Back to Basics: Social Security, Supplemental Security Income, Social Security Disability Insurance

Transcription

1 Back to Basics: Social Security, Supplemental Security Income, Social Security Disability Insurance September 27, Agenda About the ADRC Back to Basics: Social Security, Supplemental Security Income, Social Security Disability Insurance Working While Receiving Benefits Q & A, Evaluations 2 1

2 ADRC: Resources for Seniors and People with Disabilities Debra Kegel, ADRC Program Specialist CalOptima 3 Supported by the California Department of Health and Human Services Agency and U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services under Grant CFDA

3 ADRC OC Program Functions 5 Information & Resource Referrals Adult Day Care Bereavement and Burial Caregiver Support Care Coordination Disability Services/Products Emergency Hotlines Financial Assistance Health/Medical Home Modification/Repair In-Home Services Insurance Legal Services Meals/Food Recreation/Sports/Leisure Safety Sanitation Senior Centers Support Groups Transportation Veterans Services 6 3

4 Accessing Services Call the County of Orange Office on Aging at Speak to an Information & Assistance Referral Specialist Find resources at The searchable database includes thousands of resources Visit any of the partner locations: County of Orange Office on Aging 1300 S. Grand Avenue, Building B, Santa Ana, CA Dayle McIntosh Center Garden Grove Boulevard, Garden Grove, CA Calle De La Plata #110, Laguna Hills, CA Back to Basics: Social Security, Supplemental Security Income, Social Security Disability Insurance 8 4

5 Eligibility for Social Security, Supplemental Security Income, Social Security Disability Insurance Frank Van Nostrand Public Affairs Special Social Security Administration 9 SSA s Two Disability Programs Social Security Disability (SSDI) Based on work Replaces part of lost wages Amount is based on wages Family benefit Medicare Supplemental Security Income (SSI) Based on need Aged, blind or otherwise disabled Usually a U.S. Citizen Must live in the U.S. Limited income & resources 10 5

6 Two Disability Programs SSDI SSI Same strict disability standard 11 Definition of Disability for SSDI & SSI Inability to engage in any substantial gainful activity by reason of Any medically determinable impairment which Can be expected to result in death or Which has lasted or can be expected to last for not less than 12 months 12 6

7 Substantial Gainful Activity (SGA) SGA is the performance of significant and productive physical or mental work for pay or profit SGA is average countable earnings over $1000 for nonblind individuals SGA for the blind is set at $1,640 for the year SSDI Eligibility Requirements Be Insured Fully Insured 20/40 Be Disabled Also benefits for disabled widows and children 14 7

8 How Credits Are Earned 2011: 1 credit for each $1120 in covered employment maximum of 4 credits/yr ($4,480) 15 Benefits for disabled widows and disabled adult children Widow(er): Must be legal widow(er) Must be at least age 50 Must be unmarried (remarriage after age 60 is ignored) Must be disabled Disabled Adult Child: Must be disabled before the age of 22 Qualifying parent must be insured Qualifying parent must be entitled to cash benefits or deceased. 16 8

9 SSI Eligibility Requirements Be disabled Have little or no resources Have limited income Be a US citizen Reside in the US 17 Social Security Disability Insurance (SSDI) Payment amount based on average lifetime earnings Waiting period to initially receive benefits: 5 full calendar months Medicare Qualifying Period: 24 months Benefits are subject to cessation if claimant returns to work 18 9

10 Supplemental Security Income (SSI or SSIDI) Payment amount based on income, living arrangements and the state in which he/she lives No waiting period to initially receive benefits In California, automatic entitlement to Medi-Cal, without a share of cost Benefits are not subject to cessation if claimant returns to work, but SSI is reduced for additional income 19 Where do we start? Call to set up an appointment We will send you a starter kit Or, go to

11 What next? Complete medical history and how your impairment impacts on daily functioning Submit any evidence you have Complete list of treating sources and medical releases Medical Examiners will make the medical decision 21 How do we determine if you are disabled? Are you Currently Working? If earning over $1000 claim is denied Is the Impairment Severe? Does it limit your ability to work? Will it last 1 year? Does it meet or equal the listings? 20 CFR 404, Subpart P, Appendix 1 The Blue Book 22 11

12 How do we determine if you are disabled? Are you currently working? If earning over $1000 claim is denied Is the impairment severe? Does it limit your ability to work? Will it last 1 year? Does it meet or equal the listings? 20 CFR 404, Subpart P, Appendix 1 The Blue Book 23 And then... Can you do the work you did before? Work history for the past 15 years Can you do any other work? Residual Functional Capacity Age Education Past Work History Transferable Skills 24 12

13 How does the process work? Initial Claim Reconsideration Hearing 25 How long does the process take? Up to 3 5 months for a medical decision Terminal cases receive priority Immediate payments for: HIV Infection Total blindness/deafness Down Syndrome Cerebral Palsy/Muscular Dystrophy Amputation ti of a leg at the hip ALS Severe mental retardation (under age 7) Low birth weight 26 13

14 For SSDI, we will determine... Insured status Age Relationship All other non-medical aspects 27 Meanwhile, for SSI... We will determine financial eligibility We will determine Resources We will determine Income 28 14

15 Limited Resources Resources are things you own: Cash and bank accounts Land Personal property Cash value of life insurance LIMIT: $2000 individual $3000 couple 29 Excluded Resources A home that is your place of residence One automobile Household goods and personal property valued at less than $ Burial plots for use by you or your immediate family Burial funds up to $ per person 30 15

16 It s An Income Supplement! If you meet eligibility rules, it supplements income up to set levels Current payment level for in California is $ for an individual $1, for a couple Example: Chargeable income of $700 SSI payment would be $ What Is Income? EARNED INCOME - Wages & self employment UNEARNED INCOME - Money received from other sources such as SSA, VA, pensions, unemployment, cash gifts 32 16

17 General and Earned Income Exclusions General income exclusion: First $20.00 of income per month does not count Earned income exclusion - Do not count: First $65.00 per month of wages or self-employment income and 1/2 the remainder does not count 33 Living Arrangements Living alone or paying fair share of household expenses with others Living in someone else s s household Living in a domiciliary care home Living in an institution Homeless 34 17

18 Payments Are Less If You Live With Someone Individual in another s household is currently paid $ in California Couples in another s household are currently paid $1, Other Payment Rates Board and Care Home $1, No Cooking Facilities $ Medi-Cal Facility $

19 When We Review A Disability Case When Improvement is expected Diary is set When Improvement is possible - 3 years When improvement is not expected - 7 years When you become eligible for SSI under 1619 If we find that the claimant Is no longer disabled - BENEFITS STOP 37 What about Health Insurance? SSI links people to Medi-Cal SSDI links people to Medicare 38 19

20 Medicare Coverage 65 and older Receiving Social Security Disability benefits at least 24 months Permanent kidney failure 39 The Two Parts of Medicare Hospital (Part A) Paid for by taxes while still working Covers In-patient hospital costs Very limited nursing home coverage Doctors (Part B) Paid by premiums deducted from SS check ($115.40/mth) Covers roughly 80% of doctor/bills. May not need part B if still working or have other coverage 40 20

21 Medicare Enrollment Periods Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP) 41 And Now There s Part D! You may NOT need it! When you become eligible for Medicare, you can purchase Part D Prescription Drug Plans You want to sign up when first eligible, or you will pay more Program is voluntary 42 21

22 Call or Visit Website yg 43 Working While Receiving Social Security, Supplemental Security Income, Social Security Disability Insurance Benefits Thomas Olzak, J.D., Manager Youth and Career Services Braille Institute 44 22

23 Call or Visit Website Questions 46 23

24 Closing Complete Evaluations Next session November Medicare Changes, HICAP and other and Council on Aging Programs Thank you 47 24