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506. When do disabled workers' benefits end?

506.1 When do cash benefits for disabled workers end?

Your last month of entitlement to disabled worker's benefits is generally whichever of the following months occurs first:

1. The second month after the month your disability ends. However, there are certain conditions under which your benefits may continue; or re-entitlement to benefits may be established after your disability ends:

   Continuation of Benefit Payments to certain individuals participating in a program of vocational rehabilitation, employment, training, or other support services, including the Ticket to Work Program. Your benefits as a blind or disabled worker (or a blind or disabled Supplemental Security Income recipient) may be continued after your impairment is no longer disabling if:

   • You are participating in an approved program of vocational rehabilitation, employment, training or other support services, including the Ticket to Work Program;

   • You began participating in the program before our disability ended; and

   • We have determined that your completion of the program, or your continuation of the program for a specified period of time, will increase the likelihood that you will not have to return to the disability or blindness benefit rolls. Your benefits may continue until:

     • You complete the program; or

     • You stop participating in the program for any reason; or

     • We determine that your continued participation in the program will no longer increase the likelihood that you will not have to return to the disability or blindness benefit rolls.

   Extended period of eligibility for re-entitlement to benefits following trial work period. The extended period of eligibility (EPE) starts the month after the trial work period ends (whether you are working or not) and can continue forever depending on your work activity. The first 36 months after the trial work period is the reentitlement period. During the reentitlement period, benefits can be reinstated without having to file for a new period of disability. The earliest we can start your benefits again is the month after the end of the grace period. (You are paid for the first month your benefits ceased due to substantial gainful activity, and the following 2 months.) After the grace period, benefits are paid for months your earnings/work activities are below the substantial gainful activity (SGA) limit. Benefits are not paid for months your earnings/work activities are above SGA. The latest we can start your benefits again is the 37th consecutive month after the end of the trial work period.

   Note: The extended period of eligibility condition does not apply if you are entitled to supplemental security income disability payments.

2. The month before the month you reach full retirement age or when you reach full retirement age. When you reach full retirement age, your benefits are automatically converted to retirement insurance benefits; or

3. The month before the month you die.

506.2 Can you still qualify for Medicare coverage, even if you no longer receive disabled worker's benefits?

If you work you may still receive hospital and medical benefits under Medicare after you have stopped receiving disabled workers' benefits. Most people with disabilities who work will continue to receive at least 93 consecutive months of hospital and medical insurance under Medicare. You pay no premium for hospital insurance. Although cash benefits may cease due to work, you have the assurance of continued health insurance. The 93 months start the month after the last month of your trial work period. You may work and perform SGA, but must not be medically improved. You must satisfy your Medicare waiting period. Once that is complete, your continued Medicare coverage can start and continue for at least the remainder of the 93 consecutive months.

506.3 Can you still qualify for the prescription drug benefit even if you no longer receive disabled worker's benefits?

As long as you have hospital insurance or medical insurance under Medicare, you continue to qualify for prescription drug coverage.

506.4 Can you get benefits again if your benefits ended because of work?

If your benefits ended because you worked and had earnings, you can request to have your benefits started again without having to complete a new application, within 5 years from the month your benefits ended. We call this process "expedited reinstatement" or EXR. It was effective January 1, 2001.

You can be reinstated via EXR if:

• Your previous benefits ended due to work or earnings;

• You are not performing SGA in the month you request EXR;

• You are unable to perform SGA due to your medical condition;

• Your current disabling impairment(s) is the same as or related to the impairment(s) that was the basis for the previous disability entitlement;

• You request EXR within 60 months of when your previous benefits terminated, or you have good cause for filing your request late; and

• We determine that you are under a disability.

While we determine whether you can get benefits again, we can give you provisional (temporary) benefits for up to 6 months. These benefits include a cash payment and Medicare coverage. If we deny your request, we usually will not ask you to repay the provisional benefits. If we approve your EXR request, your eligible spouse and dependent children may also get benefits. We can pay you for up to 12 months before your request, if your condition kept you from working. During the first 24 months you are eligible for benefits, we will not pay you for any month(s) you perform SGA, but your Medicare coverage will continue. Once you have received 24 months of benefits, which do not have to be in a row, you get a new trial work period and extended period of eligibility.

Last Revised: Jul. 24, 2006