Ticket to Work Program Definition

The Ticket to Work program helps people with disabilities return to work. The program was created in 1999 through the Ticket to Work and Work Incentives Improvement Act, and signed into law by President Bill Clinton. The program allows workers with disabilities to test their ability to work without losing access to health care on the basis of their disability determination by the Social Security Administration (SSA).

The program's mission was to address concerns about how few people who receive Social Security disability benefits—whether Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)—were able to leave the disability rolls to work and earn a salary. Another issue was that beneficiaries who wanted to work had only one choice: a State Vocational Rehabilitation (VR) agency, which partners with public and private-sector employers to help individuals with disabilities to enter the workforce. Each year, over 1 mil­lion people with disabilities are served by State VR agencies across the country.

A key provision of Ticket to Work addresses a top anxiety of many Social Security disability recipients: losing health care coverage. Program participants can keep their Medicare coverage for at least 8-1/2 years after returning to work. SSDI beneficiaries who work qualify for premium-free Part A, which covers hospitalizations. Individuals will still be eligible for Medicare Part B, but must pay for it themselves, unless covered by another third party.

Key takeways

  • The Ticket to Work Program helps disabled participants gain independence and paid employment without losing access to critical health care coverage. 
  • Eligible beneficiaries, referred to as Ticket Holders, can receive assistance through qualified service providers, which are organizations that offer employment services, vocational rehabilitation services, and other types of support.
  • Participation in the Ticket Program is free and voluntary.
  • Tickets are used with approved employment networks (ENs) or State Vocational Rehabilitation (VR) agencies.
  • These networks are eligible for payments when the Ticket Holders they are serving achieve defined goals of work and earnings.

Due to the pandemic and The Great Resignation, more people are working from home, providing people with disabilities more opportunities to work. During the pandemic, employment opportunities for working individuals have significantly increased. The number of employed workers with disabilities increased, from 35.1% in 2021, to 37.5% as of Jan. 2022, according to the U.S. Department of Labor. Laws backed by the federal government such as Americans with Disabilities Act (ADA) ensure that disabled employees have more access and equal opportunities in mainstream American life. The Ticket to Work program supports and encourages disabled workers on the journey to financial independence and self sufficiency without causing them to lose critical healthcare and other benefits before they're firmly established in a work environment that can provide benefits. 

Understanding Ticket to Work

Ticket to Work is a free and voluntary program that supports disabled workers age 18 to 64 with job placement training and other services to aid workplace success. The program's goal is to help disabled workers achieve financial independence without relying on benefits from the SSA.

For 2022, the maximum SSI federal cash payments for individuals are $841 for individuals and $1,261 for couples, while Social Security Disability payments (also referred to as SSDI) for workers is $1,358, on average (depends on number of dependents and other factors). If a disabled employee receives SSI or Social Security they automatically qualify. When eligible workers call the Ticket to Work Help Line at 1-866-968-7842 / 1-866-833-2967 (TTY), they are given a ticket number and a work placement through an employment network or vocational rehabilitation facility.

Ticket to Work allows individuals uninterrupted access to Medicare or Medicaid coverage for as long as they pay the premiums, for up to 93 months after their SSI or SSDI payments have stopped.

Participants will then design a career development plan with a timeline and be held accountable by the SSA to achieve specific goals within a set time frame.

Employment for Ticket to Work Participants

Ticket to Work participants can find employment resources and opportunities through an employment network or from a Vocational Rehabilitation agency. An employment network (EN) consists of employers, nonprofit organizations, government agencies or combinations of these that deliver or coordinate services for Ticket to Work participants, including training, career advice, job placement, and workplace support. Vocational Rehabilitation Agencies (VR) are state-level agencies that provide education, skills training, and other aid for people who need greater assistance for work.

Program Incentives

The biggest concern for many individuals with disabilities receiving SSI or SSDI benefits is losing their health insurance. Ticket to Work allows individuals continued access to Medicare or Medicaid coverage for as long as they pay the premiums for up to 93 months after their SSI or SSDI payments have stopped.

It is important to note that many individuals may qualify for cheaper plans through the Affordable Care Act and their state's health insurance marketplace than the cost of most Medicare + supplement plan premiums. If, after a beneficiary's payments have stopped, they choose an ACA plan and cancel Medicare, they will not be able to get back on Medicare unless they get approved for SSI or SSDI through a process called expedited reinstatement. In the case of that individual they may also have to sign up for Medicare again during the General Enrollment Period (GEP) and pay penalties for the years they did not have Medicare if they cannot qualify for their state to buy them into medicare.

Another big incentive of the Ticket to Work program is that individuals with an open ticket will not be flagged for a medical review of their disability solely on the basis of returning to work.

Other Work Incentives

The SSA has several other work incentives to help individuals with disabilities start work or go back to work. They include the Trial Work Period (TWP) and Extended Period of Eligibility (EPE) as well as Expedited Reinstatements (EXRs). Note that the TWP and EPE ONLY apply to SSDI benefits, not to SSI benefits. EXRs apply to both. If you are on benefits and at any time you worked before now, make sure that you verify whether or not you have used up your TWP months by calling your local SSA field office.

What to Know About the Trial Work Period

The trial work period (TWP) is a period of nine months in which a beneficiary will receive their full check regardless of how much they earn. The nine months do not have to be consecutive. A month of earnings counts as a TWP month if the beneficiary grosses more than $970 a month from W-2 employment or has net earnings from self employment over $970 in a month or works more than 80 hours in the month of self employment. Immediately after all nine months of the TWP are up, the beneficiary goes into the Extended Period of Eligibility (EPE).

How the Extended Period of Eligibility Works

The extended period of eligibility is a period of 36 consecutive months in which a beneficiary is still entitled to their Social Security check each month they earn less than the substantial gainful activity (SGA) limit. They are not entitled to their check if they go over the limit. The SGA is based on gross earnings on W-2 income and net earnings from self employment. In 2022, the SGA limits are $1,350 a month for non-blind individuals or $2,260 a month for blind individuals. Once the 36 consecutive months of the EPE are over, or a beneficiary goes over the SGA limit their check stops entirely. The only way to get it back is through a process called an Expedited Reinstatement (EXR).

How Expedited Reinstatement Works

Expedited Reinstatement (EXR) is a term that's a bit of a misnomer. Individuals who have had their benefits stop due to work are eligible for a faster decision and provisional payments while they wait for a decision. Ideally, the EXR process is fast but in reality beneficiaries can wait months for a decision and provisional payments are not always processed quickly. Like everyone, individuals on benefits who have started or returned to work and are concerned about a possible need to go back on benefits should have a robust emergency fund to weather any payment or decision processing delays.

How Long Can Ticket Holders Receive Health Benefits?

After benefits stop, workers can apply for continued coverage of Medicare. This allows participants to receive healthcare for an additional 93 months, even though they no longer receive cash payments. After this free coverage period, participants can apply for coverage at a reduced rate with Medicare Savings Programs. It may also be possible to receive Medicaid, depending on the state where the Ticker Holder lives and their income level.

Can a Ticket Holder Work From Home?

Working from home arrangements are permitted under the Ticket to Work program. A number of employment networks specialize in remote work. Working from home can be a good fit for individuals who are housebound, immunocompromised, or who have mobility issues.

Can a Ticket Holder Start a Business?

Yes. Some Ticket to Work Program service providers have experience helping people with disabilities start their own businesses. These service providers can help participants take the first steps to self-employment: helping think about developing business goals, determining target markets, making financial projections, identifying record-keeping requirements, and writing business plans.

The Bottom Line

The Ticket To Work program helps disabled people transition back into the workplace and loosen their reliance on Social Security and Social Security Disability benefits. People who receive disability benefits can make more money, meet new people, and learn new skills when they join the workforce. Over time, participants can replace cash benefits with a paycheck and gain financial independence without immediately losing Medicaid or Medicare health benefits before they are firmly established in their careers.

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