Supplemental Security Income and Social Security Disability Insurance (SSI vs SSDI) are two federal programs designed to provide financial assistance to individuals with disabilities. While both programs are managed by the Social Security Administration and serve people with disabilities, they differ in terms of eligibility requirements, funding sources, and benefit structures.
SSI and SSDI: Quick Definitions
SSI (Supplemental Security Income): SSI provides financial assistance to individuals with limited income and resources who are aged, blind, or disabled. Funded by general tax revenues, SSI is need-based and does not require recipients to have a prior work history.
SSDI (Social Security Disability Insurance): SSDI offers disability benefits to individuals who have a qualifying disability and have earned sufficient work credits through prior employment. Funded through Social Security taxes, SSDI is based on a person’s work history and disability status rather than financial need.
Eligibility Requirements
SSI Eligibility
SSI is available to individuals with limited income and resources who are aged 65 or older, blind, or disabled. Eligibility is determined based on financial need, with specific income and asset limits. For instance, an individual must generally have less than $2,000 in countable assets (or $3,000 for couples). SSI does not require a work history, and benefits can be granted to those who have never worked, provided they meet the age or disability criteria.
SSDI Eligibility
SSDI is available to individuals with a qualifying disability who have earned enough work credits through past employment. The number of work credits required depends on the applicant’s age and the time they became disabled. Generally, applicants need to have worked recently and consistently; for instance, a person aged 31 or older typically needs 20 credits earned in the last 10 years. SSDI eligibility is not based on income or assets, but applicants must meet the Social Security Administration’s definition of disability, which requires proving that the disability prevents substantial gainful activity.
Medical Requirements
To qualify for SSI or SSDI, applicants generally need to meet the Social Security Administration’s (SSA) definition of disability, which is based on specific medical and functional criteria:
- Definition of Disability (SSA): The SSA defines a qualifying disability as a medically determinable physical or mental impairment that:
- Prevents the individual from engaging in substantial gainful activity (SGA).
- Has lasted or is expected to last at least 12 months or result in death.
Medical Requirements for SSI
For SSI applicants under the age of 65, disability status must meet the SSA’s strict definition. This includes providing medical evidence (such as treatment records, physician statements, and test results) demonstrating that the condition significantly limits one’s ability to perform basic work activities. SSI applicants aged 65 or older, however, do not need to meet the disability criteria; instead, eligibility is based solely on financial need.
Medical Requirements for SSDI
SSDI applicants must provide detailed medical documentation showing that their impairment prevents them from performing substantial gainful activity (SGA). Additionally, the disability must be expected to persist for at least 12 months or be terminal. SSDI’s requirements often involve thorough evaluations of medical history, functional limitations, and residual work capacity. Because SSDI benefits are based on work credits rather than financial need, the SSA’s disability criteria for SSDI are especially stringent to see that only those with significant impairments qualify.
How Benefits Are Calculated
SSI Benefits
SSI benefits are calculated based on an individual’s income and living arrangements. The maximum federal benefit rate is set annually, but actual payment amounts vary according to the recipient’s countable income. Any additional income—whether earned or unearned—can reduce the SSI benefit amount, as SSI is intended to supplement income only up to a minimal threshold. Additionally, living arrangements can impact the benefit calculation; for instance, recipients living with others or receiving free housing or food may receive a reduced benefit.
SSDI Benefits
Social Security benefits through SSDI are calculated based on the applicant’s average lifetime earnings before the disability, based on work history and earnings rather than financial need. This calculation considers a person’s average indexed monthly earnings (AIME), which is a weighted formula designed to provide a proportionally larger benefit to lower-income workers while still rewarding those with higher past earnings. Unlike SSI, SSDI payments are not reduced by other income or assets, as eligibility is based on work credits and contributions to the Social Security system.
Health Coverage Options
Recipients of SSI and SSDI may also qualify for health coverage, though each program offers different options:
- SSI and Medicaid: SSI recipients are typically eligible for Medicaid, which provides low-cost or free healthcare to individuals with limited income and resources. In most states, Medicaid eligibility begins immediately upon SSI approval, offering access to medical care, prescriptions, and essential services without delay.
- SSDI and Medicare: SSDI recipients become eligible for Medicare after a 24-month waiting period from the date they begin receiving SSDI benefits. Medicare coverage includes hospital insurance (Part A), medical insurance (Part B), and often prescription drug coverage (Part D), providing a range of healthcare services. During the waiting period, SSDI recipients may need to rely on other healthcare options if they are not yet covered by Medicare.
Application Process Overview
SSI Application
The SSI application process involves providing detailed financial and medical documentation to verify eligibility. Applicants must demonstrate limited income and assets by submitting bank statements, income records, and other relevant financial documents. For those applying based on disability, medical records are required to meet the SSA’s criteria for disability. After submitting all necessary documents, the Social Security Administration (SSA) evaluates both financial and medical eligibility. This process can be completed online, by phone, or in person at an SSA office.
SSDI Application
SSDI requires proof of both disability and sufficient work history. Applicants need to submit medical records documenting their condition and showing that it meets the SSA’s definition of disability. Additionally, employment history is essential to confirm the applicant has accumulated enough work credits for SSDI eligibility. This includes records of past employment and Social Security tax contributions. The SSDI application can also be completed online, by phone, or at an SSA office, and applicants may undergo a medical evaluation if additional evidence of disability is required.
The Appeal Process for Denied Claims
If an SSI or SSDI claim is denied, applicants have the right to appeal the decision through a multi-step process. The first step is Reconsideration, where a new SSA representative reviews the claim and any additional evidence submitted. If the claim is denied again, applicants can request a Hearing before an administrative law judge, who will assess the claim in a formal setting.
Should the claim be denied at the hearing level, applicants may take their appeal to the Appeals Council, which reviews cases for procedural or factual errors. If necessary, the final step is a Federal Court Review, where applicants can challenge the SSA’s decision through the federal court system. Each stage provides an opportunity to present new evidence or clarify details that may impact the outcome.
SSI and SSDI: Comparison Table
| Criteria | SSI (Supplemental Security Income) | SSDI (Social Security Disability Insurance) |
|---|---|---|
| Eligibility | Based on financial need with income and asset limit. Available to those aged 65+, blind, or disabled. | Based on work credits and employment history. Available to individuals with a qualifying disability who have sufficient work history. |
| Funding Source | Funded by general tax revenues (not Social Security taxes). | Funded through Social Security taxes paid by workers. |
| Medical Requirements | Must meet the SSA’s definition of disability if under 65. | Must meet the SSA’s strict definition of disability. |
| Benefit Calculation | Based on federal benefit rate, which may be supplemented by state payments. | Based on the applicant’s average lifetime earnings before the disability. |
| Health Coverage | Eligible for Medicaid in most states. | Eligible for Medicare after a two-year waiting period. |
| Asset Limits | Strict asset limits: typically $2,000 for individuals and $3,000 for couples. | No asset limits. |
| Application Process | Apply through the Social Security Administration (SSA). Financial documents and disability verification required. | Apply through the SSA with work history and medical records to prove disability. |
SSI and SSDI in Washington State
Specific considerations, resource, and programs may impact applicants for SSI and SSDI in Washington state.
- State Supplemental Payments (SSP) for SSI: In Washington, SSI recipients may qualify for a state supplement to the federal benefit amount, which can increase the overall monthly benefit. This supplemental payment is determined based on factors like living arrangements and may be automatically added to SSI benefits without a separate application.
- Washington State Medicaid (Apple Health): For SSI recipients, Medicaid coverage is available through Washington State’s Apple Health program. Apple Health provides comprehensive health services, including primary care, dental, and mental health support, which can be very important for individuals relying on SSI. Applicants may contact Washington’s Health Care Authority for assistance or explore Apple Health resources on the Washington Healthplanfinder website.
- Social Security Field Offices and Assistance: Washington has multiple SSA field offices where individuals can receive in-person assistance with their SSI or SSDI applications, appeals, and related questions. Major offices are located in Seattle, Spokane, Tacoma, and other cities. These locations offer personalized guidance, which can be especially valuable for applicants who need additional support. Scheduling an appointment can help minimize wait times.
- Resources for Legal Assistance: Washington residents have access to legal aid organizations, such as the Northwest Justice Project, which provides free legal assistance to those with limited income. Additionally, Russell & Hill’s team offers specialized guidance on Social Security applications, appeals, and eligibility, giving applicants comprehensive support for their unique needs.
Getting Help from an Attorney
Clarity on the differences between SSI and SSDI helps individuals choose the right program, but doing so effectively often requires more direct guidance. SSI and SSDI applications demand extensive documentation, strict adherence to eligibility requirements, and a deep understanding of the Social Security Administration’s disability criteria—all of which can be a challenge for applicants. With Russell & Hill, clients benefit from dedicated guidance in each stage, from determining eligibility to preparing appeals if a claim is denied. Our Washington SSDI lawyers can assist with gathering and presenting comprehensive medical and financial documentation, handling application details, and maximizing state-specific benefits available in Washington.
References and Additional Reading:
https://www.ssa.gov/ssi/eligibility
https://www.usa.gov/social-security-disability
https://app.leg.wa.gov/wac/default.aspx?dispo=true&cite=388-474-0012
https://www.dshs.wa.gov/altsa/home-and-community-services/medicaid