The facts about Social Security disability insurance, including eligibility requirements.
Social Security Disability Insurance, or SSDI, provides benefits to individuals who are disabled or blind. SSDI is funded by employees’ contributions to the Social Security trust fund, or the Federal Insurance Contributions Act (FICA) social security tax paid on yearly earnings.
In order to be eligible for SSDI, your loved one must have:
- Paid some of these taxes in recent years
- Worked and paid social security taxes long enough to be covered under social security insurance
Or he or she must be:
- Considered medically disabled
- Not working or working and earning less than the substantial gainful activity (SGA) level
- The widow(er) or adult child of an individual with a disability
Eligible individuals are evaluated using earning guidelines and substantial gainful activity (SGA) work ability, as well as disability guidelines. SGA is used as a factor to decide if disability insurance should continue after the individual is already receiving benefits.
What Is “Disability?”
Disability is defined as being unable to engage in SGA due to medically determinable physical or mental impairments that are expected to result in death or that have lasted or are expected to last 12 months or longer. Generally, disability can be determined by your loved one’s answer to five questions:
- Is he or she working? If so, and your loved one’s average monthly earnings are at SGA level, he or she is not considered disabled. If your loved one’s monthly earnings are below SGA level, his or her condition is assessed.
- Is your loved one’s condition “severe?” This means that the impairment significantly limits his or her ability to do basic work (e.g., remembering, seeing, walking). If it does not, your loved one is not considered disabled.
- Is his or her condition in the list of disabled impairments? If your loved one’s impairment is not on this list, the office will decide whether his or her impairment is equivalent to those impairments listed.
- Can your loved one do the work that he or she did previously? If your loved one has an impairment that is not equivalent to those listed, his or her ability to complete the kind of work he or she previously completed is assessed.
- Can your loved one do any other type of work? If your loved one can’t do the type of work that he or she previously did, his or her age, education, past work experience, and transferable skills are assessed. If he or she can perform any other type of work, your loved one’s claim will be denied.
How Does My Loved One Apply?
Application for SSDI should be made as soon as your loved one is qualified. Specific documentation is required for application, but you should call a local Social Security office even if your loved one doesn’t currently have all needed documentation. Needed documentation includes:
- A copy of your loved one’s W-2 Form (if not self-employed) or his or her federal tax return for the prior year (if self-employed)
- Dates of any prior marriages
- Appropriate laboratory test results and X-rays
- Names, addresses, and telephone numbers of doctors, hospitals, clinics, and institutions that treated your loved one and the dates that he or she was treated
- Names of all medications currently being taken and the dosage of each
- Social security number and birth certificate (or other proof of age) for each applicant
- Your loved one’s bank account number if he or she wishes direct deposit of benefits
- Work history for the past 15 years, including company names, addresses, supervisors’ telephone numbers, and the kind of work that your loved one performed
If your loved one is approved for SSDI, the payment amount he or she will receive is based on his or her lifetime average earnings covered by Social Security. This amount is adjusted annually to account for cost-of-living increases, and it may be reduced by worker’s compensation payments or public disability benefits.
What Other Benefits Can My Loved One Receive?
Eligibility for SSDI means that your loved one can receive Medicare, but unless your loved one has chronic kidney disease requiring dialysis or a transplant, he or she will need to wait two years to qualify for Medicare. Additionally, your loved one will be eligible for Medicaid, but he or she will need to wait five calendar months after his or her disability coverage begins to receive medical benefits. If your loved one leaves disability and subsequently returns due to a reoccurrence of the same problem, this waiting period is waived.
When Can SSDI Benefits Be Terminated?
Once these benefits have been granted, your loved one’s medical condition will be reassessed periodically. If your loved one’s condition is expected to improve, a new assessment will occur every three years. If not, your loved one will be assessed every five to seven years. If SSDI receives notice of your loved one’s return to work, he or she will be reassessed at that time. The last month that a person is eligible for SSDI benefit is the month:
- Before the month in which he or she turns 65, because retirement benefits start at this age.
- Before the month in which he or she dies
- When SSDI finds the individual is longer disabled because of work at the SGA level or medical improvement. (It should be noted that in this case, SSDI will be paid for a “grace period” of that month and the following two months.)
- If benefits are discontinued due to medical improvement but the individual is in a vocational rehabilitation program, the benefits will be given until program completion.
- If benefits are discontinued because of work at the SGA level but there is an extended period of eligibility, the benefits will be given until this period ends.
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