Understanding SSI/Medicaid or Medical Assistance & SSDI/Medicare

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1 Understanding SSI/Medicaid or Medical Assistance & SSDI/Medicare Presented By: Maedi Tanham Carney, CFPC M&L Special Needs Planning, LLC Transition Services Thursday November 6th, 2014

2 Who s Eligible for Supplemental Security Income (SSI)? People who are: Disabled and any age (you can also qualify if you re at least 65 years old, even if you re not disabled), AND U. S. citizens or legal aliens who meet certain requirements, AND Have income and resources (assets) below certain limits (means tested) SSI is a needs based program. Payments out of federal income tax dollars. Non-Medical and Medical Determination. Also looks at Living Arrangements.

3 How Disabled is Disabled? Definition the Same for SSI & SSDI An adult must have a severe disability that has lasted (or is expected to last) at least 12 months, or is expected to result in death The disability has to prevent the person from doing substantial work (usually, earning over $1070/month in 2014, but sometimes earnings may be higher and the person may still qualify for SSI) A blind person (who has vision no better than 20/200 in the better eye with glasses, or has a field of vision no greater than 20 degrees) is not subject to the substantial work test

4 What is the Income Limit? It depends on the kind of income the person gets. If the person has only unearned income (such as Social Security checks, child support or pensions), the income must usually be under $741/month (in 2014). If the person has only earned income (like wages or earnings from selfemployment), the earnings (before taxes) must usually be under $1,527/month (in 2014).

5 What s the Resource Limit? $2000 That includes things like cash, bank accounts, stocks, bonds, investments, whole life insurance, retirement accounts, and property (other than the home you live in) SSI does NOT count: The home the person lives in One motor vehicle Life insurance with no cash value (like term insurance) Certain burial funds Special needs trusts Property used for a job or business

6 What s the Most SSI a Person Can Get? $721/month for an unmarried person The person needs to be paying for food and shelter to get the full amount. If a person doesn t pay for food and shelter, the most SSI she can get is $483/month. A person who has other income (besides SSI) usually receives less than the maximum SSI amount.

7 What Medical Coverage Does a Person Get With SSI? Medical Assistance (Medicaid) Medical Assistance covers most medical expenses and the person pays nothing except a very small co-payment for prescriptions ($3.20 for name brand drugs; $1.10 for generic drugs) The person has to find health care providers who accept Medical Assistance

8 What Medical Coverage Does a Person Get With SSI? If the person has other insurance, Medical Assistance can sometimes cover some costs that the other insurance does not The person gets Medical Assistance automatically if she has any amount of SSI (even just $1 a month)

9 How Do You Apply for SSI? M&L Special Needs Planning, LLC helps with the application process Call (voice) or (TTY) to make an appointment to apply at your local Social Security office Some forms can be completed in advance

10 Qualify for SSI at the Age of 18 When a child (under age 18) applies, some of his or her parents income and resources are counted. This makes many children ineligible. Once a person is 18, only his or her own income and resources are counted. A child who gets SSI before age 18 has to undergo a redetermination around age 18 to see if she or he can keep SSI. This is because the disability standards for adults are different than those for children.

11 What are Some Tips to Help Get SSI Approved More Quickly? 1. Complete the online applications prior to age 18. On the child s 18 th birthday call for the in person interview. Try not to have the phone interview. 2. If you receive any forms from Social Security complete before your appointment. 3. When you fill out forms, focus on how the disability limits your son s or daughter s activities, especially the ability to work (such as standing, walking, lifting, handling, seeing, hearing, speaking, understanding and following instructions, etc.). 4. Get as many school and medical records as you can that explain your son s or daughter s disability. Social Security may tell you that you don t need to bring these to the interview, but it will save a lot of time if you do.

12 What are Some Tips to Help Get SSI Approved More Quickly? 5. If Social Security needs more information, give it to them as soon as possible. 6. After Social Security has sent the application to Disability Determination Services (DDS) to review the disability, contact the DDS examiner to see if s/he needs anything else to make a decision. In Maryland, call to get the name and number of the examiner who has the file. 7. If they schedule you for an appointment for a medical evaluation, keep the appointment.

13 What are Some Tips to Help Get SSI Approved More Quickly? 7. KEEP COPIES OF ANYTHING YOU GIVE TO SOCIAL SECURITY, AND ANY LETTERS OR FORMS THEY SEND YOU. 8. GET A RECEIPT FROM SOCIAL SECURITY ANY TIME YOU GIVE THEM ANYTHING.

14 What Should You Do If You re Denied? APPEAL within 60 days Get more (or better) records to prove the disability, if possible If you re denied again, APPEAL AGAIN More than half of SSI applications that are denied the first time are approved the third time (the second level of appeal)

15 SSI and Working Working can get you more income More income can help you become more self sufficient Being self sufficient can give you more confidence The decisions are always yours

16 SSI and Work Incentives The amount of SSI that you can receive is based on several factors, primarily other income that you receive Basically, when your income goes up, your SSI will go down However, not all earned income is counted You will always have more total income when you work than you would have from SSI alone

17 SSI and Work Incentives Earned Income Exclusion Student Earned Income Exclusion Impairment Related Work Expenses Blind Work Expenses Plan for Achieving Self Support 1619(b) Expedited Reinstatement

18 Part 2 - Social Security Disability Title Two Benefits Social Security Disability checks are different from SSI. To qualify, you must: Meet the same disability criteria as for SSI, and Have worked and paid Social Security taxes long enough, or in some cases, have a parent or deceased spouse who paid Social Security taxes. A Family Benefit. Paid out of FICA Dollars.

19 Social Security Disability There are 2 types of benefits that young adults may get from the Social Security Disability program (Title 2). The first is called Social Security Disability Insurance (SSDI). You can get SSDI if you have worked and paid Social Security taxes for a long enough time to be insured, and you meet Social Security s criteria for disability.

20 Social Security Disability The second benefit is called Childhood Disability Benefit (CDB) (formerly called Disabled Adult Child ). To qualify, you must be age 18 or older, have been disabled before age 22, and have a parent who has paid Social Security taxes and is retired, disabled or deceased.

21 Social Security Disability After you ve been eligible for Social Security Disability for two (2) years, you can get medical insurance called Medicare.

22 When Would Someone Switch from SSI to Social Security Disability? A person who gets SSI and works could pay Social Security taxes long enough to be insured and qualify for SSDI. Someone under age 24 may become insured by working as little as months. An adult on SSI whose disability occurred before age 22 could qualify for CDB if his/her parent retired, became disabled or died.

23 What Happens If You Switch from SSI to Social Security Disability? If you switch to SSDI and your check is high enough, you will lose SSI and Medical Assistance. But if you are working, you can keep Medical Assistance through the Employed Individuals with Disabilities Program Maryland s Medicaid Buy In Program.

24 What Happens If You Switch from SSI to Social Security Disability? If you switch to a Childhood Disability Benefit, you usually keep your Medical Assistance, even if you lose your SSI checks. This is rule 1634(c).

25 Social Security Disability Work Incentives Trail Work Period Extended Period of Eligibility Extended Period of Medicare Coverage Expedited Reinstatement Impairment Related Work Expenses Subsidies Special Conditions

26 Employed Individuals with Disabilities (EID) Program The Employed Individuals with Disabilities (EID) Program lets you get Medical Assistance if you: Have a disability that meets Social Security s criteria Are years old Work for pay Meet a very high income limit Meet the asset limit ($10,000) for an individual 401(k), 403(b), Keogh and pension plans are excluded as a resource

27 Employed Individuals with Disabilities (EID) Program Medical Assistance provides comprehensive health coverage if you have no other insurance. If you have Medicare, Medical Assistance can save you $1,000 - $12,000 a year on medical costs. If you have private insurance, Medical Assistance can supplement it. Monthly premiums for EID range from $0 - $55

28 Supplemental Security Income (SSI) Must be over 65, or blind, or meet SSA s definition of disabled Must have limited income and resources Goes up and down each month based on your other income Highest check is $721 per month (2014) for a single person. Medicaid Title II SSDI, CDB (DAC) Must be blind, or meet SSA s definition of disabled No resource test Same amount each month (all or nothing depending on substantial gainful activity ) Amount based on your, your spouse s or your parent s work history Eligible for Medicare Part A (hospital) and Part B (supplemental medical) after 24 months.

29 QUESTIONS AND ANSWERS Please visit our website for more workshops and our services

30 The passion to guide. The knowledge and experience to succeed. Thank You! M&L Special Needs Planning, LLC

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