CVC Patient Advocate II Nora Ciancio has a bachelor’s degree in political science and economics at the University of Richmond (Va.), and a J.D. at Penn State Law in State College, Pa. Her background is in public health and health care law, and she is admitted to the Virginia Bar. She answered these FAQs as part one of a four-part series aimed at helping you understand the U.S. Social Security’s disability assistance.
Those with chronic illnesses often have to make the difficult decision to stop working. A physician may suggest it, or you may realize on your own that working is actually harming your health or no longer sustainable. This can be a result of the exacerbation of symptoms in work environments, diminished energy, or the need for more time to manage complex medical care.
If you are no longer able to work due to chronic illness, Social Security disability benefits can provide continued income and health insurance options.
Like many government benefits programs, however, the pathway to receiving disability benefits can be confusing and time consuming. The disability process for individuals with rare, chronic diseases can be especially challenging because many times their diseases, symptoms and resulting limitations do not fall within traditional definitions and notions of what it means to be disabled.
Those suffering from chronic diseases may have some good days where they could potentially work, but those days are often followed by a slew of bad days where it is difficult to complete even simple tasks. Rare diagnoses or orphan diseases can also be largely misunderstood or even unknown to medical personnel and Social Security Administration (SSA) representatives. All of these factors, coupled with the complex nature of the application process, obscure qualification guidelines and low national approval rates, deter countless individuals from applying for federal disability benefits.
At Caring Voice Coalition, our Appeals and Disability team is committed to alleviating one area of stress in our patients’ lives by helping them navigate the disability process. We hope that the answers to the following frequently asked questions will help you better understand the disability process.
What are the different types of disability benefits?
There are two main types of disability benefits: Title II Social Security Disability Insurance (SSDI), and Title XVI Supplemental Security Income (SSI).
Social Security Disability Insurance benefits are based on work credits, or the taxes you have paid into the Social Security system. In order to be eligible for SSDI benefits, you must have paid into the Social Security tax system. For example, in 2016, you gain one work credit for every $1,260 (this amount changes from year to year) you earned under Social Security, with a maximum of four credits per year. Generally, if you have earned at least 40 credits, and 20 were in the last 10 years, you qualify to apply. The younger you are, the fewer credits you may need. To check the status of your work credits for SSDI, you should call your local Social Security office and ask for your date last insured. You must prove disability by the date that SSA provides.
Supplemental Security Income, on the other hand, is a needs-based program. In order to be eligible for SSI, you must meet specific income and financial resource guidelines. If a single person has more than $2,000 or a married couple has more than $3,000 in financial resources, you will not be eligible to receive SSI. Financial resources can include savings and retirement accounts, secondary land holdings (not your primary residence), and any other cash holdings.
Can I apply for any benefits while I am working?
Yes, as long as your earnings are below a certain amount. In order to file an application for either SSDI or SSI, you must be unable to maintain substantial gainful activity. In other words, you must be making less than $1,130 gross per month for the year 2016. Please note that the threshold for blind individuals is different.
How does SSA decide if I am disabled?
For both the SSDI and SSI benefits, SSA will go through a five-step medical evaluation after they verify that you meet the work credit or financial qualifications for benefits. SSA will look to see if:
1. You earn less than $1,130 per month.
2. You have a severe condition and your condition has lasted, or is expected to last, 12 months or more.
3. You meet or equal one of their child or adult Listing of Impairments (conditions considered severe enough to qualify as a listing). First, SSA will look to see if you meet the specific test requirements, symptoms or limitations set forth by a listing.
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- If you do not meet the requirements of a listing, SSA will look to see if your medical conditions are equal in severity to a listing. If SSA determines that you meet or equal a listing, then they will approve your disability claim. The complete listings can be found on ssa.gov.
- If you do not meet or equal a listing, SSA will go on to Step 4 and Step 5 of their evaluation.
4. You can perform any of your past relevant work.
5. You can perform any other job in the economy. If SSA decides you are able to perform past work or any other work, then you will be denied benefits.
How long will it take for SSA to give me a decision?
The current national average for an initial claim is six months. Depending on your diagnosis, and whether SSA defines it as terminal, you may be able to ask SSA to expedite the processing of your claim. The list of Compassionate Allowances and the list of Terminal Illnesses are available on ssa.gov.
What if I am denied benefits at the initial level?
If you are denied benefits for medical reasons, you have the option to appeal. The appeal process differs depending on where you live. For most of the country, there are two separate appeal stages. The first, Reconsideration, is a paper review of your application, and the national average for a decision at this stage is currently about four months. The second stage of appeal is the Administrative Law Judge (ALJ) Hearing, where you appear before a judge who will determine the outcome of your claim. Right now, it takes SSA between 16 and 18 months to schedule a hearing, and then after a hearing, it generally takes about three months for the judge to write a formal opinion.
In 10 states—Alabama, Alaska, parts of California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York and Pennsylvania—disability cases skip the Reconsideration process and go directly before a judge.
Once I am approved, how much money will I receive?
For SSDI, your monthly benefit award will depend on how much you paid into the Social Security tax system. You can determine your monthly benefit amount by calling your local SSA field office. For SSI, the maximum benefit for the year 2016 is $733 per month.
When will I get my money?
For SSDI, there is a five-month waiting period that extends between the date SSA finds you disabled and your date of entitlement. SSA always pays you the month after the end of your five-month waiting period. For SSI there is no such waiting period and payments should begin soon after SSA issues a final award letter.
What insurance can I receive?
For SSDI, you will become eligible for Medicare 24 months after your date of entitlement. SSI comes with Medicaid eligibility. Most states defer to SSA’s guidelines for Medicaid, so it should begin once you start receiving benefits, but 11 states have more stringent income requirements.
I’m overwhelmed! Where can I turn for help?
CVC is here to help! We can assess your eligibility and help you navigate the disability process from the initial filing through representation at an ALJ hearing. To see if you qualify for our assistance, call us at 888-267-1440.