussed in this booklet, or for speakers on Return to Work or other legal issues affecting people with HIV)
(312) 427-8990

Legal Assistance Foundation of Chicago, HIV/AIDS Project (legal assistance for low-income Chicago residents with HIV)
(312) 347-8309

AIDS Foundation of Chicago (to get a case manager or to learn about and discuss AIDS advocacy issues)
(312) 922-2322

Note: This manual is not intended to substitute for legal advice. Please contact one of the legal resources noted above if you have specific questions about your case.
2/1/01

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