Derek Shields >> As Jayme mentioned, I'm today's moderator. I'm with the Ticket Program Manager, and I'm pleased to welcome back to our WISE webinar, Ray Cebula. Ray received his law degree from the University of New Hampshire's Franklin Pierce School of Law. He spent 23 years providing legal services to individuals with disabilities and their interactions with Social Security and then became part of Cornell University's Work Incentive Support Center. In 2005, Ray then joined the staff of Cornell's K. Lisa Yang and Hock E. Tan Institute on Employment and Disability in their School of Industrial and Labor Relations. Today, Ray serves as the program director of YTI Online. That's Cornell's Work Incentives Practitioner Credentialing Program. And importantly for today, Ray is our guest presenter. We welcome him to today's webinar. And remember, keep the Q&A pod active, and we'll be back with Ray in a little bit. But for now, I'm going to turn it over to you, Ray. Ray, I ask you to turn on your microphone.

Ray Cebula >> Thank you, Derek. Thanks for the reminder. All right. Good afternoon, everyone. I'm happy to be with you again. Today's webinar, we're going to talk about what is the Social Security's Ticket to Work Program. A big piece of legislation, a big step forward for helping recipients return to work. Can I work and keep my Social Security benefits? That's an important question. And the answer is, yeah, but do you want to continue on beyond that point? Can I keep Medicare or Medicaid when I start working? Absolutely. Absolutely for a very long time. And who can help me achieve my work goal? Derek told you we're going to put together an employment team for you, and you're going to be the one that runs that team.

So what is Social Security's Ticket to Work Program? The first thing we need to talk about are the two different benefits that Social Security administers. The first one is the Social Security Disability Insurance program. We sometimes call that SSDI or maybe Title II. This is just what it says. It's an insurance program. As you work and pay FICA taxes, you're buying insurance. At a point depending upon your age, you will become insured, and you're insured for both Social Security disability and retirement. So this is a great program that you're getting involved in when you're working and paying taxes.

For the disability program, we have to make a distinction here. Insurance programs are based upon your work history, and there are no resource levels. Insurance, that's what this is. On the SSI side, Supplemental Security Income, generally called SSI, we're looking at a needs-based program. Social Security Administration is going to consider your disability, plus your financial status. And there are some pretty harsh rules concerning your finances right now to make you eligible for SSI. You do not need a work history, or you may be on your way to getting your work insurance for SSDI, but incur a disability sooner. So SSI could be an eligibility program that would help you bridge that gap.

What is the Ticket to Work Program? You know, the Ticket to Work Program is part of the Ticket to Work Act. It's been around since December 17 of 1999, when it was signed by President Clinton. So it's been around with us for a long time. This is a free and voluntary Social Security program. Remember that, free and voluntary. It offers career development for people ages 18 through 64 who receive Social Security disability benefits and want to work. Easy enough. Those are the qualifications, ages 18 through 64, and you want to work.

Are you eligible, or are you eligible for the Ticket to Work Program if you are aged 18 through 64? Now that 18 has a catch, because you also have to, if you were on SSI as a child, you also have to satisfy an age 18 redetermination to make sure that you're a disabled adult. Okay. And you must receive Social Security Disability Insurance and/or SSI Supplemental Security income. If you meet those qualifications, you're in.

The Ticket to Work Program can help connect you with free employment services to help you decide if work, including self-employment, is right for you. Lots of us want to return to work. Lots of us want to get back into earning income. Is it the right time? Is it the right moment for you? You know, part of your employment team can help you make that decision.

How to prepare for work? You know, work preparation is going to take a bit. You know, not only you're going to have to personally get adjusted to going to work and getting ready for that, but do you need to secure an updated credential, you know, to go back into the same work that you want to? Or do you need a bit of education to get you into a job that requires more education than the job that you had?

How about finding a paid work opportunity? This is a great thing. You know, and I always look at transition-age youth for this one. A paid work opportunity is a great chance to check out a job, to see if you like it, to learn what your capacity for work is. Is that capacity 20 hours? Is it 30 hours? Is it 40 hours? It truly is a wonderful thing. Paid work expenses can give you lots of different experiences so that you're testing the waters. What do I want to do? That's the important question for you. What do you want to do?

And succeed at work. Many, many programs that are offered by agencies in the country get you a job. But we're going to take it a little bit more than that. We're going to stick with you to make sure you're able to succeed at work, and we'll be there as long as you think you need us. You can learn more about what is Social Security's Ticket to Work in a self-guided tutorial in the Web Links pod.

Now, the Ticket to Work Help Line, Derek made mention of this. The Ticket to Work Help Line offers a toll-free Help Linen to answer your questions and support you on your journey to financial independence. No catch here. If you have a question, call the Help Line. They will respond to it. No obligation. This is a great place to find out what's out there, who's there to help. You can call that Ticket to Work  Help Line Monday through Friday, 8 a.m. to 8 p.m. Eastern. So if we turn that into Pacific, it's going to get you to 5 o'clock, 5 p.m. That line is 1-866-968-7842, and for TTY users, 1-866-833-2967.

Now, getting into the meat of this, can I work and keep my Social Security benefits? Well, you know, you can, and I said that earlier, but the goal of financial independence means more than working and keeping benefits. Now, it's all going to depend upon you, you know, how your disability is impacting your ability to work, what kind of capacity to work do you have, you know. But we hope you can work to financial independence. That's our goal for you. But if you can't, if you're working at your maximum capacity, we have a success story in the making. Social Security has many, many safety nets, like Work Incentives, to help you try working before your SSDI, Social Security Disability Insurance, or SSI, Supplemental Security Income, ends because you are working and earning. This includes the Ticket to Work Program, as well as the Social Security Work Incentives.

Now, when you start working, Work Incentives are going to happen. We need to pay attention to them. We need to help you prepare for the changes that may be happening. The Ticket to Work Program provides you with an overlay. Do you need a little bit of extra service, you know, getting your resume ready, doing interview practice, having somebody help you with your job search? You can use one, either or both. They make a great overlap when you're using them together.

So what are Work Incentives? You know, Work Incentives are really wonderful things when you think about what's going on here. They are programs and rules that help beneficiaries enter, re-enter, or continue employment by protecting their eligibility for benefits payments and/or health care coverage until they're able to replace SSDI or SSI payments with earnings from employment or self-employment according to Social Security's rules. Now, that last little phrase, according to Social Security's rules is very important because, you know, we all think of what's going on and how we want to return to work and what our goals are. But remember, Social Security has rules, and we have to abide by those rules during this process.

Whether you're looking for a job for the first time or returning to work after an injury or illness, Work Incentives can help you through the transition to work and towards financial independence. Now, we talked about that a little bit and what financial independence means and working your way towards that. These Work Incentives are such that you can actually create a situation where your benefits may drop a little bit. And then we're going to work a little bit more. You know, and if you're not comfortable taking that next step, we might be able to get another work incentive to help you drag that out a little bit more until you're ready to take that final step towards financial independence.

Who can use Work Incentives? They're available to all Social Security Disability beneficiaries, whether you receive SSDI, SSI, or both. However, some of these Work Incentives belong to one program or the other. So knowing what benefit you receive is going to be very important. So that's your first step when you're considering work. Figure out which of these benefits do you have. And two examples of Work Incentives of the Trial Work Period for SSDI. Nine months. You know, you can use those over a five-year period, but if you use them in a row, you can earn as much as you want and still get your benefits in your health care during that period. This is really a time to test your work, which jobs you want, how much money you can make, how much can you work.

And then Impairment-Related Work Expenses. This is used in both SSDI and SSI. We use them a little differently, but they're both the same thing. And these are a few of my favorite things. These are wonderful. Any expense you have that's related to your impairment that you need for work and that you pay for out of pocket can be deducted from your gross wages to reduce that to countable wages, which may keep you eligible for a longer period for SSDI, and they keep your SSI a bit higher than it would otherwise be. They're fabulous Work Incentives.

Now, what is the TWP? You know, it's the first Work Incentive that you're going to be using if you receive SSDI or Social Security Disability Insurance. It allows you to test your ability to work for at least nine months. You know, again, they don't have to be consecutive, but they do have to be captured in a five-year period. The best way, I believe, firmly, the best way to use these months is to use them right in a row. Then you get a true test of your ability to work, a true test of learning how much you can work, and a true test of, is this job the right job for me. You will receive your full cash benefit, so that SSDI check will not be reduced at all. And health care, no matter how much you earn.

Now, you need to report your wages and that work activity to continue to meet Social Security's — and continue to meet Social Security's rules for disability. You know, so reporting's a big deal, you know, we have to report. Social Security will find out, you know, three or four years from now, from the IRS that there was work income, you know, and that's going to cause problems. So it's up to you, and you signed a promise when you signed that application that you would report things that would impact your benefits. So make sure you're reporting, doing that on time, and hopefully everybody will get caught up, and everything will be fine.

Now, how is the Trial Work Period calculated? The TWP continues until you capture all of those nine months, you know, in a 60-month period. That's five years. You know, so if you work for three months and use three trial work months and don't work again for a year, and work two more months, you're accumulating those nine. We've now got five months that we have used. Social Security uses the amount that you have earned in a month before subtracting taxes, so this is gross wages to decide if a month counts towards your Trial Work Period or TWP. In 2026, if you earn $1,210 or more or work more than 80 hours a month in self-employment, you are considered to have worked a Trial Work Period service month, and we count that one month towards the nine months that you can accumulate. You can learn more about the Trial Work Period at Trial Work Period Fact Sheet. The link is in the web pod. And about another Work Incentive that's available when you complete your Trial Work Period, called the Extended Period of Eligibility. So you've worked for nine months now. Now we're going to give you — this is just a preview, but we're going to give you an extended period of eligibility that lasts for three years. So nothing's going to break on you. This isn't going to fall apart. You know, it's a great program that extends for several years now.

Now, I told you IRWEs are a few of my favorite things. Impairment-Related Work Expenses. You know, these are costs for items or services that you need to work because of your disability. Social Security can deduct the costs of an IRWE from your countable income when determining whether you're eligible for benefits or not. Both SSDI and SSI recipients are eligible to claim IRWEs.

The IRWE must meet the following criteria. It's an item or service that enables you to work. You need the item or service because of a physical or mental impairment. And you pay for it without reimbursement from any source. And the cost has to be reasonable. You know, I've never had anybody during my career be faced with this cost is unreasonable. But I'm going to give you a quick example. I take blood pressure medication. Is it because of an impairment? Yep, I have hypertension. Do I need it to work? I absolutely need it to work. Do I pay for it? I have insurance. But I do pay the co-pay. So that $3 co-pay that I pay is a $3 deduction from my income. And I'm using a small amount there because that's all it might take. So think about what you're doing. Think about what kind of services you have. Even though you need them for everyday life, you need them to work. And just think about what types of IRWEs you may have. You can also look at that Web Link pod for Impairment-Related Work Expense.

Here are some more examples for IRWEs. They're almost limitless. Prostheses, sometimes called an artificial limb. Modifications to your vehicle related to your disability that will allow you to commute to and from work. And expenses paid for a guide dog or service animal that help you work. Now, I don't know if any of you have pets. I have three pups floating around the house. They're expensive. They have to eat. They had training. They have to be licensed. They have to go to the vets. And lots of other expenses. So it's not just the pup. It's not just the collar. It's all of the equipment and taking care of that animal that you could use as an Impairment-Related Work Expense.

All right, Derek. That brings us to our first Q&A.

Derek Shields >> This is Derek speaking. Thanks, Ray. We appreciate covering such detail. I have our first question here. Thanks, everyone, for sending in your questions. We have quite a few of them, as we also have quite a few attending today. We appreciate your time. There are several questions; I got to bundle them into one. "Why does it matter if I'm receiving SSDI or SI?" Like some people aren't sure. And so they're trying to figure out what applies to them. Other people know what they have, but they're not sure, again, maybe what applies. Can you just describe that a little bit more, Ray?

Ray >> Sure, Derek. It's a very good question. You know, I mean, the easiest thing is to look at the Work Incentives. If I were to talk to you, you know, if we decided that you were receiving Social Security Disability Insurance, I would begin my discussion with telling you what a Trial Work Period was. And we talked about that. Then I would talk about the Extended Period of Eligibility. Then I might talk about Expedited Reinstatement. Now, if it turns out that you're on SSI, everything I told you is wrong, because those are just Work Incentives for SSDI. And the same with SSI. If I told you, you know, if I told you that you were on — if you told me that you were on SSI, you know, and I started talking to you about blind work expenses, you know, and how extensive these Work Incentives can be and how you might be able to keep all of your income, and all of your benefits because of blind work expenses. And it turns out you're on SSDI. Nothing I've told you is correct.

So, in order for you to get the correct advice from a benefits planner or from an Employment Network, you need to know what type of benefits you have. Two ways to do that. If you get a notice, you all received notice last October or November about the change in your benefits. Big capital letters across the top will tell you what type of benefit it is. If you have a my Social Security account, you can click into that, and it will tell you what type of benefit is. And I encourage you to get a my Social Security account. I've had one for probably a couple of decades now. And you can do that at mysocialsecurity.gov. I think you can do that. Or you can go to ssa.gov/mysocialsecurityaccount. Fabulous thing.

Derek >> This is Derek.

Ray >> Yep.

Derek >> Thanks, Ray. This is Derek again. Yeah, it's right on the homepage. Just go to Social Security's homepage, and you will find information on how to create one of those my Social Security accounts. Great way to figure out what benefits you're on. And also, if you paid into the insurance program, what's there too? Love that. All right. Next question, Ray. There's a couple of people that have an interest to go back to work and they have an idea of what they want to do. And in one case, somebody says, they're on their way to getting a job offer. "When you mention the Ticket Program is free and voluntary, does everyone need to use the program? Or what kind of choice is that for folks?"

Ray >> It's a choice. You know, it's one way to do it. You do not need to use your Ticket to Work, but, you know, you have to consider whether or not you need that type of service. The Employment Networks, who are there to talk to you about whether it's time to go to work. If you have a job offer, you know, they could provide you with benefits planning so that you will know when your earnings will affect your benefits, so that you will be able, you know, maybe you'll need a reasonable accommodation. The Employment Networks can help you have a mock discussion about how are you going to ask your employer for this reasonable accommodation and what happens if the employer says no. They'll be giving you a little primer about your legal rights if the employer does say no. So there's lots of great services. You know, if you haven't found that job yet, do you have a resume that's up to date? Do you know how to sit for an interview for employment? You know, things have changed a lot since the last time you've worked. Let's talk about that resume. Let's talk about preparing for the interview. Let's talk about drafting questions you have for your prospective employment. All of that becomes very, very important.

If you don't need that because you have a job, you can just go get benefits planning services at the WIPA program, which we'll talk about when we talk about your team, and not use your ticket. It's perfectly up to you. Remember, it's voluntary and free. So if you need any of those services, including maybe some support services while you are working for the first five or six months, you will consider using your ticket. Again, voluntary and free.

Derek >> This is Derek. Thanks, Ray. A follow-up there. If somebody does choose to go to work without the program, do they need to report wages or anything? Or do they just go on their own?

Ray >> You need to report. Remember, when you sign the application, you agree to report to Social Security. Anything that might happen that impacts your benefits. Work is one of those. Work's the big one. So you're obligated to report anyway. But, you know, if you report, you're going to get these Work Incentives to happen, right? If you don't report, Social Security finds out about this from the IRS in two years, and they're going back using an annual wage that you earned and simply dividing it up and not applying Work Incentives because you didn't tell them about them. So there's a lot — it's incredibly important to report. You know, it's a way to stop overpayments, and it may be a way to stop you from paying it back, you know, if you're reporting and giving them all of the information that they need. So without the Ticket to Work, you still got to go to report. If you don't use benefits planning services or any kind of services, then you just get a job tomorrow. You have to report that to Social Security.

Derek >> This is Derek. Thanks, Ray. We have another question here. And, you know, I'm going to start out by reading the question that came in, but it's really exploring the purpose of the Trial Work Period. So there's somebody that really wants to go back to work, and they're unsure, in effect, if their body can handle work. But they want to try it, and they also want to have the peace of mind that if it doesn't work, that they can just kind of roll back on to their benefits. There's been two other questions that are similar to that. One is, "I tried it before. Can I try it again? And what's my Trial Work Period now?" Can you walk into that a little bit more? Because I can sense some hesitancy in the questions. And the program is here to provide that support. See if you can convince some folks about the Trial Work Period being enacted.

Ray >> Yeah, you know, the Trial Work Period is a real good thing. You know, if you earn more than $1210 in a month, you use a trial work month. Now, you know, there's one school of thought that says if you're not really sure about this, why not work and earn $1000? That's still testing your ability, but you're below the trial work level, so you don't use those months. If you are using those months, please know, you are going to get all of your benefits. You are going to get all of your health care with no interruption while you're earning whatever you want to, whatever you're able to.

For somebody who's not sure if they have the physical capacity to do work, this is how you find that out. You know, if you want to work, maybe your financial goal is set at a certain level. And we tell you, well, you can do that, but it's going to be a 30-hour work week. And you're not sure about that. Well, let's try it. You know, if we work one month and use a Trial Work Period, work the second month and use a Trial Work Period, and then in month three, you're tired, you're sore, you know, you're not able to work as much, and your income starts dropping. You don't need to worry about it in month four. If your income stops, you tell Social Security my income stopped. And you're just going to be put back in regular payment, you know. So this is a great way to do it. When you think about that can go on for nine months, you know. And it's a really valuable, very protective period of work because you can earn whatever you want and still get all of your cash and health care benefits. It's the perfect time to learn what your capacity is. And then we had — can you give me a refresher on the second part of the question, Derek?

Derek >> Well, this is Derek. Yeah, you got into it. I think the second part is like the return to benefits. So let's say they go beyond the Trial Work Period and they are working, but there's a concern that, okay, I tested my capacity to work and I started working, but my body couldn't handle it over time. What's the flexibility over time to go back to work?

Ray >> Okay. A little introduction to the Extended Period of Eligibility. It's another three years that run consecutively, so 36 months in a row, where if you perform what's called Substantial Gainful Activity, that's more than $1,690 this year, you will not be paid your Social Security cash benefit. Health care stays in place. If, in a few months, your income drops below Substantial Gainful Activity, your benefits are turned back on. You know, it all depends whether you're performing Substantial Gainful Activity. And remember, if you're earning $1,700, you are above this year's SGA level. But if you have $15 in IRWEs, you're below SGA.

So we're using all of these Work Incentives to determine what your work level is. Above SGA, no check that month. Below SGA, turn the check back on. That requires reporting, reporting, reporting. If you don't tell Social Security what you're earning every month, they're not going to be able to turn the benefits back on and off. But that's a great question. And, you know, we can go on and on. After that three years, if your benefits are terminated because of work, you can start Expedited Reinstatement five years, where Social Security is still watching you, and if you drop below Substantial Gainful Activity, we can turn your benefits on. And you get six months' worth of benefits while Social Security is making sure that you're eligible to be reinstated. So we're looking at five years, three years, and nine months. That's eight years and nine months where Social Security is looking out for you.

Derek >> Ray, this is Derek again. Excellent. I think I could give folks a peace of mind and saying, hey, this might be the right thing for me to try at this time with that kind of long coverage. You brought up IRWEs. Let's talk about them for a couple of minutes. Somebody is looking at self-employment and asked if IRWEs would be possible, would they be eligible under a self-employment model?

Ray >> Absolutely. IRWEs do have a place. Now, self-employment is a very involved, very intense record-keeping process as well. Now, if you have an IRWE that is deducted as a business expense for tax purposes, you can't claim the IRWE against your Social Security. So there's a choice to be made. Most often people will take the IRWE as a business expense. But you might have an IRWE that you have. We've got to take what you bring in, what your business brings in. We're going to determine what your expenses were to bring you down to net earnings from self-employment, and then we would apply whatever IRWEs remain. So you're going to get the same Work Incentives. They're just going to be tweaked a little bit because self-employment is a very, very unique situation. Let's put it that way, every case is very, very different.

Derek >> This is Derek. Thanks, Ray. One follow-up here on IRWE, too. Just can you repeat the eligibility for that? We got about a minute, and then we'll get back to your presentation. But I just want, there's a couple of folks that are saying they're a little confused about it.

Ray >> Okay. Is the item or service that you use related to a disability, you know, that Social Security knows about? That's the first one. Two, do you need that item or service to work? If the answer is yes, do you pay for the expense out of pocket? You know, look at the — remember that service animal. We had a pup there. You know, do I need that pup because of my disability? Absolutely. Do I need it to work? Yes. If it's a service animal that has to come to work, or even a service animal that stays home. You know, you need that to work, to continue to be able to work. Do you pay for it? Well, you pay for the vet's visit, I'm sure. You know, you pay for the dog food, I'm sure, and you paid for their license. So that is what an IRWE needs to be. Remember, in the prescription drugs, if Medicaid is picking up your prescription drugs, it's not an IRWE, because you didn't pay the cost. You know, if it is, if there's a co-pay, it's the co-pay that you have paid. You haven't paid for the prescription outright. But again, related to an impairment, allows me to work, and I pay for it.

Derek >> This is Derek. Thank you, Ray. I appreciate you going through that and all the questions that were coming in. I'll be back with you all in a little bit to ask Ray some other questions, but for now, he's going to dive into the next portion of his presentation.

Ray >> Okay. Thank you, Derek. Good questions. Everybody's keeping me working today. All right. "Can I keep my Medicaid or Medicare when I start working?" This is truly the critical question. And I've worked with many people over the years, and they're not worried about the cash benefits. They know they're going to be making more. You know, they're worried about their health care. So this is truly a very important piece of this puzzle. And the answer is yes. You know, how do you do it? If you receive SSDI benefits or an SSI payment of any amount, you will keep your Medicare or Medicaid. Now, Medicare comes with SSDI. So if you get any SSDI at all, cash, you're going to keep Medicare. SSI, same thing. SSI comes with Medicaid. So long as you get a cash benefit, regardless of how low that gets, you will keep your Medicaid.

If your benefits payment stops because of your earnings, you can remain medically disabled. Remember, in this situation, it's a very unique situation; you're not losing your benefits because you're no longer disabled. You remain disabled, according to Social Security, you're losing your benefits because of work. That puts you in this special category for special treatment. So even if you lose your cash benefits, we're going to tell you how you can keep your benefits, both Medicare and Medicaid. We've got lots of Work Incentives to help with this. And the Buy-In programs that are available, I think, in 46 states now, you know, we can keep your benefits in place for a very, very, very long time. Look at Medicare and Medicaid employment supports in the Web Links pod if you want to get some more information, beyond what we're going to talk about.

So, Work Incentives help. That's the first step. For Medicaid, Medicaid while working. You know, what happens is that after you've earned enough money, and it's a bit of a $2000 a month, to lose all of your SSI benefits, you fall into this special category called 1619(b). Fabulous category, because what it allows you to do is to continue as an SSI recipient who receives zero cash but is eligible for Medicaid. Every state has a different threshold. Yesterday, I was looking at a couple of states. One of them had a $53,000 threshold. So the person was able to work themselves to zero benefits and continue to earn income up to $53,000 before we had to think about trying to fix anything. What happens if you go over $53,000? If you're in one of those states that has a Medicaid Buy-In, you can then purchase Medicaid. Now, don't let that scare you. It's on a sliding fee scale. The premiums are really, really reasonable. So you'll be paying a small premium every month to keep your Medicaid intact. And just think about it if you're making $53,000, you probably have employer health care, but is that going to meet all of the costs that Medicaid met?

And, you know, there's some stuff in there that Medicaid is going to be very, very useful for. So you participate in the Buy-In, you have your private insurance, and that's getting close to the gold standard. You know, you're going to have very comprehensive coverage. Now the top levels for those Medicaid Buy-Ins are well over $100,000. New York State this year is looking to increase their limit to $600,000 in earnings. These are very extensive programs, both 1619(b) and Medicaid, and they change the game for people who want to return to work.

Now let's switch to the other side. Medicare, the extended period of Medicare coverage for the EPMC. This is a period of seven years and nine months, 93 months following the completion of your Trial Work Period, where you're just eligible for Medicare. You know, the trick here is, are you receiving a cash Title II benefit or not? Because, you know, if you have your cash benefit, you understand that they're taking Medicare Part B premiums out of your cash benefit. If there's no cash benefit payable, you would then be responsible to make that payment every month to the Centers for Medicare and Medicaid Services. But we're going to make sure you have enough money to do that, and you're still ahead of the game. That's the idea here.

Medicare for people with disabilities who work, this is known as Premium HI. Even if you're beyond that 93 months of coverage, if you're still disabled, all you've done here is lost your cash because of work. You are still disabled according to Social Security, you can buy into the Medicare program. And we have to look at all of that, you know, we have to look at what your state is, how much is this going to cost to buy in, are you eligible for the Medicaid Buy-In in your state? As a disabled worker who used to receive Title II benefits. You know, New York is one of those states that just says you have to be disabled. You know, it doesn't matter whether you have a Social Security benefit or not. You know, so we can look at all of that and keep your health care, keep it all in place, you know, and always considering that as your wages get higher, that employer plan might be able to pick up some of it. Medicaid might pick up the rest. Or if you have all three, an employer plan, Medicare, Medicaid. And we will plan that with you and give you your options. Very, very important.

And I talked about 1619. Now, what are the requirements? You must have been eligible for an SSI payment for at least one month. That's easy enough. Continue to meet the definition of disability. You know, Social Security does those continuing disability reviews to make sure you still meet the disability standard. And provided you do, everything's good. Still meet all of the non-disability requirements for the SSI program, that's the one bummer in 1619(b). You still have to keep your resources very low. If you have unearned income, that cannot exhaust your cash benefits because that's not because of work. So we're going to watch that for you and see what's going on and provide you with some side tips, what can you do with some money if you want to save it, you know. We can help you with that, too. You have to need Medicaid benefits to work. You know, that's not even worth asking the question, seriously. You know, Medicaid is likely providing some of the very basic return-to-work services that you need to work, period. So you can't work without it, you know, unless you have this fabulous employer plan, but employer plans don't necessarily keep services that somebody with a disability needs in place.

And you have gross earnings that are below your state's threshold. We talked about that. They're all different. And you can see where your state sits with 1619(b) by looking at ssa.gov/disability research/WI/1619b.htm. And it's going to be a 1619(b) link in your web pod as well.

That was, you know, when 1619(b) happened, I just screamed hallelujah. You know, hallelujah. We do need health insurance to work. And that's Social Security's program that recognizes this.

Now, the Medicaid Buy-In, another program that is, you know, is growing and changing, at least in the 46 states that have it. You know, I think there are two more states that have enacted it, but they don't fund it yet. Many states allow you to purchase Medicaid under a Buy-In program. You might qualify if you meet the definition of disabled under the Social Security Act. So, everybody in here who's receiving benefits meets that definition. Again, some states, Ohio is another example, you just have to have a disability that creates an impairment to work. You don't have to be on benefits. There are other ways of proving whether you meet the Buy-In criteria.

You know, again, you have 46 programs out there functioning. There are 46 different programs. Most of them require that you have some earnings from work or spend so much time working. Some allow you to have significant earnings from work or self-employment and greater savings. You know, a lot of the Buy-Ins, if you get involved with that and you're on SSI, your savings ability goes from $2000 to $20,000. And that's a big deal if you're earning more money. You may want to put some aside. Under certain circumstances, people who receive SSDI benefits may be eligible for the Buy-In programs. You've got to look at your state. Who is that Buy-In for? Again, lots of states will allow an SSDI person to do that.

And remember, SSDI has Medicare, not quite as comprehensive as Medicaid. So if you need those work supports that are being provided by Medicaid, you opt for the Buy-In, and it might cost you another $25 or $30 a month. Not that expensive. You should check with your local Medicaid agency to find out what is available in your state. Again, they're all different.

Here we go, the extended period of Medicare coverage, you know, Medicare comes in four parts, A, B, C, and D. After that, it doesn't make a whole lot of sense. You know, I'm constantly trying to wrap my mind around this program. Most SSDI beneficiaries whose benefits stop due to work will continue to receive Medicare for at least 93 months after the end of their Trial Work Period. What I like to do with the people I'm counseling is say, look at this period of time where you don't have to worry, Medicare will be there. The question is, who's paying the premium, right? We talked about that earlier. But Medicare will be there for you. It's not the time to worry about losing health care. It is time to focus on your journey to work and financial independence.

We have hospital insurance, Part A. This is premium free. It's funded by FICA taxes. So I've had my Part A card for a couple of years now. And I'm still paying for it because I'm still working, right? So the FICA taxes pay for this premium, premium-free.

Supplemental medical insurance or Part B this year, Part B costs $2.50 a month. This is covering your doctor's visits, your sickness visits, your wellness visits. Anything else that comes along with that, you know, emergency rooms, things like that. Prescription drug coverage, Part D. You know, for people who don't have a plan for prescription drugs and need them, this is there. The average plan is $45 this year. And it helps with, you know, with pretty exorbitant costs. You know, my spouse has a prescription that costs $3000 a month. If it wasn't for some of these help plans, you know, $3000 a month is a lot of money. So we have those. I mentioned Part C. That's a Medicare Advantage. It's totally different. It is an option when you turn 65.

And Medicare for people with disabilities who work. You know, this is going to cover people who are not yet age 65. And continue to have a disabling impairment, and Medicare stopped because of earnings. Notice that again, earnings from work, this is a Work Incentive. And when that happens after your extended period of Medicare coverage ends, you can buy into this program.

Now, we don't have a lot of experience with this because by this time, you know, you have worked for so long, you're usually covered by an employer plan, you know, and maybe you have the Medicaid Buy-In to pick up some of the co-pays that that plan won't cover. So we don't. And at age 65, you're no longer disabled, you are aged, you know, and that means your qualifications are different. We recognize you still have a disability, but since you're 65, different rules apply. That is there as a safety net. I can't tell you it's cheap. It all depends upon how many work credits, and we talked about earning money to become insured for Title II. How many work credits you have in your bank? Again, a great way to watch for that also is on my Social Security account.

So if you have Medicare questions, you know, for more information, please contact medicare.gov. They have a very helpful  Help Line. You can talk or chat with a live person 24 hours a day, seven days a week. That number is 1-800-MEDICARE or 1-800-633-4227 or, for TTIY users, 1-877-486-2048. All right, Derek, we're back to session two.

Derek >> This is Derek again. Thank you, Ray. That's some detailed information, and sometimes it can be technical. We appreciate your descriptions and helping us all understand it better. We do have some questions on Medicaid and Medicare. The first one we have, if my earnings go up and down, how will that affect whether I keep my Medicare or Medicaid?

Ray >> That's a very good question. Actually, during 1619(b), you know, where you have to earn enough to cash out, remember, you'll lose all of your SSI cash benefits because of work. If your income goes down, we just do the math again, and there's a potential you'll be eligible for some SSI again. So there's nothing happening to your Medicaid. You're keeping it because of 1619(b). If you lose some income, you're keeping it because you're an SSI recipient, a cash recipient again. It's Social Security who's putting you in different categories, but your receipt of Medicaid should be not interrupted at all.

Now, on the other side, SSDI and Medicare, the question is, are you receiving a cash benefit? Because we talked about Substantial Gainful Activity, if you're below Substantial Gainful Activity, you get your check; if you're above, you don't, you're living on your earnings. So as your income crosses that SGA line and goes below, we tell Social Security, and they're turning your benefits on and off. Now, with Medicare, because when you receive a check, Social Security pays that Part B premium, potentially the Part D premium as well. They take that out of your benefits check. So now, if you're above SGA, you don't have a benefits check. You are then responsible to pay the premiums for Parts B and D. You know, and the easiest way to lose health care is to not pay those premiums. So we need to be in touch with Social Security all the time, particularly if you're fluctuating every month. You know, you should be in touch with Medicare as well to let them know that you're going to be paying the premium. They will eventually bill you, but I think keeping things current all the way through is a better place for you to be. So it depends on what benefit you're receiving. And it depends — you know, it's a little bit easier on the SSI side, but it's who's paying that premium for Part B and the premium for Part D if you have that.

Derek >> Thanks, Ray. This is Derek. Another question on the health insurance arena here, you know, if the goal is achieved and somebody is offered employer health insurance, does receiving that change anything about keeping Medicare, Medicaid while working?

Ray >> Well, a lot changes because now you have a choice. You know, if you meet with a health insurance counselor and they have those people out there who know these plans upward and downward. So if you meet with somebody and they tell you, oh, it appears that your employer-paid health care will meet all of your medical needs, then you might not need Medicare and Medicaid. And you could drop out of those programs without any penalty because you have good employer plans. If you want to keep your employer plan and Medicaid, I think that's a great partnership because the employer pays first, and then we have Medicaid picking up all of the non-covered services, as well as prescription drugs. Do you need Medicare, Medicaid, and a private insurance plan? I think that's overkill. You know, because your private plan is paying for your hospital stays. It's paying for your doctor's visits. So it's doing the same thing that Medicare is doing. So that should be a rare event. There may be some particulars for an individual, given their circumstances, where it might pay to keep all of it. But you have a choice. That's the wonderful thing about it now.

Derek >> Thank you, Ray. And we have a follow-up question that came in from our earlier discussion. We were talking about the Trial Work Period. And there's a question when you got into Substantial Gainful Activity in different levels, I think it was perhaps a little confusing. Could you explain the trial work level and the difference between that and Substantial Gainful Activity?

Ray >> Yep. Thank you, Derek. It is confusing. You know, it is very confusing. But the Trial Work Period looks at a service level where you're earning $1,210 and 1 penny a month or more. If you use that, if you earn that much money, you have used a trial work month. We don't care about SGA during the Trial Work Period because I told you you could earn whatever you want. You could earn $2000 a month. You could earn $10,000 a month and still get your cash benefit during the Trial Work Period. When we finish trial work, we enter the extended period of eligibility. Now we change things. Now we're looking at Substantial Gainful Activity or SGA. That level is defined by earnings more than $1690 a month, $1690, and 1 cent. So that's what we're looking at.

Now, in the SSDI side, it's an all-or-nothing program. If you earn above $1690, you're not going to get your benefit. If you earn 1690 or below, you will get your benefit. So, two different things we're looking at. We talked about Work Incentives as well. You don't use Work Incentives during your Trial Work Period. You don't need them. You can earn as much as you want. When we look at the Extended Period of Eligibility, and we're considering SGA, we're going to take your gross wage pre-taxes of $1800. That looks like it's over $1690, right? But we're going to take those IRWEs. We have some other Work Incentives we can deduct, and your countable income is what we compare to that $1690 figure, not your gross.

So all of these Work Incentives are working. And in the appropriate situation, you still get your check, even though it looks like the cash you received from employment is Substantial Gainful Activity. So two very different periods. Trial Work Period, one set of rules, $1210. EPE, the Extended Period of Eligibility, SGA $1690. I hope that helped clear it up.

Derek >> Thank you, Ray. This is Derek again. I appreciate that. And it's now time to go into your final section on who can help you. And just to check on time, if you can look at that and get about, oh, say about seven minutes, if you could do that for us, and then we'd have a final short Q&A.

Ray >> We can do it. I'm sure we can do it. Thank you, Derek. Okay. Who can help you do this? We talked about your work team. Eric talked about it. I did your employment team. The Ticket to Work service providers can help you achieve your goals. And, you know, like I said, voluntary and free, so why not, right? As you think about starting or returning to work, you may have questions that need support. You know, connecting with the Ticket Program service provider can help you develop achievable goals and determine the steps you need to take to find and maintain your employment. Ticket to Work service providers can also help you identify the type of job or career that you might enjoy and any transferable skills that you have. Lots of people think, well, I haven't been doing anything. I haven't been working. I don't have any skills. Trust me, you've got skills. We just need to figure out what they are and how they apply to the workplace.

Now, the Ticket Program providers that you'll have access to, they're all different, but we've got the Employment Networks, and we have State Vocational Rehabilitation agencies. They're both considered Employment Networks. So, an EN, what's an EN? It's a private or a public organization that has an agreement with Social Security to provide you free employment support services if you're eligible for a ticket. That sounds like a deal. Many state public workforce systems, such as the American Job Centers that used to be called one-stops, are workforce ENs. You know, and they're pretty good. You know, a job center can — you know, if you do lose your job, you know, can help you apply for unemployment benefits, can immediately get you onto a computer so you can start looking for another job. You know, if you're disabled and you're looking for work, what kind of jobs are available in your area? What does your resume need to look like? That's a really — they call them one-stops for a reason.

How can working with an EN help? I think they can help a great deal when you're considering work, particularly for some of you who might still have a doubt. You know, there's always going to be a doubt, but we're trying to minimize those doubts. ENs provide services and supports designed to help you on the path to financial independence through work. They can help you identify your work goals, what do you want to do, how much do you want to work, how much can you work. Writing a resume, you know, reviewing the resume you have, preparing for interviews — a must, you know, a must if you haven't been on an interview in a long time, it's likely very different, you know. I haven't had an interview in 26 years. I would need interview preparation. Request reasonable accommodations. You know, if you're uncomfortable doing that, the Employment Network can help you put a little — again, a mock interview together to get that request made for. Sometimes it can ask for that accommodation with you.

Receiving benefits counseling. You know, we haven't talked a lot about benefits counseling yet but, you know, benefits counseling is the part that's letting you know when your benefits will be impacted. You know, if you work nine months in a row, you've used your Trial Work Period. What happens next? You know, when are your benefits going to zero out and what can we do about that? You know, we're going to move you into 1619(b) if you're on SSI. And reporting your wages. You know, you are responsible for doing that. There are many ways to do it, and the ENs can help you discuss those ways. Some of them still do report, not many. But that's your responsibility, remember it's not your EN's responsibility.

State VR agencies. This is the big player. If you need a four-year degree or a two-year degree to get the job you want now, we're looking at state VR because they have the funding to do that. They provide a wide variety of services to help people with disabilities return to work, enter new lines of work, or enter the workforce for the first time. A State VR agency may offer benefits counseling and may also be able to help you with vocational rehabilitation, training, and education. Again, the big-ticket items are generally going to require a state VR agency.

So, how can working with VR help? Usually, the more significant your disability, the more significant services that you're going to need, the more likely they are to be provided by a State VR agency. In some states, this can include intensive training, education, and rehabilitation. If I have lost my left arm and I have a prosthesis, how do I need — what do I need to learn to do with that prosthesis in order to work? You know, so that's the physical rehabilitation part. Get the education and whatever training I need as well. They may also provide career counseling and job placement assistance, as well as counseling about how earnings from work may affect your benefits. Many ENs and VR agencies have benefits planners in-house.

How do you find a service provider? You know, you can look for a list by calling the Ticket to Work  Help Line, 1-866-968-7842, or TTIY users can call at 1-866-833-2967, Monday through Friday, 8 a.m. to 8 p.m. Eastern time. And the Ticket to Work  Help Line  can give you the names of providers near you. Or people who — you know, ENs, if they're bigger, they may not be near you, but they can still help you. To find a service provider online, visit the Find Help page. This is fantastic. And I'm on it several times a week, looking Florence, South Dakota, can I find an Employment Network for somebody? You can search by your zip code if you want somebody local. What types of services do they offer? They may offer services to people with mental health issues. You know, if I have a physical impairment, that's not going to be the guy I want. I need somebody who helps with physical impairments so we can search that way. The disability type, you could put in your disability and find out who is used to and has experience working with people who may be in your similar situation.

Languages spoken. I would prefer to have an EN who speaks Spanish. I'm just more comfortable dealing with somebody in my native language. ToS in Spanish. It's going to give you people who provide those services in Spanish.

And then the provider type. You don't need to search the entire world for everybody. You can search by EN, if you just want an Employment Network. Those workforce ENs, the one-stop centers, or state VR agencies. And limit your search so that you don't get overwhelmed with a hundred hits. And we're back to question and answer, Derek. Did I cover — did I leave you a couple of minutes?

Derek >> Hey, Ray, this is Derek. Fabulous. We have time for a couple of questions before we go to wrap up. So, about the team, let's talk — a follow-up question on the ENs, specifically about planning. A lot of folks are like, I want to work, I don't know how to get to actually working. Talk about the ENs and the development of a work plan. What's that like?

Ray >> You know, you do have to have a plan, and it is the work plan, right? That's how you agree to get your services, you negotiate and you sign this plan. The ENs, I think, are one of the primary people on your employment team who can actually have that conversation with you. You know, I want to work, I want to earn more money, I don't know how to get there. That's the discussion. Is it your time to work? I want it to be now, okay. Then let's see how you get there. If we're looking for a job immediately, you know, what kind of skills, those transferable skills, do you have? If you need — you know, maybe you were a plumber, and your license is long gone, and now you want to get that license back. Do you need more training? You know, is there a test you need to take, you know, to get that license back? That's one of those steps to get you to work from where you are now. So they know about your neighborhood employment situations. So if you get a local EN, if I find an EN in Santa Fe, they're going to know the jobs. What's available here? You know, who is hiring? Who are the best employers for people with disabilities? So there's a lot of information you need to get from where you are to work. And the ENs are really equipped to have that discussion with you and to figure out what steps you need to take before you can actually open the door and enter your workplace.

Derek >> This is Derek. Thank you, Ray. Let's dig into that a little bit further. You started talking about the ENs, they know the employers. Talk specifically, can an EN help a beneficiary of Social Security find a job?

Ray >> Specifically, yes. That is one of the steps that could be in your plan. You know, I've been in Santa Fe now for seven years. Do I know everything about the employment market? No. I would want some help from an Employment Network to let me know what's out there. You know, do I want to be self-employed? What does the city and the state require of me to become self-employed? So, you know, the employers, if I get a smaller EN in the Santa Fe area, you know, they may know the businesses as well. You know, it's not like they're going to talk to you and say, well, apply for a job at Walmart. Well, that might not be the right spot for you to fit in. Is there a private, you know, concern that you might work for? You want to be a receptionist in a medical office. Well, there are lots of doctors here. It depends on what type of doctor you might want. Do you want to work in a hospital setting? We've got a hospital here. Do you want to work in an emergency room setting, you know, one of those urgent care places? So the ENs will know where those places are. What are the two hospitals in Santa Fe? Where are all the urgent cares? Do you want to be close to your house, or are you willing to commute across town? So that's what the EN is going to help you with on a local level. And just the fact that they've usually been working in Santa Fe for a very long time means they're going to have their pulse on the employment market.

Derek >> This is Derek. Well, Ray, thank you for that. You know, we have to cut it off there so we can go to wrap up. I'll just mention to everybody that there are ENs that are local, ENs that are regional, and ENs that are national. And some of them do direct job placement services locally. Some of them do job placement assistance locally or nationally. And that's really a selecting point. If it's something that's important to you, you can work in selecting the EN that has the right service for you. And with that, Ray, we really appreciate you presenting today on "How Will Work Affect My Social Security Disability Benefits." It's excellent to have you with us as always.

Ray >> You're very welcome, Derek. It has been a pleasure.

Derek >> All right. Now, as Ray mentioned, there's different ways to get started. I think it's important that you select one if you're thinking about it, and we encourage you to reach out. First, make sure that you're eligible, and like we said, be 18 through 64 years old and receiving SSDI or SSI due to a disability. With that eligibility in mind, you can use the Find Help tool on our Choose Work! website to search for Employment Networks or Vocational Rehabilitation agencies. And you go to choosework.ssa.gov, and you find that Find Help tool under that Find Help section. You can use the categories that Ray explained earlier to find the EN or other employment team agency of your choice there.

Importantly, too, if you prefer, you can reach out to the Ticket to Work  Help Line. Those beneficiary support specialists, they're agents that are ready for you to call and ask those personal questions, and they'll help you in providing an Employment Network list too. You can call them at 1-866-968-7842 or via TTY at 1-866-833-2967. Important that you reach out to them to get that guidance.

Now, how to connect. There's different ways to do so. You can visit us at Choose Work! contact page. One way that you'll find listed there is the Choose Work! blog, or you can sign up for our email updates. We do encourage you to do that. All the subscription options are online. The link is also in the Web Links pod under Ticket to Work contact information. Importantly, if you prefer updates sent straight to your mobile phone, you can opt in to receive text messages. They'll be about webinar announcements or success stories, or other helpful tips. Text "Ticket" to 1-571-489-5292. Standard messaging rates may apply depending on your mobile plan. If you have any questions, you can always email us too at tickettowork@ssa.gov. It's important to know whether you're just getting started or looking for guidance along the way, the Ticket program is definitely here to help.

And we ask you to join us next month for our WISE webinar. This one will be on March 25 from 3 to 4:30 p.m. Eastern Time. The topic will be a general overview of what is Ticket to Work. This is a very popular session, and although we touched on it today, this next one will go into a deeper dive. Registration is available on the Choose Work! website, right on the homepage, or you can call the help line at the numbers provided. We encourage you to register today. Thank you again for attending. We appreciate your time. And this ends today's webinar.