SSDI Benefits Analysis Report
The purpose of this report is to provide an ADEN Participant a written record which
verifies current SSA disability, and related benefits, and the impact of work on these
benefits. We have based the information in this report on information received from
you, and from the Social Security Administration (SSA).
The goal of the Ticket to Work program, and services through the American Dream
Employment Network (ADEN) is to assist SSA disability beneficiaries in returning to
gainful employment, leading to self-sufficiency. We hope this report will assist you in
understanding how your work activity will lead to a reduction, and/or eventual
elimination of benefits, and to a successful transition to self-sufficiency.
Summary of Your Current Situation
Name:
SSN:
Date:
The following is a list of income, benefits and services you reported that you get
from the SSA and other places (child support, food stamps, Medicaid, etc.), as
well as information we received from the Benefits Planning Query (BPQY) report
requested from SSA.
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Your date of onset (the date SSA first established that you became disabled) is listed as:
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Your date of entitlement to cash benefits was
Your current benefits amount reported is
/month
Your BPQY Report indicates that List whether Dependents benefits are being paid
You are scheduled for a Continuing Disability Review (medical review) every
years, and the next one scheduled is for
o Remember that if you make Timely Progress while your Ticket is assigned
to ADEN, SSA will not conduct your scheduled medical Continuing
Disability Review unless it was started prior to assigning your Ticket.
o For more information about Timely Progress Review guidelines, see:
http://www.ssa.gov/pubs/EN-05-10062.pdf
You currently receive Medicare Part A and Part B Indicate if they notified you of a Part D
plan, and adjust as necessary if opted out of Part B
o MEMBERS: This will be discovered in part through the discovery process with
your Participant, and from the BPQY
BPQY shows that you have used
month(s) of your Trial Work Period (TWP)
The BPQY shows the following earnings Discuss earnings listed
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
What we discussed about your employment plans or goals:
Member Instructions: Use this section to describe your Participants Employment
Plan, and potential earnings you will base your advisement on, if not already
employed. If using an employment projection, use the estimated wage and hours for
the examples you will provide later in this report
Analysis of your Current Situation and Plans
How your plans may affect your SSA disability benefits:
TRIAL WORK PERIOD
Trial Work Period (TWP) months protect your SSDI benefits, and any Dependents
benefits paid under this program, regardless of how much you earn. There are a total of
nine (9) TWP months available to you, to help you determine if you are able to return to
work, without fear of losing your benefits or health insurance. SSA will examine your
earnings during the TWP months, and if earnings are more than $810/month gross
(2016 amount), they will count that as a TWP month. These months do not need to be
consecutive, however, when you have accumulated nine TWP months based on work
activity over $810/month gross within a 60 month period, then the next part of your
Work Incentive package begins, which will be described next.
Let’s review your use of TWP Months, according to the BPQY:
Your TWP months started on this date:
Total number of TWP months used:
Total number of TWP months still available:
AFTER TRIAL WORK PERIOD
Gross Wages vs. Countable Wages – This is something that comes into play after the
TWP is over. You will find references to both gross wages, and countable wages in this
report. Gross wages equate to your total monthly earnings, before taxes or other
deductions. Countable wages equate to the portion of earnings that SSA will count,
after deducting allowable work incentives that will be described in further detail in this
report. SSA will use countable wages to make determinations about your continued
eligibility, and/or receipt of cash benefits.
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
Grace Period - After your TWP is completed, SSA looks for a pattern of earnings that
exist above the SGA limit, the first month of this pattern of earnings is called your
cessation month. SSA will pay you for your cessation month, and for the next two
months. This three month period is called your Grace Period. These 3 months act like
TWP months in that, you can retain all of your SSDI cash benefits during this time. The
cessation of benefits is a bit confusing, but simply means you do not meet all rules of
SSA’s disability definition at this time because your wages are over the SGA limit.
Extended Period of Eligibility - The month after the last TWP is used will be the
beginning of your Extended Period of Eligibility (EPE), which is a 36 month period of
time. The EPE will end in 36 months whether you are working or not. This period of time
should be used to evaluate your long-term ability to work at self-supporting levels of
income. The EPE protects your Medicare insurance, and your status as an SSDI
beneficiary, even though you may not be entitled to a cash benefit, depending on your
earnings during this time. For months that your gross wages are above the Substantial
Gainful Activity (SGA) limit, which is $1,130/month (non-blind rate), or $1,820/month
(blind rate) for 2016, you may not be eligible for your SSDI cash benefit. For months
that your countable wages are above the SGA level, you will not be entitled to a cash
benefit. This is called benefits cessation. Even during EPE months that benefits are in
cessation (you are not receiving a cash benefit), you continue to be connected to the
SSDI program as a beneficiary. If wages fluctuate, and fall below SGA, you would again
be entitled to your SSDI cash benefit for months below SGA level earnings.
Planning your path to Self-Sufficiency, and going off benefits, must include wages that
adequately replace your SSDI cash benefits. Remember that during the EPE, and
thereafter, SSA looks at “Countable Wages”, which means they will look at Gross
Wages minus any applicable Work Incentives, which equates to Countable Wages SSA
will look at in making SGA determinations.
NOTE: The important thing to remember about the EPE, is that you have a safety
net during this time to protect you! Your eligibility, and connection to the
program is not in question during this period of time.
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
The following visual illustration should help to clarify what we’ve covered so far:
TWP-9 Months
available
EPE-36 Month
period
Gross Earnings
During this period, countable earnings over
Countable
over $810/month
SGA- $1,130/month for 2016, $1,820/month
earnings over
for 2016 uses an
(blind rate) = benefits cessation for that month
SGA = termination
available TWP
(No cash benefits) – Applies AFTER the Grace
month
Period has been established
Self-Sufficiency
Let’s track your important dates:
Date you used your last TWP month:
Date of first month of EPE:
Date of last month of EPE:
Date of benefits termination:
AFTER EXTENDED PERIOD OF ELIGIBILITY
As the chart above illustrates, continued work above SGA, which is the goal of
the Ticket to Work program, leads to benefits termination. Benefits termination
will occur the month after the Grace Period has been established and your EPE is
over. This will signify that you have achieved your goal of self-sufficiency,
congratulations for achieving this goal!
But what happens after benefits termination if you find that you have to stop
working due to your medical condition, or find that your limitations won’t allow
you to continue work at a Substantial Gainful Activity?
Expedited Reinstatement of Benefits - There is an option to return to benefits, within a
60 month period after benefits termination called the Expedited Reinstatement of
benefits (EXR). EXR is another work incentive designed to support SSDI beneficiaries.
You could consider this the last safety net for SSDI beneficiaries who successfully
return to work and lose entitlement to SSDI because of SGA level employment, and
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
then have to stop working because of the original disabling condition for which you were
approved for benefits.
You can file an application for EXR if your countable wages fall below the SGA limit or
you need to stop working during the 60 month period after benefits termination due to
your disabling condition. (After this five year period is up, you would need to file a new
application for benefits to re-enter the disability system)
If you file an application for EXR, SSA will pay you provisional benefits for six months
while they process your EXR application. Even if Social Security denies your application
for EXR, you will not need to pay back any provisional benefits paid to you while your
application was pending. The odds are in your favor when you file an application for
EXR, for SSA must prove that you have medically improved since the time you were
originally approved for benefits. In most cases, individuals who apply for EXR need to
do so because their condition has worsened, not improved.
Once approved for EXR, after receiving benefits for 24 months, not necessarily
continuously, you will be eligible for a new Trial Work Period, Extended Period of
Eligibility, and will be issued a new Ticket to Work (This is called a new period of
disability). These rules apply to persons who are disabled by impairments other
than statutory blindness; special rules apply to blind beneficiaries.
Additional Work Incentives:
There are additional work incentives you can use once you return to work. An
Impairment Related Work Expense (IRWE) is an example of a work incentive that
allows SSA to deduct certain allowable expenses from your gross wages to accurately
evaluate countable wages after the Trial Work Period is completed. In order to
determine if an IRWE exists in your situation, keep in mind that it is an expense that is
paid for by you, it is related to your impairment, and it is necessary for you to continue to
work. Once the amount of the IRWE expense is approved by SSA, it will be deducted
from your monthly gross wages to determine your actual countable wages. Examples
of IRWE might be co-pays for prescriptions, certain transportation expenses, or durable
medical goods you pay for out of pocket. See your ADEN contact, for assistance in
determining if you are paying for items or services that would qualify as an IRWE.
Another Work Incentive that SSA can use to evaluate your countable wages is
Subsidy. According to SSA, a Subsidy exists when your employer pays more for your
services than they may actually be worth. For example, if your employer offers you
more paid breaks than others with similar job titles, or offers a more flexible schedule,
extra supervision or time off work, some of your wages may be subsidized, according to
SSA. If subsidized wages exist, SSA will place a value on the exceptions an employer
is making for you, and then deduct that amount from your monthly gross wages, to
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
determine t your actual countable wages. If your countable wages are less than SGA,
then you will remain eligible for your SSDI cash benefit, even if your gross wages
exceed the SGA level. You could think of Subsidy as a way your employer is providing
you a workplace accommodation. Once a Subsidy is developed, it is in effect for as
long as you work for that employer. This Work Incentive does NOT apply in every case,
if you are uncertain about whether your employment situation would qualify for Subsidy,
or have additional questions about this Work Incentive, see your ADEN contact.
How your goals may affect other benefits you receive:
Medicare – Your Medicare (Part A and Part B if applicable) will remain in effect
throughout the Trial Work Period and the Extended Period of Eligibility regardless of
whether you are in receipt of cash benefits. Additionally, based on SSA policy, you will
be eligible for Extended Medicare Eligibility beyond the 36 month EPE. The length of
additional coverage you are entitled to is dependent on your earnings during a period of
time within the EPE, and in some cases, beyond this period. However, you are entitled
to Extended Medicare Eligibility for at least 93 months from the beginning of your EPE,
and in some cases, depending on your earnings; it can be extended for a longer period.
Your specific period of extended Medicare coverage is determined by your local SSA
field office.
Medicaid – While Medicaid is often considered insurance for individuals with very low
income and limited resources, there is a program to assist individuals with disabilities
who are working, generally called Medicaid Buy-In programs. If available in your state,
you may be eligible for this program, once you start working. Please see your ADEN
contact to find out more about Medicaid Buy-In programs, and eligibility criteria.
MEMBERS: You will need to know your state level program rules and eligibility criteria.
These are sometimes found online, through contact with local Departments of Social
Services (or Health and Human Services). If unsure, contact your Medicaid Division
Coordinator (or Manager) to inquire about Medicaid eligibility.
Financial Plans for the Future to Sustain Self Sufficiency:
Financial wellness is a key factor in securing long-term self-sufficiency, and can be
achieved when people have the right information and tools. We all want to be able to
pay our bills, get out of debt, have good credit, and be able to make choices about how
we spend money. This is very difficult on a fixed income that is only received once a
month (i.e. SSA disability benefits). ADEN is interested in helping you secure a more
stable financial future through gainful employment. See your ADEN contact for more
information about financial planning resources in your community, and completing a
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
Financial Health Assessment. Remember that your tax contributions, once working, will
assist you in establishing an increased Social Security Retirement benefit as well.
Let’s review potential strategies that might help you with your financial goals:
Member Instructions: Enter any specific Asset Development strategies that you are
recommending for this Participant here, i.e. ABLE, EITC, FSS, IDA, PASS, etc.
Try to establish a long, and short-term financial goal. This will also provide you targeted
Long-Term support services you can establish with your Participant.
If the Participant is willing to complete a Financial Health Assessment with you,
establish that as a goal with a target date for completion in this report.
Important Things for You to Remember
Recap of Important Dates:
According to the BPQY, your use of TWP months started on this date:
According to the BPQY, total number of TWP months used:
Date you used your last TWP month:
Date of first month of EPE:
Date of last month of EPE:
Date of benefits termination:
Recommended follow-up:
The following represent key benchmarks when we should meet again:
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When you start working
The month before your TWP ends
Two months after the EPE begins (planning for the end of the Grace Period)
Two months prior to the end of your EPE
When there is a change in employment
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American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
Based on your circumstances, I recommend we meet next on this date:
Member Instructions: Enter a follow up date to meet with your Participant, which will be based on
their use of Work Incentives, for example: When Participant returns to work (so you can help
develop a placement letter for SSA, and any other agencies that would need to know). At the
meeting you establish, you will then develop the next meeting based on your Participants
circumstances at that time. You should always have the next meeting developed based on their
key benchmarks, even if well in advance, so you and your Participant will be prepared.
Things to tell SSA:
The following events represent key times that require you to notify SSA in writing.
Additionally, you should either call, write or email your ADEN contact to notify them as
well:
1) When you start or stop working (Complete SSA notification letter with your ADEN
contact)
2) There is an Increase or decrease your hours
3) You get married
4) You leave school or go back to school
5) You move
6) Verification of monthly wages It is your responsibility to report your wages to your
local SSA Field Office monthly! This will help in protecting you from potential
overpayments.
Please adhere to the following guidance:
1. Request a receipt from SSA when providing pay check stubs each month, which
proves you have reported your wages to their office.
2. Keep a copy of your monthly pay check stubs that you provide to SSA.
3. Send a copy of pay check stubs to your ADEN contact for at least the first three (3)
months after you begin working.
Record keeping:
It is advised you keep the following documents in one central location:
1. This Benefits Analysis Report
2. All letters you receive from SSA, and notes and receipts whenever you report
changes and income
3. A notebook that contains notes of contacts made and events that you
document for yourself, including:
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The agency where you made the report
The date you made the report;
Who you talked to;
What you told them; and
What papers you submitted
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844.687.2336 • Deaf & Hard of hearing: 711 • info@AmericanDreamEN.org • AmericanDreamEN.org
American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.
NOTE: The information in this report is meant to help you better understand your benefits, and help you
make informed choices about your future. To prepare this report, we depended on the information you
gave us, and information received from SSA. Keep in mind that if you left something out, or if your
situation changes, this information may not be accurate. Remember that SSA and other agencies make
decisions about your benefits. This report is meant to be a resource, not a decision about eligibility.
ADEN Contact Signature:
______________________________
Date:
__________________
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844.687.2336 • Deaf & Hard of hearing: 711 • info@AmericanDreamEN.org • AmericanDreamEN.org
American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket
to Work service provider.