Christina Miller & Associates Disability Firm

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Emotional and Financial Resources while waiting for Disability Benefits

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When people learn about the two or more year period of waiting from initial application for disability benefits until the hearing for a Judge, the question they always asks me is one of survival.  I often get a distressed look from people followed by a question that goes something like, “Two years?  What am I going to do?  How am I supposed to live?”  This question breaks my heart as it is not an easy one to answer.   However, there are resources available to disabled persons that can be quite helpful on several fronts.  Check out the “Resources” tab on our home page for a quick reference list of the some of the most important programs I will be covering in this blog.

In terms of emotional resources, many people are unaware that many counties provide free support groups.  There are also suicide hotlines and mental health facilities in most areas.  If you or a loved one reaches a point of desperation where emergency mental health is needed, do not hesitate to call 411 for your local suicide hotline in order to learn what resources are available.  Most counties also provide free Narcotics Anonymous Meetings and Alcoholics Anonymous meetings to anyone needing this type of help.

In terms of financial resources, you may have paid into benefits that you can tap into. The first of these is your state disability insurance (SDI) benefits. Most employers contribute a portion of your each of your paychecks to your SDI account.  Based on what you have paid in, you could have saved the maximum of 52 weeks of benefits in your account.  In order to apply for these benefits or to check the balance of your account, contact your local Employment Development Department.

If your disability was the result of a work related injury, you may consider filing a claim for Worker’s Compensation benefits.  Doing this more than a couple days after the fact carries many risks and burdens. If you are interested in doing this, I recommend you consult with an experienced Worker’s Compensation attorney.  In a best case scenario, a Worker’s Compensation case could provide up to two years of temporary disability benefits (at a rate of 2/3rds of your average weekly earnings, generally speaking), permanent disability benefits and medical care.

Some people forget about unemployment.  If you were let go from your previous job for any reason, you should consider filing for unemployment benefits.

I also advise my clients to negotiate their debts with creditors.  The last thing you want are unpaid credit card balances or medical bills going into collections and ruining your credit. This could lead to you being sued and losing vital assets like your home.  Some creditors offer programs for disabled persons that allow interest levels or minimum payments to be suspended for periods of time.  These are called forbearance programs.  Contact each of your creditors and ask if they offer any of these programs.

Although it’s not glamorous, there is always welfare and other general aid programs available to those who qualify.  If you have no income, contact your state’s welfare office and inquire about food stamps and general assistance options.

If you paid into any form of short term, long term or PERS disability programs, these are wonderful resources.  Check your policies!

Choosing Medicare Coverage

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You received the good news that you have qualified for Medicare (either by age or disability).  Once that relief sets in, you will likely begin considering what type of Medicare coverage is right for you and whether or not you need a supplement. You will find that there is a lot of information out there.  What follows is my attempt to simplify the process of understanding the coverage options while making sense of the basics of Part A, B, C and D.

Firstly, I should explain that there are two main types of Medicare coverage; Medicare (Part A and B), and Medicare Advantage Plans (Part C).  The following is a summary of the basics of each type of coverage:

“Traditional” Medicare – Part A and B

As stated above, traditional Medicare coverage involves two parts.  Part A is basically your hospital insurance and Part B is your medical insurance.  The coverage is through Medicare and you can be seen at any hospital, doctor’s office or medical facility that accepts Medicare. The cost for this coverage is broken down into two parts.  Most people do not pay a monthly premium for Part A.  However, you are responsible for hospital inpatient deductibles and coinsurance payments.  Concerning Part B, the monthly premium is around $134.00, depending upon your income.

Note: More information concerning the costs associated with this plan can be found on the Medicare website via this link: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Medicare Advantage Plans – Part C

You can opt for a Medicare Advantage Plan (Part C) in place of traditional Medicare, if you choose.  This type of coverage encompasses both Part A and B and is provided by private insurance companies that have been approved by Medicare to offer this coverage.  Unlike with traditional Medicare, these plans usually restrict you to utilizing hospitals, doctors and other providers approved within the plan guidelines.  In some cases, you are allowed to see whomever you choose, however you face paying more or all of the costs involved. The cost for these plans differ based on the plan but often times involve a monthly premium, copays or coinsurance and sometimes restrictions on how often you can see a doctor or have a test.

Note:  If you are interested in running a cost analysis of several of these types of plans, visit the Medicare Plan Finder at https://www.medicare.gov/find-a-plan/questions/home.aspx.

Prescription Drug Coverage – Part D

If you choose the traditional Medicare coverage, you will need to decide if you wish to purchase a supplement to cover the costs of prescription drugs.  If so, you will need to find a plan through a private company that has been approved by Medicare to provide this coverage.  You will pay a monthly premium for the coverage, depending upon what plan you choose.  If you wish to compare plans, you can reference the link above for the Medicare Plan Finder.

If you are going the Medicare Advantage Plan route and prescription drug coverage is important to you, choose a plan that includes Part D coverage within the plan.  These plans that include Part A, B and D coverage are often called “MA-PD”s.

Note:  Remember that you cannot enroll in Medicare Prescription Part D coverage if you are already enrolled in a Medicare Advantage Plan.  Your Medicare Advantage Plan will terminate your coverage and you will be placed back on traditional Medicare.

There are also Medicare MSA plans, Medicare Cost Plans, PACE for the elderly and a boat load of other considerations.  This is all complicated and the internet is loaded with information. If you get lost, give me a call.  I would be happy to sit down with you and make sure you understand how all of this works.  Or, you can always call Medicare and ask questions at 1-800-MEDICARE.  May you find the plan that works best for you!

Secrets to the Social Security Administration’s System for Determining Medical Eligibility for Disability Benefits

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Whether you are applying for SSD or SSI benefits, the SSA uses the same five step process to determine whether or not an adult person is medically disabled under their rules. This process is known as the “Five Step Sequential Evaluation”. We have created a very basic summary of this process, however it is by no means inclusive of all issues faced at each step, and it is rather a brief overview to give you an idea of the general process utilized.

At Step 1, the SSA begins by looking into whether or not an individual is working or performing what they call substantial gainful activity (SGA). Generally speaking, if a person is working at or over the SGA limit, they are denied disability at this step. The SSA sets a yearly income limit and if a person earns over that limit for that year, they are deemed to be performing substantial gainful activity. Of important note, however, is that there are exceptions to this rule. If a person’s employer is providing special accommodations or a certain amount of money is being spent on impairment related work expenses, then the SSA will look into the specifics of the job and make their determination in consideration of all of these factors.

If the SSA determines that an individual is not performing substantial gainful activity, then their claim progresses to Step 2. At Step 2, the SSA looks at your disabilities and determines whether or not they are severe. To be considered severe, the SSA requires that an individual’s disabilities interfere with basic work activities (physical and mental). They also require that the disabilities will last for at least 12 months or will result in death.

If an individual’s disabilities meet the requirements of Step 2, then the SSA proceeds to Step 3 of their evaluation. At Step 3, the SSA looks at what are called the “Listing of Impairments”. Within the “Listing of Impairments” for adults, the SSA has created fourteen main categories as follows: Musculoskeletal System, Special Senses and Speech, Respiratory Disorders, Cardiovascular System, Digestive System, Genitourinary Disorders, Hematological Disorders, Skin Disorders, Endocrine Disorders, Congenital Disorders that Affect Multiple Body Systems, Neurological Disorders, Mental Disorders, Cancer (Malignant Neoplastic Diseases) and Immune System Disorders. Within each of these sections, the SSA provides medical criteria that apply to the evaluation of disability under each of these categories. At this step, the SSA will determine what sections apply to your particular disabilities and then determine whether or not your disabilities meet or equal the severity of the requirements of each listing.

If the SSA determines that your disabilities meet or equal that of a listing, you are found medical disabled at Step 3 and the analysis is discontinued. If however, you are found not disabled at this Step, the SSA will proceed to Step 4 of the analysis.

At Step 4, the SSA will evaluate your residual functional capacity (RFC). Your RFC is essentially an assessment of an individual’s functional abilities to sustain physical and mental work related activities on an ongoing, sustained basis despite the limitations imposed by his/her disabilities. Once your RFC is established, the SSA will utilize it at this step to determine your ability to return to your past relevant work. Past relevant work is any work that you performed within the last 15 years that you actually learned and carried out for a sufficient amount of time. If the SSA feels that an individual retains the physical and mental abilities to perform his/her past relevant work, then he/she is determined not medical disabled at this step. If the SSA determines that an individual does not retain the RFC to return to his/her past relevant work, then the analysis continues on to the final step, Step 5.

At Step 5, the SSA will determine whether or not sufficient work exists in the national economy that the individual could perform with his/her disabilities. In making this determination, the SSA will consider the individual’s age, educational background, work experience along with his/her disabilities. This analysis will also take into consideration what adjustments the individual could make to other work considering the transferability of skills obtained while in the workforce. At this step, the SSA will consider what is called the Medical-Vocational Guidelines or the “Grids”. These are tables broken into RFC exertional levels. The individuals RFC is considered along with a gridded list of age groups, educational levels and work experience levels to yield a determination of disabled or not disabled. This step is very complicated and involves far too much to fully explain in a blog article. However, the main point here is that the SSA looks to determine whether or not an individual is employable with consideration to the factors discussed above and sometimes consideration to certain special medical-vocational profiles. If the SSA determines that you meet a GRID rule, a special medical vocational profile or that enough jobs are not widely available in the national economy in consideration of the impairments imposed by your disability, then an individual is found to be disabled at this step.

2017 Changes to Social Security

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With the New Year, many people have questions concerning the 2017 changes to Social Security. The IRS publishes these annual changes and we prepare to advise our clients as to how the changes will affect them.

What follows is what we believe are the most important financial benefit changes that people should be aware of:

1. In 2017, the SS income rate increased by only .3%. People often refer to this meager raise as a COLA or cost of living adjustment. Why is this important? This means that the average retired couple’s monthly SS retirement benefit increased from around $2,254.00 last year to about $2,260.00. Some folks depend on increases based on trends from the past. Know the current numbers to best plan for the years to come.

2. The monthly maximum benefit for the majority of people receiving SS payments increases by $48.00 to $2,687.00 per month. This means some folks will pocket an extra $576.00 just due to the monthly increase.

3. This one is specifically for those disabled and collecting disability benefits in 2017. The changes happening within the disability system are far too numerous for this post, however, I do want to note one important change. Anyone on SSD/SSI benefits is familiar with the term “substantial gainful activity” or “SGA”. Well, in 2017, the SGA rate for blind persons raises to $1,790.00 per month, up $10.00. SSI rates are up as well, although not by much. These rates go from $735.00 per individual and $1,103.00 for qualifying couple (before adding in the state supplement). A raise is a raise though, right?

4. Good news for folks who are collecting their SS retirement benefits while still working! If you elected to start collecting retirement benefits before your full retirement age, you can earn more money without facing penalties in 2017. That raise jumps from a max earnings of $1,310.00 in 2016 to $1,410.00 per month in 2017. If you waited to start collecting your retirement until your full retirement age, you can earn $3,740.00 per month before facing penalties. That is way up from the cap of $3,490.00 seen in 2016. Want even better news? If you were able to wait until after reaching your full retirement age to draw these benefits, there is no cap whatsoever.

5. This one applies to the working class that is currently paying into the system. I should note that we may see a change in these figures with a new president in office. However, presently, the amount of income subject to Social Security taxes has increased for those making between $118,500.00 and $127,200.00. If your income falls within this bracket, you will note that while in 2016, you only had to pay the 1.45% income tax for Medicare, in 2017, you will be required to pay the full 7.65% for both SS, as well as, Medicare. Self-employed folks who are required to pay both the employer and employee portions of this tax will pay 15.3% on all income up to the max income listed above. Making over 200K or making 250K between yourself and your spouse? Then you will also have to pay an additional .9% Medicare tax.

Does the SSA offer medical benefits if I qualify for Social Security Disability or Supplemental Security Income?

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Yes, they do. If you are approved for Social Security Disability (SSD) benefits, you are automatically enrolled in Medicare once you have been found qualified for SSD benefits for a period of two years. The SSA will determine what date you became disabled, so this wait can vary, depending upon how long it has been since the date of onset (of your disability) is determined.

With that said, there are two parts to Medicare that you are enrolled in, once the two years has passed. The first is called Part A. This is essentially hospital coverage. It helps pay for in-patient hospital bills and post-hospital care. This coverage is free. The second part is called Part B. It is the basic medical insurance coverage for things like doctor visits and other medical services. Unlike Part A, this coverage is only available if you pay a premium for it. So, it’s optional.

Note: You may have also heard of other optional Medicare supplements such as Part C (Medicare Advantage) and Part D (Prescription Drug Coverage). Concerning Part C, there are a myriad of separate plans available through private companies if a person wishes to add this coverage. Part D is a little different in that you can enroll for this added supplement during the SSA’s Medicare Part D open enrollment periods. For more on all of this, visit www.medicare.gov.

Now, Supplemental Security Income (SSI) is a different ballgame altogether. Recall that SSI is a need based benefit for those who have very limited income and assets and who did not pay enough into the system to qualify for Social Security Disability benefits. As such, these folks do not get Medicare coverage along with their SSI benefit. Instead, they can utilize Medicaid benefits. Most of the people who qualify for SSI are already utilizing Medicaid benefits, therefore nothing significant changes concerning their medical coverage. Visit www.medicaid.gov for more information concerning Medicaid benefits.