This is a short, easy-to-understand guide to the Social Security Disability Insurance program, commonly known as SSDI — what is it, how it works, who it is for, frequently asked questions, and more.
If you have a question about Social Security Disability Insurance, we hope to answer it clearly in this jargon-free, comprehensive guide.
Let’s start with the basics.
- 1 What is SSDI?
- 2 SSDI vs SSI: What’s the difference?
- 3 Who can get disability benefits?
- 4 How do I apply for disability benefits?
- 5 When should I apply for disability?
- 6 What information do I need to apply for Social Security Disability?
- 7 Who decides if I am disabled?
- 8 How is a decision made?
- 9 What happens when my claim is approved?
- 10 Can my family get Social Security benefits?
- 11 How do other payments affect my benefits?
- 12 When do I get Medicare?
- 13 What do I need to know about working?
What is SSDI?
Social Security Disability Insurance is a part of the Social Security Administration and general trust fund. It was set up to assist workers who became disabled and could no longer carry on in the workforce. SSDI would provide supplemental income to these workers.
In 1956, U.S. Congress enacted a law that established the Social Security Disability Insurance program of the Social Security Administration. This part of Social Security law had been debated between Democrats and Republicans, Liberals and Conservatives, for almost 20 years.
The main components of SSDI are:
- Only those with substantial work histories are eligible for SSDI.
- SSDI is funded through payroll taxes.
- SSDI is subject to strict disability guidelines.
- SSDI will provide basic, but not extravagant benefits.
- The program requires that there are return-to-work supports in place.
These are the basic tenants of the Social Security Disability Insurance Program.
In addition to these 5 tenants, additional regulations apply.
- Recipients will receive monthly benefits equal to their projected retirement benefit only if it is expected that they will not be able to work for at least a year or they will die within a year.
- Once awarded SSDI, your medical records will be reviewed every 5 to 7 years and your financial records will be reviewed annually.
- SSDI is part of the regular Social Security Retirement Insurance program and the benefits are paid out of the same fund. These benefits can be paid directly to the worker as well as to his or her children or dependents.
When Congress passed the bill, they fully expected that it would be for those who had already worked many years – particularly those in their 50s and 60s.
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SSDI vs SSI: What’s the difference?
There are two distinct disability programs administered by the Social Security Administration. These are the Social Security Disability Insurance program and the Supplemental Security Income (SSI). Though very different they are easily confused.
What is the difference between these two?
There are two main differences between these programs, mainly in where the program funding comes from and who is eligible for the benefits.
SSDI, like the Social Security Retirement Fund is paid for by payroll deductions for Social Security taxes and FICA taxes, while SSI is funded by the general tax revenue fund.
SSI eligibility is income-based while SSDI depends on the work credits you have garnered over the years you have worked.
Who can get disability benefits?
As noted above, one of the differences between SSDI and SSI is who can get benefits under each program.
To be eligible for either program, you must be a U.S. citizen who is blind or disabled. For SSI, you must also meet income requirements that are set at the state level.
There is no income requirement for SSDI, but you must have enough ‘work credits’ to qualify. Usually, this means that if you are over 31, you earned 20 credits in the past 10 years.
The requirements for SSDI include the inability to perform any substantial work due to a mental or physical impairment that will either result in death or last a year.
You must be able to show that you can neither do your own job nor any other job.
How do I apply for disability benefits?
Applying for Social Security disability benefits can be a daunting process.
Most people are denied the first time they apply and they should appeal. The key is to provide the SSA with the information they require the first time around.
You have two choices. You can go to the SSA website or local office and fill out the required paperwork, including medical records and physician statements.
For many, this is an overwhelming task and they hire an attorney who is experienced in SSDI claims to handle all of this for them, including any appeal. If you do hire an attorney, the fees are set by law so that it is affordable.
When should I apply for disability?
If you can’t work, you should apply for Social Security disability benefits as soon as you are eligible to do so.
Most people will be eligible the day after their last day of work, or the day after their earnings for the month are lower than $1070 per month, and they expect their condition to last at least a year.
You should apply as soon as you are eligible because it typically takes 90 to 120 days for your SSDI application to be processed and if you are denied and appeal, it will take substantially longer.
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What information do I need to apply for Social Security Disability?
You may be asked for a variety of documents when applying for SSDI and these may include:
- Identification – Social Security number, passport, birth certificate or proof of legal status.
- U.S. military discharge papers if before 1968
- Tax returns and/or W-2 forms
- Completion of the Adult Disability Report
- Medical records including test results, physician notes and reports, workers compensation reports, long or short-term disability reports
- Pay stubs, settlements, or any proof of medical disability and payments
- There may be other questions you are asked or information you need to provide regarding your identity, your health, and your work history
Who decides if I am disabled?
Employees of the Social Security Administration who are claims examiners along with SSA physicians will decide if you meet the rules for Social Security Disability.
These examiners and physicians are a part of the Disability Determining Services. They are professionals who are trained to make determinations using Social Security regulations, laws, and guidelines.
How is a decision made?
Using all the information you or your representative(s) have provided and following the regulations, guidelines, and laws regarding approval for SSDI benefits, DDS employees decide your claim.
If the local DDS denies your claim, you may appeal to an Administrative Law Judge in the Office of Disability Adjudication and Review.
What happens when my claim is approved?
If your claim is approved, the local SSA office will complete any non-medical aspects of the claim as needed, compute your benefit, and begin making payments. You will receive a lump sum payment from the day you became eligible until the day your monthly benefit starts. You will then receive a monthly benefit.
Can my family get Social Security benefits?
The answer to this question depends upon your individual circumstances. Who receives benefits based on your disability and what they receive can be both straightforward and complicated at the same time.
The following members of your family may apply for and receive benefits:
- Current spouse
- Divorced spouse
- Disabled children
- Adult child who became disabled before the age of 22
Certain documentation will be asked of any family members applying for benefits.
Each approved family member will receive up to 50 percent of your disability benefit. What family members receive will not impact what you receive, but there is an overall family benefit limit. This is usually around 150 to 180 percent of your total benefit.
How do other payments affect my benefits?
As mentioned above, payments to other family members will not impact your benefit payments.
When do I get Medicare?
You will automatically receive Part A and Part B of Medicare on the first day of the 25th month of receiving SSDI benefits.
What do I need to know about working?
There are many different aspects to working while receiving SSDI benefits or preparing to return to full-time work without SSDI benefits.
The SSA does not expect you to jump right back into work even if your disability improves to the point where you might be able to do so. If you can’t return to SGA or “Substantial gainful activity”, you can earn up to $1170 a month without losing your benefits.
Earning more than this could put your benefits at risk unless you are engaging in a trial work period and/or have a “Ticket to Work”. Under those circumstances, you can work for a certain period to see if you are capable of SGA on a permanent basis.
If you are capable of SGA, then you will be expected to return to work and benefits will discontinue. If you are not capable of SGA, your benefits will continue and your trial work period will discontinue.