What Does it Mean to Ambulate Effectively?

There is a wide variety of conditions and impairments that may qualify a person for Social Security Disability Insurance or Supplemental Security Income benefits. What is important to understand is that the Social Security Administration (SSA) is not as concerned with the diagnosis itself as they are with the limitations that an impairment may impose on an individual’s ability to work. Certain impairments, like lower extremity joint disorders, require SSA to look at a person’s ability to ambulate effectively when assessing disability. SSA defines effective ambulation in specific terms.

In order to ambulate or walk effectively, an individual must be able to walk without a hand-held device that would otherwise prevent an individual from using at least one upper extremity to carry items. For example, a person must use his/her hands to operate a walker or a manual wheelchair. Thus, a person using a manual wheelchair or walker would have difficulty with ambulation because such devices require the use of both hands to be operational. Conversely, a person who relies on a cane to walk has an available hand to carry items.

Furthermore, to ambulate effectively, SSA also indicates that a person must be able to walk at a reasonable pace over sufficient distance to carry out activities of daily living. Effective ambulation further requires that a person be capable of walking at a reasonable pace on rough or uneven surfaces for a full block. A person must be capable of walking up a few steps at a reasonable pace with the use of a single handrail to be considered ambulatory. Finally, a person must be able to use public transportation to carryout routine ambulatory activities like shopping to meet SSA’s requirements for effective ambulation.

For more information on SSA’s definition of “effective ambulation,” please see: http://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm

By: Joyce Trudeau of Premier Disability Services, LLC®

Social Security Disability vs. State Disability

People often confuse the term Social Security Disability Insurance (“SSDI”) with State Disability Insurance (“SDI”), when in reality the programs are quite different. There are 5 states that have state-mandated disability insurance requirements: California, Hawaii, New Jersey, New York, and Rhode Island. The territory of Puerto Rico also has mandatory insurance requirements.

SSDI is administered by the federal government through the Social Security Administration (“SSA”). It provides a cash benefit to disabled workers who have paid into the Federal Insurance Compensation Act. A person’s monthly benefit for 2017 can be as low as a few dollars to as high as $2,687.00 depending on one’s contributions to FICA. If you have minor children, the benefit may be increased. SSDI is not meant to be a full income replacement, however, which often surprises some people.

Recipients of SSDI also qualify for Medicare once they have been entitled to SSDI benefits for 24 months. Recipients can remain on SSDI until SSA has determined that a disability has improved or until the recipient is well enough to return to work. At retirement age, a disabled person can still receive his/her SSDI rate if this rate is higher than his/her retirement rate. However, SSA will start referring to these benefits as retirement benefits regardless of what rate you are being paid at.

State disability programs may vary from state to state. For example, California has its own state-run disability program due to their high cost of living. It is a temporary program and only lasts for a maximum of one year. Benefits cannot be extended past one year even if you remain disabled after those 365 days. The program is administered by the Employment Development Department (“EDD”), a State agency that also administers unemployment. Recipients of SDI do not receive health insurance with this benefit, but recipients may be able to file for Medi-Cal separately if they meet the financial requirements.

You can apply for SSDI and SDI simultaneously, but please note that there can be an offset of these public benefits if you are awarded.

If you or someone you know is unable to work due to a medical condition, please contact us for a free case evaluation!

By: Thomas A. Klint of Premier Disability Services, LLC®

It’s Open Enrollment for Medicare

Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. The open enrollment period for Medicare for 2018 coverage began on October 15, 2017 and will continue through December 7, 2017.

During this annual enrollment period you can make changes to various aspects of your coverage.

• You can switch from Original Medicare to Medicare Advantage, or vice versa.
• You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
• And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.

If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria.

• You must be enrolled in Medicare Part A and B.
• You must live in the plan’s service area.
• You cannot have End-Stage Renal Disease (some exceptions apply).

There are specific times when you can sign up for these plans, or make changes to coverage you already have. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

If you didn’t sign up for Medicare A and B when you were first eligible, you have a chance to do so each year from January 1 to March 31, with coverage effective July 1.  You may be subject to a late enrollment penalty however.  For Medicare Part B, the penalty is an additional 10 percent of the premium for each 12-month period that you were eligible but not enrolled.

Read more here: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html

Plan finder: https://www.medicare.gov/find-a-plan/questions/home.aspx

By: Joyce Trudeau of Premier Disability Services, LLC®