Understanding SSDI vs. SSI Can Save You Time, Effort, & Maximize Benefits

Tai Prohaska, MPH
Manager of Strategic Alliances, Allsup

There are two main federal disability benefits that can be a lifeline for individuals diagnosed SSDI vs SSIwith cancer: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs are administered by the Social Security Administration (SSA), and people often get them confused.

Before applying for either program, it’s best to understand the difference between them, and their eligibility criteria, so you don’t waste your time, effort, and resources applying for benefits that will be denied. On the flip side, understanding these programs can help ensure you get the benefits you deserve. About 8% of all Social Security disability beneficiaries qualify for both programs.

Social Security Disability Insurance (SSDI)

SSDI is a payroll tax-funded, federal insurance program. A portion of the FICA taxes workers pay is set aside for SSDI (as well as Social Security retirement and Medicare). SSDI provides you with income if you are unable to work due to a disability or until your condition improves, and guarantees income if your condition does not improve. To qualify for SSDI, you must:

  • Be between 21 and full retirement age
  • Have worked five out of the last 10 years
  • Be unable to work and are expected to be unable to work for 12 months or longer, or have a terminal condition.

The average monthly SSDI benefit in 2017 is $1,171 for a disabled former worker and $1,996 for a disabled former worker with dependents.


Supplemental Security Income (SSI)

SSI is a means-based program for low-income individuals, so eligibility is based in part on your income and resources. To qualify for SSI, you must be:

  • Aged 65 or older;
  • Blind; or
  • Unable to work for 12 months or longer due to a medical or mental health condition that is expected to last at least one year or result in death; and
  • Have no more than $2,000 in resources (for an individual) or $3,000 (for a couple).

The SSA does not count the home you live in or your car as resources.

The maximum monthly SSI benefit in 2017 is $735 for an individual and $1,103 for a couple. Most states pay some persons who receive SSI an additional amount called a “state supplement.”

Concurrent Benefits

Some individuals are eligible for both SSI and SSDI. This happens when a person is approved for SSDI, but receives a monthly payment that is less than the SSI maximum payment ($735 in 2017). This can happen when a person has not worked much in recent years, or earned low wages. People who are eligible for both programs can file a concurrent claim for disability benefits with the SSA.

Resources

Triage Cancer has resources to help you find out more about disability insurance and how it can help you:

For more information about the Social Security Administration’s disability benefits, visit: www.ssa.gov/disabilityssi or read this guide: www.ssa.gov/pubs/EN-05-10029.pdf.

Early Withdrawal from Retirement Plans

Need Cash? Is early withdrawal from a retirement plan right for you?

Have you been financially impacted by a cancer diagnosis? Need access to money to Early-Withdrawlpay your medical bills or daily living expenses? Withdrawing money from your retirement plans may be an option for you.  However, it is important to understand the tax implications of doing that.

Fortunately, the IRS understands that you may need to dip into your retirement savings a little earlier than expected. And, unlike most of the tax code, this is pretty easy to understand.

Normally, if you withdraw money from a 401k or IRA plan before reaching age 59.5, you would be subject to an “early withdrawal tax” of 10%, above and beyond the normal income tax owed on the withdrawal. However, here are three exceptions to that rule, which can really make a difference:

  401K Plans IRA, SEP IRA, SIMPLE IRA, & SARSEP Plans
If the participant/IRA owner is totally and permanently disabled. No early withdrawal tax No early withdrawal tax
If your amount of unreimbursed medical expenses is greater than 10% of your Adjusted Gross Income. No early withdrawal tax No early withdrawal tax
If you are using your withdrawal to pay for health insurance premiums while unemployed. 10% early withdrawal tax applies No early withdrawal tax

There are close to 15 more exceptions to the Early Withdrawal Tax.  It is also important to know that with ROTH IRAs, you can always withdraw the money you’ve contributed (not the interest earned) tax free and penalty free.

When considering your financial situation as you face a cancer, remember to count every dollar. There could be money out there you thought you could not touch!

For more information on navigating finances after cancer, visit CancerFinances.org, read the financial topics on the Triage Cancer blog, or visit our other financial resources.

Tackling Health Care in September

Congress is back in session this week, which means they will likely be tackling health care issues. September will bring more proposed and actual changes to our health care system:

  • Last week, a group of eight governors released a market stabilization plan, which asks Congress to fund the cost-sharing reductions through 2018, improves risk pools, and makes other suggestions to increase competition among insurance companies selling plans in the marketplaces.
  • This week, the Senate Health, Education, Labor, & Pensions Committee (HELP) is scheduled to hold two hearings on how to stabilize the premiums of individual plans sold through the state health insurance marketplaces. These hearings will include state governors and state insurance commissioners.
  • A group of Republican Senators have proposed an amendment to the larger ACA repeal and replace proposals that were not previously passed by the Senate. Senators Graham, Cassidy, and Heller have proposed block granting to states the money allocated for the ACA financial assistance programs and Medicaid expansion, as well as place a per capita cap on the traditional Medicaid program. Click here to read the amendments.
  • The Trump Administration announced that they would cut the advertising budget by 90%, which promotes the availability of health insurance through the state health insurance marketplaces. They are also cutting the grants to local organizations that work in communities to help people enroll in health insurance coverage.
  • The Administration had already announced a six-week shorter open enrollment period, from November 1, to December 15, for coverage that begins on January 1, 2018.

If you or someone you know needs information about their health insurance options, visit www.CancerFinances.org.

Stay tuned for updates from Triage Cancer, as we learn more about these changes and how they might impact the cancer community.

Important Social Security Information for People Affected by Hurricane Harvey

The following information is from the Social Security Administration’s press release, issued on Thursday August 31, 2017. Our hearts go out to all those impacted by Hurricane Harvey.

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Many Social Security and Supplemental Security Income (SSI) benefit payments are scheduled for Friday, September 1.  The following information covers the various delivery methods for these payments in the wake of Hurricane Harvey.

Payments by Paper Check Delivered by the US Postal Service

Hurricane Harvey’s impact on the Gulf Coast resulted in the temporary suspension of mail delivery service, as well as the closure of some postal facilities in the Houston area.  The U.S. Postal Service is providing additional information on how customers displaced by Hurricane Harvey can retrieve checks they receive via the mail.

Provided here about.usps.com/news/state-releases/tx/tx.htm is a list of Post Office locations, by ZIP Code, where checks will be made available for pick-up beginning Friday, September 1.  People must have proper identification to receive their check.

Payments by Direct Deposit

Nearly all payments issued by direct deposit will arrive as scheduled.  If a person’s payment is delayed, they should contact their financial institution.  If the financial institution is not operating, please see the “emergency payment” information below.

Payments by Direct Express Debit Card (a Treasury Department program)

For recipients in the affected areas who receive their payment through a Direct Express card, fees will be waived, even if they have evacuated out of the area. Payments will be posted to Direct Express cards on September 1.

People may contact Direct Express at 1-888-741-1115.

Emergency Payment Locations

Social Security has established three emergency payment locations in Texas where Social Security and SSI beneficiaries may request an immediate payment in person if they cannot receive their regular payment.  The locations and hours are:

Friday, September 1, and Saturday, September 2:

Houston: NRG Center
2 NRG Park, Houston, TX 77054
From 9:00 AM – 4:00 PM

Dallas: Kay Bailey Hutchison Dallas Convention Center
650 S. Griffin Street, Dallas, TX 75202
From 9:00 AM – 4:30 PM

Austin: Tony Burger Center
3200 Jones Road, Austin, TX 78745
From 9:30 AM – 3:00 PM

For people who cannot receive their regularly scheduled Social Security payment as a result of Hurricane Harvey, in most cases they can go to any open Social Security office and request an immediate payment.  A list of offices that are currently closed, as well as additional information for the public, is available at www.socialsecurity.gov/emergency.

To find the nearest open Social Security office outside of the affected areas, call 1-800-772-1213 (TTY 1-800-325-0778) or go to www.socialsecurity.gov/locator.

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To get more Social Security news, follow the Press Office on Twitter @SSAPress.

Do You Need a Medigap Policy? Your Ability to Get One May Depend on Where You Live.

Americans who receive their health insurance through Medicare may want to purchase Medigapextra coverage through a Medigap Policy.  However, one’s ability to purchase a Medigap policy may depend on where they live.

Medicare is a government funded and run health insurance program for eligible individuals. To be eligible for Medicare, you must be:

  • 65+ years old;
  • have collected SSDI more than 24 months; or
  • have been diagnosed with end stage renal disease (ESRD) or ALS.

Medicare coverage is divided into four parts:

  • Part A: Hospital Insurance. Includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance. Includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare-approved private insurance company. Make sure to select a plan that covers your health care providers.
  • Part D: Prescription Drug Coverage. You have different plans to choose from depending on where you live, with different premiums and formularies. Make sure to select a plan that covers the drugs you take.

For more information about Medicare, you can read our Quick Guide on Medicare, or watch this webinar.

Parts A and B of Medicare are often called “original Medicare,” because that is the coverage that originally existed. Part B of Medicare has an 80/20 cost share, meaning that Medicare covers 80% and you are responsible for 20% of your medical expenses covered under Part B.  In order to help people pay for the 20% and for other things that Medicare does not cover, Medicare created an option to buy supplemental health insurance coverage, called Medigap. There are different Medigap plans, which are named by letters, which are offered by private health insurance companies. You must have Medicare Parts A and B to buy a Medigap plan.

Medicare’s website allows you to type in your zip code and whether or not you already own a Medigap policy, and it shows you the different Medigap policies available to you. . Medicare also provides a chart comparing Medigap plans A-N and their benefits. For example, Medigap plan A does not cover skilled nursing facility care coinsurance, while Medigap plan F does. Medigap plans K and L have an out-of-pocket limit, while the other 12 plans do not. It is important to note that three states – Massachusetts, Minnesota, and Wisconsin – offer different Medigap plans not available in other states. There are separate pages for the Medigap plans on Medicare’s website for these exceptions.

Medigap policies, however, are only available in certain states. According to Medicare, “each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer.”

While Medigap policies seem like they would be welcomed and encouraged in each state, there are 22 states that are allowed to not sell Medigap policies to those under 65 years of age who qualify for Medicare because of a disability. Those states are: Alabama, Alaska, Arizona, Arkansas, Idaho, Indiana, Iowa, Kansas, Kentucky, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Utah, Virginia, Washington, West Virginia, and Wyoming. Simply put, if you live in one of these and are on Medicare but under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65.

The remaining 28 states require insurance companies to offer people under 65 at least one Medigap plan: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin.

Click here for more information about Medigap plans and coverage.

Washington State Helps People Take Time Off Work

Paid family and medical leave is a lifeline for families who need to take time off work toPaid family and medical leave bond with a new child, for their own serious medical condition, or to care for family member with a serious medical condition, but are concerned about the loss of income. The federal Family and Medical Leave Act (FMLA) provides 12 weeks of unpaid leave, but many employees who are eligible don’t take it, because they can’t afford the loss of income.

In July, Washington Governor, Jay Inslee, signed into law a paid family and medical leave benefit.

This law will begin on January 1, 2020, and will allow employees to take up to 12 weeks off of work for: their own serious medical condition or to care for family member with a serious medical condition; or to bond with a new child; or 16 weeks for a combination of both. If an employee has pregnancy complications, then the employee may be eligible for an additional two weeks of leave. Employees are eligible for up to 90% of their income, under this paid family leave benefit.

An individual must work 820 hours before qualifying to take the leave. Both employers and employees will pay into a fund to cover the cost of leave for employees. Employers with less than 50 employees are exempt from paying into the system. Self-employed individuals are eligible if they pay the employee share into the system.

Washington is one of 6 states that offer paid family leave for caregivers. Washington had passed a law in 2007, but was never funded, so it never went into effect.

Here is a brief overview of what other states offer for caregivers:

California

  • Began: 2004
  • Paid by: employee
  • Length: 6 weeks
  • Benefit: 55-70% of income

New Jersey

  • Began: 2009
  • Paid by: employer-employee
  • Length: 6 weeks
  • Benefit: 66% of income

Rhode Island

  • Began: 2014
  • Paid by: employee
  • Length: 4 weeks
  • Benefit: 60% of income

New York

  • Begins: 2018-2020
  • Paid by: employer-employee
  • Length: 8-12 weeks
  • Benefit: 50% of income

Washington, D.C.

  • Begins: July 2020
  • Paid by: employer
  • Length: 8 weeks
  • Benefit: 90% of income

Cities have also been working to offer paid leave programs. For example, in San Francisco, the County Board of Supervisors unanimously approved full pay during family leave.

It is important to note that each state has a different definition of which family members you can care for and be eligible for paid family leave.

5 states (CA, NY, NJ, RI, HI) and Puerto Rico also offer state disability insurance benefits for employees who need to take time off for their own medical condition.

For information on what might be available to you in your city or state, visit our website to see resources and our chart of state laws.

Enrolling in Medicare Part B – What You need to Know!

Medicare is a government health insurance program for eligible individuals. To be Medicare Part Beligible you must be: 65+ years old; have collected SSDI benefits for more than 24 months; or have been diagnosed with end stage renal disease (ESRD) or ALS. Medicare coverage is broken up into “parts:”

  • Part A: Hospital Insurance – includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance – includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part D: Prescription Drug Plan (PDP) – different plans to choose from depending on where you live, with different premiums and formularies.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare approved private insurance company.

You can enroll in Medicare for the first time during Initial Enrollment Periods, when:

  • You’re newly eligible for Medicare because you turn 65. You get a 7-month period to pick your plans, which starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • You’re newly eligible for Medicare because you’re disabled and under 65.
  • You’re already eligible for Medicare because of a disability, and you turn 65.
  • You are working and receiving insurance through your work, you can enroll up to 8 months after you stop working.

If you fail to enroll during these windows, you can enroll during the General Enrollment Period (GEP), which is January 1st through March 31st, every year. However, if you sign up during the GEP, but were eligible earlier than that, you could be facing a Medicare Part B late enrollment penalty.

Most people receive their Part A coverage at no cost, but they do have pay for Part B coverage.  Since Part B is something you pay for, you have the right to refuse the coverage.  Refusing Part B coverage is an important decision to make, so please consider it wisely.

Consider these examples, to help you decide if you should keep Part B:

  • I’m still working and have coverage through my employer. Or, my spouse is still working and I’m covered by his or her employer. Ask your employer or union benefits administrator if they require you to sign up for Part B. If your employer doesn’t require you to sign up for Part B right away, you can usually sign up for Part B later during a Special Enrollment Period without a late enrollment penalty.
  • I’m retired and have coverage through a former employer, or I have COBRA or VA coverage. If you’re retired and have retiree health insurance from a former employer or union, or you have COBRA or U.S. Department of Veterans Affairs (VA) coverage, Medicare generally will become your primary health insurance. Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your non-Medicare plan. If you don’t keep Part B, your current coverage might not pay your medical costs during any period in which you were eligible for Medicare Part B, but didn’t sign up for it.
  • I have coverage through the Health Insurance Marketplace as an individual or through an employer. If you have a Marketplace plan for individuals or families, you should keep Part B and drop your Marketplace plan so it stops when your Medicare starts. You won’t be eligible for premium tax credits or other savings for a Marketplace plan once your Part A coverage starts and you if you miss your enrollment period you will end up paying a penalty for enrolling late.
  • I have TRICARE coverage (insurance for active-duty military, military retirees, and their families). You must have Part B to keep TRICARE coverage. However, if you’re an active duty service member or the spouse or dependent child of an active-duty service member, you may not have to get Part B right away.
  • I have CHAMPVA coverage. You must have Part B to keep your CHAMPVA coverage.
  • I have coverage through a private insurance plan. If you accept Medicare Part B, Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your private plan.
  • I don’t have other health insurance. If you don’t have other health insurance, you should accept Part B if you want coverage for things like doctors’ services or preventive services.

Before you make any decisions about opting out of Part B, speak to the Social Security Administration (and keep detailed notes of each conversation).

Resources

For a more information about Medicare please read the booklet entitled Welcome to Medicare.

You can also find more information on our Triage Cancer blog, by reading our Quick Guide to Medicare, or watching our webinar on “Making Sense of the Medicare Maze.”

Don’t Be Late! Medicare Part D Penalty

Within the alphabet soup that is Medicare, there are important deadlines of which to be Medicare Part D Penaltyaware.  If you are late to enroll you may be forced to pay a Medicare Part D penalty.

Medicare Part D is the prescription drug benefit of Medicare.  Like all of Medicare, there are specific and limited times that you can enroll in the program.  It is important to understand these enrollment periods, so you can avoid late enrollment penalties.

When can you enroll in Medicare Part D?

The Initial Enrollment Periods for Medicare include:

  • You’re newly eligible for Medicare because you turn 65. You get a 7-month period to pick your plans, which starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • You’re newly eligible for Medicare because you’re disabled and under 65.
  • You’re already eligible for Medicare because of a disability, and you turn 65.
  • You HAVE Medicare Part A coverage, and you get Medicare Part B for the first time by enrolling during the Part B General Enrollment Period (January 1–March 31).

The Penalty

You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. Creditable prescription drug coverage is coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

The late enrollment penalty is an amount that’s added to your Part D premium each month. If you have a penalty, you may have to pay it each month for as long as you have Medicare drug coverage!  The Part D late enrollment penalty is calculated as 1% of the national base beneficiary premium for each full, uncovered month that you didn’t have Part D or creditable coverage.

For example, if there was a period of 14 months that you did not have Part D or creditable prescription drug coverage, this is how the penalty is calculated:

14 months x 1% = .14

.14 x $35.63 (2017 base beneficiary premium) = $4.98

$4.98 rounded to the nearest $.10 = $5

$5.00 would be added to your monthly Part D premium for as long as you have Medicare Part D (which is usually for the rest of your life).  So each year you would be paying an additional $60 in Part D penalties. Over 20 years that would be $1,200 in completely avoidable penalties.

For more information about Medicare, read our Quick Guide to Medicare, or watch our webinar on “Making Sense of the Medicare Maze.”

For more information on the Part D Late Enrollment Penalty, visit www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf  or https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

Opioid Crisis in America

Every day, about 90 Americans overdose on Opioids, according to the National Institute Opioid-Crisison Drug Abuse. This has been termed the ‘opiod crisis.’ Opioids come in a variety of modes, including prescription pain relievers, synthetic opioids, and even heroin. The CDC estimates that the “economic burden” of prescription opioid misuse is approximately $78.5 billion a year; this sum includes the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

The opioid epidemic became prevalent in the late 90s, when healthcare providers began to prescribe them at greater rates, after the risks of addition were downplayed by drug producers. In 2015, nearly 33,000 Americans died of opioid overdose, including by prescription opioids, heroin, and fentanyl, a powerful synthetic opioid.

The opioid crisis also has an impact on the labor market. A Goldman Sachs economist found that the opioid epidemic may be responsible for the lack of people looking for work in the current job market. According to the U.S. Bureau of Labor Statistics, the number of people working or actively looking for work has fallen since the Great Recession and has stagnated near 63% for the last four years.

The United States Department of Health & Human Services (HHS) released its 5 priorities for dealing with the opioid crisis:

  1. Improving access to treatment and recovery services
  2. Promoting use of overdose-reversing drugs
  3. Strengthening our understanding of the epidemic through better public health surveillance
  4. Providing support for cutting edge research on pain and addiction
  5. Advancing better practices for pain management

In April, HHS announced that they would be administering grants totaling $485 million to all 50 states, the District of Columbia, four U.S. territories, and the free associated states of Palau and Micronesia, in order to combat the crisis. A table including the grant breakdown for each state/territory can be found here.

While the HHS’s efforts are a great start, there is a lot of work to be done. For more information on the epidemic, watch the New England Journal of Medicine special report, given by NIDA Director Dr. Nora Volkow and Dr. Collins, in May 2017.

The response to the opioid crisis by many in the health care field is to stop prescribing opioid medications.  Many cancer patients are being caught in the middle of this crisis. Patients already often underreport their pain, but those who seek assistance from their health care team for pain, are often undertreated or not taken seriously enough. It is crucial for patients to have open and ongoing conversations with members of their health care team to effectively address their pain and need for palliative care.

If you are prescribed opioid medications, here is practical information about opioids.