Social Security Disability Health Insurance

Iii: Who Receives Ssdi

Eligibility criteria are strict, and most SSDI applicants are rejected. Applicants for SSDI benefits must be

• Insured for disability benefits .
• Suffering from a severe, medically determinable physical or mental impairment that is expected to last 12 months or result in death, based on clinical findings from acceptable medical sources.
• Unable to perform substantial gainful activity anywhere in the national economy regardless of whether such work exists in the area where the applicant lives, whether a specific job vacancy exists, or whether he or she would be hired.

Lack of education and low skills are considered for older, severely impaired applicants who cant realistically change careers but not for younger applicants.

There is a five-month waiting period for SSDI, but Supplemental Security Income may be available during that period for poor beneficiaries with little or no income and assets.

SSA denies applicants who are technically disqualified and sends the rest to state disability determination services for medical evaluation. Applicants denied at that stage may ask for a reconsideration by the same state agency, and then appeal to an administrative law judge at SSA. Roughly half of people who get an initial denial pursue an appeal.

SSA monitors disability decisions at all stages of the process. SSA conducts ongoing quality reviews at all stages of the application and appeal process. Many reviews occur before any benefits are paid, thus reducing errors.

What Is The Difference Between Ssi And Ssdi

SSI eligibility is determined based on age, disability and available resources, while SSDI is based on a persons disability and work credits.

For most people, medical requirements that will allow you to receive disability payments are the same for both, and disability is determined using the same process. Both SSI and SSDI are managed by the Social Security Administration as well.

The most notable difference between SSI and SSDI is that SSDI is only available to people who have accumulated enough work credits, while SSI is available to low-income individuals who have not accumulated enough work credits or who have never worked. In addition, SSDI is based on your work history, but SSI is strictly based on a financial situation of considerable need.

Additionally, SSI benefits begin on the first of the month that a social security disability application is submitted and approved, but for SSDI there is a five-month waiting period. People who qualify for SSI can also receive Medicaid benefits. After receiving SSDI benefits for two years, a disabled person will be eligible for Medicare benefits. The amount of SSI benefits depend on where a person lives and what their monthly income is, while SSDI benefit amounts are dependent on a persons earnings record.

Disability Application Starter Kit

To assist you in creating your application, Social Security has developed a Disability Starter Kit that provides information about the documents and information that you will be requested to provide. Because an application can be complicated and lengthy, this is a good place to start and to keep you organized. The kit also explains how Social Securitys disability programs work and what decision-making processes are used to determine your eligibility.

Social Security offers two kits, one for adults and another for children. The adult Disability Starter Kit can be found here. And the child Disability Starter Kit can be found here.

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What Do I Need To Know About Advance Designation

You should be aware of another type of representation called .

Advance Designation allows capable adult and emancipated minors who are applying for or receiving Social Security benefits, Supplemental Security Income, or Special Veterans Benefits the option to choose up to three people in advance who could serve as their representative payee, if the need arises.

In the event that you can no longer manage your benefits, you and your family will have peace of mind knowing that someone you trust may be appointed to manage your benefits for you. If you need a representative payee to assist with the management of your benefits, we will first consider your advance designees. We must still fully evaluate them and determine their suitability at that time.

You can submit and update your advance designation request when you apply for benefits or after you are already receiving benefits. You may do so through your personal account, contacting us by telephone at 1-800-772-1213 , or at .

Who Is Eligible For Social Security Disability Insurance

For you to qualify for SSDI, which entitles you to monthly payments that can help keep you financially afloat during tough times, Social Security Administration rules state that:

• You must be incapable of working because of your medical condition.
• In the estimation of SSA, you are incapable of adjusting to other work in your condition.
• Your disability has lasted or could last at least one year or could result in death.

If you believe you qualify, you can apply online or by calling the SSA at 1-800-772-1213.

To receive SSDI, you must have paid an appropriate amount of Social Security taxes through work based on your age. Your spouses work history wont help you qualify, but your spouses earnings wont be used against you when applying for SSDI. The more Social Security taxes you have paid, the larger your SSDI payments will be.

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Why Is There A Shortfall In The Disability Insurance Trust Fund And What Can Be Done About It

As described above, Disability Insurance is funded by a dedicated share of payroll tax contributions0.9 percent of taxable wages paid by workers and the same amount by employers. Since the mid-1990s the Social Security Administration has consistently projected that the Disability Insurance trust fund would have sufficient reserves to cover all scheduled benefits until 2016, but that after that date, additional funds would be needed to avoid a shortfall in the necessary funds to continue paying full benefits. If no action is taken to address the shortfall, the Disability Insurance trust fund will only be able to pay 80 percent of scheduled benefit levels after 2016.

Congress has addressed similar shortfallsin both the Disability Insurance trust fund and the Old Age and Survivors Insurance trust fund, which pays retirement benefitsnearly a dozen times in the past by temporarily reallocating the share of overall payroll tax revenues that is dedicated to each trust fund. In some cases, they have reallocated funds from the Disability Insurance trust fund to the Old Age and Survivors Insurance trust fund in others, they have reallocated funds from the Old Age and Survivors Insurance trust fund to the Disability Insurance trust fund.

Benefits For People With Disabilities

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.

Social Security Disability Insurance pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes.

pays benefits based on financial need.

When you apply for either program, we will collect medical and other information from you and make a decision about whether or not you meet Social Security’s definition of disability. Periodically, we will need updated information about your condition. You may receive a Disability Update Report . This form can now be completed online.

Use the Benefits Eligibility Screening Tool to find out which programs may be able to pay you benefits.

If your application has recently been denied, the Internet Appeal is a starting point to request a review of our decision about your eligibility for disability benefits.

If your application is denied for:

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What Conditions Qualify For Social Security Disability Insurance

There is no set list of approved disabilities, but the Social Security Blue Book, also known as Disability Evaluation Under Social Security, is an online directory of physical and mental health conditions that automatically qualify if you meet the stringent requirements for diagnosis. For adults, they are broadly split into 14 categories.

• Blood disorders like sickle cell anemia, thrombosis and hemophilia
• Cancer, including Leukemia, lymphoma, multiple myeloma, breast cancer and prostate cancer
• Cardiovascular illnesses, such as congenital heart disease and heart failure
• Cognitive andmental health conditions, such as bipolar disorder, dementia, depression and intellectual disabilities
• Congenital disorders that affect multiple body systems, such as non-mosaic Down syndrome
• Digestive system illnesses, such as bowel or liver disease
• Endocrine disorders, such as diabetes, thyroid disease, hyperglycemia and hypoglycemia
• Genitourinary disorders like chronic kidney disease
• Immune system diseases like HIV, inflammatory arthritis and lupus
• Musculoskeletal issues that are congenital or acquired, such as spinal disorders or amputations
• Neurological disorders, such as Parkinson’s disease, epilepsy, multiple sclerosis and traumatic brain injuries
• Respiratory illnesses, such as asthma, cystic fibrosis and chronic obstructive pulmonary disease
• Special sense and speech disorders, such as impaired hearing, sight and speech
• Skin disorders, such as burns, dermatitis and ichthyosis

My Condition Is Not Listed In The Blue Book Can I Still Receive Ssdi Benefits

While the Blue Book is a fairly comprehensive guide, by no means does it contain every ailment or disability that could keep a person from working. If you have a condition not listed in the Blue Book , you can still apply for SSDI. The main thing to remember is that you will need to provide substantial proof that your condition has rendered you unable to work.

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Consulting With A Social Security Attorney

Conducting research and applying for Social Security on your own can be lengthy, stressful, and confusing. It is also vital that applications are completed correctly, as any mistakes could lessen your chance of qualifying.

Social Security attorneys have expansive knowledge of the SSDI process that can help you avoid the common mistakes many applicants make. They can also present your case as favorably as possible to give you the best shot at receiving disability insurance. If you are thinking of filing for SSDI, consider speaking with a Social Security attorney beforehand to discuss your options.

What Other Requirements Are Beneficiaries Required To Meet

In order to receive Disability Insurance, a worker must have worked during at least one-fourth of his or her adult lifetime and during at least 5 of the 10 years before disability onset. There is also a five-month waiting period before a worker can qualify for benefits.

Supplemental Security provides assistance to people with severe disabilities who have very low incomes and assets and who either lack sufficient work history to be covered for Disability Insurance or receive only a very small Disability Insurance benefit. It is important to note that many Supplemental Security beneficiaries, although lacking the sustained work history necessary to be insured under Disability Insurance, have worked and paid into the Disability Insurance system. And others, particularly women, are not eligible for Disability Insurance because they took time out of the paid labor force to care for children or other family members.

Workers must apply for and exhaust all other available benefits before qualifying for Disability Insurance or Supplemental Security. Accordingly, Social Securitys disability programs serve as a true last resort for people with severe disabilities and little to no ability to work.

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Special Circumstances: Medicare With Als Or End

Medicare eligibility rules for people with ALS or end-stage renal disease are different. Individuals who qualify for Medicare with ALS or ESRD do not have to wait for your 25th month of disability to be eligible for Medicare.

If you qualify with ALS: You will automatically get Medicare Part A and Part B the month your disability benefits begin.7

If you qualify with ESRD:8

• For most people, Medicare coverage will start on the 1st day of the 4th month of dialysis treatment.
• If you have an employer group health plan, Medicare will begin on the fourth month of dialysis.
• Treatments if you have employer coverage.
• If you participate in an at-home dialysis training program, your coverage may begin the first month of a regular course of dialysis provided the following are true:
• You participated in training from a Medicare-approved training facility for the first three months of your regular dialysis
• Your doctor expects you to finish training and be able to do your dialysis treatments yourself

Note, according to Medicare in order to qualify with ESRD all of the below must apply:9

For further information related to ALS and Medicare, visit www.alsa.org.

For further information related to ESRD and Medicare, visit www.medicare.gov.

Will My Current Health Insurance Work With Medicare And Medicaid

While you can qualify for disability programs with your current health insurance plan, understanding how it will work with Medicare or Medicaid is more complicated. For the first two years you have SSDI, you probably will not have Medicare, so this is not an issue. After this period, though, it is important to understand how they will interact.

When Medicare kicks in, it will either become your primary insurance over your current insurance plan, or it will serve as a secondary insurance to this plan. Your primary insurance always pays out to cover your bills first. Once your benefits from that plan cover costs up to your limit, your secondary insurance kicks in. This should pay a portion of your leftover costs, if not the rest of your bill. In this way, your secondary insurance supplements the primary policy.

Medicaid always acts as your primary insurance, while your current health insurance will act as the secondary plan.

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How To Claim Disability In Ontario

If youve been injured or have become ill and need to recover lost income, it may be time to file a disability claim. The process can be quite complex, so it may be wise to consult with an Ontario disability insurance lawyer at Injury Disability Lawyers.

Our lawyers are well-versed in Ontario disability insurance laws and will help walk you through the steps necessary to secure the compensation you need during your injury or illness.

The Facts On Social Security Disability Insurance And Supplemental Security Income For Workers With Disabilities

Social Security Disability Insurance and Supplemental Security Income provide critical lifelines for the roughly 12 million people with disabilities in the United States.

Nearly one out of every six working-age Americans29.5 million peoplehas a disability, making them much more likely to experience economic hardship than people without disabilities. Many people with disabilities are able to work, although they face greater challenges finding work than people without disabilities. But many individuals with severe and long-lasting disabilities have no or only limited capacity to work and are particularly vulnerable to economic hardship.

For roughly 12 million people with disabilities, Social Security Disability Insurance and Supplemental Security Income, both core components of our nations Social Security system, provide critical lifelines. The modest but vital assistance that Disability Insurance and Supplemental Security provide makes it possible for individuals with severe disabilities and health conditions to live independently, keep a roof over their heads and food on the table, and pay for needed, often life-sustaining medications and other basic expenses.

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If You Get Ssi Disability And Dont Have Medicaid

You can apply for Medicaid coverage. But whether you need to apply depends on your state

• In many states, SSI recipients automatically qualify for Medicaid and donât have to fill out a Medicaid application.
• In other states, your SSI guarantees you Medicaid eligibility, but you have to sign up for it.
• In a few states, SSI doesnât guarantee Medicaid eligibility. But most people who get SSI are still eligible.

If you have SSI Disability and donât have Medicaid, you can apply for Medicaid coverage 2 ways:

Who Is Eligible For Ssdi

Workers who are no longer able to work as a result of their disabling medical condition. Eligibility is based on work history and severity of disability. To qualify, you generally need to have worked in jobs covered by Social Security for at least 5 of the past 10 years , ending the year your disability began. In some cases, usually with younger workers, applicants may be eligible with fewer credits. You also need to meet the definition of disability as outlined by Social Security.

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Social Security Disability Insurance: How To Apply For Benefits

Less than half of disability applicants are accepted on their first try.

Dan Avery

Writer

Dan is a writer on CNET’s How-To team. His byline has appeared in Newsweek, NBC News, The New York Times, Architectural Digest, The Daily Mail and elsewhere. He is a crossword junkie and is interested in the intersection of tech and marginalized communities.

Over 8 million Americans receive disability payments from the Social Security Administration, mostly through Social Security Disability Insurance, or SSDI.

To qualify, you must be diagnosed with an injury or condition that prevents you from working for at least a year or is expected to result in death.

Another form of disability benefit is Supplemental Security Income, or SSI, which is funded by the Treasury Department and aids individuals whose financial resources are below specified limits.

Applicants for both programs need to present substantial evidence to support a disability claim. The process can take a considerable amount of time, usually involving an in-person or phone interview. Here’s what you need to know to apply for Social Security disability benefits, including what is available and what conditions qualify.