As we were discussing in part I, there are a multitude of considerations individuals need to take into account following the receipt of a favorable decision. One of the more important considerations is how one will be able to remain in treatment and what health insurance will be covering your treatment as you move forward.
Medicare insurance entitlement (just like a senior citizen who has reached retirement age) is available once one has been collecting Social Security Disability Insurance (SSDI) for a period of 24 months (in their 25th month of eligibility to a check). Accepting Medicare is not required (even though one may see the premium automatically taken out: this can be cancelled with a simple phone call). However, foregoing Medicare during this enrollment period can result in an increased cost should one choose to enroll at a later date. If one is already receiving state Medicaid (referred to as Mainecare in Maine, MassHealth in Massachusetts and simply Medicaid in New Hampshire), one may be entitled to apply with their local Department of Human Services office or, in Massachusetts, the Department of Transitional Assistance, so as to request that the State pay the Medicare premium. In this way, one can have both Medicare and Medicaid health insurance, with the state picking up the tab for both: in this way, Medicare pays first and Medicaid becomes secondary insurance.
Should, however, one lose their Medicaid upon receipt of a favorable decision (which happens if one’s monthly entitlement to SSDI is too high), another health insurance option available is through the Affordable Care Act (ACA), otherwise known as Obamacare. The discontinuance of Medicaid as a result of one’s SSDI income would be considered a qualifying event, allowing for enrollment at that time for ACA insurance.
Likewise, as a Social Security lawyer (in ME, MA and NH for more than 27 years) , we are frequently contacted by claimants going through a review: the Social Security Administration (SSA) periodically undertakes reviews of one’s claim (assuming one is not on the verge of retirement age). This review process can occur in a year’s time or perhaps in 3 to 5 years. Assuming the favorable decision is rendered at the hearing level, a claimant may even see as part of the decision that the Administrative Law Judge (ALJ) has ordered a review in what might be a year or 18 months’ time. Thus, remaining in significant ongoing treatment will prove critical to ensuring that, should there be a review, there will be ample evidence of the severity one’s condition going forward.
One should also remain aware of the rules that apply in the event one feels capable of attempting a return to work: both in terms of a trial work period and an Extended Period of Eligibility. Even though one may not be earning gainful wages (defined as $1170 per month in 2017), making simply $840.00 in 2017 will cause one to use up a trial work period month. One needs to understand there is an obligation to report any earnings promptly to SSA. SSA simply does not keep good track of trial work period months, nor will they call and let you know your rights to a reinstatement of your benefits should you use up your trial work period and benefits cease. We have seen many claimants come to our office after reporting their benefits to SSA for years, only to find out that their local SSA office is just figuring out that they have used up their trial work period and that there has been a massive overpayment (for which SSA is only now seeking recovery). Reporting such income timely is required, and is just as important for purposes of SSI benefits (which program likewise requires claimants to report any changes in their living circumstances as this may have an impact as to how much SSI income they receive per month). Assuming one does report their income timely, it leaves open the possibility that one can seek by a waiver of any such overpayment (as one can say they did not cause it as they reported their income promptly). A waiver of all or a part of an overpayment, however, cannot be granted unless it is shown that the claimant is not at fault for causing the overpayment (and that the claimant remains incapable of making payment of some or all of the overpayment through their disposable income, that is, with the income they have after necessary living expenses, and thus requires that part or all of the overpayment be waived). Thus, reporting one’s income timely is imperative.
Finally, it is important to consider whether the decision received is fully favorable. If not, there may be a way of appealing the decision without risk to your retroactive and your ongoing checks. Speaking with your Social Security disability lawyer on this score will be important to ensure that all avenues are pursued short of causing risk to your current entitlement (which may not be necessary).
The above list of considerations following the receipt of a favorable decision is not exhaustive. Each individual’s set of circumstances is different. The above is meant to provide you with a good sense as to the considerations you should undertake, and how and why consulting with a skilled Social Security lawyer, such as at the Law Offices of Russell J. Goldsmith, makes sense. Call now at 1-800-773-8622 for a free evaluation of your particular claim.