| How
does EXR apply to Benefits Planning Assistance and Outreach (BPAO)
activities?
Whether an individual should reapply for benefits or request Expedited
Reinstatement is a complex decision. Factors such as benefit amount,
access to work incentives, provisional payments, disability determination,
waiting periods, and access to medical insurance are all essential
factors. The Social Security Administration is best equipped to
help someone make a decision, since they, and only they, make the
decision of what will be paid, and whether benefits are payable
at all.
Benefits
Specialists should help the individual understand the complexity
of the situation:
For Example:
Can
an Individual Request EXR and Reapply for Benefits at the
Same Time?
|
SSA’s
Program Operations Manual System (POMS) specifically states
that EXR and reapplication are mutually exclusive. Benefits
Specialists will need to help customers choose between EXR
and reapplication based upon the unique status and needs of
the individual balanced by the specific advantages and disadvantages
of each approach. This is an important decision and has many
complex factors. |
How
does EXR affect the availability of work incentives as compared
to re application?
|
Social
Security Disability Beneficiaries (SSDI/CDB/DWB)
1. An important aspect of EXR is that it allows the individual
to get another Trail Work Period (TWP) and Extended Period
of Eligibility (EPE) - but not immediately. The individual
must not engage in substantial gainful work activity (SGA)
for 24 months before being entitled to another Trial Work
Period. These 24-months don’t have to be consecutive.
If someone who requests EXR returns to substantial work,
the 24-month clock stops ticking until she again stops performing
SGA. Once the 24 months has passed, the person receives
a new Trial Work Period, and Extended Period of Eligibility,
and all of the other work incentives conferred on initial
applicants for Social Security disability benefits.
2. Another important benefit of EXR is that it may significantly
increase eligibility to Medicare. If individuals request
EXR, they will receive Medicare beginning with the first
month of provisional payments, and throughout the initial
period of reinstatement. Even though payments are suspended
and the 24-month clock stops ticking for months of SGA,
Medicare coverage would continue for those months as well.
Once the individual has received 24-months of payments,
s/he has a new Trial Work Period, and a new Extended Period
of Medicare coverage.
Supplemental
Security Income recipients (SSI)
If the individual receives SSI, and not Social Security
disability benefits, then use of SSI work incentives is
immediately possible after reinstatement. Once someone gets
SSI through Expedited Reinstatement he must receive benefits
for 24-months before he may again request EXR. If the entitlement
ends before the 24-months have passed, the person would
have to reapply to get SSI payments again.
|
What
if I request EXR or re-apply for benefits and then return
to work at a substantial level shortly thereafter thereafter,
how will this affect my EXR request or the status of my application?
|
If
the individual plans to return to work shortly after making
the EXR request, or filing for re-application, then there
are special considerations. Work above SGA shortly after applying,
either for SSI or Social Security disability benefits may
cause the SSA to reopen and deny the application. EXR would
permit provisional payment for the few months that the individual
is below SGA. The payments would be suspended for months above
SGA, but there would be no overpayment. |
Are
there differences if the individual is blind? |
EXR
is applied to blind individuals in the same way it applies
to other beneficiaries, with some exceptions. For blind people
who are over age 55, there is a special provision that may
let them come in and out of payment status, depending on earnings,
without having to reapply. For those individuals, EXR is not
possible. Also, when considering reapplication or EXR for
blind individuals, remember that there are some basic differences
in the work incentives. For Social Security disability beneficiaries,
the financial limit that is used to consider work as substantial
is significantly higher. For SSI recipients, additional deductions
can be made when considering gross income to determine what
income is countable. These work incentives apply immediately
if the person is reinstated. Under reapplication, the limit
for substantial work only applies
after the Trial Work Period is complete. |
If
someone reapplied and was denied, may they request EXR?
|
The
medical disability standard for reapplication is more difficult
to meet than the medical standard for EXR. A person could
choose to reapply, and then be denied. If that happens, they
may request Expedited Reinstatement. The EXR request date
will not be retroactive to the application date.
|
What
happens if someone was receiving CDB benefits previously, and
got married before or after the benefits were terminated?
|
When
CDB benefits are terminated due to marriage, individuals will
not be able to apply again on that parent’s record,
unless the marriage was void or annulled. |
What
happens with individuals who are eligible for both Social
Security disability and
SSI?
|
People
on SSI are required to apply for any other benefit for which
they are eligible. If someone receiving SSI has earnings that
drop below the Substantial Gainful Activity limit, they must
apply or request EXR. Which they do depends on the respective
payment amounts. Individuals who are
entitled to SSI are required to procure whatever benefit will
pay the earliest and the highest amount.
|
Are
there risks involved with EXR?
|
Yes.
The largest risk is to Medicare coverage. Under the Social
Security disability programs, a person may receive extended
Medicare coverage for at least 93 months after the Trial Work
Period ends. The person must still be disabled in order to
receive this Medicare extension. If someone applies for Expedited
Reinstatement, and is found to have a medical improvement,
she no longer is disabled under Social Security law. That
means her Medicare stops. If the person reapplies for benefits,
instead of requesting Expedited Reinstatement, neither a denial
nor approval will affect Medicare entitlement under the Extended
Period of Medicare Coverage. |
IF
EXR is denied, may individuals reapply?
|
Yes
, and the EXR request date will protect retroactivity for
the individual’s application date. |
Resources:
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