 | | | Social Security Disability Insurance (SSDI): Frequently Asked Questions
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1) What is the Social Security Disability Insurance (SSDI) program? |
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Social Security Disability Insurance (SSDI) is wage replacement income for individuals who have paid FICA taxes that meet Social Security's rules for disability. SSDI is financed with Social Security taxes paid by workers, employers, and self-employed persons. SSDI provides a variety of benefits to family members when a primary wage earner becomes disabled or dies. SSDI benefits are payable to disabled workers, widows, widowers, and children or adults disabled since childhood who are otherwise eligible.
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2) By what other name is the Social Security Disability Insurance (SSDI) program known? |
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Social Security Disability Insurance is referred to as DI, SSDI, or Title II (Title Two of the Social Security Act). Some use more inaccurate terms such as "SSA benefits," "Social Security disability benefits," or "Social Security benefits," which can cause confusion with other Social Security’s programs.
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3) Who pays for Social Security Disability Insurance (SSDI)? |
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Workers, employers, and the self-employed pay Federal Insurance Contributions Act (FICA) taxes that are used to fund SSDI.
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4) Is the Social Security Disability Insurance (SSDI) program the same in all states? |
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Yes. SSDI is a federal program of the Social Security Administration (SSA) and is available to legal residents in all 50 states, US Districts, and US Commonwealths.
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5) Who is eligible for the Social Security Disability Insurance (SSDI) program? |
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The primary wage earner who becomes disabled, according to Social Security’s rules, and has paid FICA taxes for the required length of time is eligible for SSDI. A worker's dependent, such as the widow or Childhood Disability Beneficiary (CDB) (formerly referred to as a Disabled Adult Child, or DAC), are also eligible. See the SSDI Program Description for eligibility details. |
6) What health coverage comes with SSDI? |
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Medicare (Part A and Part B) comes with SSDI after you have been eligible for Social Security Disability Insurance cash benefits for 24 months.
If your disability is the result of kidney disease requiring regular dialysis or transplant, or of Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig's Disease, you may qualify for Medicare coverage when eligible for Social Security Disability Insurance.
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7) How is the Social Security Disability Insurance (SSDI) benefit calculated? |
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Social Security Disability Insurance monthly benefit amounts are based on your lifetime average earnings. Annual adjustments, called indexing, are made to account for cost-of-living modifications or increases. Your Social Security Disability Insurance benefit amount may be reduced due to Workers' Compensation payments and/or other public disability benefits payments, such as State Disability Insurance. |
8) How long will the Social Security Disability Insurance benefit last? |
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You will continue to receive a disability benefit as long as you continue to be disabled and meet work and other eligibility requirements. If you are still eligible when you reach full retirement age, disability benefits will automatically be converted to retirement benefits. See the SSDI Program Description for more details. |
9) What are the medical requirements or rules for eligibility in the Social Security Disability Insurance program? |
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10) How is Substantial Gainful Activity (SGA) determined? |
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Substantial Gainful Activity can be measured in two ways:
- Total actual monthly wages (dollars). Any work that generates gross (before taxes) earned income that is equal to or greater than $940 (SGA) as of 2008 ($1,570 for blind beneficiaries).
- Substantial Gainful Activity can be the dollar value the Social Security Administration (SSA) places on work activity even if wages are not paid. If SSA considers the value of the work to be $940 or more, the work is considered Substantial Gainful Activity as of 2008 ($1,570 for blind beneficiaries).
See the Social Security Administration's Work site for more details on Substantial Gainful Activity.
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11) Does what I have in the bank and/or what I own, such as a home or car, affect my eligibility for the Social Security Disability Insurance (SSDI) program? |
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No. There are no limits on what you own or have in the bank for this program. SSDI is based on FICA contributions paid by the wage earner through an employer or by a self-employed individual.
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12) What can I do ahead of time to apply for a disability benefit? |
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You are the central person in a disability claim. It is your responsibility to inform your medical provider(s) that you are applying for a disability benefit. Ask your medical provider to clearly document all medical findings that will support your claim. You are responsible to report any symptoms to your doctor, even if they seem insignificant. By reporting to your medical provider(s), you build a health care team that can help support a disability claim. Deciding when to apply for disability benefits can be an important part of what you and your doctor discuss.
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13) What other preparation will help a claim for disability benefits? |
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You will expedite the process if you provide Social Security:
- Social Security number and proof of age, such as a certified copy of a birth certificate (including your spouse and children if they are also applying for benefits);
- Names, addresses, and telephone numbers of doctors, hospitals, clinics, and institutions that treated you and the dates of those treatments;
- Names of all medications you are taking and the prescribed dosage(s);
- Medical records from your doctors, therapists, hospitals, clinics, and caseworkers;
- Lab tests and their results;
- A summary of where you've worked during the past 15 years and the kind of work you did. A resume can provide some of this information;
- A copy of your most recent W2 Form or, if you are self-employed, your federal tax return for the past year;
- Marriage and dependents information, and/or dates of any prior marriages; and,
- Proof of application to any other public benefit such as State Disability Insurance or Worker’s Compensation.
Gathering these materials can seem overwhelming. Be patient with yourself and the process. Gather these materials and file your claim in a timely manner.
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14) How do I apply for the Social Security Disability Insurance (SSDI) program? |
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You can call or visit your local Social Security office to schedule an appontment or apply online. Local Social Security Administration (SSA) offices and phone numbers can be found using SSA's Office Locator or by calling (voice) 800-772-1213 (TTY) 800-325-0778. To file a claim for SSDI you will need to complete:
- SSA-3368 (Disability Report);
- SSA-827 (Medical Releases); and
- SSA–3369 (Vocational Report).
Processing the SSDI claim should take 1-6 months if all required documentation is provided. When a claim is denied by Social Security and appeals are filed, the SSDI claim process can take longer.
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15) What is the difference between the Supplemental Security Income program (SSI) and the Social Security Disability Insurance program (SSDI)? |
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The Supplemental Security Income program is funded by taxes from the general fund. This program is based on individual financial need and is designed to assist those who have limited income and resources. Social Security Disability Insurance is paid for by FICA deductions from wages. This is a social insurance program that pays benefits based on contributions made by a wage earner. |
16) What other benefit programs are available to me and how will they work with the Social Security Disability Insurance (SSDI) program? |
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Many additional benefits programs may be available to you depending on your work history and what benefits an employer has provided. They may include California State Disability Insurance (SDI) program and privately sponsored short and long term disability programs. Supplemental Security Income (SSI) may be available if your Social Security Disability Insurance payments and/or other benefits do not exceed Supplemental Security Income limits, and you meet all other asset limitations. You may also be eligible for health coverage such as Medicare (after waiting periods have been satisfied) Medi-Cal (Medicaid), or private medical insurance coverage. |
17) Can I qualify for the Social Security Disability Insurance (SSDI) program while I am eligible for State Disability Insurance (SDI) or Supplemental Security Income (SSI)? |
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Yes. State Disability Insurance (SDI) may be available if you have paid into the program. Your Social Security disability benefit may be reduced when receiving other public benefits simultaneously. The combined amount of Social Security benefits, State Disability Insurance, and other public disability, such as workers' compensation, cannot exceed 80 percent of what Social Security considers your average current earnings. One example of the formula used is when they consider average monthly earnings in the year prior to the start of Social Security Disability Insurance benefits. For more information, see How Workers' Compensation And Other Disability Payments May Affect Your Benefits. You may consider consulting a benefits planner when accessing more than one public program. |
18) How do I stay enrolled/eligible in the Social Security Disability Insurance (SSDI) program? How often do I have to reapply? |
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You will continue to receive a disability benefit as long as you continue to be disabled and meet eligibility requirements. You do not need to reapply. Social Security conducts medical reviews to verify if your disabling condition has improved. If you begin earning wages while receiving benefits, Social Security has specific Work Incentive rules on how your earned income will effect your benefit. It is important to keep SSA informed of any changes in your earned income.
Underreporting earnings to Social Security may result in overpayment where you will be responsible to pay back those benefits. Make sure to report all of your gross income. Gross income is the amount you are paid before taxes are deducted from your paycheck. If you are self-employed, you can report earnings based on your most recent IRS tax return. To avoid an overpayment, report earnings to the Social Security Administration at 800-772-1213 (voice) or 800-325-0778 (TTY).
When an individual reaches retirement age, generally at age 65, he or she is enrolled in the Social Security reitrement program instead of SSDI.
Since January 2000, when you receive Social Security retirement you will no longer have any limits on your earnings and the benefits you receive.
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19) Are there rules for immigrants to qualify for the Social Security Disability programs? |
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Yes. You must be a legal United States and California resident. The Social Security Administration provides an explanation of the rules. Another source of information for immigrants and Social Security is the People's Guide.
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20) What if I think I may be disabled for less than one year? |
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State Disability Insurance or other private disability programs may be the ones you want to consider. The Social Security Disability Insurance program requires that you meet Social Security's definition of disability. This means that you must be unable to engage in any Substantial Gainful Activity (SGA) due to any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months. |
21) What happens when I work while receiving benefits from the Social Security Disability Insurance (SSDI) program? |
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Social Security work incentives, as well as the new Ticket to Work program, support your efforts to re-enter the workforce. There are two time periods the Social Security Administration (SSA) uses when you start earning income while remaining disabled according to Social Security rules. They are called the Trial Work Period and the Extended Period of Eligibility. These are time periods that will allow you to earn income and maintain your benefit eligibility. As you consider working, keep these definitions in mind:
- SSA defines disability as an inability to work because of a disabling condition that will continue for at least one year. Therefore, your disability will be questioned if you work during the first year of receiving disability benefits.
- SSA defines work as any activity that generates earned income.
SSA defines earned income as the gross (before taxes) amount of income that you receive.
Make sure to report all of your gross income to Social Security to avoid overpayments. If you are self-employed, you can report earnings based on your most recent IRS tax return. You can report earnings promptly to the Social Security Administration at 800-772-1213 (voice) or 800-325-0778 (TTY).
See SSDI and Work for an extended discussion of the SSDI work rules.
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22) How does the Trial Work Period (TWP) and the Extended Period of Eligibility (EPE) work? |
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The Trial Work Period (TWP) consists of nine Trial Work months occurring within a five-year window when you receive full Social Security Disability Insurance benefits and work. These work months can be one right after the other (consecutively) or intermittently (non-consecutively). The trial work months add up to what Social Security calls a Trial Work Period only if they all occur within five years (60 months) of each other. Social Security calls this the Five-Year Window.
A Trial Work Month is any month when gross earnings (income before taxes) are $670 or more (in 2008). As already mentioned, the 9 Trial Work Months do not have to be used consecutively, meaning one right after the other. In other words, if you worked for six months then stopped working for any amount of time, you will still have three more months remaining of your Trial Work Period.
If you do not work a total of nine months within the five-year window, the window rolls (moves) forward until you have worked nine Trial Work Months. Once your Trial Work Period closes (ends), the Extended Period of Eligibility automatically begins.
The Extended Period of Eligibility (EPE) is the 36 consecutive months that start at the end of the Trial Work Period. Different rules apply during this period.
In the Extended Period of Eligibility, any month in which gross earnings (income before taxes) are at least $940 (for 2008), your wages are at what Social Security rules call Substantial Gainful Activity (SGA). The SGA earnings for blind beneficiaries are different: in 2008, SGA for the blind is $1,570.
Refer to the SSDI Eligibility Closeup for an example showing how the Trial Work Period, Extended Period of Eligibility, and Grace Period work.
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23) I have extra expenses while working due to my disability. What are Impairment Related Work Expenses (IRWE) and how do I use them? |
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Impairment Related Work Expenses (IRWE) are documented expenses for services or items related to one's impairment that you pay for in order to support your work. Wheelchair repairs, out of pocket payments for prescription drugs or medical expenses, and a computer screen reader are examples of IRWE’s needed for work.
Impairment Related Work Expenses must be verified with original receipts or canceled checks.
Impairment Related Work Expenses are approved at the local Social Security field office on a case by case basis.
There is no fixed list of approved Impairment Related Work Expenses.
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24) If I have to stop working after I use all of the Social Security work incentives, can I re-apply for benefits without filing a new application? |
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Yes. Social Security has an easy to use Expedited Reinstatement of Benefits form. If your benefits end due to employment, they can be reinstated immediately if you received Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). You can receive these benefits for six months while Social Security decides your disability status if: - Supplemental Security Income and/or Social Security Disability Insurance benefit payments were stopped due to earnings from work;
- You are unable to work or perform Substantial Gainful Activity--or earn $940 ($1,570 for blind beneficiaries) per month--due to an impairment that is the same or related to those of the original disability; and,
- The request for reinstatement is submitted within 5 years of the month the benefits ended for the original disability.
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25) Are there any Social Security programs that can help fund my preparation for the workforce? |
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Yes. The Plan for Achieving Self Support Program (PASS) allows certain people with disabilities to set aside earned income or unearned income. Social Security will exempt this income when it is placed into an approved PASS plan and used towards a vocational goal, such as college or a training school. PASS is a Supplemental Security Income (SSI) program. You must meet SSI financial rules to use the program. A detailed application is required. PASS can be a valuable tool for competitive employment. |
26) Can I be eligible for more than one Trial Work Period (TWP) or Extended Period of Eligibility (EPE)? |
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Yes. You can be eligible for a new 9 month Trial Work Period, a 36 month Extended Period of Eligibility, and a 3 month Grace Period. To qualify, you need to be disablied from a differnt condtion or be reinstated for Social Security Disability Insurance Benefits (SSDI) for 24 months or more. |
27) How often will Social Security review my disability claim? |
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When Social Security awards disability benefits, they schedule a review depending on the severity of your disabling condition(s) and on when you may medically improve.
- If medical improvement is expected soon, Social Security will review your claim within the first three years;
- If medical improvement is considered possible, Social Security will review your claim at least once every three years;
- If medical improvement is not expected, Social Security will review your claim every five to seven years.
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