The Social Security Administration offers two programs that provide monetary assistance for those who are no longer able to work due to a mental or physical disability: Social Security Disability Insurance (SSDI) benefits and Supplemental Security Income (SSI) benefits. While the medical eligibility for each program is the same, there are distinct differences in financial eligibility and medical insurance coverage worth exploring.
SSD benefits are payable based upon an individual’s work history and contributions made to the Federal Insurance Contributions Act (FICA). In general, if an individual has worked five out of the last ten years, then that person may be eligible for SSD benefits. In addition, a disabled claimant’s spouse and children may be eligible to receive a reduced benefit amount based upon the worker’s history, called auxiliary benefits.
SSI benefits are benefits for individuals who are both disabled and meet income and resource limitations. Work history is not considered in a claimant’s application for SSI benefits. Rather, claimants must have no more than $2,000 ($3,000 for couples) in cash and assets that can be quickly converted to cash in order to be eligible for benefits.
Monthly Benefit Amount
SSD and SSI benefits have different monthly payment amounts. The SSD benefit program is funded by the Social Security Trust Fund via FICA contributions. For SSD, the monthly benefit amount is based upon a worker’s average earnings history. The monthly benefit amount is called the Primary Insurance Amount (PIA). This monthly payment is different for each SSD recipient since it is based on the individual’s work history and contributions, but the maximum amount is about $3,000 per month. The PIA represents the amount a person would receive if he/she elected to begin receiving retirement benefits at his or her full retirement age. Household income and assets do not impact the monthly benefit amount. SSD recipients do have a five month waiting period for benefits, which means Social Security will not pay a claimant any benefits for the first five months after the claimant became disabled.
SSI benefit amounts are based on both Federal and State laws. The SSI benefits program is funded by general fund taxes. The current maximum benefit amount for SSI is $783 per month for an individual and $1,175 for an eligible individual with an eligible spouse. The monthly maximum amount is usually adjusted each year for cost-of-living changes. This maximum benefit amount can be reduced, depending upon household income and assets. If a claimant has too much in income and assets, then even if that individual is found medically disabled, there will be no payable monthly benefits. Unlike SSD, SSI beneficiaries do not have a five-month waiting period and benefits are payable in the month following the month the application was filed.
SSD benefits include Medicare coverage. Coverage does not take effect immediately, however, as there is a 24 month waiting period from the month disability benefits first became payable. Medicare coverage consists of hospital insurance (Part A), supplementary medical insurance (Part B), and Medical Advantage (Part C). In addition, voluntary prescription drug benefits (Part D) are also available.
While SSI recipients are ineligible for Medicare, they are able to obtain Medicaid coverage. This coverage is meant to offer health insurance to claimants with limited income and resources.
Can a Claimant Qualify for Both SSI and SSD?
Claimants can have both an SSD and an SSI claim pending at the same time. This is called a concurrent claim. In the majority of cases, a person who is eligible for SSD benefits will not be eligible for SSI benefits. However, if a claimant’s PIA is lower than the maximum federal benefit amount, then the claimant may be eligible to collect their SSD benefit as well as a small amount of SSI. For example, if a claimant had a PIA of $600 based upon his or her work history, then he or she may be eligible for an additional $183 in SSI benefits in order to maximize the monthly benefit amount.
If you would like to discuss the specifics of your case and determine whether or not you are eligible for SSD or SSI benefits, please contact us today.