Posted on January 10, 2006 by Knight Ridder, Tribune News Service
Q: I am getting Social Security disability benefits. If I try to return to work, will that affect my checks? I read that people on Social Security could earn up to $12,480, but I don’t expect to make that much. F.M., Uniontown
A: The $12,480 limit doesn’t apply to disability cases. The disability program uses special rules called “work incentives” that allow a person to keep their cash benefits and Medicare coverage while attempting to return to work. A disabled person returning to the workforce is protected by one work incentive called a “trial work period.” As long as the work activity is reported and the person continues to have a disabling condition, their full Social Security benefit will be paid regardless of how much they earn during the trial work period. After the trial work period ends, benefits will stop if the earnings are considered “substantial.” For Social Security purposes, substantial means earnings of $860 or more per month in 2006. For more information about work incentives, visit Social Security’s Web site at www.socialsecurity.gov or call 800-772-1213 and ask for the publication, Working While Disabled: How We Can Help.
Q: My neighbor and I are both disabled and receiving Supplemental Security Income (SSI). His amount is over $600 a month. My check went up this month but it is still $200 less than his. Why would I be paid less? My disability is much worse and I’ve been disabled longer. T.K., Mogadore
A: The severity and duration of a condition are considered in the initial disability determination, but they are not used as factors in calculating the benefit amount. SSI is a needs-based program and payments are affected by other income and/or support from other people. For example, if you receive free rent or you’re paying less than your fair share of the household expenses, the SSI amount would be reduced. You need to call 800-772-1213 and ask the representative to explain how the SSI payment was determined and why it is less than $603 (this is the 2006 SSI standard rate for an individual).
Q: I have a question about my Medicare Part D prescription coverage. What happens if my doctor gives me a prescription and it’s not covered by my drug plan? Do I have to pay the pharmacy the full amount? N.K., Canton
A: There are protections built into the new Part D process to protect people when a situation such as that occurs. Medicare drug plans weren’t required to cover every drug available, but they were required to cover every type of drug. That’s why it is so important for people to review what specific drugs are covered by the Medicare drug plans and to pick one that covers the prescriptions they are taking at that time. Later, if your doctor believes you need to take another prescription drug not covered by your plan, you or your doctor can contact the plan and ask to be granted an exception. An exception means the plan agrees to pay for the new drug. If the plan refuses to give you an exception, you can appeal the plan’s decision. When you first joined, the Medicare drug plan should have sent you information about its appeal procedures. Read the information carefully and call your plan if you have any questions.
Always consult with an experienced social security disability professional when you need help getting your disability benefits.