Ticket to Work Program
SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income)
The Ticket to Work Program is an innovative program from the Social Security Administration for individuals with disabilities who want to work. It increases your choice in obtaining the employment services, vocational rehabilitation services, and other support services you may need to get or keep a job. It is a free and voluntary service. You can use the Ticket if you choose, but there is no penalty for not using it. Also, the Social Security Administration (SSA) will not conduct a medical review of your case while you are using the Ticket.
This program is available in all 50 States and 10 United States Territories. Many Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability beneficiaries will receive a “Ticket” they can use to obtain services from a state vocational rehabilitation (VR) agency or another approved provider of their choice. The SSA calls these approved providers “Employment Networks,” which are private organizations or government agencies that have agreed to work with the SSA in providing employment services to beneficiaries with disabilities.
For Ticket to Work information, including a list of approved Employment Networks, contact the SSA Ticket Program Operations Support Manager, MAXIMUS, at its toll free numbers; 1-866-YOURTICKET (1-866-968-7842) or 1-866-833-2967 (TTY/TDD); from 8 a.m. to 10 p.m. Eastern time (Monday through Friday).
You can also find current information about the Ticket to Work Program at www.ssa.gov/work/Ticket/ticket_info.html and at www.yourtickettowork.com
Impairment-Related Work Expenses (IRWE)
SSDI and SSI. With IRWE, the cost of certain impairment-related items and services that you need to work from your gross earnings when the SSA decides if your "countable earnings" demonstrate performance of Substantial Gainful Activity (SGA). It does not matter if you also use these items and services for non-work activities. IRWE are also excluded from your earned income when your SSI monthly payment amount is being calculated by the SSA.
IRWE is deducted for SGA purposes when:
1. The item or service enables you to work;
2. You need the item or service because of your disabling impairment;
3. You paid the cost and are not reimbursed by another source; for example, Medicare, Medicaid, or private insurance;
4. The cost is "reasonable," that is, it represents the standard charge for the item or service in your community; and
5. You paid the expense in a month that you are or were working. Occasionally, an impairment-related work expense may be used before the first or after the last month of work activity.
In addition, IRWE is deducted from SSI payments when:
• You meet requirements 1 through 4 above, and
• You paid the expense in a month that you received earned income or performed work while you used the impairment-related item or service.
Note: In certain situations, the SSA can deduct IRWE amounts for expenses paid before you start or after you stop work.
Subsidy and Special Conditions
SSDI and SSI
"Subsidy" and "special conditions" are the names of the support you receive on the job that may result in you receiving more pay than the actual value of the services you perform. “Subsidy" is support provided by your employer. “Special conditions" are generally provided by someone other than your employer, for example, a vocational rehabilitation agency. The SSA considers the existence of subsidy and special conditions when it makes an SGA decision. It uses only earnings that represent the real value of the work you perform to decide if your work is at the SGA level. The SSA does not take into account subsidy or special conditions when it figures your SSI payment amount.
Subsidy or special conditions may exist if:
• You receive more supervision than other workers doing the same or a similar job for the same pay;
• You have fewer or simpler tasks to complete than other workers doing the same job for the same pay; or
• You have a job coach or mentor who helps you perform some of your work.
If your employer and/or other involved parties cannot or will not set the real value of your work, the SSA will decide the value of your work.
Unincurred Business Expenses (Self-Employed Only)
SSDI and SSI
"Unincurred business expenses" is the name the SSA uses for contributions made by others to your self-employment business effort. For example, the state vocational rehabilitation agency gives you a computer for your business, or a friend works for your business as unpaid help. If you are self-employed, the SSA generally follows the Internal Revenue Service (IRS) rules to figure your net earnings from self-employment. However, the IRS only allows you to deduct expenses for which you actually paid or incurred debt. When the SSA makes an SGA decision, it also deducts unincurred business expenses from your net earnings because it wants an accurate measure of the value of your work. It does not deduct unincurred business expenses from earnings when figuring your SSI payment amount.
For an SSDI item or service to qualify as an unincurred business expense, it must meet the following two requirements:
• It must be an item or service that the IRS would allow as a legitimate business expense if you had paid for it; and
• Someone other than you must have paid for it.
Unsuccessful Work Attempt
SSDI and SSI
An unsuccessful work attempt is an effort to do substantial work, in employment or self-employment, that you stopped or reduced to below the SGA level after a short time (6 months or less) because of:
• Your impairment; or
• Removal of special conditions (see “Subsidy and Special Conditions,” above) related to your impairment and essential to the further performance of your work.
When the SSA makes an SGA decision for initial eligibility for SSDI or SSI, it does not count earnings during an unsuccessful work attempt that occurred prior to your award.
SSDI
When the SSA makes an SGA decision to determine if your disability continues or ceases because of your work, it does not count earnings during an unsuccessful work attempt.
During the extended period of eligibility, it considers unsuccessful work attempt(s) as part of its SGA decision(s) for months up to and including the month (if any) in which it ceases your disability.
During the trial work period, or after the month (if any) in which the SSA ceases your disability, it does not consider unsuccessful work attempts because they only have effect when the SSA makes an SGA decision.
SSI
The SSA only considers an unsuccessful work attempt at the time you file an initial claim. Unsuccessful work attempts are not considered after that time.
Trial Work Period (TWP)
The TWP allows you to test your ability to work for at least 9 months. During your TWP, you will receive full SSDI benefits regardless of how high your earnings might be so long as your work activity has been reported and you have a disabling impairment.
Your TWP starts with the first month you are eligible for SSDI benefits or the month in which you file for benefits, whichever is later. The TWP continues until you accumulate 9 months (not necessarily consecutive) in which you performed what the SSA calls “services” within a rolling 60-consecutive-month period. It uses this "services" rule only to count TWP months.
You are not eligible for disability benefits or a TWP if you work at the SGA level within 12 months of the start of your impairment(s) and before the SSA approves your claim for disability benefits. This is because your impairment does not meet its definition of disability.
What happens when you complete your trial work period? The SSA can consider medical evidence that might demonstrate your medical recovery at any time. Therefore, it is possible for your benefits to stop due to your medical recovery before the end of your TWP. Unsuccessful work attempts do not apply during the TWP.
After you complete your TWP, you begin your extended period of eligibility, unless the SSA reviews your disability case and finds your impairment has medically improved.
• If the SSA decides that you cannot work at the SGA level, your SSDI benefits continue.
• If it decides that you can work at the SGA level, it pays your SSDI benefits for the month your disability ceased due either to medical improvement or your work at the SGA level plus the next 2 months. It calls this the “grace period.” Then, it stops paying your benefits.
Note: The SSA will not conduct a medical review of your disability case if you are participating in the Ticket to Work [link to Ticket to Work doc] program and your ticket is “in-use.”
Extended Period of Eligibility
If the SSA stopped your disability payments because you worked at the SGA level, it can automatically start your benefit payments again. No new application and/or disability determination is required.
The earliest it can start your benefits again is the month after the end of the grace period. (You are paid for the first month your benefits cease due to SGA and the following 2 months.)
The latest the SSA can start your benefits again is the 37th consecutive month after the end of the trial work period. If your earnings change significantly from month-to-month, it is possible that the SSA could restart your benefits frequently during this period.
Your benefits can start again for any month in the period described above in which:
• You continue to have a disabling impairment, and
• Your earnings in that month fall below the SGA level.
If you are eligible for a benefit payment for the 37th month, you will continue to be eligible for benefits until you:
• Work a month at the SGA level, or
• Medically recover.
What happens if you continue to work? If your benefits end because of your work, the SSA may be able to start your benefits again if you stop work within 5 years.
Continuation of Medical Coverage
Most individuals with disabilities who work will continue to receive at least 93 consecutive months of hospital and supplementary medical insurance under Medicare, after the nine month trial work period. You do not pay a premium for hospital insurance. Although cash benefits may cease due to work, you have the assurance of continued health insurance.
The 93 months start the month after the last month of your TWP. How do you qualify? You must work and perform SGA, but not be medically improved.
When would you get less than 93 months? You must satisfy your Medicare waiting period. Once that is complete, your continued Medicare coverage can start and continue for at least the remainder of the 93 consecutive months.
Medicare for Individuals with Disability Who Work
After premium-free Medicare coverage ends due to work, some individuals who have returned to work may buy continued Medicare coverage, as long as they remain medically disabled. Some individuals with low incomes and limited resources may be eligible for State assistance with this cost.
You are eligible to buy Medicare coverage if:
• You are not yet age 65;
• You continue to have a disabling impairment; and
• Your Medicare stopped due to work.
What kind of Medicare can you buy? You can buy Premium Hospital Insurance (Part A) at the same monthly cost that uninsured eligible retired beneficiaries pay ($410 if you have less than 30 quarters of coverage, or $226 if you have 30 or more quarters of coverage for 2007); and
You can buy Premium Supplemental Medical Insurance (Part B) at the same monthly cost that uninsured eligible retired beneficiaries pay ($93.50 for 2007); or
You can buy Hospital Insurance separately without Supplemental Medical Insurance. You can buy Supplemental Medical Insurance only if you also buy Hospital Insurance.
You may qualify for a reduction in the monthly amount of your premium for Hospital Insurance, if you:
• Have 30 or more quarters of coverage on your earnings record; or
• Have been married for at least 1 year to a worker with 30 or more quarters of coverage; or
• Were married for at least 1 year to a deceased worker with 30 or more quarters of coverage; or
• Are divorced, after at least 10 years of marriage, from a worker who had 30 or more quarters of coverage at the time the divorce became final.
When can you enroll? You may enroll:
• During your initial enrollment period (the month you are notified about the end of your premium-free health insurance and the following 7 months);
• During the annual general enrollment period (January 1 through March 31 of each year); or
• During a special enrollment period. You can enroll at any time while you are working, covered under an employer group health plan, still have a disabling impairment, or during the 8-month period that begins with the first full month after your employment or group health plan coverage ends, whichever occurs first.
How does it work with an employer group health plan? If you purchase Premium Hospital Insurance (Part A) and maintain your employer group health plan, Medicare will be your primary payer if you are working. Your group health plan would become a secondary payer.
When does the State pay premiums for Medicare? States are required to pay Hospital Insurance premiums for some working individuals with disabilities. You qualify if you:
• Are eligible to enroll in Premium Hospital Insurance for individuals with disabilities who work;
• Meet certain income and resource standards; and
• Are ineligible for Medicare on any other basis.
NOTE: Individuals with disabilities who work should contact their State agency for information
Continued Payment Under a Vocational Rehabilitation (also known as Section 301 Program)
SSDI and SSI
If the SSA finds you no longer have a disabling impairment due to medical improvement, your benefit payments usually stop. However, if you participate in an appropriate program of vocational rehabilitation services, employment services or other support services, your benefits may continue until your participation in the program ends.
To qualify:
• You must be participating in an appropriate program of vocational rehabilitation services, employment services or other support services before your disability ends under SSA rules; and
• The SSA must review the situation and decide that your continued participation in the program would increase the likelihood of your permanent removal from the disability benefit rolls.
Your benefits may continue until you complete your program, your participation in the program stops, or the SSA decides that your continued participation in the program will not increase the likelihood of your permanent removal from the disability benefit rolls.
(The information is based on The Red Book from the Social Security Administration, as well as insights and information provided by Employment Works/CP of Colorado.)
