Things were going pretty well for Susan, at least in her professional life. She had a decent job at an architectural firm. She made about $50,000 per year, which was pretty good in her mind, but not enough to make the 33-year-old single mother rich. The downside of the job was that she worked really hard and didn’t have much money or time left at the end of the day for her 13-year-old son, Griffin. It had been just the 2 of them since her husband’s death 10 years before and while things got better little by little, she had only been able to save up about $15,000 in the bank over the years and $5,000 in a retirement account — better than nothing, but not enough to live on if she lost her job.

While Susan felt the job was taking her in the right direction for her long-term career goals, it didn’t come with benefits. Susan knew that employer-provided benefits like health coverage and private disability insurance would be nice, but it had been so hard to find a job in the first place that she had given up on finding one with benefits. Instead, she just got individual health coverage for herself and her son through HealthCare.gov, which was surprisingly affordable because she and her son qualified for tax subsidies from the federal government to buy coverage. Since both she and Griffin were healthy, she had signed them up for the cheapest bronze-level plan they could get.

Health Coverage After an Accident

Driving home from a late night at work one unusually rainy evening, Susan was in a great mood. She really felt like she was finally hitting her stride at work. The next thing she knew, she couldn’t control the car and it sailed into the median. By the time the paramedics arrived, she was unconscious.

Susan sustained serious head and spine injuries in the crash. After a series of operations that kept her in the hospital for 2 months, she was moved to a long-term care facility. While Susan was in the hospital, her son Griffin went to stay with his grandparents, who lived an hour away.

Susan found it hard to remember names and suffered terrible migraines. She also lost movement of her legs. Then there were the financial problems. Susan’s health insurance was the cheapest bronze-level plan available, and it had a $5,000 deductible. That meant she had to pay the first $5,000 in medical bills before her insurance would pay anything. And, even after she had paid the $5,000, she had to keep paying high co-insurance for her treatment.

The bills for her care were astronomical, but thanks to her plan’s out-of-pocket maximum, she only ended up paying $9,200 for her care. Before the accident, Susan thought she had planned well for the future, but now she could see that this accident was wiping out her savings account.

Looking into Disability Benefits

Susan now wished she had had short-term disability insurance to pay for these expenses, but it was too late to think about. Now her task was to figure out how to survive without using up all of her retirement savings. She knew that she had to see if there were any disability-based benefits she could get, because if there were, she needed to get moving on the paperwork. She also could tell that she wouldn’t be going back to her job — there was no way she would be able to concentrate on work with everything she had gone through mentally and physically. It would be a long road to recovery.

When Susan started feeling a bit more up for it, she spoke with Teresa, a social worker at the hospital, about her financial situation. Teresa knew that Susan and her son had a private insurance plan through HealthCare.gov, so she started explaining what Susan needed to do to get started.

“The first thing you can do after leaving your job is to update your information on HealthCare.gov. Once you aren’t working, your income will be down to zero, which means that both you and Griffin will qualify for free AHCCCS coverage. HealthCare.gov will let you switch right over from your current private insurance plan to AHCCCS. It’ll be a really good deal for you, because you won’t have to pay for a monthly premium for AHCCCS.”

Susan relaxed a bit about the medical expenses, but was still worried about all of her other bills — rent, credit cards, electricity, water, and everything else that adds up without you even noticing. Now that she couldn’t work, she had no idea what she would do to pay them. Susan asked Teresa if there were any cash benefits she could get.

“You could be eligible for some Social Security benefits,” Teresa told Susan. “Unfortunately, that’s not my expertise. What I recommend is that you call a Work Incentive Consultant. That’ll let you talk to somebody who understands all these different programs.” Susan’s eyebrows wrinkled. She remembered trying to get Social Security Child’s Benefits for Griffin after her husband had died and learning that her husband hadn’t worked long enough to qualify. Susan had spent a lot of money on a lawyer and in the end, Griffin didn’t get any benefit.

Teresa thought she knew what was on Susan’s mind. “Don’t worry, you can get help from a Work Incentive Consultant for free.”

When Susan called Benefits 2 Work Arizona at 1-866-304-WORK (9675) to find a Work Incentive Consultant, she spoke with Tom. Tom explained that Susan wouldn’t qualify for Supplemental Security Income (SSI) because her retirement account was over the SSI resources limit. However, since she been working and paying Social Security taxes for many years, he thought she would probably qualify for Social Security Disability Insurance (SSDI).

“Susan, do you have access to a computer and the Internet?” asked Tom.

“Yes, I’ve got my laptop here at the hospital and there’s Wi-Fi access,” replied Susan.

“That’s good, because there are a couple of good steps for you to take online,” said Tom. “First, go to the Social Security website and sign up for an account. Once you’ve done that, you’ll be able to see how much Social Security estimates you’ll get each month in SSDI benefits. And, with your account, you can also start an online SSDI application.”

“Wow, that’s pretty useful,” commented Susan. “Will I be able to do the application all on my own? And what about Griffin’s Child’s Benefits, is that a separate application?”

Tom said that it would be great for Susan to get her application started online, but that she would have to give Social Security additional information, like medical evidence of her disability, proof of citizenship (like a birth certificate), and other necessary documentation. More paperwork would be needed for Griffin, too. So, he suggested that she start her application now, just to get the claim into Social Security’s system, but that she come meet him in person in person after leaving the hospital, so that he could help her with the remaining paperwork.

A couple of weeks later, Susan had adjusted to using her power wheelchair and was ready to leave the hospital and head home. One of the first things she did after getting home was call up Tom again and schedule an appointment to finish her SSDI application and request Child’s Benefits for her son. After Tom helped her submit the applications, he said that if they were approved for benefits, they would start getting them about 5 months after her car accident. “Since SSDI is intended to be a long-term disability benefit, there is a 5-month waiting period,” explained Tom. Susan was thankful that her parents could keep helping her and Griffin out with their expenses for a few more months.

Getting Benefits

Social Security approved the application and sent a letter stating that Susan would get $1,004 a month in SSDI benefits each month based on her earnings record and that Griffin would get $488 in Social Security Child’s Benefits, which was given to the family based on Susan’s disability. Tom had also explained that Griffin’s benefits would actually get sent to Susan, because he was still a minor, and that she would act as his representative payee, which just meant that she would manage his benefit for him.

Seven months after her disability began, Social Security started direct-depositing $1,492 each month in Susan’s bank account for her SSDI and Griffin’s Child’s Benefits. By this time, Susan’s $15,000 in savings had gone down the drain in a matter of months. Her only consolation was that at least she hadn’t had to touch the $5,000 in her retirement account.

Meanwhile, the doctors told her she wouldn’t be able to go back to work for the foreseeable future. That meant that she and Griffin were going to have to survive on the $1,492 in benefits they got each month. Things were going to be tight. Both she and Griffin would have to make sacrifices.

After she had been on Social Security Disability Insurance (SSDI) for 2 years, Susan became eligible for Medicare. Susan had been on AHCCCS due to her low income, but now that she was on Medicare, she couldn’t get income-based AHCCCS anymore and her $1,004 per month in SSDI was more than disability-based AHCCCS's income limits. (Griffin could stay on AHCCCS, since he didn’t qualify for Medicare.)

At first, Susan was worried about not getting AHCCCS anymore for herself, since it had worked so well for her. But it turned out that Medicare was also a pretty good deal for Susan. Her income and resources were low enough that she qualified for the Specified Low-Income Beneficiary (SLMB) Medicare Savings Program, which meant she didn’t have to pay the Medicare Part B premium. She also automatically qualified for Medicare Part D’s Low Income Subsidy (LIS), so she didn’t have to pay the Part D premium either. On top of that, she didn’t have to pay a deductible for prescription drug benefits.

Susan needed 2 more years before she felt ready to go back to work. By then it had been more than 4 years since her accident; years that were a major adjustment, both physically and financially for her family. While her migraines had become much less frequent and she was no longer as forgetful as she was immediately after the accident, she would be using a wheelchair for the rest of her life. And both she and Griffin had had to get used to living very carefully with their money, which was really hard for a teenager who wished he could have nicer clothes and a new videogame system.

Susan and Griffin really needed more income so that they could live a little better; struggling on benefits just wasn’t right for their family. After all she’d been through mentally and physically, Susan wasn’t prepared to go back to work full-time. However, she did want to try giving work a shot. But first, she needed to clarify a couple of things related to the Social Security Disability Insurance (SSDI) and Child’s Benefits they got from the Social Security Administration (SSA) and her Medicare and his AHCCCS health coverage.

Both the benefits from Social Security and the health coverage had been a huge help and Susan didn’t want to lose them, so she decided to talk to a Work Incentive Consultant again. She remembered Tom at Benefits 2 Work Arizona and gave him a call.

“I remember you — the architect,” Tom said. “Glad to hear you’re doing better. What’s up?”

Susan explained the situation, “I want to go back to work, but my family still needs the benefits we’ve been getting, because I’m not ready to go back to work full-time, due to my disability.”

“I understand,” Tom paused. “The good thing is that all of the benefits you and Griffin are getting right now — SSDI, Medicare, and AHCCCS — are designed so that you can work, make some money, and keep getting benefits if you need them.”

“That’s a relief,” commented Susan. “How do the rules work? And what do I have to do to make sure everything goes smoothly when I find a job?”

Learning SSDI’s Work Rules

“It’s a little complicated, but I can explain it,” Tom said. According to Tom, the short version was this: she would continue to get the $1,004 per month in SSDI direct-deposited into her bank account for at least her first 9 months of working and making more than $1,160 in a month. Months where she made less than $1,160 would not count against this time limit, which was called the Trial Work Period. If she earned more than $1,160 for a total of 9 months, then, depending on how much she was working, she would keep getting SSDI for an additional 3-month grace period, but after that her benefits would stop. However, if her countable income dropped below $1,620 a month at any time during the following 3 years, she could give Social Security a call and start getting SSDI again. “That’s called the Extended Period of Eligibility (EPE),” Tom explained. “It’s there to help you just in case your income drops again.”

“So, it sounds like I’ll be able to test the waters for a while to see if I am able to balance my disability, a part-time job, and my parenting responsibilities for at least a year,” Susan said. “And then I’ll have 3 more years where I can easily restart my SSDI benefits if for some reason I am not able to keep up with work due to my disability. What about the $488 a month that we’re getting to help with Griffin’s expenses?”

Tom continued explaining, “His benefits are based on your SSDI benefits, so any month you get SSDI benefits, he’ll get Child’s Benefits. If you stop getting SSDI after the 9-month Trial Work Period and 3-month grace period are completed, he’ll stop getting Child’s Benefits. If at any point during the 3-year Extended Period of Eligibility you get SSDI benefits, he’ll also get Child’s Benefits.”

“This makes sense,” Susan said. “So, we’ll have 12 months where we’ll be getting both my work income and the benefits from Social Security. After that, if I keep working, it’ll just be the work income. Since I plan to make more money by working than we get from SSDI and Child’s Benefits, we’ll be in better shape overall. What about our health coverage? Will I lose my Medicare and Griffin his AHCCCS? Will that happen before or after the SSDI Trial Work Period ends?”

“Well, I’ve got good news there,” said Tom. “Right now, you have Medicare. Even if you stop getting SSDI benefits after your Trial Work Period ends, your Medicare will continue for at least 93 months (that’s 7 years and 9 months). So, there’s nothing for you to worry about there.”

“For Griffin, he’s been getting AHCCCS because your family income is below 138% of the Federal Poverty Guidelines (FPG). Your income is going to go up, and your total combined income from your SSDI benefits, his Child’s Benefits, and your new job will probably go over 138% of FPL. If that happens, Griffin will have to switch to a private plan using HealthCare.gov, which is pretty easy. You just need to make sure to update your family income on HealthCare.gov.”

Then Tom added. “The best news for you is that once you start working, you’ll qualify for AHCCCS Freedom to Work.”

Susan paused for a moment and then said, “But I thought Griffin and I couldn’t get AHCCCS because we'll have too much income after I start working? And why would I want AHCCCS Freedom to Work if I already have Medicare?”

Tom explained that AHCCCS Freedom to Work had a higher income limit than AHCCCS for people with disabilities usually had. “AHCCCS Freedom to Work helps people with disabilities who get jobs and have higher income. Griffin can't get it because he doesn't have a disability, but you can. You can make up to $79,270 per year and still get AHCCCS Freedom to Work coverage.”

Tom also told Susan that there were other good reasons to have AHCCCS Freedom to Work and Medicare at the same time. "You will no longer qualify for a Medicare Savings Program due to your increased income, but AHCCCS Freedom to Work makes you automatically eligible for the Part D Low Income Subsidy, which can help pay for out-of-pocket expenses for medications. As an added bonus, AHCCCS Freedom to Work might pay for some in-home services, if you need them.”

Tom continued, “You’ll have to pay a premium for AHCCCS Freedom to Work, which is based on your income, but the most your premium could be is $35 per month. That means that once you start working, it's almost surely worth it for you to sign up for AHCCCS Freedom to Work so that you'll pay less for Medicare.” Tom knew that this was pretty complicated, so he added, “Call me up after you get your job and I’ll help you out.”

Susan thanked Tom for the information and said she would get in touch with him.

Susan started getting in touch with her old contacts at architectural firms. The local economy was in bad shape, but Susan was lucky, because her old firm happened to need somebody and they knew that she did good work. After accepting the job offer in writing, Susan sent the HR department a written request for reasonable accommodations. She was using a wheelchair now and knew she needed a few things:

• A parking place near the entrance to the office
• A desk at an appropriate height for her power wheelchair
• An office of her own, rather than a cubicle, so that she could better concentrate, despite the lingering effects of her head injury
• To have all staff meetings be held in an accessible location (they were currently held in a room that could only be reached by going up 2 steps)

The HR department was very understanding of her requests. As an architectural firm, they were even embarrassed about the meeting room and completely rebuilt its entrance to include a ramp.

Susan started out by working about 12 hours a week, because she was afraid of pushing herself too hard. During these months, she made about $1,200 a month at her job. It was less than she made before, because she was only part-time, but it was a start that let her test the waters and see if her mind and body could really handle the rigors of working again. And, since it was the Trial Work Period, the family still got Susan’s $1,004 in SSDI and Griffin’s $488 in Child’s Benefits.

Things went really well for her, and just 3 months later, she started working to 25 hours a week. Now she was making about $2,500 per month, a lot more than her $1,004 in SSDI benefits and Griffin’s $488 in Child’s Benefits. And, for the remaining 6 months of the Trial Work Period and 3 months of the grace period, she and Griffin kept getting the Social Security benefits, meaning the family’s total income was almost $4,000 per month.

Susan was really happy with the higher income. She and Griffin were able to allow themselves a few luxuries and she was even able to finally put some money into her savings account again, for the first time in years. Not only that, but she felt a lot better about herself — she was doing what she loved and was once again a productive member of the community.

Susan remembered what Tom said about AHCCCS Freedom to Work, so she contacted Tom again and asked what she needed to do. He told her to sign up for AHCCCS Freedom to Work online using Health-e-Arizona. Susan also updated Griffin’s information on HealthCare.gov and, as expected, he no longer qualified for AHCCCS because the family’s total income from work and benefits was now over 138% of FPG. Instead, she had to switch him over to an affordable individual health plan, which was easy to do on HealthCare.gov.

Susan also made sure to keep reporting her income to her local Social Security office; she wanted to make sure that all of her records were accurate. As Tom had explained, the family stopped getting the Social Security benefits after a year, because Susan kept working and earning more than $1,620 per month. That meant their unearned income went down to zero. When this happened, Susan called Tom and he reminded her, “Remember, for the next 3 years, you are in your Extended Period of Eligibility (EPE). That means that if your disability gets worse and you can’t work enough to earn $1,620 per month, you can get back on SSDI.”

“Good to remember,” replied Deanna, “but I actually think I’m ready to start working full-time again, to make more money for our family’s expenses. Of course, it’s good for me to know that if I ever need it, SSDI will be there for me.” She talked to the architectural firm and they gave her more hours. When she did this, her Medicare was unaffected, but she updated her information on Health-e-Arizona to reflect her SSDI stopping and her higher income from work. Since her earnings doubled, she had to pay a slightly higher premium for her AHCCCS Freedom to Work coverage. She also updated Griffin’s information on HealthCare.gov, but there was no change in his coverage because the family’s higher earned income was balanced by the end of their cash benefits from Social Security.

Susan was an architect and single mother. After an automobile accident, she spent 4 years without working due to disabilities caused by the accident. During that time, she got Social Security Disability Insurance (SSDI) benefits and her son got Social Security Child’s Benefits. He was covered by AHCCCS the whole time, while she started out with AHCCCS and later got Medicare. When she felt ready to start working again, she learned that there were work incentives for people with disabilities.

To improve her life situation, Susan:

• Signed up for AHCCCS on HealthCare.gov
• Talked to a Work Incentive Consultant
• Created an account on the Social Security website and began her application for SSDI benefits
• Applied for Social Security Child’s Benefits for her son, Griffin
• Began getting Medicare health coverage 2 years after her SSDI start date
• Spoke with a Work Incentive Consultant about work incentives and learned about how she could give work a try without immediately losing benefits
• Looked for a job
• Found a job and requested reasonable accommodations
• Started saving up money in a bank account
• Signed up for AHCCCS Freedom to Work using Health-e-Arizona
• Reported the changes in her income to the local Social Security office and for Griffin’s health coverage on HealthCare.gov
• Switched Griffin from AHCCCS to an individual health plan due to Susan’s higher income

After Susan had been working and making more than $1,620 per month for an entire year, she and Griffin stopped getting benefits from Social Security. At that point, Susan decided to start working full-time.