- Substantial Gainful Activity (SGA)
- Trial Work Period
- Extended Period of Eligibility (EPE)
- Impact of Work Incentives on SGA Determination
- SGA Determination Process
- Extended Medicare Coverage (Pre TWWIIA)
- Extended Medicare Coverage Under TWWIIAA
- TWWIIA Extended Medicare Coverage Decision Tree
- Final Comments
- Practice Quiz
- Final Quiz
Impact of Work Incentives on SGA Determination
There are work incentives available to individuals who receive Social Security that will allow them to continue receiving cash benefits while they test their ability to work and sustain work. The work incentives are to assist the individual in becoming more self-sufficient as they pursue an employment goal. Below is a discussion of the SSDI employment supports (work incentives).
Impairment-Related Work Expenses
SSA will deduct the cost of certain impairment-related items and services that an individual needs to work from the gross earnings when deciding if the individual's countable earnings demonstrate performance of SGA.
SSA will deduct IRWE using the following criteria:
- The item or service enables the individual to work;
- The individual needs the item or service because of the disability or impairment(s);
- The individual pays for the cost and will not be reimbursed by another source;
- The cost is "reasonable" - that is, it represents the standard charge for the item or service in the individual's community; and
- The individual paid the expense in a month of work.
Subsidies and Special Conditions
Subsidy and special condition are SSA's names for support an individual receives on the job that may result in the individual receiving more pay than the actual value of the services being performed. Subsidy is support provided by the employer. Special conditions are generally provided by someone other than the employer, for example a vocation rehabilitation agency.
SSA considers the existence of subsidy and special conditions when making an SGA decision. Only earning that represent the real value of the work being performed is used to determine if the work is at the SGA level.
Unsuccessful Work Attempt
An unsuccessful work attempt is an effort to do substantial work, in employment or self-employment that the individual stopped or reduced to below the SGA level after a short time (6 months or less) because of
- The impairment(s); or
- Removal of special condition related to the impairment and essential to the further performance of work.
If an individual is receiving SSDI benefits, earnings during an unsuccessful work attempt do not count when deciding if the individual has engaged in SGA. Once SSA determines the individual has engaged in SGA and benefits are ceased, UWA policies can no longer be applied during the remaining months of the EPE.
When an individual's earnings or work activity varies from month to month, it may be necessary to average "countable earnings" reported over a number of month in order to make an SGA determination. Earnings that fluctuate are averaged:
- If work is the same, total earnings are averaged over the entire work period.
- If work is significantly different or a regulatory change occurs in SGA amounts, earning are averaged over separate periods of work. If an individual's countable earnings, when averaged, indicate SGA, the individual may, for purposes of the disability determine, be considered to have engaged continuously in SGA during the entire period being averaged.
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