a= CENTER for

RETIREMENT
RESEARCH

at BOSTON COLLEGE

WORK-RELATED OVERPAYMENT AND BENEFIT SUSPENSION EXPERIENCES
OF FEDERAL DISABILITY BENEFICIARIES

Marisa Shenk and Gina Livermore

CRR WP 2021-14
November 2021

Center for Retirement Research at Boston College
Hovey House
140 Commonwealth Avenue
Chestnut Hill, MA 02467
Tel: 617-552-1762 Fax: 617-552-0191
https://crr.bc.edu

Both authors are with Mathematica Policy Research. Marisa Shenk is a research analyst and
Gina Livermore is a senior fellow and is the director of the Center for Studying Disability Policy.
The research reported herein was pursuant to a grant from the U.S. Social Security
Administration (SSA) funded as part of the Retirement and Disability Research Consortium.
The opinions and conclusions expressed are solely those of the authors and do not represent the
opinions or policy of SSA, any agency of the federal government, Mathematica Policy Research,
or Boston College. Neither the United States Government nor any agency thereof, nor any of
their employees, make any warranty, express or implied, or assumes any legal liability or
responsibility for the accuracy, completeness, or usefulness of the contents of this report.
Reference herein to any specific commercial product, process or service by trade name,
trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement,
recommendation or favoring by the United States Government or any agency thereof. The
authors appreciate the helpful feedback of Jody Schimmel Hyde on an early draft. They are also
grateful to Alex Bryce of Mathematica for his help with data analysis.

© 2021, Marisa Shenk and Gina Livermore. All rights reserved. Short sections of text, not to
exceed two paragraphs, may be quoted without explicit permission provided that full credit,
including © notice, is given to the source.
About the Center for Retirement Research

The Center for Retirement Research at Boston College, part of a consortium that includes
parallel centers at the National Bureau of Economic Research, the University of Michigan, and
the University of Wisconsin-Madison, was established in 1998 through a grant from the U.S.
Social Security Administration. The Center's mission is to produce first-class research and forge
a strong link between the academic community and decision-makers in the public and private
sectors around an issue of critical importance to the nation's future. To achieve this mission, the
Center conducts a wide variety of research projects, transmits new findings to a broad audience,
trains new scholars, and broadens access to valuable data sources.

Center for Retirement Research at Boston College
Hovey House
140 Commonwealth Ave
Chestnut Hill, MA 02467
Tel: 617-552-1762 Fax: 617-552-0191
https://crr.bc.edu/

Affiliated Institutions:

The Brookings Institution
Mathematica - Center for Studying Disability Policy
Syracuse University
Urban Institute
Abstract

This paper examines the work-related overpayment and benefit suspension experiences of
recently employed Social Security Disability Insurance and Supplemental Security Income
beneficiaries using data from the 2017 National Beneficiary Survey. It documents overpayment
and benefit suspension rates and the characteristics of beneficiaries experiencing these events
and examines the association between knowledge of Social Security Administration work
incentive provisions and beneficiaries' expectations, benefit suspensions, and overpayments. It
also documents reasons that some who achieve benefit suspension discontinue or reduce their
work effort and return to receiving benefits. The findings are descriptive and do not attribute
causality to the relationships between awareness of program provisions and the overpayment and

benefit suspension experiences.

The paper found that:

e Among recently employed beneficiaries, overpayment and benefit suspension rates
differed by program, age, education, race, and ethnicity.

e Awareness of key provisions was positively associated with the likelihood of benefit
suspension and anticipating a benefit suspension after controlling for other personal
characteristics. We observed a positive association between beneficiaries who were
aware of their ability to retain their health insurance after losing cash benefits and those
who experienced a benefit suspension.

e About half of beneficiaries whose benefits were suspended had returned to benefits or
were in the process of doing so at the time of the interview. These beneficiaries reported
a variety of reasons for resuming benefits, with health-related reasons being the most
common. Awareness of key provisions was not associated with benefit resumption after
suspension. However, anticipating a benefit suspension was associated with a reduced
likelihood of resuming benefits among SSI recipients.

e Although beneficiaries aware of key provisions were more likely to report their
employment to the Social Security Administration relative to unaware beneficiaries, after
controlling for other characteristics, awareness of earnings-related provisions was not
associated with the likelihood of overpayment or changes in employment after

experiencing an overpayment. However, among those who experienced a benefit
suspension, anticipation of the suspension was associated with a smaller likelihood of

experiencing a DI overpayment.

The policy implications of the findings are:

Increasing beneficiaries' knowledge about key provisions such as health insurance
coverage could prompt more beneficiaries to work at levels that suspend benefits,
improve their anticipation of and planning for benefit suspensions, and reduce the
chances of overpayments.

Targeting policies, information, or supports to beneficiaries with earnings-related benefit
suspensions could help them remain off of benefits, especially those that address health
needs.

Examining the job attributes, health insurance, and other characteristics of beneficiaries
who resume benefits after suspension might identify supports to help these beneficiaries

remain employed.
Introduction

Federal disability beneficiaries who work, particularly those whose earnings exceed the
Social Security Administration (SSA) substantial gainful activity (SGA) level, are at risk of
having their benefits suspended retroactively and, as a result, of receiving cash benefits that they
are not owed. This is generally referred to as an overpayment. Little is known about the extent
to which beneficiaries anticipate these events or about beneficiaries' employment responses after
experiencing them. In this study, we examine the characteristics, awareness of SSA work
incentive provisions, employment, and benefit resumption experiences of Social Security
Disability Insurance (DI) and Supplemental Security Income (SSID) beneficiaries who experience
disability benefit suspensions and overpayments. The data for the study come from the 2017
National Beneficiary Survey (NBS). The 2017 NBS is the first survey round to include a large
sample of beneficiaries who recently worked above the SGA level and thus are most at risk of
experiencing benefit overpayments and suspensions. The sample is nationally representative of

beneficiaries who were participating in the SSI and DI programs in June 2016.

This study addresses the following questions:

e What are the characteristics of beneficiaries who experience overpayments and
benefit suspensions because of earnings? At the time of interview, how
knowledgeable are they about key SSA work incentives?

e Among those experiencing benefit suspensions, what share expected them? Do
beneficiaries who experience overpayments and suspensions report changing their
employment in response? Is knowledge of SSA work incentives correlated with
expectations and reported employment responses?

e What are the reasons that some who achieve benefit suspension discontinue or

reduce their work effort and return to receiving benefits?

We found differences in overpayment and benefit suspension rates by program, age,
education, and race and ethnicity. Although we found low rates of awareness of key SSA work
incentives among recent workers and those experiencing a benefit suspension, awareness of key
provisions was positively associated with the likelihood of benefit suspension and of anticipating

a benefit suspension, after controlling for other personal characteristics. Awareness of key
provisions was not associated with benefit resumption after suspension. Beneficiaries reported a
variety of reasons for resuming benefits after a suspension, with health-related reasons most
common. Although beneficiaries who were aware of key provisions were more likely to report
their employment to SSA, after controlling for other personal characteristics, awareness of
earnings-related provisions was not associated with the likelihood of overpayment or changes in
employment after experiencing an overpayment. However, among DI beneficiaries who
experienced a benefit suspension, anticipation of the suspension was associated with a smaller
likelihood of experiencing a DI overpayment as well as a reduced likelihood of resuming

benefits among SSI recipients.

Background
SSI and DI Program Rules Concerning Earnings

The SSI and DI programs offer income support to adults who are unable to work because
of a significant health condition. To qualify for either program, an applicant must demonstrate
an inability to engage in substantial work due to a medically determinable impairment expected
to last at least 12 months or result in death. SSA defines substantial work (referred to as
substantial gainful activity, or SGA) as being equivalent to monthly earnings in excess of $1,310
(in 2021) for most individuals.

Although initial eligibility for DI and SSI is contingent on limited earnings and the same
medical criteria, the programs differ in terms of how earnings are treated in determining the
monthly cash payments and ongoing eligibility. Under DI, individuals can work and earn at any
level for up to nine months without losing eligibility for DI cash benefits. This nine-month
period is referred to as the trial work period. SSA considers beneficiaries to be in a trial work
period if monthly earnings exceed $940 (in 2021) or if they are working more than 80 self-
employed hours per month. If individuals earn more than the SGA level in any month after
completing the trial work period, they enter the 36-month extended period of eligibility and
become ineligible for any DI cash benefits; however, if they completed the 24-month Medicare
waiting period prior to becoming ineligible for DI, they remain eligible for Medicare through an
extended period of Medicare eligibility of up to about nine years. Although DI cash benefits are
suspended during the extended period of eligibility, they may resume in any month during the

extended period that beneficiaries do not earn above SGA. Once the beneficiary completes 36
extended period of eligibility months, SSA terminates DI cash benefits if the individual is
working above SGA. The expedited reinstatement provision allows individuals whose benefits
ended because of earnings to request that their benefits restart without having to submit a new
application. Aside from sustained employment above SGA, there are only a few ways that DI
benefits can be terminated: medical improvement, transition to the Social Security retirement
program upon reaching the full retirement age (age 66 and 2 months for those turning age 66 in
2021), and death.

In the SSI program, monthly payments decline by $1 for every $2 of earnings after $65 of
earnings and a $20 per month general income exclusion; thus, SSI payments can decline with
very low levels of earnings, but only gradually as earnings rise. SSI program provisions allow
participants to earn above the SGA level and remain eligible for SSI (Section 1619[a]) and
Medicaid (Section 1619[b]) benefits even after SSA suspends SSI payments because of earnings.
Individuals remain eligible for SSI and Medicaid until their earnings exceed a "threshold
amount," which is based on annual per capita Medicaid expenditures for SSI recipients and
varies by state. Individuals can remain on SSI but receive no cash payments indefinitely if they
continue to have earnings high enough to keep their SSI payments at zero and low enough to be
under the Section 1619(b) threshold. SSA would only terminate the SSI eligibility of such
individuals if they became ineligible because of medical improvement or a change in their assets,
unearned income, living arrangements, or several other circumstances unrelated to their earnings.

In addition to those described above, the DI and SSI programs have several provisions
intended to help beneficiaries in their efforts to return to work. Most allow beneficiaries to
remain eligible for Medicare or Medicaid and keep more of their cash benefits while working or
preparing for work,! but others provide resources to help beneficiaries improve their ability to
work. For example, SSA's Ticket to Work program will reimburse employment service
providers for helping beneficiaries go to work if those beneficiaries meet specific earnings
milestones. SSA's Work Incentives Planning and Assistance program provides grants to local
organizations to offer information and counseling to beneficiaries regarding what happens to

their cash and public health insurance benefits as they work and increase their earnings.

 

' Examples of these are exclusions from benefit and eligibility computations of impairment-related and blind work
expenses and contributions to approved plans for achieving self-support.
Employment, Benefit Suspension, and Overpayments

Many SSI and DI beneficiaries work after entering the disability programs. During the
first five years after entering the programs, about 22 percent of beneficiaries have worked at
some point (SSA 2020), with those ages 18 to 29 being most likely to work (41 percent).
Despite employment being common, few SSI and DI beneficiaries work enough to leave the
disability rolls; only about 5 percent had their benefits suspended for work and even less had
their benefits terminated for work during their first 15 years of participating in the programs
(SSA 2020). Among those whose benefits are suspended because of earnings, overpayments are
common. One study estimated that about 70 percent of DI beneficiaries experiencing benefit
suspension during a two-year period also experienced at least one month in which benefits were
overpaid (Hoffman et al. 2019). On average, these work-related overpayments lasted more than
nine months and the median overpayment was over $9,000. Thus, overpayments are common
among beneficiaries who work at levels resulting in suspension of their DI beneficiaries and are
sizeable.

Previous studies provide some information about the characteristics of beneficiaries who
experience benefit suspensions and overpayments. Younger beneficiaries are more likely to
have benefits suspended or terminated (Ben-Shalom and Stapleton 2015; Liu and Stapleton
2011; SSA 2020). However, Livermore (2011) found that, holding other characteristics constant,
age was not a significant predictor of benefit suspension. That study found that in a multivariate
context, SSI-only recipients and beneficiaries with low monthly benefits and those who were
married, living with children, and in good physical and mental health were more likely to leave
disability rolls because of work. Among beneficiaries experiencing benefit suspension,
overpayment prevalence rates were highest among those who were Black, had less than a high

school education, and had low monthly benefits (Hoffman et al. 2019).

Work Incentives and Responses to Overpayments and Benefit Suspensions

Little is known about the extent to which beneficiaries who experience benefit
suspensions and overpayments are knowledgeable about the relevant SSA work incentive
provisions and whether they anticipate these events. Qualitative studies of DI beneficiaries who
experienced overpayments found that some were unaware of their responsibility to report

earnings to SSA, the cut-off at the SGA level for earnings after the trial work period, and other
work provisions that could lessen the impact of overpayments, such as impairment-related work
expenses (Kregel 2018, O'Day et al. 2016). The SSA Office of the Inspector General found that
SSA overpaid nearly $371 million to beneficiaries because they failed to report their earnings
and noted that many beneficiaries may be unaware of provisions that allow them to voluntarily
suspend benefits to avoid an overpayment (SSA OIG 2018).

Avoidance of overpayments and the need to repay large sums is thought to be a reason
why some working beneficiaries choose to keep earnings below an amount that would trigger
benefit suspension. Beneficiaries report that overpayments are a source of frustration, fear, and
anger (Gubits et al. 2013). However, most of the evidence related to employment responses after
receiving overpayments is based on small qualitative studies. One quantitative study indicates
that notifications of overpayment debt were followed by declines in work at the SGA level in the
months of and following the notification (Hoffman et al. 2020). A qualitative study of DI
beneficiaries who experienced overpayments and subsequently sought benefits counseling found
that about half of them immediately stopped working upon receiving notice of the overpayment
(Kregel 2018). Other qualitative studies have shown that some DI beneficiaries maintained or
increased work after experiencing an overpayment (O'Day et al. 2016; Hoffman et al. 2017).
One of these studies found that many beneficiaries working above the SGA level had a limited
understanding of their benefits, options for retaining public health insurance after returning to
work, and SSA provisions that could support work (O' Day et al. 2016). The loss of health
insurance was a particular concern, even more so than the loss of cash benefits for some
beneficiaries.

Research to date also provides little information about the reasons why individuals who
work enough for SSA to suspend their benefits do not sustain their earnings and why many of
those who leave the disability rolls because of earnings subsequently return. Of the 3.5 percent
of DI beneficiaries and less than 0.5 percent of SSI recipients who had earnings high enough for
SSA to terminate their benefits during their first 15 years in the programs, about half of such DI
beneficiaries and one-quarter of such SSI recipients eventually returned to the disability rolls
(SSA 2020). The most common reasons for leaving jobs among all working beneficiaries are
being fired or laid off and the onset or worsening of a health condition (Livermore et al. 2009)
but existing studies have not explored the reasons why beneficiaries resume benefits after SSA

suspends them because of earnings.
Hypotheses

Based on the findings from the literature and the relevance of information about how
earnings affect benefits in beneficiaries' decisions to work, we address the following hypotheses
in our investigation of the relationship between awareness of SSA provisions and overpayment

and benefit suspension experiences:

e Recently employed beneficiaries who are aware of key SSA work supports are
more likely to work at levels that trigger a benefit suspension, anticipate a benefit
suspension, and report their employment to SSA.

e __ Beneficiaries aware of the work-related provisions are less likely to experience
overpayments and less likely to change their employment after receiving an
overpayment.

e Among those experiencing benefit suspensions, those who anticipate them are less

likely to experience an overpayment and less likely to return to benefits.

Data and Methods

We used data from the NBS fielded in 2017. The 2017 NBS is the first of the NBS
rounds to include a large sample of SSI and DI beneficiaries who recently worked above the
SGA level. The oversample of SGA earners is nationally representative of beneficiaries on the
rolls in June 2016 who earned above SGA for three or more consecutive months during the six-
month period before they were interviewed in 2017. The NBS collects extensive information
about beneficiaries' characteristics, health status, employment experiences, and knowledge of
SSA work incentives. The 2017 NBS also collected information about whether beneficiaries'
benefits were suspended, if they expected their benefits to be suspended, the extent to which
beneficiaries changed their work activity in response to an overpayment, and the reasons why
beneficiaries returned or planned to return to benefits after suspensions due to earnings." The file

also includes administrative data that help describe workers who experience benefit

 

? Benefit suspension and resumption status was self-reported. We classified those experiencing a benefit suspension
who reported receiving cash benefits or being in the process of getting back on cash benefits at interview as
resuming benefits.
overpayments and suspensions, including benefit levels and time spent participating in the SSI
and DI programs.

There are two limitations of the NBS data to keep in mind when interpreting the findings:
(1) the overpayment and benefit suspension information is self-reported and so subject to
respondent recall bias and (2) the data do not allow us to determine when beneficiaries became
aware of work incentive provisions relative to experiencing an overpayment or benefit
suspension. This second limitations means, for instance, that a positive association between
awareness and benefit suspension could be because beneficiaries more knowledgeable about
work support provisions are more likely to work at levels that suspend benefits, or because the
benefit suspension itself prompted beneficiaries to learn about the provisions, or both. Because
we do not know when the awareness was gained relative to the suspension and overpayment
events, we cannot infer the direction of any associations we find. The findings are descriptive
and do not identify causality.

We present analyses on samples of recently employed beneficiaries, recent workers who
experienced benefit overpayments, and recent workers who experienced benefit suspensions.
Table 1 shows the sample sizes for these subgroups. We present all descriptive statistics
separately for DI beneficiaries and SSI recipients including those receiving SSI and DI
concurrently (representing 17 percent of the full sample) in both sets of statistics.

We present descriptive statistics comparing the characteristics, knowledge of SSA rules,
and work experiences of recently employed beneficiaries who did and did not experience
overpayments and benefit suspensions. For those who experienced a recent benefit suspension,
we also examine the extent to which the suspensions were anticipated, reasons why some
returned to benefits, and the factors that might cause others to return in the future. We conducted
tests to identify statistically significant differences between selected subgroups.

Finally, we estimated linear regression models to assess the associations between
knowledge of program rules and the likelihood of anticipating a benefit suspension, experiencing
suspensions and overpayments, changing employment after an overpayment, and resuming
benefits after a suspension. These models controlled for other personal and health characteristics

(sex, age, race, ethnicity, education, time on the disability rolls, impairment, functional
limitations, and SSA's expectation of medical improvement?). Because the work-related
provisions differ between the DI and SSI programs, we estimated the models separately for
beneficiaries who were eligible for each type of benefit, including those concurrently eligible for
SSI and DI in both sets of models.

The standard errors for all the analyses account for the NBS sampling design and we

estimated all statistics by using the relevant survey weights.

Results
How Common Were Earnings-Related Overpayments and Benefit Suspensions among
Recently Employed Beneficiaries?
Overpayments

About 16 percent of recently employed beneficiaries, representing just over 300,000
nationwide, reported that they had been asked to repay SSA because they were overpaid (Table
1). This percentage is higher among DI beneficiaries (24 percent) than among SSI recipients (14
percent). There was some variation in overpayment rates by characteristics among recently
employment beneficiaries (Appendix Table Al). Recently employed SSI and DI beneficiaries
ages 56 and older had relatively low overpayment rates (10 and 8 percent, respectively), whereas
almost one-third of recently employed Hispanic or Latino DI beneficiaries (32 percent) reported
experiencing an overpayment. Because just 15 percent of beneficiaries were recently employed,
the percentage who experienced an overpayment among all beneficiaries was small, at 2.4

percent.

Benefit Suspension
Among all beneficiaries, 1.9 percent reported experiencing a recent benefit suspension
(Table 1). The rate among those who had been recently employed was 13 percent, representing

nearly 250,000 beneficiaries. Perhaps in part reflecting the differences in the treatment of

 

3After award, SSA periodically will assess beneficiaries' ongoing medical eligibility for DI and SSI. At the initial
and subsequent medical reviews, SSA classifies beneficiaries' medical improvement likelihood in one of three
categories: medical improvement expected, possible, or not expected. The timing of SSA's subsequent medical
reviews is based in part on this classification; those with medical improvement expected are subject to reviews at
shorter intervals (every 6 to 18 months) than those with medical improvement possible (every three years) or not
expected (every seven years). We include this variable in the regression models to reflect another facet of
beneficiary health.
earnings between the programs, a somewhat higher percentage of recently employed SSI
recipients reported that their disability benefits completely stopped because they were working in
the past year than recently employed DI beneficiaries (15 percent and 11 percent, respectively).
There was also variation in benefit suspension rates by personal characteristics, with
beneficiaries ages 56 and older (3 to 4 percent) and those with intellectual disability (6 to 7
percent) in both programs having among the lowest rates (Appendix Table Al). Those with
relatively high rates of benefit suspension include DI beneficiaries who had not completed high
school (17 percent) and SSI recipients with a sensory disorder (37 percent) and those with a

college degree (26 percent).

How Do the Characteristics of Beneficiaries Who Experience Overpayments and Benefit
Suspensions Because of Earnings Differ from Other Recently Employed Beneficiaries?
Beneficiaries Experiencing Overpayments

There were differences in personal characteristics between recently employed
beneficiaries who reported experiencing an overpayment and those who did not (Table 2).
Beneficiaries in both programs who experienced overpayments were younger, were more likely
to be employed at interview, and had been participating in the disability programs for a longer
period of time. They also were more likely to claim they reported their employment to SSA
around the time they began working; however, the difference was statistically significant only for
SSI recipients. Among DI beneficiaries, there were differences in education level; those
experiencing overpayments more likely to have some college but less likely to have a four-year
degree or higher, compared with those who did not experience an overpayment. There were also
some differences among SSI recipients; those experiencing an overpayment were more likely to
be female and less likely to have an expectation of medical improvement. Beneficiaries with
overpayments were similar to other recently employed beneficiaries in terms of race (non- White
or White) and ethnicity.

With respect to health and functioning, beneficiaries experiencing overpayments were
less likely to report difficulties with activities of daily living (ADLs) than other recently
employed beneficiaries, though their difficulties with instrumental activities of daily living
(IADLs), total number of difficulties, and general health status were similar (Table 2). This
might be the result of those in better health being more likely to work and earn at higher levels
that might trigger overpayments, compared with working beneficiaries in poorer health. There
were some differences in the types of health conditions that limit activities, with those reporting
overpayments being less likely to have a sensory disorder (10 percent versus 19 percent for DI
beneficiaries) and an intellectual disability (50 percent versus 62 percent for SSI beneficiaries).
Blind beneficiaries are subject to a higher SGA level ($2,190 in 2021, relative to $1,310 for non-
blind beneficiaries), which might contribute to a smaller percentage of those with sensory

disorders experiencing overpayments.

Beneficiaries Experiencing Benefit Suspension

Similar to the likelihood of experiencing overpayments, there were differences between
recently employed beneficiaries who did and did not experience a benefit suspension in terms of
age and employment status (Table 3). Those reporting benefit suspensions were younger and
more likely to be employed at the time of interview than other recently employed beneficiaries.
Those who experienced recent benefit suspensions reported fewer difficulties with ADLs and
IADLs than other recently employed beneficiaries (Table 3). About 54 percent of DI and 58
percent of SSI beneficiaries with suspensions reported no ADL/IADL difficulties compared with
38 and 43 percent, respectively, of all recently employed beneficiaries. The two groups were
similar in terms of general health and reasons for limitation, though SSI recipients with a recent
benefit suspension were less likely to have a musculoskeletal condition than other recently
employed recipients (3 percent versus 8 percent). The likelihood of benefit suspension did not
differ significantly between recently employed beneficiaries in either program who did and did
not report their employment to SSA when they began working.

A large share of those who experienced a benefit suspension were employed at interview
(79 percent and 70 percent of DI and SSI beneficiaries, respectively), and a large share of those
resuming benefits after suspension also were employed (66 percent and 54 percent of DI and SSI
beneficiaries, respectively) (Table 3). Beneficiaries resuming benefits in both programs were
more likely to be non-White and had been participating in the disability programs for a longer
period of time compared with others who experienced a benefit suspension. There were also
differences in education level in both programs; beneficiaries resuming benefits were less likely
to have a college degree. DI beneficiaries resuming benefits were less likely to report being able

to perform their pre-disability job. Among SSI recipients, beneficiaries resuming benefits were

10
less likely to be of Hispanic ethnicity, more likely to report difficulties with ADLs or IADLs, and
more likely to be ages 26-40 and less likely be ages 41-55, relative to those who did not resume
benefits. Those resuming benefits after a suspension in both programs were also more likely to
report a psychiatric condition and to be in poor or very poor health compared with others who

experienced a suspension and were less likely to report no limiting conditions (Table 3).

Among Those Experiencing Benefit Suspensions, What Share Expected Them?

Among beneficiaries experiencing a recent benefit suspension, more than half said that at
the time they started working or earning more, they knew they would stop receiving cash
disability benefits from Social Security (Appendix Table Al). This percentage was larger among
DI beneficiaries (63 percent) than among SSI recipients (54 percent). The percentage that
expected the benefit suspension varied somewhat by personal characteristics. In both programs,
those with a college degree (77 percent) and those who did not complete high school (77 percent
and 66 percent among DI and SSI beneficiaries, respectively) were more likely to anticipate the
benefit suspension, relative to others, as were those whom SSA categorized as medical
improvement expected (84 percent and 68 percent, respectively). Beneficiaries in both programs
requiring assistance with at least one ADL or IADL were among the least likely to expect the
benefit suspension (49 percent), as were non-White SSI recipients and those with psychiatric
conditions (47 percent). Among DI beneficiaries, the youngest age group was more likely than
older beneficiaries to expect benefits to stop, but the opposite was true among SSI recipients. In
both programs, those who reported their employment to SSA when they started working were

substantially more likely to anticipate the benefit suspension.

How Aware Are Beneficiaries about SSA Work Supports and Provisions?

Most recently employed DI beneficiaries had heard of the trial work period (51 percent)
and were aware of the SGA rule, that is, that working above SGA for more than nine months
could lead to a loss of DI benefits (63 percent), but just under one-third (30 percent) had heard of
the extended period of Medicare eligibility (Table 4).4 Relative to DI beneficiaries, recently

employed SSI recipients appeared less aware of key SSI provisions; fewer than one in five had

 

4 Appendix Table A2 lists the NBS questions about awareness of SSA provisions on which the statistics in this paper
are based.

11
heard of the $1 for $2 earnings exclusion (19 percent) and Section 1619(b) continued Medicaid
coverage. Relative to the awareness rates of the specific Medicare and Medicaid provisions, a
larger percentage of beneficiaries in both programs said they knew they could keep their public
health insurance after losing their cash benefits (39 percent). Nearly half of all recently
employed beneficiaries (47 percent) had heard of Ticket to Work and about 29 percent had heard
of benefit specialist services. Awareness rates were lowest for the impairment-related and blind
work expense provisions and SSI plans for achieving self-support (13 percent each).

Relative to other recently employed beneficiaries, those with overpayment and benefit
suspension experiences were more likely to have heard about several SSA work incentives,
including the trial work period (61 percent and 68 percent, respectively), Ticket to Work (61
percent and 66 percent, respectively), and the ability to keep health insurance after benefit loss
(53 percent and 58 percent, respectively) (Table 4). They were also more likely to have heard of
the specific Medicare and Medicaid provisions. Anticipation of benefit suspension was
positively correlated with awareness of nearly all work supports queried; the awareness rates of
all provisions except one were significantly higher among those who said they had anticipated
their benefit suspension than among those who said they had not. The exception was the plan for
achieving self-support; awareness of this provision was low for both groups and did not differ
statistically.

Awareness of the key provisions related to working and retaining cash benefits and health
insurance varied by other beneficiary characteristics (Appendix Table A3). Among recently
employed DI beneficiaries, awareness of the SGA rule was lowest (45 percent or less) among
young beneficiaries (ages 18-25), Hispanic and Latino beneficiaries, and those with intellectual
disability, and was highest (72 percent or more) among recent awardees and those with a college
degree. Awareness of the $1 for $2 earnings exclusion was also relatively lower among young
beneficiaries and higher among SSI recipients with a college degree. Those with a
musculoskeletal condition and those designated by SSA as medical improvement expected were
least aware of the SSI earnings exclusion provision (5 percent or less). DI and SSI beneficiaries
had similar patterns for awareness of the ability to retain health insurance after cash benefits
cease, although the rates among DI beneficiaries were substantially higher than among SSI
recipients. In both programs, Hispanic and Latino beneficiaries and those with a sensory

disorder had relatively high rates of awareness of the health insurance rules, whereas

12
beneficiaries with intellectual and musculoskeletal disabilities had relatively low rates. Those
who reported their employment to SSA after starting work had substantially higher awareness

rates of all key provisions relative to those who did not report their employment.

Do Beneficiaries Who Experience Overpayments Report Changing Their Employment in
Response?

Most beneficiaries reported not changing their employment effort in response to an
earnings-related overpayment (Table 5).> About 24 percent of DI beneficiaries and 13 percent of
SSI recipients reported changing their employment in response to an overpayment. Most who
experienced an overpayment were employed at the time of interview (81 percent of DI and 74

percent of SSI beneficiaries).

Do Beneficiaries Who Experience a Benefit Suspension Resume or Plan to Resume
Benefits? If So, Why?
Resumption of Benefits After Suspension

About half of beneficiaries who had a recent benefit suspension had resumed or were in
the process of resuming benefits at the time of the interview (Table 5). Among those who had
resumed or were in the process of resuming benefits, more than half were employed at interview
(66 percent of DI beneficiaries and 52 percent of SSI recipients, authors' calculations not
shown). Similar percentages planned to earn enough to leave benefits again in the future (51

percent of DI beneficiaries and 64 percent of SSI recipients) (Table 6).

Reasons for Resuming Benefits

Among beneficiaries resuming benefits, the majority cited a health-related reason and
smaller shares reported job-related or personal reasons for returning to benefits (Figure 1).
Beneficiaries were asked whether they returned to benefits because of their health, job, or
personal circumstances, and could choose multiple reasons or none of them. Nearly three-
quarters of DI beneficiaries (73 percent) cited a health-related reason; about one in five reported

a job-related reason (16 percent) or a personal circumstance (21 percent). Most of those who

 

5 The NBS public use file does not include information about the direction of the employment change, only
information about whether a respondent reported changing work effort in response to an overpayment.

13
cited a job-related reason or personal circumstance also cited a health-related reason (74 percent;
not shown); 20 percent of DI beneficiaries did not respond affirmatively to any of the three
reasons queried. Relative to DI beneficiaries, SSI recipients were less likely to report health-
related reasons for returning to benefits and more likely to report job-related and personal
reasons. About one-half (56 percent) cited a health-related reason and between one-quarter and
one-third reported job-related reasons (28 percent) or personal circumstances (30 percent). One-
quarter of SSI recipients who were resuming or had resumed benefits did not report any of the
reasons.

Beneficiaries were asked what specifically about their health, job, or personal
circumstances might have caused them to work less or stop working.® The reasons for resuming
benefits varied, but the distributions were similar across programs (Table 6). About one-third of
beneficiaries reported an existing health problem getting worse (31 and 32 percent of DI and SSI
beneficiaries, respectively). Between 5 and 15 percent of beneficiaries reported health
interfering with job performance, needing time for medical appointments/hospitalizations, and
new health problems. Similarly small shares of beneficiaries in both programs reported the
potential loss of benefits, low pay, or stressful work as reasons for resuming benefits. Less than
5 percent reported other reasons, including lack of transportation, child care, personal assistance,
or stamina for work.

The NBS queried beneficiaries whose benefits remained suspended and who were not
seeking to resume them about health, job, and personal reasons they might need to resume
benefits in the future (Table 6). Nearly half (44 and 55 percent of DI and SSI beneficiaries,
respectively) did not report that any of the three reasons queried would prompt a return to
benefits. Among those who indicated one of the three reasons might prompt a resumption of
benefits, the distribution of the specific reasons was similar to those who had resumed or were
resuming benefits, with health reasons being most common. However, the non-health reasons

reported were substantially less prevalent and varied.

 

6 Open-ended responses were back-coded. Some beneficiaries might have reported a specific health-related reason
despite not reporting in a previous question that health was a reason they returned to benefits.

14
Is Awareness of Key SSA Work Incentives Correlated with Benefit Suspension,
Anticipation of Suspension, and Resumption of Benefits After Suspension?

Beneficiaries aware of key provisions governing earnings might be more likely to risk
working at levels that suspend benefits because they know they will not lose health insurance
and anticipate the benefit suspensions; they may be less likely to resume benefits after a
suspension because they are not surprised by the loss of cash benefits. To test whether
awareness of the provisions related to retention of health insurance and cash benefits was
associated with the likelihood of these events, we estimated regression models predicting benefit
suspension outcomes, including variables representing awareness of (1) the ability to keep health
insurance after benefit loss, (2) the DI SGA rule, and (3) the SSI $1 for $2 earnings exclusion
(Appendix Table A4). We believe these provisions to be the most relevant to beneficiary
concerns about benefit loss and the rules governing the calculation of benefits.

After controlling for other personal characteristics, awareness of the ability to retain
health insurance after cash benefits cease is positively associated with a likelihood of
experiencing a benefit suspension among recently employed DI beneficiaries that is twice the
rate of those unaware of the provision. Among recently employed SSI recipients, those aware of
the health insurance provision had a 50 percent greater likelihood of experiencing a benefit
suspension than among their unaware peers (Figure 2). Awareness of the SGA rule and $1 for
$2 earnings exclusion provisions was not associated with the likelihood of a benefit suspension.
The positive association between awareness of the health insurance provisions and the likelihood
of a benefit suspension suggests that knowing that one can maintain health insurance after cash
benefits cease might prompt some beneficiaries to earn at levels that suspend benefits. But it
also could be because beneficiaries who experience a benefit suspension become knowledgeable
about the provisions as a result of experiencing the suspension and seeing that they do not lose
their health insurance.

One would expect that working beneficiaries aware of the key provisions related to the
impact of earnings on benefits would be more likely to anticipate when a benefit suspension
might occur. We found this was true among DI beneficiaries but not among SSI recipients.
Among DI beneficiaries, awareness of the SGA rule was associated with a substantially greater
likelihood of anticipating suspension (38 percentage points greater after controlling for other

characteristics) (Appendix Table A4). Knowledge of the $1 for $2 earnings exclusion was not

15
associated with anticipating a suspension among SSI recipients. Among both DI and SSI
beneficiaries, awareness of the ability to maintain public health insurance was positively
associated with anticipating a benefit suspension.

Finally, we tested whether awareness of the three key provisions was associated with
resuming benefits after suspension. This might be the case if lack of awareness and fear of
losing benefits prompted some beneficiaries to limit their work activity and resume cash benefits
because the loss was unexpected. Among both DI and SSI beneficiaries, we found no

relationship between awareness of key provisions and resumption of benefits (Appendix Table
AA).

Is Awareness of Earnings-Related Provisions and Anticipation of a Benefit Suspension
Correlated with Overpayments and Benefit Resumption?

If beneficiaries are aware of how SSA considers earnings in the benefit calculations, they
might be more likely to report their earnings to SSA as they accrue, in an effort to avoid
overpayments. Among those who are overpaid, lack of awareness of the provisions might
prompt changes to employment in response to the overpayment out of a fear of benefit loss and
unexpectedly experiencing it. To test whether awareness of the provisions related to retention of
cash benefits was associated with the likelihood of experiencing an overpayment and a change in
work effort after an overpayment, we estimated regression models predicting those outcomes.
The models include variables representing awareness of (1) the DI SGA rule and (2) the SSI $1
for $2 earnings exclusion (Appendix Table A5). After controlling for other personal
characteristics, awareness of these provisions was not associated with the likelihood of
experiencing an overpayment among all recently employed beneficiaries. There also was no
association between awareness of the cash benefit provisions and employment changes in
response to an overpayment.

Among those who experienced a benefit suspension-the group most at risk of an
overpayment-we found that anticipating the suspension was negatively associated with
experiencing an overpayment as well as with resuming benefits after a suspension (Appendix
Table A6). Among DI beneficiaries, anticipating the suspension was associated with a 12-
percentage point lower likelihood of experiencing an earnings-related overpayment, but was not

associated with resuming benefits after controlling for other characteristics. Among SSI

16
recipients, the opposite was true; anticipating a suspension was associated with an 11-percentage
point lower likelihood of benefit resumption but was not associated with the likelihood of

experiencing an overpayment.

Discussion
Summary of Key Findings

We found differences in benefit suspension rates by age, education, race, ethnicity, and
health status. To some extent, the differences reflect factors that contribute to the capacity to

work and earn at higher levels:

e Younger beneficiaries and those in better health had relatively higher rates of benefit
suspension and lower rates of resuming benefits after suspension. Relative to people
with other health conditions, those with psychiatric conditions were much more
likely to resume benefits after a suspension.

e Non-White DI beneficiaries and those without a high school diploma or equivalent
in both programs were more likely to experience a benefit suspension. This is
somewhat surprising because individuals in these groups typically have lower
earnings. However, after controlling for other characteristics, race and education
were not significant predictors of benefit suspension among recently employed

beneficiaries.

Although we found generally low rates of awareness of key SSA work incentives among
recent workers and those experiencing a benefit suspension, awareness of key provisions was
positively associated with the likelihood of benefit suspension and of anticipating a benefit

suspension, after controlling for other personal characteristics.

e Awareness of the provisions allowing beneficiaries to maintain public health
insurance after losing cash benefits was associated with markedly higher rates of
benefit suspension, all else held constant. This awareness was lowest among those
with an intellectual disability in both programs, as well as among SSI recipients with

musculoskeletal disorders.

17
e Inthe DI program, awareness of the SGA rule was low among Hispanic and Latino
beneficiaries and those with an intellectual disability.

e Inthe SSI program, awareness of the $1 for $2 earnings exclusion was low among
all subgroups analyzed; only those with a college education had a rate that was
greater than about 25 percent.

e Recent workers who did not report their employment to SSA had markedly lower
rates of awareness of the key provisions relative to those who reported their

employment.

About half of all beneficiaries with SSA-suspended benefits had resumed or were in the
process of resuming benefits at the time of the NBS interview. Nonetheless, a majority of these
beneficiaries were employed, though not necessarily above the SGA level. Awareness of key
SSA provisions was not associated with resuming benefits after a suspension. Although
beneficiaries reported a variety of reasons for returning to benefits, health-related reasons were
by far the most common.

The likelihood of experiencing an overpayment was relatively higher among some
subgroups of beneficiaries, including DI beneficiaries of Hispanic and Latino ethnicity and SSI
recipients with sensory disorders. Although beneficiaries aware of key provisions were more
likely to report their employment to SSA, after controlling for other personal characteristics,
awareness of earnings-related provisions was not associated with the likelihood of overpayment
or changes in employment after experiencing an overpayment. However, among those who
experienced a benefit suspension, anticipating the suspension was associated with a smaller
likelihood of experiencing a DI overpayment, as well as a smaller likelihood of resuming
benefits among SSI recipients.

The findings suggest that beneficiary awareness of key SSA rules governing the
treatment of earnings is associated with benefit suspension and overpayments. Although it is
difficult to disentangle the direction of the relationships because the survey data do not tell us
whether beneficiaries became aware of key provisions before or after they experienced a
suspension or overpayment, the data provide some evidence of the role of awareness before these
events occur through the information we have on beneficiaries' anticipation of a suspension.

The findings suggest that awareness of key provisions, particularly those related to maintaining

18
health insurance, might prompt some beneficiaries to risk the loss of cash benefits by increasing
their earnings. Awareness of the provisions helps beneficiaries anticipate that SSA will suspend
their cash benefits when their earnings reach a certain level; anticipation of a suspension, along
with being more aware of the program rules, is associated with a greater likelihood of reporting

employment to SSA and a smaller likelihood of experiencing an overpayment.

Study Limitations

The results in this analysis are nationally representative of SSI and DI beneficiaries.
However, the data and findings have two key limitations. First, the information on suspensions
and overpayments are self-reported and subject to potential biases that may cause self-reported
experiences to differ from actual suspensions or overpayments. Second, the study provides
descriptive evidence of an association between awareness of SSA work provisions and benefit
suspensions, but causation and the direction of any relationships cannot be determined because
the timing of awareness and overpayment or suspension events is unclear: some beneficiaries
may become aware of work provisions after their benefits are suspended, others might
experience a benefit suspension in part because knowledge of work supports prompted them to
earn at levels that suspend benefits. Although anticipation of a benefit suspension is also self-
reported and subject to potential recall bias, it sheds some light on the direction of the
relationships between knowledge and overpayment and suspension. We found that awareness
was positively associated with anticipating a benefit suspension, and anticipating a suspension
was negatively associated with experiencing an overpayment as well as with resuming benefits

after a suspension.

Implications of the Findings

The findings suggest that improving knowledge of the SSA provisions governing
earnings among beneficiaries who are working or want to work might prompt more beneficiaries
to work at levels that result in benefit suspension, anticipate those suspension, and take actions
that reduce the likelihood they will incur an overpayment. Knowledge of the health insurance
provisions seems particularly relevant in prompting beneficiaries to earn at levels that suspend
benefits. This is not surprising given the importance of health insurance to people with

disabilities, the finding that many beneficiaries resume benefits because of health reasons, and

19
the qualitative evidence that some beneficiaries working above SGA are fearful of losing their
public health insurance. Targeting information and making it more accessible to subgroups with
relatively high rates of overpayments, such as working beneficiaries of Hispanic and Latino
ethnicity, might improve earnings reporting and reduce the likelihood of overpayments.

The high rate of return to benefits after a suspension suggests an opportunity to intervene.
Most beneficiaries who resumed or were in the process of resuming benefits were still working
when they were interviewed. Such beneficiaries might be able to resume their higher earnings
with support. However, it is unclear what type of supports would be effective. The majority of
those who resumed benefits did so because of a worsening health condition or because their
health interfered with their job performance. Those with psychiatric conditions were particularly
likely to return to benefits. The types of supports and accommodations needed are likely to vary
substantially depending on the specific health issue and the individual's occupation. Thus, any
intervention to help beneficiaries remain working and off of benefits would need to be highly
individualized.

SSA is involved in several initiatives that could shed light on the types of health-related
supports that are effective in helping people with disabilities remain attached to the labor force
and remain off of benefits. SSA's Supported Employment Demonstration is testing whether
providing integrated vocational, medical, and behavioral health services to people with mental
health conditions who recently applied for DI or SSI can reduce reliance on disability benefits
and help them become or remain employed. In partnership with the U.S. Department of Labor,
SSA is evaluating the Retaining Employment and Talent after Injury/IIIness Network (RETAIN)
demonstration. RETAIN is testing early interventions that coordinate health care and
employment supports to help workers stay at work or return to work quickly after
experiencing the onset of a work-threatening injury, illness, or disability. Finally, SSA is
planning to conduct a study of beneficiaries who exit the disability programs because of
medical improvement. Like those who exit because of earnings, a large share of those who
leave because of medical improvement return to benefits (Hemmeter and Stegman 2013,
Anderson et al. forthcoming). The study will explore the reasons why they return and the
types of supports that might help them succeed in remaining off of benefits. Lessons from all
of these initiatives could inform policies and interventions aimed at helping beneficiaries who

leave the disability programs because of earnings remain off of benefits.

20
Earnings-related overpayments and benefit suspensions can be disruptive to beneficiaries
and expensive to SSA. Future research could examine the characteristics of those who resume
their benefits after an earnings-related benefit suspension to better understand the health
conditions, job characteristics, health insurance status, and needs of this group, as well as any
accommodations they require. Understanding their circumstances alongside the reasons they
report for returning to benefits might yield further insights about the types of supports that could

help them to both remain employed and avoid experiencing an overpayment.

21
References

Anderson, Michael, Denise Hoffman, Monica Faird, and Kai Filion. 2021 (forthcoming).
"Outcomes Following Disability Insurance Termination." RDRC Working Paper.
Washington, DC: Mathematica Policy Research.

Ben-Shalom, Yonatan and David Stapleton. 2015. "Long-Term Work Activity and Use of
Employment Supports Among New Supplemental Security Income Recipients." Social
Security Bulletin 75(1): 73-95.

Gubits, Daniel, Michelle Derr, Jillian Berk, Ann Person, David Stapleton, Denise Hoffman,
Stephen Bell, Rachel Cook, and David Wittenburg. 2013. "BOND Implementation and
Evaluation: Stage 2 Early Assessment Report." Cambridge, MA: Abt Associates and
Washington, DC: Mathematica Policy Research.

Hemmeter, Jeffrey and Michelle Stegman. 2013. "Subsequent Program Participation of Former
Social Security Disability Insurance Beneficiaries and Supplemental Security Income
Recipients Whose Eligibility Ceased Because of Medical Improvement." Social Security
Bulletin 73(2): 1-38.

Hoffman, Denise, Priyanka Anand, John Jones, and Serge Lukashanets. 2020. "How Do Work-
Related Overpayments Affect the Earnings of Overpaid Social Security Disability
Insurance Beneficiaries?" DRC Working Paper. Washington, DC: Mathematica.

Hoffman, Denise, Benjamin Fischer, John T. Jones, Andrew McGuirk, and Miriam Loewenberg.
2019. "Work-Related Overpayments to Social Security Disability Insurance
Beneficiaries: Prevalence and Descriptive Statistics." Social Security Bulletin 79(2): 65-
83.

Hoffman, Denise, Sarah Croake, David R. Mann, David Stapleton, Priyanka Anand, Chris Jones,
Judy Geyer, Daniel Gubits, Stephen Bell, Andrew McGuirk, David Wittenburg, Debra
Wright, Amang Sukasih, David Judkins, and Michael Sinclair. 2017. "2016 Stage 1
Interim Process, Participation, and Impact Report." Cambridge, MA: Abt Associates and
Washington, DC: Mathematica Policy Research.

Kregel, John. 2018. "A Qualitative Study of Employment Experiences of SSDI Beneficiaries
After Receipt of an Overpayment." DRC Working Paper No. 2018-06. Washington, DC:
Mathematica Policy Research.

Liu, Su and David Stapleton. 2011. "Longitudinal Statistics on Work Activity and Use of
Employment Supports for New Social Security Disability Insurance Beneficiaries."
Social Security Bulletin 71(3): 35-59.

Livermore, Gina A. 2011. "Social Security Disability Beneficiaries with Work-Related Goals
and Expectations." Social Security Bulletin 71(3): 61-82.

22
Livermore, Gina, David Stapleton, and Allison Roche. 2009. "Work Activity and Use of
Employment Supports under the Original Ticket to Work Regulations: Characteristics,
Employment, and Sources of Support among Working-age SSI and DI Beneficiaries."
Washington, DC: Mathematica Policy Research.

O'Day, Bonnie, Frank Martin, Hannah Burak, Gina Freeman, Kathleen Feeney, Grace Lim,
Elizabeth Kelley, and Katie Morrison. 2016. "Employment Experiences of Young Adults
and High Earners Who Receive Social Security Disability Benefits: Findings from
Semistructured Interviews." Washington, DC: Mathematica Policy Research.

U.S. Social Security Administration, Office of the Inspector General. 2018. Incorrect Payments
to Disabled Beneficiaries Who Return to Work. Washington, DC. Available at:
https://oig.ssa.gov/audits-and-investigations/audit-reports/A-07-17-50131

 

U.S. Social Security Administration. 2020. DI & SSI Program Participants: Characteristics &
Employment, 2015. Washington, DC.

23
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Table 5. Employment Response to Overpayment and Benefit Resumption Status After Suspension

 

 

 

 

Recent overpayment DI SSI
Unweighted number 1,353 1,403
Weighted number (1000s) 186 192
Employment response to overpayment ("%)

Changed 24.2 13.2

Unchanged 75.8 86.8

Recent benefit suspension

Unweighted number 1,488 1,231

Weighted number (1000s) 149 134

Benefit resumption status (")

Receiving cash benefits 30.5 34.6
Employed at interview 55.0 47.2
Not employed at interview 45.0 52.8

In process of getting back on cash benefits 23.5 12.9
Employed at interview 80.9 64.9
Not employed at interview 19.1 35.1

Cash benefits remain suspended 46.0 52.6
Employed at interview 94.3 86.7
Not employed at interview 5.7 13.3

 

Source: 2017 National Beneficiary Survey, weighted data.

33
Table 6. Reasons for Returning to Benefits

 

 

 

 

Resumed or resuming benefits DI SSI
Unweighted number 641 568
Plans to earn enough to stay off benefits in the future (%) 50.9 64.4
Reason for returning to benefits (%)?

Health-related 72.5 56.5
Job-related 16.4 27.7
Personal circumstances 21.1 30.0
Did not report any of the above reasons 19.5 24.9
Specific reason for returning to benefits (%)*

Existing health problem gets worse 31.2 32.1
Health interferes with job performance 11.6 14.1
Might lose benefits 8.3 6.3
Need time for medical appointments 7.4 8.7
New health problem 6.2 5.8
Job does not pay enough 5.4 6.9
Work is too tiring or stressful 4.6 7.9
Need to be hospitalized 3.0 5.4
Lack reliable transportation to and from work 2.6 4.1
Need help caring for children or others 2.0 2.9
Lack the strength, physical energy, or stamina required to work 2.0 1.7
Benefits still in suspense

Unweighted number 847 663
Reasons might return to benefits (%)*

Health-related 53.9 39.6
Job-related 10.0 7.1
Personal circumstances 8.9 12.2
Did not report any of the above reasons 44.0 55.5
Specific reason might return to benefits (%)*

Existing health problem gets worse 36.9 23.6
Health interferes with job performance 19.4 14.0
New health problem 4.9 4.6
Get injured 3.9 3.5
Lack the strength, physical energy, or stamina required to work 3.2 1.4
Health status fluctuates unpredictably 3.1 3.5
Need time for medical appointments 2.9 3.4
Work is too tiring or stressful 2.2 1.1
Lack reliable transportation to and from work 2.2 1.6
Job has a negative impact on health 1.3 2.4
Might lose benefits 1.1 3.0

 

4 Multiple responses possible.
Source: 2017 National Beneficiary Survey, weighted data.

34
Figure 1. Reasons for Returning to Benefits After a Recent Earnings-Related Suspension (%)

73

   

DI = Health

= Job
= Personal circumstances
= Did not report any of the above reasons

   

20

56

SSI

 

0 20 40 60 80 100

Note: Multiple responses were possible. Totals can sum to more than 100 percent.
Source: 2017 National Beneficiary Survey, weighted data.

35
Figure 2. Regression-adjusted Benefit Suspension Rates (%) by Awareness of Key SSA Rules

25

20

15

10

DI

ms All @Aware ©® Not aware

@ 16
11 a 11
10 O8
Suspension By By

rate among awareness of awareness of
recently SGA rules health
employed DI insurance
coverage **

SSI

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15 16
8

15 © 13

Suspension By awarenessBy awareness
rateamong of$1for$2  ofhealth
recently earnings insurance

employed exclusion coverage **
SSI

Notes: Estimates are regression-adjusted for differences between those aware and not aware of programmatic rules

in terms of sex, age, race, ethnicity, education, time on the disability rolls, impairment, functional limitations, and
SSA's expectation of medical improvement. * p<0.10, ** p < 0.05, *** p < 0.01.

Source: 2017 National Beneficiary Survey, weighted data.

36
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RECENT WORKING PAPERS FROM THE
CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE

 

How Has COVID-19 Affected the Labor Force Participation of Older Workers?
Laura D. Quinby, Matthew S. Rutledge, and Gal Wettstein, October 2021

The Impact of Claimant Representation Fee Schedules on the Disability Applicant Process
and Recipient Outcomes
Cody Tuttle and Riley Wilson, September 2021

Does Media Coverage of the Social Security Trust Fund Affect Claiming, Saving, and
Benefit Expectations?
Laura D. Quinby and Gal Wettstein, September 2021

Does Social Security Serve as an Economic Stabilizer?
Laura D. Quinby, Robert Siliciano, and Gal Wettstein, July 2021

Are Older Workers Capable of Working Longer?
Laura D. Quinby and Gal Wettstein, June 2021

Do Stronger Employment Discrimination Protections Decrease Reliance on Social Security
Disability Insurance? Evidence from The U.S. Social Security Reforms
Patrick Button, Mashfiqur R. Khan, and Mary Penn, June 2021

Trends in Opioid Use among Social Security Disability Insurance Applicants
April Yanyuan Wu, Denise Hoffman, and Paul O'Leary, March 2021

The Value of Annuities
Gal Wettstein, Alicia H. Munnell, Wenliang Hou, and Nilufer Gok, March 2021

Will Women Catch Up to Their Fertility Expectations?
Angi Chen and Nilufer Gok, February 2021

The Consequences of Current Benefit Adjustments for Early and Delayed Claiming
Andrew G. Biggs, Angi Chen, and Alicia H. Munnell, January 2021

Intended Bequests and Housing Equity in Older Age
Gary V. Engelhardt and Michael D. Eriksen, January 2021

The Effect of Early Claiming Benefit Reduction on Retirement Rates
Damir Cosic and C. Eugene Steuerle, January 2021

All working papers are available on the Center for Retirement Research website
(hitps://crr.bc.edu) and can be requested by e-mail (crr@bc.edu) or phone (617-552-1762).

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