1619(a) - Rules that allow Supplemental Security Income (SSI) recipients to keep their SSI benefit at a lower level when they return to work.
1619(b) - Rules that allow Supplemental Security Income (SSI) recipients to keep their Medicaid after losing SSI cash because of earnings.
ADAP - A program that pays for some or all of the costs associated with HIV/ AIDS medications. ADAP only covers Federal Drug Administration (FDA) approved medications on it s formulary (list of covered prescriptions).
Administrative Law Judge - A judge who hears an appeal.
Advance Earned Income Tax Credit (AEITC) - A program that allows individuals with at least one qualifying child to increment ally receive the Earned Income Tax Credit in their paycheck during the year.
Affidavit of Support - A contract signed by the sponsor that shows that the immigrant applying for a green card is not likely to become dependent on the government for cash welfare or long-term care (nursing homes). There are two types of Affidavits of Support: Old (Traditional) and New (Enforceable).
Age 18 Redetermination - People on SSI, who turn 18 years old, get an eligibility review to see if they will meet the adult definition of disability, which is different than the definition for children.
Aged - The Social Security Act considers people who are 65 years or older as aged.
Ancillary Services - Protective shoes, clothing, tools, fees, or other services necessary for work.
Annual Election Period - The period from November 15 through December 31 when you can enroll in and switch Medicare Part D plans.
Asset Limit - The maximum amount of assets you're allowed to own while maintaining eligibility for a particular disability benefits program.
Assets - Things you own, like a car or a house. You can own a certain number of assets and still qualify for most health care and disability benefit programs. The home you live in and the car you drive to work are exempt under most Social Security and state disability benefit programs.
Adult Care (a.k.a. Aging and Long-term Care Administration)- A DSHS program focused on promoting choice, independence and safety through innovative services for adult clients.
Basic Plan - A Medicare Part D plan that meets just the minimum requirements laid out by the Centers for Medicare and Medicaid Services. (CMS).
Benchmark Plans - Certain Medicare Part D plans that have their monthly premiums fully covered by the Low Income Subsidy.
Beneficiary - The person who is receiving a benefit.
Benefits Estimator - The online Benefits Estimator offered on this website to help you see how going to work will impact your income and life.
Benefit Period - The time period that Medicare uses to measure an individual’s use of hospital and skilled nursing facility care. A benefit period begins the day an individual enters a hospital or skilled nursing facility (SNF). The benefit period ends after the individual is released and hasn't received any further hospital care (or skilled care in a SNF) for 60 consecutive days. If an individual goes into the hospital after one benefit period has ended, a new benefit period begins. The inpatient hospital deductible may be charged for each benefit period. There is no limit to the number of benefit periods an individual may have.
Benefits Planner - A trained-expert who can help you understand or apply for benefit programs. Their goal is to help you avoid financial problems while developing a sustainable plan for your future.
Benefits Planning Query (BPQY) - A report that summarizes your current Social Security disability benefits. To order one, visit your local Social Security office or call 800-772-1213 (voice); 800-325-0778 (TTY). Be sure to review your BPQY carefully. If you have questions about it, contact a benefits planner or Social Security.
Blind - Blindness in Social Security disability programs is "statutory blindness," which means: You have a central visual acuity of 20/200 or less in your better eye, even while you are wearing a correcting contact lens or glasses in that eye; or You have a limitation in the field of vision of your better eye, so that: You have a contraction of peripheral visual fields to 10 degrees from the point of fixation, or The widest diameter of your visual field subtends an angle no greater than 20 degrees, or You have a contraction of peripheral visual fields to 20 percent or less visual field efficiency. If you have a visual impairment that is not "blindness" as defined above, but your reduced vision (alone or in combination with other disabilities) prevents you from working, you may still be eligible for SSI benefits.
Blind Work Expenses (BWEs) - provide an additional work incentive for individuals receiving SSI due to blindness. BWEs include costs for any work related items that are paid out of pocket and not reimbursed, and not deducted from earnings as impairment related work expenses.
Blue Book (Listing of Impairments) – Social Security book that gives detailed information about disability programs to health care professionals. The Blue Book is available online, and defines the conditions considered severe enough to prevent a person from doing any gainful activity.
Break- Even Point (BEP) - This is the income amount which reduces your Supplemental Security Income payment to zero when Social Security uses the countable income calculation. Your break- even point can be determined by your earned and unearned income, living arrangements, and applicable income exclusions.
Cash Value - The amount of cash accrual and interest that the insured may be able to borrow money from.
Childhood Disability Benefits (CDB) – also called Disabled Adult Child’s benefits (DAC), are payable to a disabled adult child of an insured worker who has retired or become disabled, or has died. The child must have a disabling condition that began prior to the time the child attained age 22. The disabled child must be 18 years of age or older to access Childhood Disability Benefits. Although it was just stated that the disability had to begin prior to the age of 22, individuals cannot be found entitled to CDB until they have turned 18. Those under age 18 may be eligible for child’s benefits not based on disability.
Citizenship Status - Assuming they meet all other eligibility criteria, U.S. citizens and Qualified Aliens (including those who meet I-551 or I-94 status) are eligible for both Social Security and Washington public benefits programs. Legal residents who don't have I-551 or I-94 status may be eligible for some Washington programs, but not for Social Security programs.
Coinsurance - The part of the payment for medical services that a person has to pay. For example, your health coverage may pay for 80% of the costs of a service, while you will have to pay the remaining 20%.
Community Work Incentives Coordinator (CWIC) - The federal government pays benefits planners in communities around the country to help people think ahead about work incentives and benefits issues. CWIC'S are benefits planners who are trained by the Social Security Administration to assist beneficiaries with programs including Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI) in addition to other related programs.
Conditional Permanent Resident - U.S. Resident with a I-551 C Card.
Consolidated Omnibus Budget Reconciliation Act (COBRA) Administrator - An outside company that processes COBRA and/or OBRA premiums.
Continuation Coverage - Group health coverage through COBRA, Cal-COBRA, or OBRA.
Continuing Disability Review (CDR) - A periodic review to determine if there has been any medical improvement in your condition and to determine if you continue to be eligible for Social Security benefits for other reasons. The two types of reviews are called a medical CDR and a work CDR.
Copayment - A set amount you have to pay when you receive medical services. For example, you may have to pay $10 or $20 every time you visit the doctor or get a prescription refilled. This is known as a "copayment."
Countable Income Calculation - The calculation used to determine how much of your unearned and earned income is counted when determining your SSI benefit and eligibility.
Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.
Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide.
Step 3: Add your countable unearned income to your countable earned income to find your total countable income.
Different programs may include more deductions or exclude certain types of income. See the program descriptions for details.
Coverage Effective Date - The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.
Creditable Coverage (Medicare) - Coverage that is at least as good as that offered through Medicare Part D. Your health coverage plan can tell you whether or not your coverage is creditable.
Creditable Coverage - Under HIPAA, creditable coverage is prior health coverage that allows you to reduce pre-existing condition exclusionary periods when applying for new coverage. Most forms of health coverage can count as creditable.
Custodial Parent - A parent that lives with the child.
Deductible (Medicare) - The amount an individual is responsible for paying before Medicare begins to pay. For Part A, the deductible must be paid each benefit period. For Parts B and D, the deductible must be paid each year.
Deductible - The amount an individual is responsible for paying for health care services before the insurer begins to pay.
Deemed Income - The amount of another person’s income – spouse, sponsor, sponsor’s spouse, parent – that is considered to belong to the individual regardless of whether the person receives this money.
Deemed Income (SSI) - The amount of another person’s income (a spouse or parent, for example) that is considered to belong to the individual regardless of whether the person receives this money.
Deeming Rules - Rules used by Social Security and Medicaid that determine an individual’s eligibility when living with a non-disabled spouse. If the individual is a minor, deeming rules apply to the parents.
Dependent - A person, usually a child, who is economically dependent on another person. Different programs have different specific definition of when someone is a dependent.
Developmental Disabilities (Administration) - A DSHS program focused on providing support and fostering partnerships that empower people to live the lives they want.
Disability - (Definition used by private insurers) Definition of disability may be two-tiered: an inability to participate in the employee's own occupation (regular work) on the first tier, and an inability to participate in any occupation (any work) on the second tier. Refer to policy for definitions of disability.
Disability - (Definition used by Social Security for Adults) The inability to engage in any Substantial Gainful Activity (SGA) due to any medically determinable physical or mental impairment which can be expected to result in death or last for a continuous period of at least 12 months. A person must not only be unable to do his/her previous work but cannot, considering age, education, and work experience, engage in any other kind of SGA which exists in the national economy. It doesn't matter whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he/she applied for work. The worker’s impairment(s) must be the primary reason for his/her inability to engage in SGA.
Disability - (Definition used by Social Security for Children) A child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
Disabled Adult Child (DAC) Benefits - See Childhood Disability Benefit (CDB).
Disclosing a Disabling Condition - Generally, the only time it is required to disclose a disabling condition at the workplace is when requesting a reasonable accommodation. Even then, the requirement is to present the employer with a request that a reasonable accommodation is needed for the person to perform the essential functions of the job.
Disregard - A specified amount of earned or unearned income that is excluded from consideration in the financial eligibility requirements for a Medicaid program.
Domestic Abuse - Assaultive or coercive behavior that includes: physical abuse, sexual abuse, psychological abuse, economic control, isolation, stalking, and threats.
Domestic Partners - "State registered domestic partners" means two adults who meet the requirements for a valid state registered domestic partnership.
Domestic Violence Survivors - Are people who endured and survived domestic abuse.
Donut Hole - The gap in Medicare Part D coverage when you have between $2,830.00 and $6,440.00 in total drug costs in a year. Medicare will not help pay for your drug costs during this period unless you qualify for the Low Income Subsidy.
Dual-Eligible’s - A term used to describe individuals eligible for both Medicare and Medicaid.
Duration of Ticket - Services Ticket program services may be used for sixty months (5 calendar years) and sometimes longer. Full use of sixty months of services under current rules is allowed once during each period of a Social Security disability.
Earned income is any cash or in-kind item that an individual receives in exchange for work performed. Earned income includes:
• Wages are payments an individual receives (before deductions like taxes) for working as someone else’s employee. Wages may include salaries, commissions, bonuses, severance pay, military basic pay, sheltered workshop earnings, and any other special payments a person receives because of their employment.
• In-kind Earned Income includes the value of food or shelter, or other items an individual receives instead of cash in exchange for work performed. The most common type of in-kind earned income is when room and board is provided as part of what an individual receives for live-in employment. SSA assesses in-kind earned income by applying current market value. If an individual receives an item (instead of cash) that is not fully paid for and he/she is responsible for an unpaid balance, only the amount previously paid is counted as income.
• Net Earnings from Self-Employment (NESE) is the amount of gross receipts from a trade or business that an individual operates, less allowable deductions. Generally, SSA allows the same deductions as the IRS when determining NESE.
Earned Income Deduction - Income received from work that is disregarded in the countable income calculation. This calculation evaluates an individual’s financial eligibility for SSI related Medicaid, including Healthcare for Workers with Disabilities.
Earned Income Tax Credit (EITC) - A federal income tax credit for low income working individuals and families. The credit reduces the amount of federal income tax owed and can result in a refund check.
Eligibility Category - One of several types of health coverage programs that Medicaid offers. Each eligibility category has specific requirements, and an individual may be eligible for more than one category. Eligible Non-Citizen Either a: U.S. permanent resident (has an Alien Registration Card or I-551 Card), U.S. permanent resident (has an Alien Registration Card or I-551 Card), Refugee, Asylum Grantee, Parolee, or Cuban-Haitian entrant with an Arrival Departure Record (I-94) from the Immigration and Naturalization Service (INS).
Employer Sponsored Health Coverage - Health coverage offered through an employer.
Employment Network (EN) - An employment services agency that is approved by Social Security. Employment Networks may offer a variety of services such as job readiness services, placement services, vocational rehabilitation, training, job coaches, transportation or other supports. Examples: Employers, employers offering or arranging for job training, an employer collaborating with a community based organization, Transportation providers, employer working with a community based organization, consumer groups, staffing and placement agencies, public or private schools providing transitional education or career development services, Organizations working with ethnic, disability, or religious faith groups.
Exception - A request to the plan to either cover a drug that is not on the formulary or to bypass utilization controls.
Exclusion - A service that a health coverage plan won't pay for. Cosmetic surgery, for example, is not covered under most plans.
Expedited Reinstatement of Benefits - Immediate reinstatement of benefits for individuals whose Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) ended due to employment. This provision is available for up to 5 years after Social Security work incentives have been exhausted.
Explanation of Medical Benefits (EOMB) - A statement from your health insurance company showing the health care services you have received and how much the insurance company has paid for those services.
Extended Period of Eligibility (EPE) - The 36 consecutive months that start at the end of the Trial Work Period. During the Extended Period of Eligibility, any month in which gross earnings are $1,000 or more (for 2010), an individual’s wages are considered Substantial Gainful Activity (SGA). When an individual’s earning first reach SGA, a three month grace period begins, allowing a beneficiary to continue receiving Social Security Disability Insurance (SSDI) payments regardless of wages. After the three month grace period, an individual will not receive SSDI income benefits for months when wages are at or above SGA. If wages fall below SGA, SSDI payments will resume. Beneficiaries who continue to earn SGA income after the EPE will no longer be eligible for SSDI payments. The SGA earnings for blind beneficiaries are different. In 2010, SGA for the blind is $1,640.
Federal Adjusted Gross Income - Total taxable income. This includes money, goods, property, and services from all sources after any adjustments or deductions that are shown on a federal tax return.
Federal Benefit Rate (FBR) - The national benefit amount, established by the Social Security Administration (SSA), for Supplemental Security Income (SSI) recipients. The Federal Benefit Rate (FBR) is administered by SSA for all states and Commonwealths annually. For 2010, the FBR is $674 for an individual and $1,011 for a couple.
Federal Poverty Level (FPL) - A table of income amounts used to determine financial eligibility for federal and state programs. Each year, the Department of Health and Human Services (HHS) issues the Federal Poverty Guidelines. In the Federal Register. The Federal Poverty Level for one person is $10,830. For each additional person, add $3,480. For Medicaid programs, these figures go into effect in March or April of each year.
Five-Year Window - The sixth consecutive months during which an individual works nine Trial Work Months. The Window begins on the onset date of disability, but rolls forward until an individual has worked nine Trial Work Months that all occur within a 60 consecutive month period of time.
Formulary - A list of drugs that a health plan covers.
Full-Scope Medicaid - Complete medical services offered to beneficiaries.
General Enrollment Period - The period of time between January 1 and March 31 when a Medicare beneficiary can sign up for Part B coverage. Benefits will not begin until July 1 of that year, and a beneficiary may be subject to a late enrollment fee of 10% for each 12 month period they did not have Part B Medicare.
General Income Exclusion (SSI) - The $20 of earned or unearned income that is not considered when determining the amount for the Supplemental Security Income (SSI) benefit.
General Assistance (GA) - A state program that provides relief to those who are unable to support themselves by their own means, or by friends or relatives, other public funds, or other assistance programs.
Grace Period - The three-month period following the first month when an individual's wages reach or exceed Substantial Gainful Activity. An individual receives full Social Security Disability Insurance (SSDI) payments regardless of wages during this period.
Grant - A monetary reward that does not have to be repaid.
Gross Benefit Amount - The total benefit amount an insurance company pays before deductions. Deductions are made for an individual’s disability income and for earnings he/she is receiving.
Gross Income - Income before taxes and other deductions are made.
Group Coverage - Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.
Guaranteed Issue Period (Medicare supplement) - A period of time when an individual can enroll in a Medicare supplement plan without medical underwriting or waiting periods. Medicare supplement providers cannot deny coverage during these periods.
Health Maintenance Organization (HMO) - A common type of health care coverage plan. HMOs require that you only see certain doctors and that your primary care physician decides when you need to see a specialist.
Health Screening - A process that allows Medicare supplement carriers to refuse coverage based on an individual’s health history. This process is also known as medical underwriting.
Health Status - HIPAA and Washington laws prevent employer-sponsored health coverage plans from denying coverage based on health status. This includes physical and mental health conditions, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability.
HIV/AIDS Disability Form 4814 for Social Security - A form for individuals with HIV/AIDS who are applying for Social Security Disability Insurance (SSDI) benefits. The form requires physicians to identify whether an individual has one of the 41 opportunistic infections listed on the form, and to specify any "repeated manifestations" of other symptoms that restrict certain aspects of the individual's life.
Home Health Care (Medicare) - Services covered by Medicare including part-time or periodic skilled nursing care; home health aide services; physical therapy; occupational therapy; speech-language therapy; medical social services; durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers); medical supplies; and other services.
Hospice Care - Services covered by Medicare Part A for people with a terminal illness. May include prescriptions for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in the person’s home; however, Medicare may cover some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest). May also be provided under Washington Medicaid program.
Hospital Stay - Services covered by Medicare Part A that include a semiprivate room, meals, general nursing, and other hospital services and supplies.
Impairment Related Work Expenses (IRWEs) include deductions from earnings for work related goods or services that are related to an individual’s impairment, paid out of pocket and not reimbursed.
Incurring Medical Expenses - Being responsible for medical expenses before Medicaid coverage begins.
Independent Living - Living on one’s own, in the community, outside of an institution.
Independent Review Entity - A person outside of a Part D plan who reviews an appeal. This is the first person outside of the plan to review an appeal.
Individual Threshold Amount - A personal income limit that enables an individual to retain Supplemental Security Income-Related Medicaid coverage when their earnings go above the state's threshold amount. Social Security will determine an Individual Threshold Amount if the individual has Impairment Related or Blind Work Expenses, a Plan to Achieve Self-Support, a publicly funded personal attendant, or medical expenses above the state average amount.
Individual Work Plan (IWP) - A formal agreement between a ticket holder and an Employment Network that describes how services will achieve an employment goal. The Plan includes specific steps and a time schedule that may span several years.
Individualized Education Plan (IEP) - An educational plan for a student receiving special education services. The IEP is created with input from parents, teachers, staff, and the student. It includes information on the student’s current performance, goals and evaluation, and on what specific services the student will need.
Initial Enrollment Period - The first time an individual is eligible to enroll in a group’s benefits programs. During this period, the individual’s medical history is not subject to review. Once enrolled, however, pre-existing condition exclusionary periods may apply. For Medicare The period when a beneficiary can first sign up for Medicare Part B or Part D. For Social Security Disability Insurance (SSDI) beneficiaries, the initial enrollment period begins the 24th month of a beneficiary’s Social Security disability payments. In general, it begins three months before you meet Medicare's eligibility requirements and lasts seven months.
In-Kind Support and Maintenance - Food and/or rent only which is supplied or paid for by someone else, not the person receiving a Supplemental Security Income (SSI) cash benefit. Sometimes referred to as ISM. As of March 9, 2005, clothing is no longer considered ISM.
Inpatient - An individual who has been admitted to the hospital.
Inpatient Care - Health services received after an individual is admitted to the hospital.
Interval Steps - Measurable milestones that show progress towards achieving a vocational goal in a Plan for Achieving Self-Support. For example, if the goal is to obtain a job, the job search would be considered an interval step.
Investment Income - Dividends, capital gains net income, certain rental and royalty income, net passive activity income, and taxable and tax-exempt interest.
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Lawful Permanent Residents (LPRs) - People living within the U.S. with a green card.
Legal Adulthood - Being legally able to sign contracts, vote, and enjoy other rights and responsibilities of adulthood. Generally, in the United States, people become legal adults when they turn 18. This is a separate concept from Representative Payee.
Lifetime Maximum - A limit of how much an insurer will spend on you. For example, a plan might cover medical costs until they've paid $100,000 on your services, at which point they will no longer help pay for your medical costs.
Lifetime Reserve Days - The days following a 90-day hospitalization. Medicare allows an individual 60 lifetime reserve days per benefit period that may only be used once during an individual’s lifetime. Medicare will pay for lifetime reserve days, whether used at once or over the individual's lifetime. However, the individual must pay for the daily coinsurance of $550.00 in 2010.
Liquid Assets - Cash or other property which can be converted to cash within 20 days, excluding non-work days. Liquid assets include: checking and savings accounts, stocks, bonds, mutual fund shares, promissory notes, mortgages, and life insurance policies. Accessible cash resources that include: individual/joint checking and savings accounts, retirement accounts, stocks, bonds, mining rights and cash value in a life insurance policy.
Long Term Disability Insurance - Private insurance that replaces some of your income when you can't work because of a disability. Long Term Disability (LTD) generally covers disabilities that last more than a year. To apply for LTD, speak with your employer's human resources department, or contact a private insurance company.
Long-term Care - Services that assist individuals with long-term medical and personal needs. Long-term care may include medical services, physical therapy, custodial care, and assistance with activities of daily living (dressing, eating, bathing, etc.). Long-term care may be provided at home, in the community, or in facilities, including nursing homes and assisted living facilities. Medicare will not pay exclusively for custodial care.
Look-back Period - A period of time prior to enrollment in a new health plan used to define pre-existing conditions. If, for example, your health plan has a “6-month look-back,” any health condition that you received medical advice, diagnosis, care, or treatment for within the six months prior to enrollment would be considered a pre-existing condition.
Low Income Subsidy - Help paying for Medicare Part D costs for those who meet income and asset rules. Also known as "Extra Help".
Match - Funds paid by an IDA program when an individual deposits money into the account.
MAXIMUS - A private organization authorized by the Social Security Administration (SSA) to manage the Ticket to Work Program. As Program Manager, MAXIMUS provides outreach, recruitment, training, and payment processing to Employment Networks.
Medicaid - is a cooperative federal-state program authorized by Title 19 of the Social Security Act. On a federal level, Medicaid is administered through the Centers for Medicare and Medicaid Services (CMS) within the U.S. Department of Health and Human Services (DHHS). On a state level, overall responsibility rests with one state agency in each state. Actual administration of Medicaid is often delegated to any number of other entities, including one or more other state agencies.
Medicaid Buy-In - A program that allows individuals working with a disability to retain Medicaid coverage through premium payments. In Washington, this program is called the Healthcare for Workers with Disabilities (HWD) program.
Medical Provider - The person who provides a medical certification of a disability. They can be a licensed physician, surgeon, U.S. government medical office, osteopathic physician, chiropractor, podiatrist, optometrist, dentist, designated psychologist, nurse-midwife, nurse practitioner, midwife, or accredited religious practitioner.
Medical Savings Account (Medicare) - A Medicare Advantage (Part C) option where Medicare gives your plan money to deposit into a savings account. You can use this money to pay for Medicare costs. After you meet a high yearly deductible, the plan will help pay for Medicare services.
Medical Treatment/Care - Any medical care received by an individual for a medical condition. Examples of medical treatment include being prescribed medication, physician consultations, and therapy for a mental or physical condition.
Medical Underwriting - The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.
Medically Necessary - Services or supplies that are considered by Medicare to be appropriate and needed for treatment.
Medicare is our country’s health insurance program for people age 65 or older, certain people with disabilities who are under age 65, and people of any age who have permanent kidney failure. The program is financed by a portion of the Federal Insurance Contributions Act (FICA) taxes paid by workers and their employers. It also is financed in part by monthly premiums paid by beneficiaries. The Centers for Medicare and Medicaid Services or CMS is the federal agency in charge of the Medicare program. However, the Social Security Administration determines who is eligible for Medicare, enrolls people in the program, and disseminates general Medicare information.
Medicare + Choice Plan - See Medicare Advantage Plan.
Medicare Advantage Prescription Drug (MA-PD) Plan - Medicare Part D drug coverage that is offered through a Medicare Advantage plan.
Medicare Appeals Council - A group of people within the Centers for Medicare and Medicaid Services (CMS) who hear Medicare appeals after they have gone to an Administrative Law Judge.
Medicare Carrier - A private insurance company that contracts with Medicare.
Medicare Cost Plan - A way to organize your Medicare benefits. When you use services within the plan’s network, it helps pay for costs. When you use services outside the plan’s network, Original Medicare helps pay.
Medicare Health Maintenance Organization (HMO) - A Medicare Advantage option that can have lower copayments than the Original Medicare Plan, but generally limits individuals to visiting doctors, specialists, or hospitals within the plan's network. Plans must cover all Medicare Part A and Part B services, and some plans cover extras, like prescription drugs. Medicare Managed Care Plans are only available in some areas of the country. Also known as "Medicare Managed Care Plan."
Medicare Managed Care Plan - See Medicare HMO.
Medicare Modernization Act - The 2003 law that created the Medicare Part D program.
Medicare Part A - The part of Medicare that helps pay for medical care you get while you’re in a hospital.
Medicare Part B - The part of Medicare that helps pay for medical care you get when you are not staying in a hospital, such as when you go to see a doctor.
Medicare Part C, also known as "Medicare Advantage," - A Medicare program that offers benefits by private insurance companies. These plans can provide more choice and extra benefits. Medicare Advantage Plans include: Managed Care (Medicare HMOs), Private Fee-for-Service, Preferred Provider Organization, and Special Needs Plans. Everyone who has Medicare Parts A and B is eligible to join a plan, except most people with End-Stage Renal Disease (ESRD). The program used to be called "Medicare + Choice."
Medicare Part D - The part of Medicare that helps pay for prescription drugs.
Medicare Plans - Health coverage options that include: Original Medicare, Medicare Advantage Plans, and Medicare supplement.
Medicare Preferred Provider Organization (PPO) - A Medicare Advantage option that gives the choice of visiting providers within the network or seeing a provider outside of the network for an additional cost. A person in this plan does not need a referral from their primary care physician to see a specialist.
Medicare Private Fee-for-Service Plan - A Medicare Advantage option that allows an individual to go to any Medicare-approved doctor or hospital. The insurance plan, rather than the Medicare program, decides what services it will cover and how much it will pay. Although an individual may pay more under this plan, he/she may have extra benefits that the Original Medicare Plan doesn't offer.
Medicare Savings - Programs that pay for Medicare premiums. The types of Medicare costs that Medicaid pays for in these programs depend on your income.
Medicare Supplement - A supplemental insurance policy sold by private insurance companies to fill gaps in the Original Medicare Plan. Medicare supplement plans are available only to individuals using the Original Medicare Plan, and it is illegal for an insurance carrier to sell a Medicare supplement to an individual who does not have Original Medicare. Medicare supplements are also referred to as "Medigap."
Medigap - See Medicare supplement.
Milestone - A significant, visible step toward achieving a vocational goal.
Needs Assessment (CARE) - An evaluation that measures a person’s ability to complete activities of daily living (dressing, toileting, bathing, eating, respiration, getting around in the house) and instrumental activities of daily living (housekeeping, shopping, taking medication, meal preparation, managing finances, and getting around out of the house). The needs assessment determines an individual’s level of need for the In Home Supportive Services Program.
Net Benefit Amount - The benefit amount an insurance company pays after deducting income.
Net Countable Earned Income - The portion of an individual's earned income that is taken into account when evaluating financial eligibility for Medicaid.
Network - A group of doctors or medical service providers who have signed a contract with a health coverage plan. If you have health coverage through a Health Maintenance Organization (HMO), you generally have to see doctors within the network. Preferred Provider Organizations (PPOs) plans allow you to see doctors outside of your network, but you will have to pay more.
Non-preventive Care Services - Health care services that are medically necessary and are aimed at treating illnesses, as opposed to preventing them. (Contrast: preventive care services.)
Onset Date (SSA) - The date, after reviewing an individual's medical records, which Social Security determines that a disability began. The date Social Security receives an application does not necessarily establish the onset date.
Open Enrollment Period - The annual time period when an individual may add or change coverage in an employer-provided or association-affiliated insurance plan. Changes during most of these annual periods will require medical underwriting to add benefits not elected during the initial enrollment period. The federal government calls this period "open season", and other insurers may use different terms.
Original Medicare - A pay-per-visit health coverage plan that allows individuals to go to any doctor, hospital, or other health care supplier who accepts Medicare and who is accepting new Medicare patients. The individual is responsible for paying a deductible and copayment. Under Original Medicare, Medicare pays a portion of the Medicare-approved amount, while the individual pays for his/her share (coinsurance). Original Medicare has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
Out-Of–Pocket Cost - The costs an individual pays without assistance from Medicare, Medicaid, or other insurance.
Out-of-pocket Maximum - The maximum amount of money that you have to spend on health costs in a year. After you reach the out-of-pocket maximum, your policy will pay the entire cost of covered services. The out-of-pocket maximum does not count the premiums you pay and certain other costs may or may not be counted.
Outpatient Services - Health services received after an individual is released from the hospital.
Overpayment - Payment that exceeds the approved benefit amount.
Paramedical Services - Services that are prescribed by a doctor and often administered by in-home care providers. They typically require some level of training or judgment and are essential to the health of the recipient. Common examples include injections, administration of medication, catheter insertion and care, tube feeding, ventilator and oxygen care, treatment of wounds, and other services requiring sterile procedures.
Parental Control - Social Security uses this as one measure of whether or not a beneficiary should receive an independent living benefit rate. A child is considered to be under "parental control" if their parent has the authority to make decisions on their behalf.
Parental Deeming - The process used to determine how much of a parent's income is spent on a child’s basic needs. Some of the parent's income may be considered the child's when determining whether or not the child is eligible for disability benefit programs.
Parent-to-Child Deeming - Social Security’s process of figuring out how much of parents’ income is used to pay for a child’s basic needs. The amount of deemed income is subtracted from the benefit amount.
PASS - A Supplemental Security Income (SSI) program that allows you to set aside income and resources for expenses related to a specific work goal. Income that you use for these expenses will not cause your SSI benefit to decrease. Resources that you spend on PASS expenses won't count towards the SSI limit.
PASS Cadre - A group of experts who review, approve, and monitor Plans for Achieving Self-Support (PASS). To find a PASS cadre in Washington, click here
Patient Assistance Program (PAP) - A program administered by a pharmaceutical company that provides financial assistance with prescription drug costs. PAPs offer free and discounted prescription drugs to those who qualify.
Payer of Last Resort - The insurer who pays medical claims last when an individual has multiple sources of health coverage.
Permanent Resident - U.S. Permanent Resident with either an Alien Registration Card or I-551 Card.
Permanently and Totally Disabled - Unable to engage in any Substantial Gainful Activity (SGA) due to any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months.
Permanently Residing in the U.S. Under Color of Law (PRUCOL) - Non-citizens who are residing in the United States with the knowledge and permission of the Department of Homeland Security (DHS). This category includes non-citizens: Subject to an Order of Supervision; On whose behalf an immediate relative petition has been approved and who are entitled to voluntary departure; Who have properly filed an application for an adjustment to lawful permanent resident status; Granted a stay of deportation; Granted voluntary departure and who are awaiting issuance of a visa; In deferred action status or who entered and have continually resided in the US since before January 1, 1972.
Personal Assistance Services (PAS) - Services designed to assist an individual with a disability perform activities of daily living at home or in the workplace.
Pharmacy Network - A group of local pharmacies you can buy prescription drugs from. If you purchase drugs from within your pharmacy network, your prescription drug plan should cover it.
Plan for Achieving Self-Support (PASS) - See PASS.
Point-of-service (POS) - An option offered by some Medicare Managed Care Plans that allows an individual to use doctors and hospitals outside the plan at an additional cost.
Pre-existing Condition - Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.
Pre-existing Condition Exclusionary Period - The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.
Preferred Provider Organization (PPO) - A type of health insurance plan. You pay a monthly premium and, when you use medical services, copayments and deductibles. PPOs have networks of physicians. You can see any doctor in the network without getting prior authorization from a primary care physician. Seeing a doctor outside of the network is more expensive.
Premium - A regularly scheduled payment to an insurer or health care plan.
Prescription Drug Plan (PDP) - A Medicare Part D plan that only offers drug coverage. Also known as a "stand-alone" plan.
Presumed Maximum Value (PMV) Rule - A rule that sets a maximum value on the amount of certain types of In-Kind support and maintenance that Supplemental Security Income (SSI) counts. The PMV rule generally applies when someone is getting free food or shelter, but not both. The PMV at any given time is 1/3 of the Federal Benefit Rate + $20. For 2010, the PMV is $244.66 for an individual and $357.00 for a couple.
Presumptive Disability - A status granted to Supplemental Security Income (SSI) applicants who have a high chance of being found disabled according to Social Security Administration (SSA) standards. If the SSA finds you presumptively disabled, they will begin benefit payments while your application is still being reviewed. The SSA may find you presumptively disabled if you meet the medical criteria of the Blue Book Listing of Impairments or if you have HIV/AIDS and meet the criteria of SSA Form 4814. In either case, you must also meet SSI financial requirements to be eligible for presumptive disability benefits. Repayments of presumptive disability benefits are not required even if SSI benefits are ultimately denied.
Preventive Care Services - Health care services aimed at keeping you healthy by preventing illness; for example, Pap tests, pelvic exams, yearly mammograms, and flu shots. (Contrast: non-preventive care services.)
Primary Care Physician - A doctor that provides basic care and acts as an individual’s first point of contact when seeking health services. In many Medicare Managed Care Plans (Medicare HMOs), an individual must see their primary care doctor before going to a specialist.
Primary Care Provider (PCP) - The doctor, nurse practitioner, or other medical service provider who is in charge of your medical care in a Health Maintenance Organizations (HMO). In HMOs, you have to see a PCP in order to get a referral to see a specialist. Other types of health coverage might not have PCPs, or might charge you more if you see a specialist without getting a referral from a PCP.
Primary Payer - The first insurer to pay medical claims when an individual uses multiple sources of health coverage.
Prior Authorization (Medicare) - A utilization control that requires you to have a drug plan's permission to get a certain drug.
Prior Authorization (Private Health Coverage) - When your doctor or medical service provider must get permission from your health care plan before providing you with certain services or referring you to another provider for services.
Private Health Coverage - Coverage that is not funded by local, state or federal government. Private health coverage can be paid for by an individual, employer, or association.
Proof of Good Health - The review of an individual’s medical records, or the performance of medical to determine eligibility for coverage.
Protective Filing Date - The date an individual first contacts the Social Security Administration (SSA) to file for Supplemental Security Income (SSI) benefits. The protective filing date establishes the earliest possible date an individual can receive SSI benefits.
Protective Supervision - Monitoring the activities of a person with cognitive disabilities to assure that they are no harm to themselves or others.
Qualified Alien - You are considered a qualified alien if the Department of Homeland Security (DHS) says you are in one of the qualified categories. There are seven categories of non–citizens who are qualified aliens. You are a qualified alien if the Department of Homeland Security (DHS) says you are in one of the seven categories.
Qualified Disabled Working Individual (QDWI) - A Medicare Savings Program that pays for Medicare Part A premiums. The QDWI program is for Social Security Disability Insurance (SSDI) beneficiaries who lose their free Medicare Part A due to earnings. To qualify, an individual must: be less than 65 years old, be eligible for Medicare Part A, have income at or below 200% of the Federal Poverty Level, have assets at or below the limit and meet all other Medicaid eligibility requirements.
Qualified Individual - A Medicare Savings Program that pays for Medicare Part B premiums. To qualify, an individual must: Be eligible for Medicare Part A and B, Have countable income less than 135% of the Federal Poverty Level (until 3/31/2009, $1,218.00 per month for individuals, $1,639.00 for couples), Have assets at or below the limit ($4,000 for individuals, $6,000 for couples), and Meet all other Medicaid eligibility requirements.
Qualified Medicare Beneficiary (QMB) - A Medicare Savings Program that pays for Medicare Part A and Part B premiums, coinsurance and deductibles. To qualify, you must: Be eligible for Medicare Part A and Part B, Have countable income at or below 100% of the Federal Poverty Level (until 3/31/2010, $903 per month for individuals, $1,215 for couples), Have countable income at or below 100% of the Federal Poverty Level (until 3/31/2010, $903 per month for individuals, $1,215 for couples), Meet all other Medicaid eligibility requirements; This program does not apply benefits retroactively.
Qualifying Child - An IRS classification that may allow a taxpayer to claim the EITC and certain other tax credits. In general, to be a taxpayer’s qualifying child, a person must satisfy four tests: 1) Relationship - The taxpayer’s child or stepchild (whether by blood or adoption), foster child, sibling or stepsibling, or a descendant of one of these. 2) Residence - has the same principal residence as the taxpayer for more than half the tax year. Exceptions apply, in certain cases, for children of divorced or separated parents, kidnapped children, temporary absences, and for children who were born or died during the year.3) Age — must be under the age of 19 at the end of the tax year, or under the age of 24 if a full-time student for at least five months of the year, or be permanently and totally disabled at any time during the year.4) Support — did not provide more than one-half of his/her own support for the year.
Qualifying Events - Events that may end individuals' employer-sponsored group health coverage but qualify them for COBRA or other continuation coverage. See the COBRA Program Description for details.
Quick Benefit Restart - A feature of the SSI program that makes it easy to restart your SSI benefit if you lost it because of work alone. If you are 1619(b) eligible and you stop working, you will be able to get your SSI benefit restarted quickly without having to file a new application or wait for medical review.
Reasonable Accommodation Request - A request to an employer to make a modification to a job or workplace that allows an employee to successfully perform the essential duties of a job. The request can come from the employee, or an employee's friend, family member, or medical provider. Reasonable accommodation rules are case-by-case situations, and employers and employees can negotiate the terms under the law.
Referral - A written authorization to visit a specialist from an individual’s primary care doctor. In many Medicare Managed Care Plans (Medicare HMO), an individual must get a referral before receiving care from anyone except the primary care doctor. If an individual fails to get a referral, the plan may refuse to pay for care.
Refugees - Non-citizens who, while outside the U.S. and their home country, were granted permission to enter and live in the U.S. because they had a well-founded fear of persecution in their home country.
Regular Attendance (SEIE definition) - To be considered “regularly attending” school for the Student Earned Income Exclusion (SEIE), a student has to meet one of the following requirements: 1) Attend a college or university for at least 8 hours a week under a semester or quarter system. 2) Be in grades 7 - 12 for at least 12 hours a week. 3) Be in a course of training (with shop practice) to prepare for a paying job for at least 15 hours a week. 4) Be in a course of training (without shop practice) for 12 hours a week. In some circumstances, like illness or unavailability of transportation, students may be allowed to spend less time than indicated above and still be considered “regularly attending” for the purposes of the SEIE.
Representative Payee (PASS) - An individual who receives benefits on someone else's behalf. Social Security conducts a careful investigation before appointing a relative, friend, or other interested party as the representative payee of individuals who need help managing their benefits.
Representative Payee (Youth) - Someone who receives benefits on another person’s behalf. For children under 18, a parent or guardian is usually the representative payee.
Resources - Accessible cash resources that include: individual/joint checking and savings accounts, retirement accounts, stocks, bonds, mining rights and cash value in a life insurance policy.
Resource Exclusions - Items that do not count as resources.
Retirement, Survivors, and Disability Insurance (RSDI) - Social Security program that provides monthly income to people with disabilities, survivors or dependents of people with disabilities, and retired people. Social Security Disability Insurance (SSDI) is one part of RSDI.
Retroactive Payments - Payments made for the period between disability onset and application approval.
Satisfactory Academic Progress - An institution's minimum academic requirements that a student must meet to be eligible for federal student aid.
Secondary Payer - A health insurance plan that supplements a primary insurance plan. Health care costs not covered by the primary plan can be submitted to the secondary payer, which often covers some or all of the deductibles, co-payments, and other services not covered by the primary insurance provider.
Section 301 - A rule that allows certain people to keep their Social Security benefits after being found to no longer be medically disabled. For Section 301 to apply, a beneficiary has to be participating in a Social Security approved employment support program, and participation in that program has to increase the likelihood that the beneficiary will not need Social Security benefits after completing the program. Vocational rehabilitation and PASS are two examples of “Social Security approved employment support programs."
Service Provider - A person or group working with Social Security to help you find your path to work. Service providers may offer help such as career planning, benefits counseling, job placement, training or legal advocacy.
Service Wait - The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirements.
Share of Cost (SOC) - The amount of money an individual pays for health care costs before Medicaid.
Short Term Disability Insurance - Private insurance that replaces some of your income when you can't work because of a disability. Short Term Disability (STD) generally covers disabilities that last a year or less. To apply for STD, speak with your employer's human resources department, or contact a private insurance company.
Skilled Nursing Facility Care - Services that include a semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies. Medicare covers skilled nursing facility care after the individual has been in the hospital for 3 days.
SNAP - A federally funded program that helps people with low-income buy food. Supplemental Nutrition Assistance Program.
Social Security Administration (SSA) - Agency that oversees the SSI and SSDI programs. You contact SSA by calling 1-800-772-1213 (ph) or 1-800-325-0778 (TTY), or you can use the Social Security office locator at: office locator.
Social Security Disability Insurance (SSDI) is a Disability Insurance Benefit (DIB) that is payable to a worker insured under title II of the Social Security Act. To be insured, the worker must have a minimum amount of wages taxed under the Act over a sufficient number of calendar quarters as determined by the Social Security Administration (SSA). SSA calls these periods of work “Quarters of Coverage” (QCs) or credits.
Social Security Medical Determination Only - a certification that an individual is medically eligible for Social Security disability programs. Individuals can use this medical award document to qualify for OBRA even if they are not eligible for Social Security disability programs for non-medical reasons.
Social Security's 1619(b) Provisions - Allow Supplemental Security Income (SSI) beneficiaries to retain Medicaid coverage when their combined income is too high to receive any SSI cash benefit. To continue receiving Medicaid, an individual must meet all of the following 1619(b) provisions:
1) Received an SSI benefit payment in the past twelve months.
2) Meet medical disability requirements.
3) Meet non-disability requirements.
4) Need Medicaid health coverage to keep working.
5) Have wages below the 1619(b) amount of 28,470 annually as of 2010 in Washington
Special Enrollment Period - The time when an individual can apply for Medicare coverage without a late enrollment penalty and can sign up for Medicare supplement without a pre-existing condition waiting period. The special enrollment period typically spans the first eight months following the loss of group health coverage.
Special Enrollment Rights - Allow a person to qualify for health coverage without having to undergo medical underwriting. Special Enrollment Rights can be requested from an employer within 30 days after previous health coverage is exhausted or terminated. They apply to individuals who do not enroll during the initial enrollment period or have lost their health coverage.
Specified Low-Income Medicare Beneficiary (SLMB) - A Medicare Savings Program that pays for Medicare Part B premiums. To qualify, you must: 1) be eligible for Medicare Part A and Part B. 2) Have countable income less than 120% of the Federal Poverty Level (until 3/31/2010, $1,083.00 per month for individuals, $1,457.00 for couples) 3) Have assets at or below the limit ($4,000 for individuals, $6,000 for couples), and meet all other Medicaid eligibility requirements.
Sponsor - A person who, by signing an affidavit of support, agrees to support an immigrant as a condition of the immigrant’s admission for permanent residence in the U.S.
Sponsorship - The act of legally sponsoring an immigrant to enter the U.S.
SSI Resource Exclusions - In addition to your home and one car, there are several other resources that may be excluded when determining your SSI countable resource total. Earned Income Tax Credits (EITC), Child Tax Credits (CTC), Food Stamps, grants, scholarships, fellowships, gifts, property essential to self-support, Individual Development Accounts (IDAs), and many other items may be excluded. Review your resources and your resource exclusions with your PASS Cadre.
State Health Insurance Assistance Programs (SHIP) - State programs that receive money from the federal government to provide free, local health insurance counseling on Medicare. In Washington this program is known as Statewide Health Insurance Benefits Advisors (SHIBA).
State Supplemental Program - The State Supplemental Program (SSP) is a state funded cash assistance program for certain clients who the Social Security Administration determines are eligible for Supplemental Security Income (SSI).
Student (SEIE definition) - A student is generally someone who is under 22 and regularly attending school.
Students and the Student Earned Income Exclusion (SEIE) – The SEIE is a work incentive that allows certain SSI beneficiaries who are under age 22 and regularly attending school to exclude a specified amount of gross earned income per month up to a maximum annual exclusion. The SEIE decreases the amount of countable earned income, thus permitting SSI recipients to keep more of the SSI check when they work. In many cases, the SEIE allows students to test their ability to work without experiencing any reduction in their SSI check. Only SSI beneficiaries who meet all of the SEIE eligibility receive this work incentive. To qualify for the SEIE an individual must be:
• Under the age of 2
• Regularly attending school, college or training to prepare for a paying job
• Working
Subsidy and Special Conditions - For the purposes of calculating Substantial Gainful Activity (SGA), subsidy and special conditions are support you receive on the job that may result in your receiving more pay than the actual value of the services you perform. Subsidy refers to support you receive from your employer; special conditions are generally provided by someone other than your employer, for example a vocational rehabilitation agency. Social Security considers the existence of subsidy and special conditions when they make an SGA decision. They use only earnings that represent the real value of the work you perform to decide if your work is at the SGA level. This works in your favor - if Social Security decides that subsidy or special conditions exist, you can earn more while continuing to receive benefits. Subsidy or special conditions may exist if: You receive more supervision than other workers doing the same or a similar job for the same pay; You have fewer or simpler tasks to complete than other workers doing the same job for the same pay; or You have a job coach or mentor who helps you perform some of your work.
Substantial Gainful Activity (SGA) - Work that disqualifies an individual from Social Security disability benefits. Social Security uses earning limits to determine whether or not an individual is performing SGA. For 2010, SGA is $1,000 ($1,640 for people who are blind).
Supplemental Security Income (SSI) is a benefit paid to people who are disabled, blind, or age 65 or older who have few resources and low income, and who meet certain citizenship or residency requirements. The funds used to pay SSI benefits do not come from the Social Security trust fund, but are paid out of general federal tax dollars under title XVI of the Act.
Surrender Value - If you were to cancel a life insurance policy prior to death or maturity, you would likely receive some portion of the full value of that policy. The amount you would receive is known as the “surrender value.” The surrender value of your policy should be written into it. If you do not know the surrender value, contact your policy administrator to find out. Not all policies have a surrender value (i.e. - burial insurance and many term insurance policies).
Tax Credit - A dollar for dollar reduction in taxes. A tax credit can be used as a deduction from taxes owed.
Temporarily Inactive Ticket - A Ticket that has been temporarily inactivated because a beneficiary could not make progress on his/her Individual Work Plan due to illness or disability. The clock stops on the timely progress review schedule, and beneficiaries are not penalized for the delay.
Temporary Aid to Needy Families (TANF) - A federal welfare program, formerly known as Aid to Families with Dependent Children (AFDC) that provides income support and access to Medicaid for low-income adults with children. In Washington, TANF is known as WorkFirst.
Ticket - A standard form that indicates eligibility for the Ticket to Work Program.
Ticket on Demand - A term for requesting a Ticket to Work by calling the Ticket Program Manager: (866) 968-7842.
Ticket to Work Program - A program of the federal Social Security Administration (SSA) designed to expand access to employment for Social Security beneficiaries with disabilities.
Tiered Drug Levels - A utilization control that makes some drugs cheaper to use than others.
Timely Progress - Active participation in the Individual Work Plan (IWP) during the first two years of the Ticket program. Thereafter, timely progress is referred to as "increased work activity and earnings" (Year 3, 4, and 5).
As long as an individual is making timely progress on the IWP, Social Security will not initiate a medical continuing disability review.
Title II Child’s Benefits - Benefits received because a parent is (or was) eligible for Social Security Disability or Social Security retirement insurance. Title II child’s benefits end at 18, unless the child is in high school or another secondary school, in which case they end at 19.
Trial Work Month (SSDI) - Any month when gross income reaches at least $720 (for 2010). Trial Work month income levels are indexed annually for increases or decreases in the cost of living. Previous Trial Work month gross income levels were: $670 in 2008, $640 in 2007, $620 in 2006, $590 on 2005, $580 in 2004, S570 in 2003.
Trial Work Period (TWP) provides beneficiaries an opportunity to test work skills while maintaining full benefit checks, no matter how much the beneficiary earns. Each year, SSA sets a monthly amount to use as a guideline for determining use of TWP months. Only months that would count as TWP months (or “Trial Work Service Months”) by the SSA are those in which: (1) an individual earns pre-tax wages of more than the guideline; or (2) works over 80 hours in self-employment. This work incentive for title II beneficiaries ends when a beneficiary performs nine months of work over the TWP guideline within a rolling period of 60 consecutive months. The TWP service months do not have to be consecutive to be counted.
Note: When a beneficiary performs Substantial Gainful Activity (SGA) level work for the first time after the TWP, this first month is called the “cessation month”. SSA allows a payment to be made in this month and the two succeeding months, called the grace period, for a total of three months. Even though the months have different names, they are really one work incentive and they are always applied together as one 3-month block. These are sometimes referred to collectively as the Grace Period.
Underinsured Individual - An individual who has insurance that covers only some health care costs.
Unearned income is as any cash or in-kind item an individual receives that is NOT earned income. Unearned income includes:
• Periodic public payments or private annuities or pensions usually related to prior work or service (Social Security benefits, Veteran’s benefits, Railroad Retirement benefits, Worker’s Compensation, Unemployment Compensation, etc.)
• Alimony and child support payments are cash or in-kind contributions to meet some or all of a person’s needs for food and shelter. These periodic payments may be court ordered or voluntary. Alimony or spousal maintenance is the unearned income of the adult named in the court order. Generally, child support payments made on behalf of an SSI child are counted as unearned income to the child. For SSI recipients under age 18, one-third of the amount of a child support payment made to or for an eligible child by an absent parent is excluded.
• Rental payments for things such as housing and the use of land or machinery are considered to be unearned income in most cases. SSA will only count the value of rental payments after expenses related to the rental properties are deducted.
Unincurred Business Expenses - Financial or other assistance from an agency or individual to help establish or sustain a self-employed person’s business. Examples include a government agency paying for some of your business expenses, or providing you with things of value (e.g. office space) free of charge. Social Security rules do not penalize you for receiving unincurred business expenses. Instead, Social Security deducts the value of any unincurred business expenses from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level for any given month. SSA uses fair market value to assess the value of any unincurred business expenses.
Uninsured Individual - An individual who has no health coverage.
Unpaid Help - The estimated value of any unpaid assistance from your spouse, children or others provided to your business. If someone provides your business with 10 hours/month of free web design work, and the prevailing wage for that kind of work in your community is $25/hour, the value of that unpaid help is $250/month. Social Security rules do not penalize you for receiving unpaid help. Instead, Social Security deducts the value of any unpaid help that your business receives from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level each month.
Utilization Controls - Rules that plans use to keep their prescription drug costs down. You may, for example, need prior authorization from the plan to use a particular drug.
Value Third Reduction (VTR) Rule - A rule that decreases the amount of the Supplemental Security Income (SSI) benefit that a person is eligible for by 1/3. The VTR rules apply when someone is receiving both food and shelter from another person.
Victim of Trafficking - An individual who is a victim of sex trafficking; or, a victim of the forced or fraudulent recruitment, harboring, transport, or provision of a person for labor or services that subject the person to involuntary servitude, peonage, debt bondage, or slavery.
Victim of Violence/Victim of Abuse/Domestic Violence Survivors – A person who has endured assaultive or coercive behavior that includes: physical abuse, sexual abuse, psychological abuse, economic control, isolation, stalking, and threats.
Violence Against Women Act (VAWA) - A law that allows qualified immigrants in an abusive situation to apply for a lawful immigration status directly to the Department of Homeland Security without the assistance of a sponsor.
Vocational Rehabilitation - State agencies that provide employment supports for people with disabilities. These supports include things like job training, transportation, and counseling.
Waiting Period (Medicare Supplement) - A delay in covering services for an individual with a pre-existing condition. Individuals are exempt from a waiting period if they have had 6 months of previous, continuous coverage.
Welfare-to-Work Activities - Activities that meet the Welfare-to-Work requirement. Most recipients must participate in 20 hours of core activities. Your county may include all or some of the following as acceptable core activities: Subsidized or unsubsidized employment, Work experience, On-the-job training, Work-study, Self-employment, Community services, Vocational education and training. The rest of the Welfare-to-Work requirement can be fulfilled with non-core activities, which may include: Adult basic education, Job skill training directly related to employment, Education directly related to employment, Secondary school, Mental health, Substance abuse and domestic violence services.
Welfare-to-Work Tax Credit - An employer tax credit that targets individuals who are long term Temporary Aid to Needy Families (TANF) recipients.
Work Credits (SSDI) - One of the eligibility requirements for SSDI is to have worked and paid FICA taxes for specified periods of time. If you work and earn at least $1,120 for one quarter (three months), and pay FICA taxes, you earn one SSDI "work credit." You can earn up to four credits within a 12-month period. The number of work credits needed to qualify for SSDI depends upon how old you were when Social Security determined that you are disabled. If you were determined disabled before age 24, you need 6 credits within the past 3 years to be eligible for SSDI. If you were determined disabled between the ages of 24 and 31, you need 12 credits within the past 6 years to be eligible for SSDI. If you were determined disabled after you turned 31, you need the number of work credits shown in the table below. And unless you are blind, you need to have earned at least 20 of those credits in the 10 years prior to becoming disabled. Work Credits Required for SSDI Eligibility for those Born After 1929, became disabled at age: 31 through 42, 44, and 46, 48,50,52,54,56,58,60 and 62 or older.
Work Experience - Welfare-to-Work training activities or community service that provides job skills that will lead to unsubsidized employment.
Work Goal - The specific job an individual wishes to have after completing a Plan for Achieving Self-Support. Also known as a vocational or occupational goal.
Work Incentives - Social Security’s rules that are used to adjust Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits when an individual works.
Work Incentives Planning and Assistance (WIPA) - WIPA projects are community-based organizations that work to enable beneficiaries with disabilities to make informed choices about work, and to support working beneficiaries to make a successful transition to financial independence.
Work Opportunity Tax Credit (WOTC) - A federal program that encourages employers to hire job seekers from one of nine targeted groups by offering employers a federal tax credit. The purpose of the WOTC is to help job seekers in the targeted groups overcome barriers to employment.
Work - Physical or mental activity that is actually performed and results in earned income.
Workers' Compensation - A program that replaces income when you can't work because of on-the-job injuries.
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Youth Transition Demonstration Project - Social Security sponsored pilot projects that attempt to help 14-25 year olds transition from school to work. For more information, see Program Development and Research.
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