The Social Security Administration (SSA) was established in 1935 under President Franklin D. Roosevelt and was created to secure Social Security benefits through various social welfare programs passed by the federal legislature. Today, the administration serves over 69 million Americans each year through several different programs.
One major priority of the SSA is to help those with disabilities through two different programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both disability programs provide eligible Americans a monthly benefit to supplement their income to help cover everyday living expenses and to help those who are unable to work.
Each program has its own eligibility criteria and the programs serve different groups of people. SSI currently provides benefits to over 8 million Americans, and SSDI provides benefits to over 10 million. Together, these programs serve an essential need in our communities.
What’s the Difference Between SSI and Social Security Disability?
Although both programs are run through the SSA, they each have different guidelines, functions, and criteria for qualifying. Some people may qualify for both an SSDI and SSI benefit at the same time.
The biggest difference between the two is this: SSDI is a form of disability insurance that you paid into, while SSI is a need-based program. SSDI benefits require a certain number of earned work credits to qualify, while SSI sets income limits for Americans who are either disabled, blind, or over age 65.
Both programs provide financial assistance in the form of a monthly payment, and they both help an individual or family qualify for other government-run health insurance programs like Medicaid, Medicare, or SNAP (food stamps). Many disabled individuals may find they qualify for both programs, however, you do not need to be disabled to qualify for SSI if you are over 65 years old.
SSDI payments are usually higher than SSI payments, with an average monthly cash benefit of $1,128 compared with SSI’s average monthly case benefit of $577. Applications for SSI are usually approved faster than SSDI, and beneficiaries typically receive their first payments from SSI sooner than those with SSDI.
SSDI requires that an applicant has both a qualifying disability and has worked long enough (ie. paid into the Social Security system) to be considered “insured.” In general, you can either have a partial disability or full disability which prevents you from working for at least 12 months or is expected to end in death. Some disabled workers may still be able to work in some capacity, but to qualify you must be unable to engage in substantial gainful activity (SGA).
Your disability typically must also be listed in the SSA’s list of impairments, commonly referred to as the “Blue Book.” The Blue Book lists all conditions that are pre-approved for medical eligibility, however, it is possible to be granted an exception if your condition isn’t listed here.
For the work credits requirement, you typically need to have worked for at least 10 years. You can earn a maximum of 4 credits per year, and need to have at least 40 credits to qualify.
Waivers are available and required work credits are less if you are younger. For the youngest age bracket, you only need 20 work credits. You may also be granted a waiver if you were married and did not earn work credits since your spouse was the main earner for your family.
Applications for SSDI can be submitted in person, online, or over the phone by calling 1-800-772-1213. Online is typically the most efficient way to apply. By applying online you can start your application immediately, stop and save at any time if you need to gather more information, and have easy access to reference it or any supporting documents.
Any way you apply, you must provide personal information, submit documentation that’s relevant to your disability, and sign a medical release. By preparing these items in advance, you can expedite your application process.
Be prepared to provide your basic personal information like a birth certificate and the Social Security number and date of birth of yourself, your spouse, and any minor children. You will also be asked for detailed information about your medical history, including names and contact information for providers you’ve seen regarding your disability, test results, and any relevant medical records.
There will also be questions about your work history. Gather documentation about your current employment situation including salary, the dates that you worked, names of past and current employers, W2’s and tax forms for the previous year, and any past or current military service.
Though SSDI is a federal program, your application will go to your state’s disability determination agency to be reviewed. You will receive an initial confirmation that your application was received. After it’s been reviewed, you may be contacted to supply any missing information before you receive the final determination.
Applicants may also be able to qualify for SSA’s Compassionate Allowance program, which can expedite applications for those with the most severe conditions. The SSA keeps a Compassionate Allowance List (CAL) with diseases and disabilities that are serious enough to automatically qualify for both SSDI and SSI. When you indicate you have one of these conditions, it will usually fast-track your application. However, this benefit will only help you get your decision earlier, and most people will still have to wait five months until their first check is received.
If your application is complete and the SSA does not have to ask for additional medical records or missing information, it usually takes 3-5 months. Once a decision is made, SSDI applicants will receive a letter in the mail detailing the SSA’s decision.
You can always check the status of your application by logging into your Social Security online account or by calling the SSA at 1-800-772-1213. To ensure that your disability is valid and that no one is taking advantage of the system, you must wait five months before receiving your first disability payment, and you will not receive back pay for this time. However, the count starts on your Established Onset Date, which is usually your application date – not the date of approval.
There are a few exceptions to the waiting period for those with conditions considered severe enough that they should start receiving benefits immediately, such as those suffering from amyotrophic lateral sclerosis (ALS). This fast-track program is called Compassionate Allowances.
The average monthly payment for an SSDI recipient is currently $1,154. Payments are determined by calculating your average lifetime earnings, also called the average indexed monthly earnings (AIME). However, if you’re also receiving other benefits like workers’ compensation or a pension, your monthly payment may be reduced.
Yes, you can work or return to work and still receive SSDI benefits. Since disability benefits are primarily intended to help those who aren’t able to work, there are certain regulations to follow. In most cases, you can be employed partially as long as your income stays under the threshold of substantial gainful activity. Or, if your condition improves and you’d like to try working again, the SSA gives you a nine-month grace period to see if this is a viable option. If, after nine months, you can return to work, your benefits may be reduced or terminated altogether depending on how much you are able to earn.
The SSA offers beneficiaries access to their Ticket to Work program, which provides free training, job search help, vocational rehabilitation, and other support to gain employment. Taking part in the Ticket to Work program does not mean that your benefits will automatically stop, only that you are exploring your options for employment.
As long as you remain disabled, you can continue to qualify for and receive SSDI payments. If you are receiving SSDI when you turn the retirement age of 65, your disability benefits will simply transition into Social Security retirement benefits. However, if you are able to work again because your disability has improved or gone away completely, you could lose your benefits. The SSA regularly reviews your SSDI benefit, and if it’s determined that you can work and earn a sufficient income, your disability benefits will be terminated. SSDI benefits may also drop off if you are sent to prison.
You may be eligible for retroactive SSDI back pay if your application takes longer than five months to receive compensation.
The SSA usually takes between three and five months (and sometimes longer) to process your application. There is a required five-month waiting period for all benefit recipients, which is subtracted from any potential back pay you are due. So, if the SSA took five months to approve your application, you wouldn’t receive any back pay. However, if they took eight months to approve your application, you would receive three months of back pay. Keep in mind, however, that even if you win an appeal case that lasted 2 years, SSDI back pay is limited to 12 months of disability payments.
Supplemental Security Income (SSI) is another federal program run by the SSA that provides monthly financial compensation to low-income Americans who need help meeting basic expenses. Although disabled individuals are eligible for this benefit, it’s also available to the elderly. Beneficiaries also must meet certain low-income requirements.
SSI benefits are reserved for those who are disabled, blind, or over the age of 65. All applicants must also meet the requirements for limited income and resources. This income limit is set each year and is based on current cost of living data. It takes into account both earned and unearned income.
Earned income generally refers to wages, and unearned income refers to any cash benefit like workers’ compensation, pensions, Social Security benefits, unemployment, or rent. In 2021, the monthly limits for unearned income are $814 for individuals and $1,211 for a couple where both spouses are eligible. However, an applicant can have an earned income of as much as $1,673 for an individual and $2,467 for couples and still qualify for SSI.
You can apply for SSI online, in person at a Social Security office, or over the phone by calling 1-800-772-1213. However, if you are applying on behalf of a disabled child, the process is a bit different and you must first start a child disability report. After this has been reviewed by the SSA, you will be contacted by a representative who can help you apply. For people over the retirement age of 65, you need to apply either in person at a local Social Security office or by calling the toll-free number.
Individual SSI payments vary since they are based on need. The more income you have, the lower your SSI payments will be. There are also caps on how much any person can receive in benefits from the SSI. In 2022, the caps on monthly payouts are $841 for an individual and $1,261 for a qualifying couple.
Also, because SSI is based on the beneficiary’s income, you must report any changes in income or the status of your disability within ten days to the SSA, including changes to a spouse’s income or a dependent child’s. If you do not report these changes in a timely manner, you run the risk of losing your benefits completely.
The most common way beneficiaries lose their monthly SSI payments is if their income or assets exceed the federal limits for the program. Because of this, many SSI recipients are worried that if they return to work, they will automatically lose their benefits – but this is not the case. Like SSDI, SSI also offers the Ticket to Work program, which allows beneficiaries to ease back into work to explore their options by offering a nine-month work trial period. During this time you will continue to receive your regular benefit, even if you’re making more than the program’s income limits.
After the 9-month trial window is over and you continue to work, you have 36 months in which you can continue to receive your monthly benefit for any months you earn less than a “substantial” amount, which in 2021 is $1,310 for individuals.
46 states including Washington D.C. currently offer additional monthly benefits that are added onto federal SSI payments. Arizona, Mississippi, West Virginia, and North Dakota do not contribute. Each state determines the amount of money that’s added onto payments and it can range from $10 to $400 in additional benefits each month.
SSI recipients are eligible for other need-based programs such as Medicaid and Supplemental Nutrition Assistance Program (SNAP). In most states, if you qualify for SSI you will automatically qualify for these programs as well.
Medicaid provides health insurance to low-income Americans. The program currently covers around 75 million people. Although Medicaid is a federal program, it is run on the state level and each state has its own guidelines on income qualifications and what coverage comes with it. Medicaid also covers the health needs of low-income children through the Children’s Health Insurance Program (CHIP). CHIP can help by providing health insurance for children, even if the parents themselves aren’t able to qualify for Medicaid.
SNAP benefits (formerly called “food stamps”) is a federal program that helps low-income families purchase healthy food. This is usually done in the form of a monthly allowance or voucher that recipients can use at grocery stores and in some cases local farmers markets. Some states will automatically submit an application for SNAP benefits when you apply for SSI, while others will offer you the choice to pursue SNAP benefits on your SSI application.
If your SSDI or SSI claim is denied, you have the right to appeal this decision. Denials can happen for all sorts of reasons, and you shouldn’t give up just because you’re denied on the first try. Sometimes mistakes are made by the SSA representative reviewing your file, or perhaps the medical evidence was deemed insufficient. Appeals can be done on your own or you can enlist the help of a Social Security disability attorney. A disability lawyer can help file your disability claim, gather any supporting documents, and help with communication and any eventual interviews or court dates.
The appeals process is broken into four stages. If you wish to contest the SSA’s decision you must follow each step in order. The first step is called Reconsideration and it is the most basic and straightforward level in the appeals process. Within 60 days of your denial, you can ask that a new SSA representative review your application to see if an error was made. Approximately 10-15% of reconsiderations result in approval. However, if your appeal is denied, you can move on to the next level of appeals where you can request a formal disability hearing with an administrative law judge.
The second level of the appeals process is called Adjudication. You must apply for an appointment at your closest Hearing and Appeals offices within 60 days of your most recent denial. A judge will review your application and look at any new documentation, medical evidence, or witnesses that you bring to the hearing.
Many people choose to retain a disability lawyer at this point since the court process can be complex and lengthy. Be aware that this can be a long process and it’s not unusual for it to take over a year to receive a hearing date. After your hearing, you will be notified within 60 days that your application has been approved or denied. Roughly 13% of applications receive approval at this point.
The third and fourth levels of appeal require you to submit a disability claim first with the Social Security Appeals Council and then with a federal court. At this stage of the appeals process, it is highly advised that you hire legal counsel.
If you have a long-term disability that significantly limits your ability to work for at least 12 months, you may qualify for Social Security disability benefits. Social Security Disability Insurance and Supplemental Security Income serve millions of Americans each year. Though applying for these programs involves significant preparation and effort, these programs can ensure you and your family are taken care of, even if you are suffering from a disability that prevents you from gainful employment.
Your primary care physician can help you review all your medical data and work with you to gather enough evidence to use for your application. If you have any questions about these disability programs, reach out to an SSDFacts Advocate today.