Social Security Disability vs. Supplemental Security Income and Subsequent Entitlements
This is the fourth in a series of brochures developed by the Patient Advocate
Foundation, Inc. The information herein is in response to frequently asked questions (FAQ’s) by patients. The brochure is intended to provide general but informative responses to these inquiries. Any incident, inquiry or issue may vary according to these specific facts and circumstances relating to the individual.
SSDI is a federal disability insurance program designed for individuals who have worked enough to earn sufficient "work credits". Under this program monthly payments are based on the individual’s earning record, which is on file with the Social Security Administration.
SSI is a federal financial assistance program which provides monthly payments to individuals who have either never worked or have insufficient credits on their earnings record to qualify for SSDI. SSI recipients are typically required to have limited financial resources and assets that do not exceed $2,000.00. In 2003 the basic SSI benefit program will pay $552.00 per individual or $829.00 per couple per month.
These programs are administered by the Social Security Administration and the disability criteria are the same for both. In order to qualify for SSI or SSDI, an individual must have an impairment or a combination of impairments that preclude substantial gainful work activity that is expected to last a continuous period of 12 months or longer or that is expected to result in death.
The challenge for patients who are diagnosed with progressive diseases, such as early stage cancer or multiple sclerosis, is that upon initial application their condition may not meet the Social Security disability requirements. A patient may expect to undergo surgery, with an estimated recovery time of six weeks, and then complete a chemotherapy regimen which lasts for six months after which time the disease will have been eradicated and the patient can return to normal activities. Unfortunately disease paths are not predictable nor are a patient’s ability to tolerate certain treatments or therapies, which leaves many Americans with no access to disability income, or the subsequent health coverage benefits, during a crucial time in their lives.
There are certain steps that you can take to ensure a smoother and more expedient application and approval process. We have provided a list of tips below:
- Apply for SSDI/SSI benefits as soon as a critical diagnosis is rendered
- When you go to apply for benefits, take a copy of your medical records and a letter of support from your physician
- Bring a list of medications you are currently taking
- Submit a copy of your most recent tax return along with a recent paycheck stub
- Make sure that you can provide appropriate documentation such as your Social Security number and the name, address and phone number of your treating physician(s)
- Get the name of a specific case worker who will be reviewing your file
Be aware that many disability applications, up to 60% of all filed, are denied the first time. Do not give up! You have the right to appeal this denial and can do so very effectively with the proper medical support; physician’s notes which indicate a decline in your condition, the onset of medication side effects, etc. Do not file a new application after a denial, appeal the original decision and request that your record be reviewed again. SSDI benefits can be paid retroactively up to a year from the date of official disability. For more on the application process, you may call (800) 772-1213 or visit www.ssa.gov. To request a copy of Your Guide to the Appeals Process, a guide for patients facing insurance or disability denials, call the Patient Advocate Foundation at (800) 532-5274 or visit www.patientadvocate.org to download the publication. Once a person is approved for SSDI or SSI they are able to access many additional resources, such as Medicare and Medicaid.
Upon approval for benefits the Social Security Administration will issue a notice of award letter which advises you of their determination. This letter also contains two important terms:
deemed and entitled.
- Deemed: the date that your disability was officially recognized
- Entitled: the date on which you can actually begin to access the benefits
In most states individuals who qualify for SSI will also become eligible for Medicaid. For those who receive SSDI approval they will begin receiving monthly payments only after five full months of disability and will be entitled to Medicare coverage 24 months after the entitlement date, which is the date that a person becomes eligible for payments. Please recognize that it actually takes 29 months from your disablement date until you are eligible for Medicare coverage, not 24 months, which is a common point of confusion for recipients.
Many disabled individuals will seek health coverage through employer sponsored COBRA (Consolidated Omnibus Budget Reconciliation Act) plans. Under ordinary circumstances, COBRA coverage is only 18 months. However there are special provisions for disabled beneficiaries. You may qualify for an 11 month COBRA extension if you aredeemed disabled by the Social Security Administration within the first 60 days of the COBRA election period. This regulation makes it critical for a patient to apply for SSDI/SSI immediately upon the activation of your COBRA benefits. The patient is also responsible for notifying the employer once disability status has been awarded. To learn more about your rights to health benefits under COBRA, you may visit the Employee Benefits Security Administration website (part of the U.S. Department of Labor website) at http://www.dol.gov/esba.
For those facing serious illnesses which result in dramatic lifestyle changes and emotional adjustments, these program guidelines may seem overwhelming. The Patient Advocate Foundation offers a host of direct patient services including assistance with Social Security denials, debt crisis intervention, access to care for the uninsured and underserved patient populations and medical claims reconciliation. Should you suffer from a chronic, debilitating or life-threatening disease and wish to receive individualized assistance from a member of our case management department, please call 1 (800) 532-5274.
Patient Advocate Foundation Mission Statement
The Patient Advocate Foundation is a national,non-profit organization that serves as an active liaison between the patient and their insurer, employer, and/or creditors to resolve insurance, job retention, and/or debt crisis matters relative to their diagnosis through case managers and attorneys. Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.