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SSI v. SSDI: Understanding & Filing for Disability Benefits

People with a disability may be eligible for Supplemental Security Insurance or Social Security Disability Income.SOCIAL SECURITY AND DISABILITY

People whom the Social Security Administration finds disabled may be eligible for Supplemental Security Income (SSI) and Texas Medicaid or for Social Security Disability Insurance (SSDI) and, after 24 months, Medicare. Some people are eligible for both.

Qualified disabled or elderly veterans with a limited income may also be eligible for pension benefits. These must be applied for separately.

Applications for Supplemental Security Income and Social Security Disability Insurance are available at www.ssa.gov.

Financial eligibility determinations do not include income from an ABLE Account or a Special Needs Trust.

Applying for Supplemental Security Income and Social Security Disability Income

Patience, precision and perseverance are needed to navigate the Social Security application maze.

Just like Medicaid and Medicare, SSI and SSDI sound similar and are easy to confuse. Many parents of disabled children know to apply for SSI three months before their child turns 18 in order for the child to receive SSI as an adult. Fewer seem to also know that they should also apply for SSDI if the child is unmarried and is disabled both before 22 and as an adult. SSDI benefits for a disabled adult child are called “childhood disability benefits”. They are the equivalent of 50% of the retirement benefits of a parent who is retired or disabled and 75% of the retirement benefits of a parent who has died. Like those benefits, they grow with a cost-of-living adjustment.

Social Security is a complex area. While efforts are being made to improve and standardize its administration, funding and in some places office hours have been cut back substantially. Applicants should not be surprised by errors, long delays and lost files. Keep and submit complete records in person, requesting a receipt, as well as by priority or registered or certified mail, return receipt requested. Reply promptly. Appeal repeatedly. Often the key to securing Social Security benefits appears to be to simply not give up.

Getting Help in the Application Process

There are many resources to help you successfully apply for SSI and SSDI.Texas Parent to Parent offers a two hour introductory class. NOLO’s Guide to Social Security Disability: Getting and Keeping Your Benefits and other books such as Social Security Disability Guide and How to Get SSI and Social Security Disability are available at many libraries and can be purchased online. The Social Security Administration’s internal guidelines, the Program and Operation Manuals (“POMS”) are available online at https://secure.ssa.gov/poms.nsf/home!readform.

If something goes terribly awry, you might want to consult an attorney or contact your Congressperson. But in most instances polite perseverance will move the application through what can be an exasperating series of delays and denials.

You or your disabled family member can appoint someone as your personal representative to help with the application. Use Form SSA-1686, found at www.ssa.gov/forms.ssa-1696.html.

There are levels of appeals. It is only at the fourth level, appealing to an Administrative Law Judge, that it may be necessary to hire a lawyer. The lawyer is paid out of the back benefits if your claim is approved or you and the lawyer can file a fee petition. Many lawyers who specialize in this area are members of the National Organization of Social Security Claimant Representatives. They handle Social Security appeals day in and day out.

 

After Benefits have been Awarded

Handling benefits and reporting correctly after a claim is approved helps preserve them.

After benefits have been awarded, the Social Security Administration will accept a statement from the beneficiary or a form from a physician stating that an SSI or SSDI recipient is incapable of handling their own finances. It will then appoint a representative payee.

SSI or SSDI benefits are automatically deposited in a separate bank account. SSI must be spent first on housing and food and then on medical care and education. SSI benefits can be supplemented by funds from an ABLE Account by Permitted Distributions from a Special Needs Trust and, within limits, earned income.

In-kind support and maintenance, such as that for someone living with gainfully employed parents, can reduce SSI benefits but by no more than a set amount per month. Unearned income, such as birthday gifts, of up to $20 per month do not reduce SSI benefits. The first $65 of earned income and half of the rest is not counted. But at $1,550 (2024), the beneficiary is said to have “substantial gainful activity.” After 9 months of “substantial gainful activity,” they may lose SSI, at least temporarily.

Texas Medicaid

In Texas, SSI automatically comes with Medicaid.

But you do not need to qualify for SSI to qualify for Medicaid. Qualifying for Medicaid and Medicaid waiver programs varies greatly from program to program. There are at least 104 Medicaid programs in Texas. Eligibility for each program should be investigated separately.

Family Benefits

If you become disabled after paying into Social Security through payroll deductions for at least 10 years (as few as 18 months if you are under 24, with the number rising with age), Social Security Disability Insurance is payable to you at the full amount you would collect as a retirement benefit. It is replaced by your retirement benefit when you reach “full retirement age” (between 66 and 67 depending on when you were born). In addition, some of your family members may be eligible for a Social Security Disability Insurance benefit based on your work record. These include

Unmarried children under 18 (19 if in high school);

Unmarried children 18 or older who became disabled before age 22;

Your current, or in some cases former, spouse age 62 or older or caring for your child under 16 or caring for your disabled child of any age if that child is also receiving Social Security Disability Income;

A disabled widow or widower age 50 or older;

A disabled divorced widow or widower age 50 or older if you were married for more than 10 years.

It’s never too early to plan for your future.

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