SOCIAL SECURITY DISABILITY AND SUPPLEMENTAL SECURITY INCOME

The federal government pays disability benefits through two programs: 1) the Social Security disability (SSD) insurance program and 2) the Supplemental Security Income (SSI) program

  • SSD goes to people who cannot work because they have a medical condition that is expected to last at least one year or result in death.

  • The SSI program makes payments to people with low income who are age 65 or older or are blind or have a disability. Even though the Social Security Administration manages the SSI program the benefits are not paid for by Social Security taxes. SSI is paid for by U.S. Treasury general funds, not the Social Security trust funds.

SSD SPECIFICS

DIFFERENCE: If you have worked and paid into Social Security long enough, you may be eligible for Social Security benefits (not SSD but referred to as retirement benefits) while you are receiving SSI. Retirement benefits can be paid to people age 62 or older and their families. Disability benefits (SSD) go to people with disabilities and their families. There are also Survivors benefits, which are paid to the families of workers who have died. If you think you may qualify for Social Security benefits (Retirement or Disability), call Social Security to make an appointment to talk with a Social Security representative.

BENEFITS: Social Security pays benefits to people who

  • cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability. (While some programs give money to people with partial disability or short-term disability, Social Security does not.) AND

  • meet the earnings requirement for disability benefits. There are two different earnings tests, both of which must be satisfied -
  • a "recent work" test based on your age at the time you became disabled; and

  • a "duration of work" test to show that you worked long enough under Social Security. (Certain blind workers have to meet only the "duration of work" test.)

FAMILY MEMBERS: Certain family members of disabled workers also can receive money from Social Security. This is explained in "Can my family get benefits?"

HOW TO APPLY: There are two ways that you can apply for disability benefits. You can:

1) Apply at www.socialsecurity.gov; or

2) call the toll-free number, 1-800-772-1213, to make an appointment to file a disability claim at your local Social Security office or to set up an appointment for someone to take your claim over the telephone. The disability claims interview lasts about one hour. If you are deaf or hard of hearing, you may call the toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. If you schedule an appointment, a Disability Starter Kit will be mailed to you. The Disability Starter Kit will help you get ready for your disability claims interview.

WHEN TO APPLY: You should apply for disability benefits as soon as you become disabled. It can take a long time to process an application for disability benefits (three to five months). To apply for disability benefits, you will need to complete an application for Social Security Benefits and the Disability Report. You can also print the Disability Report, complete it and return it to your local Social Security office. Your processing time will go faster if you are ready to supply the following information -

  • Your Social Security number;
  • Your birth or baptismal certificate;
  • Names, addresses and phone numbers of the doctors, caseworkers, hospitals and clinics that took care of you and dates of your visits;
  • Names and dosage of all the medicine you take;
  • Medical records from your doctors, therapists, hospitals, clinics and caseworkers that you already have in your possession;
  • Laboratory and test results;
  • A summary of where you worked and the kind of work you did; and
  • A copy of your most recent W-2 Form (Wage and Tax Statement) or, if you are self-employed, your federal tax return for the past year.

Note 1: In addition to the basic application for disability benefits, there are other forms you will need to fill out. One form collects information about your medical condition and how it affects your ability to work. Other forms give doctors, hospitals and other health care professionals who have treated you permission to send us information about your medical condition.

Note 2: Do not delay applying for benefits if you cannot get all of this information together quickly the SSA representative will help you get it.

REVIEW PROCESS: The SSA will review your application to make sure you meet some basic requirements for disability benefits. They will check whether you worked enough years to qualify. Also, they will evaluate any current work activities. If you meet these requirements, they will send your application to the Disability Determination Services office in your state.

This state agency completes the disability decision for the SSA. Doctors and disability specialists in the state agency ask your doctors for information about your condition. They will consider all the facts in your case. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information. They will ask your doctors certain questions such as:

  • What your medical condition is;
  • When your medical condition began;
  • How your medical condition limits your activities;
  • What the medical tests have shown; and
    What treatment you have received.

Warning - Make sure to include all your physical and emotional conditions/disabilities no matter how long you have had them - and not just the last disability that caused you to stop working.

They also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled.

The state agency staff may need more medical information before they can decide if you are disabled. If more information is not available from your current medical sources, the state agency may ask you to go for a special examination. We prefer to ask your own doctor, but sometimes the exam may have to be done by someone else. Social Security will pay for the exam and for some of the related travel costs.

THE DECISION: A five-step process is used to decide if you are disabled -

  • Are you working? If so and your earnings average more than a certain amount each month, they generally will not consider you disabled. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003). If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

  • Is your medical condition "severe"? For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities-such as walking, sitting and remembering-for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.

  • Is your medical condition on the List of Impairments? The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

  • Can you do the work you did before? At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.

  • Can you do any other type of work? If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

BLIND: There are a number of other special rules for people who are blind. For more information, ask for If You Are Blind Or Have Low Vision-How We Can Help (Publication No. 05-10052).

APPEAL: When the state agency reaches a decision on your case, you will receive a letter. If your application is approved, the letter will show the amount of your benefit and when your payments start. If your application is not approved, the letter will explain why and tell you how to appeal the decision if you do not agree with it. If you disagree with a decision made on your claim, you can appeal it. The steps you can take are explained in The Appeals Process (Publication No. 05-10041), which is available from Social Security. You have the right to be represented by an attorney or other qualified person of your choice when you do business with Social Security. More information is in Your Right To Representation (Publication No. 05-10075), which is also available from
Social Security.

BENEFITS: If your application is approved, your first Social Security disability benefits will be paid for the sixth full month after the date your disability began.

EXAMPLE: If the state agency decides your disability began on January 15, your first disability benefit will be paid for the month of July. Social Security benefits are paid in the month following the month for which they are due, so you will receive your July benefit in August.

Also you will receive What You Need To Know When You Get Disability Benefits (Publication No. 05-10153), which gives you important information about your benefits and tells you what changes you must report.

HOW MUCH: The amount of your monthly disability benefit is based on your average lifetime earnings. The Social Security Statement that you receive each year displays your lifetime earnings and provides an estimate of your disability benefit. It also includes estimates of retirement and survivors benefits that you or your family may be eligible to receive in the future. If you do not have your Social Security Statement and would like an estimate of your disability benefit, you can request one at www.socialsecurity.gov or call our toll-free number, 1-800-772-1213.

FAMILY: Certain members of your family may qualify for benefits based on your work. They include:

  • Your spouse, if he or she is 62 or older;
  • Your spouse, at any age if he or she is caring for a child of yours who is younger than age 16 or disabled;
  • Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time; and
  • Your unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of disability for adults.)

NOTE: In some situations, a divorced spouse may qualify for benefits based on your earnings if he or she was married to you for at least 10 years, is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children.

SSI SPECIFICS

Eligibility: Whether you can get SSI depends on your income and resources (the things you own). SSI makes monthly payments to people who have low income and few resources and are:

  • Age 65 or older;
  • Blind; or
  • Disabled.

Income: Income is money you receive such as wages, Social Security benefits and pensions. Income also includes such things as food and shelter. The amount of income you can receive each month and still get SSI depends partly on where you live. You can call them to find out the income limits in your state.

Not Counted: Social Security does not count all of your income when they decide whether you qualify for SSI. For example, they do not count:

  • The first $20 a month of most income you receive;
  • The first $65 a month you earn from working and half the amount over $65;
  • Food stamps;
  • Shelter you get from private nonprofit organizations; and
  • Most home energy assistance.

Spouse Income: If you are married, they will include part of your spouse's income and resources when deciding whether you qualify for SSI. If you are younger than age 18, they include part of your parents' income and resources. And, if you are a sponsored noncitizen, they may include your sponsor's income and resources.

Student: If you are a student, some of the wages or scholarships you receive may not count.

Working Disabled: If you are disabled but work, Social Security does not count wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income when we decide whether you qualify for SSI.

Blind Expenses: Also, Social Security does not count any wages a blind person uses for work expenses. For example, if a blind person uses wages to pay for transportation to and from work, the wages used to pay the transportation cost are not counted as income. If you are disabled or blind, some of the income you use (or save) for training or to buy things you need to work may not count.

Resource Considerations: Resources are things you own. Resources that are considered in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks and bonds. You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

Not Considered: Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, not counted are:

  • The home you live in and the land it is on;
  • Life insurance policies with a face value of $1,500 or less;
  • Your car (usually);
  • Burial plots for you and members of your immediate family; and
  • Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

Other requirements: To get SSI, you must live in the U.S. or the Northern Mariana Islands and be a U.S. citizen or national. In some cases, noncitizen residents can qualify for SSI. For more information, ask for Supplemental Security Income (SSI) For Noncitizens (Publication No. 05-11051). If you live in certain types of institutions, you may get SSI.

Other Benefits: If you are eligible for Social Security or other benefits, you should apply for them. You can get SSI and other benefits if you are eligible for both. If you live in a city or county rest home, halfway house or other public institution, you usually cannot get SSI. But there are some exceptions. Also -

  • If you live in a publicly operated community residence that serves no more than 16 people, you may get SSI.
  • If you live in a public institution mainly to attend approved educational or job training to help you get a job, you may get SSI.
  • If you live in a public emergency shelter for the homeless, you may get SSI.
  • If you live in a public or private institution and Medicaid is paying more than half the cost of your care, you may get a small SSI benefit.

Children: Disabled or blind children also can receive SSI. You can get more information in Benefits For Children With Disabilities (Publication No. 05-10026).

Still More Benefits: If you get SSI, you also may be able to get help from your state or county. For example, you may be able to get Medicaid, food stamps or other social services. Call your local social services department or public welfare office for information about the services available in your community.

  • Food stamps - if everyone in your home signs up for SSI or gets SSI, Social Security will help you fill out the food stamp application. If you do not live in a home where everyone signs up for SSI or gets SSI, you must go to your local food stamp office to get food stamps. You can get more information about food stamps by visiting the government website or calling them to get Food Stamps And Other Nutrition Programs (Publication No. 05-10100).

  • Medicaid - when you get SSI, you also may get Medicaid which helps pay doctor and hospital bills. Your local welfare or medical assistance office can give you information about Medicaid.

  • Help paying for Medicare - if you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. You can get more information about these programs from the Centers for Medicare & Medicaid Services (CMS) by calling the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.

  • Drugs - you also may be able to get extra help paying for the annual deductibles, monthly premiums and prescription co-payments related to the Medicare prescription drug program (Part D). You may qualify for extra help if you have limited income (tied to the federal poverty level) and limited resources. These income and resource limits change each year and are not the same as the SSI income and resource limits. You can contact Social Security for the current numbers. If you have both Medicaid with prescription drug coverage and Medicare, Medicare and SSI, or if your state pays for your Medicare premiums, you automatically will get this extra help and you don't need to apply.

HOW TO APPLY: If you are applying for SSI, you can complete a large part of your -application by visiting the government website at www.socialsecurity.gov. You also can call them toll-free at 1-800-772-1213 to ask for an appointment with a Social Security representative.

IF DENIED: If you disagree with a decision made on your claim, you can appeal it. The steps you can take are explained in Your Right To Question A Decision Made On Your Supplemental Security Income (SSI) Claim (Publication No. 05-11008). You have the right to be represented by an attorney or other qualified person of your choice. More information is in Your Right To Representation (Publication No. 05-10075).

 


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