When an adult develops a serious disability, it can be extremely difficult or impossible for them to continue engaging in their normal routines both at home and at work. Those who are unable to work often struggle to make ends meet, especially if they are living on a fixed income and incurring unusually high medical expenses. Fortunately, a sick or disabled adult may qualify for financial assistance in the form of Social Security disability benefits. These funds can help pay for everyday expenses, medical bills and supportive care.
Before applying for disability benefits, it is important to understand what benefit options are available, what the eligibility requirements are for these programs and how the application process works. A little preparation will go a long way towards maximizing the Social Security benefits one receives.
How the SSA Defines Disability
Even though an older adult may be sick or injured, not all ailments are considered to be a disability in the Social Security Administration’s eyes. For this reason, the SSA has set a very specific definition of disability. If a person does not meet this definition, they will not be eligible for disability benefits.
The SSA’s definition of disability is based on a person’s ability to work. An applicant must meet the following criteria:
- They cannot do the work they were able to do prior to becoming disabled;
- They have a medical condition that makes them unable to adjust to other types of work; and
- Their medical condition has lasted—or is expected to last—for at least one year or result in death.
The Differences Between SSDI and SSI
If an adult meets the SSA’s definition of disability, he or she may qualify for one or both types of Social Security disability benefits. These include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each of these benefit programs has its own set of technical eligibility requirements.
SSDI is an entitlement program that offers benefits to disabled workers who are younger than the full retirement age (65-67, depending on one’s birth year). Eligibility for SSDI is based on work history and Social Security tax contributions. Those who are awarded SSDI benefits will automatically qualify for Medicare after a two-year waiting period.
Some older adults opt to begin receiving SSDI benefits instead of collecting their Social Security retirement benefits early at a permanently reduced rate. (The earliest a person can start collecting retirement benefits is age 62.) This allows them to receive their full benefit amount later on. Once a senior receiving SSDI reaches full retirement age, their benefits will automatically convert to their full retirement benefit amount.
SSI is a needs-based program that offers financial assistance to elderly, blind or disabled individuals who have few assets and low income. Eligibility for SSI is based on strict financial limitations. Once an individual is awarded SSI benefits, he or she will automatically qualify for Medicaid. SSI and retirement benefits can be received simultaneously.
In some cases, applicants may qualify for benefits from both the SSDI and SSI programs. In most cases, though, a person cannot receive SSDI and retirement benefits concurrently.
Medical Eligibility Requirements for Disability Benefits
In addition to meeting the SSA’s definition of disability and the various technical eligibility requirements, applicants are also required to meet very specific medical criteria. These criteria vary from condition to condition and can be found in the SSA’s Blue Book. Essentially, the blue book is an official manual that contains specific medical requirements for all potentially disabling conditions.
The Blue Book recognizes the following age-related health conditions among others:
- Arthritis
- Diabetes
- Vision loss/impairment
- Hearing loss/impairment
- Alzheimer’s disease
- Other forms of dementia
To access all blue book listings, visit the SSA’s listings website.
For most people, the medical requirements for both SSDI and SSI are the same. No matter the applicant’s condition, to qualify for Social Security disability benefits, all applications must include extensive medical evidence. This may include the findings of physical and mental exams, doctors’ notes, surgical reports, imaging results, and lists of prescription medications.
The Application Process for Disability Benefits
If you or someone you are caring for is a likely candidate for disability benefits, you can begin the application process online at the SSA website or in person at a local Social Security office. It is important to note that if an applicant is not physically or mentally capable of applying on their own, a caregiver or loved one is able to apply on his or her behalf.
The SSA does not require a person helping an applicant to complete additional paperwork, but the applicant themselves must be the one to sign it. However, if a person will be helping an applicant manage their benefits and doing business with the SSA on their behalf, then this person must be appointed as an authorized representative. A beneficiary who is not capable of managing their payments will need a representative payee who has been vetted and appointed by the SSA to help them do so. The SSA typically looks to responsible family members or friends to serve in this role, but a qualified organization may be appointed as a payee if there are no other candidates.
Once the initial application is submitted, it may take between three and five months to receive a decision. Although the application may be approved at this stage, always be prepared to face the possibility of a denial. If the application for disability benefits is denied, a written appeal must be filed within 60 days of receiving the determination letter. While this may seem discouraging, it’s important to realize that many more applicants are approved during the appeals phase than during the initial application.
The appeals phase of the application process is made up of two parts: the reconsideration and the appeal hearing. The reconsideration will allow an applicant to correct any inconsistent or incomplete information and provides the opportunity to supply further medical evidence pertaining to their disability. Some states do not have reconsideration and go straight to the appeal hearing.
Waiting for an appeal hearing is often the longest part of the process. On the day of the scheduled hearing, the applicant will appear before an administrative law judge to answer questions and provide proof of their disability. At this stage of the process, it may be best to retain the services of a qualified attorney or advocate. A legal professional will know exactly what the judge will expect and can increase the chances of success. Just be aware that disability lawyers—even those who work for non-profit organizations and legal aid offices—usually charge fees on a contingency basis. However, the SSA must approve these fees and enforces limits on these amounts.
Preparation and persistence are the keys to a successful application for disability benefits. If you still have questions about eligibility requirements or how to apply, visit https://www.ssa.gov/, make an appointment at a local Social Security office, or call the SSA toll-free at 1-800-772-1213. The SSA also offers the Benefit Eligibility Screening Tool (BEST) to help individuals determine what programs they may be eligible for.
Sources: What You Need to Know When You Get Social Security Disability Benefits (https://www.ssa.gov/pubs/EN-05-10153.pdf); Supplemental Security Income (SSI) (https://www.ssa.gov/pubs/EN-05-11000.pdf)