SSDI Benefits [Eligibility & How to Apply]

Social Security disability insurance (SSDI Benefits) is a Social Security program that pays monthly benefits to you if you become disabled before you reach retirement age and are not able to work.

In this post, we will walk you through what you need to know to successfully apply for SSDI benefits, including how much you will receive if approved, work and medical eligibility requirements, how disability decision is made and what happens after you apply.

This post on SSDI Benefits will cover the following:

  • What is Social Security Disability Insurance (SSDI)?
  • How Much in SSDI Benefits Can I Get?
  • Who is Eligible for SSDI?
  • Can I Apply for SSDI while Working?
  • How do I apply for SSDI?
  • What Documents Do I need when I Apply?
  • How is the Decision on Disability Made?
  • When do I get Medicare?
  • What happens if my application is denied?

"SSDI Benefits Eligibility and How to Apply"

What is Social Security Disability Insurance (SSDI)?

Social Security Disability Insurance (SSDI) pays monthly benefits to workers who can no longer support themselves due to serious and long-lasting medical impairment.

Benefits are based on the disabled worker’s past earnings and are paid to the disabled worker and to his or her dependent family members.

To qualify for the SSDI program, you must have worked a certain number of years in a job where you paid Social Security taxes (FICA) taxes.

If you haven’t worked long enough when you become disabled, and have low income and assets, you can apply for Supplemental Security Income (SSI) instead.

SSDI recipients are considered “insured” because they have worked for a certain number of years and have made contributions to the Social Security trust fund in the form of payroll Social Security taxes.

There are currently about 156 million workers who have earned enough work credits to be eligible for SSDI protection in case of a severe, long-lasting medical impairment.

In 2019, about 8.5 million disabled workers received SSDI. In addition, 1.5 million children and 117,000 spouses also received benefits.

Why did Congress Set up the SSDI Program?

The SSDI program was enacted in 1956 to provide benefits to disabled workers who have paid into the Social Security system and who are younger than the Social Security full retirement age.

The goal of SSDI is to replace a portion of a worker’s income in the event of illness or disability in amounts that take into consideration what the person was earning before they become disabled.

Risk of Becoming Disabled Rises with Age

Studies show that a 20-year-old worker has a 1-in-4 chance of becoming disabled before reaching full retirement age.

The risk of disability rises with age. People are twice as likely to collect SSDI at age 50 as at 40 — and twice as likely at age 60 as at 50.

As the Center on Budget and Policy Priorities (CBPP) shows, the percentage of people receiving disability benefits increases as you get older.

For example, while only 1.2% of people ages 30-34 are currently collecting disability benefits, 7.2% of workers ages 50-54 were on disability, and that number is 17.3% for workers ages 60-66.

"Risk of claiming disability benefits rises with age"

Financial Consequences of Disability

Disability can have devastating economic consequences. Not only can disability happen to anyone, but it greatly impacts a person’s economic circumstances.

Once you become disabled, your earnings, total family income, and your ability to purchase essentials like food and housing all fall significantly.

As the chart below from the CBPP shows, disability can lead to a 77% drop in your earnings, a 28% drop in your family income and a 25% drop in your ability to afford food and housing.

"Effects of Disability on your Income"

How Much in SSDI Benefits Can I Get?

If you are approved for SSDI benefits, the amount you receive each month will be based on your average lifetime earnings before your disability began.

It is not based on how severe your disability is or your household income.

The estimated average SSDI benefits payment as of November 2019 is $1,237 per month.

However, you can receive up to to $2861 in benefits based on your average lifetime earnings.

Note that if you are receiving disability payments from other sources, your payment may be reduced.

Who is Eligible for SSDI?

To be eligible for SSDI, you must meet strict eligibility requirements established by the Social Security Administration (SSA). About 70% of SSDI applications are initially rejected by the SSA.

The Social Security Administration uses medical disability criteria AND non-medical criteria to make their decision on whether you qualify for Social Security disability.

Here are the SSDI eligibility requirements:

Disability Requirements

To become eligible to receive disability benefits, you must first be able to prove that you are medically disabled as defined by the Social Security Administration.

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability.

No benefits are payable for partial disability or for short-term disability.

That is because the SSA program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings, and investments.

“Disability” under Social Security is based on your inability to work. You are considered disabled under Social Security rules if:

    • You are not able to do work that you did before (substantial gainful activity);
    • It is determined that you cannot adjust to other work because of your medical condition(s); and
    • Your disability has lasted or is expected to last for at least one year or to result in death.

Can I Apply for SSDI while Working?

It is important to note that to be considered a disabled person for Social Security purposes, an applicant must be unable to perform any income-producing work.

This generally means earning above a certain amount, called Substantial Gainful Activity (SGA). This amount changes annually.

The applicants cannot be working above the SGA level when they apply for benefits.

An applicant earning more than the SGA amount who applies for Social Security disability or SSI benefits will be denied instantly, without their symptoms, diagnosis, or medical records even considered.

This practice is called a technical denial. However, disabled individuals may be working part-time when they apply for Social Security disability, but only if they aren’t earning more than the SGA amount.

For 2020, the monthly SGA amount for blind individuals is $2110. For non-blind individuals, the monthly SGA amount for 2020 is $1260.

SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to SSDI and SSI benefits.

Work Requirements

To be eligible for disability benefits you must also meet two different earnings tests.

The first earnings test is called a “recent work test”. This looks at your age when you first became disabled.

The other earning test is called a “duration of work test”. This looks into whether you have worked long enough under Social Security program rules to be eligible for SSDI benefits.

Certain blind workers have to meet only the duration of work test.

The number of work credits you need to meet the work requirements for disability benefits depends on your age on the date you became disabled.

Younger workers may qualify with fewer credits.

However, in general, a worker needs 40 credits to qualify. Twenty of those credits must be earned within the last 10 years before becoming disabled.

Recent Work Test

The following table shows the rules for how much work you need for the recent work test, according to the SSA. This is based on your age when your disability began.

The rules are based on the calendar quarter in which you turned or will turn a certain age.

The calendar quarters are:

  • First Quarter: January 1 through March 31
  • Second Quarter: April 1 through June 30
  • Third Quarter: July 1 through September 30
  • Fourth Quarter: October 1 through December 31
If you become disabled… Then you generally need:
In or before the quarter you turn age 24 1.5 years of work during the three-year period ending with the quarter your disability began.
In the quarter after you turn age 24 but before the quarter you turn age 31 Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled. Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled.
In the quarter you turn age 31 or later Work during five years out of the 10-year period ending with the quarter your disability began.

Duration of Work Test

This test determines how long you worked by the age you were when the disability began.

The following formula shows how many quarters of coverage you need to meet the duration of work test, according to the SSA:

In general, you may take the year you became disabled and subtract the year you attained age 22, in order to get the number of quarters of coverage necessary to meet the duration requirement.

However, you must have a minimum of six quarters of coverage to meet the duration requirement.

This minimum requirement for six quarters of coverage is also applicable for those who have not yet attained age 22 and may apply for disability based on their own earnings.

If you become disabled… Then you generally need:
Before age 28 1.5 years of work
Age 30 2 years
Age 34 3 years
Age 38 4 years
Age 42 5 years
Age 44 5.5 years
Age 46 6 years
Age 48 6.5 years
Age 50 7 years
Age 52 7.5 years
Age 54 8 years
Age 56 8.5 years
Age 58 9 years
Age 60 9.5 years

How do I apply for SSDI?

To apply for Social Security disability benefits, you’ll need to complete an application for Social Security benefits.

There are three ways to apply for Social Security Disability Insurance:

Option 1 – Online

You can begin the process and complete a large part of your SSI application by visiting the Social Security website. Click here to be taken there.

If you need help creating a mySocialSecurity account, see our mySocialSecurity account help, which provides a step-by-step process on creating an online account.

Option 2 – Call the SSA

The second option in applying for SSI benefits is to call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778).

Option 3 – Visit Local Social Security Office

The third option is to visit your local Social Security office. For a Social Security office near you, click here.

An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.

If you schedule an appointment, the SSA will send you a Disability Starter Kit to help you get ready for your disability claims interview.

The Disability Starter Kit also is available online here.

You have the right to representation by an attorney or other qualified person of your choice when you do business with Social Security.

More information is in Your Right To Representation see SSA Publication No. 05-10075, which is also available at your local Social Security Office location.

When Should I Apply for SSDI?

You should apply for disability benefits as soon as you become disabled. In general, it can take a long time to process an application for disability benefits (approximately 3 to 5 months).

However, since about 70% of all initial applications are rejected, your case could take a few years to get through the appeals process – possibly up to 3 years.

What Documents Do I need when I Apply?

When you apply for SSDI, you will need the following information to complete your application:

"Information you need to apply for SSDI Online and in person"

What Happens After I Apply for SSDI?

Once you submit your completed SSDI application, the Social Security Administration will review your case and make a determination about whether you are eligible for benefits or not. Here’s how the process works:

Step 1 – Basic Requirements

Once your application is submitted, the SSA will review your application to make sure you meet some basic requirements for disability benefits.

They will check whether you worked enough years to qualify.

Furthermore, they will evaluate any current work activities you listed in your application.

If you meet these requirements, they will process your application and forward your case to the Disability Determination Services (DDS) office in your state.

It is the state agency that completes the initial disability determination decision.

Doctors and disability specialists in the state agency will ask your doctors for information about your condition. Here’s the kind of medical information they will request about you:

    • Your medical condition(s)
    • When your medical condition(s) began
    • How your medical condition(s) limit your activities
    • Medical tests results
    • What treatment you’ve received
    • Your ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions.

The state agency staff may need more medical information before they can decide if you’re disabled.

If your medical sources can’t provide needed information, the state agency may ask you to go for a special examination.

Usually, this special examination will be performed by your own doctor.

However, sometimes, the state agency may ask that the exam be conducted by someone else.

The Social Security Administration will pay for the exam and for some of the related travel costs.

Who makes the decision for Social Security disability?

When you apply for Social Security Disability, your state’s Disability Determination Services office determines whether you are disabled or not.

Your doctor does not make the decision about your disability.

How is the Decision on Disability Made?

The state agency reviewing your SSDI application will use a five-step evaluation process, to decide if you are disabled. Here’s how the 5-step process works:

Step 1 – Are you working?

If you are currently working and making more than the Substantial Gainful Activity (SGA) amount each month, you will not be considered to be disabled.

If you are not currently working, or your monthly earnings average is less than the SGA amount, the state agency then looks at your medical condition at step two.

Step 2 – Is your medical condition “severe”?

For you to be considered to have a disability by Social Security’s definition, your medical condition must significantly limit your ability to do basic work activities for at least 12 months.

Basic work activities include lifting, standing, walking, sitting, and remembering.

If your medical condition isn’t severe, you won’t be considered to be disabled. If your condition is severe, the agency staff begins step three.

Step 3 – Does your medical condition meet or medically equal a listing?

The Social Security Administration has a listing of impairments that describes medical conditions that they consider severe enough to prevent a person from doing any gainful activity.

The listing of impairments applies regardless of age, education, or work experience.

Within each listing, experts specify the objective medical and other findings needed to satisfy the criteria of that listing.

If your medical condition meets, or medically equals (meaning it is at least equal in severity and duration to), the criteria of a listing, the state agency will decide that you have a qualifying disability.

If your medical condition doesn’t meet or medically equal the criteria of a listing, the state agency goes on to step four.

Step 4 – Can you do the work you did before?

During this step, the state agency decides if your medical condition(s) prevents you from performing any of your past work.

If it doesn’t, the agency will decide you don’t have a qualifying disability.

If it does, the state agency proceeds to step five.

Step 5 – Can you do any other type of work?

If you cannot do any of your past work, the next step is to determine if there’s other work you can do despite your medical condition(s).

During this evaluation, the agency will consider your age, education, past work experience, and any skills you may have that could be used to do other work.

If you can’t do other work, the state agency will determine you as disabled.

If you can do other work, you don’t have a qualifying disability.

There are special rules for people who are blind.

The Decision on your SSDI Application

Once the state agency makes a decision regarding your SSDI application, the Social Security Administration will mail you a letter.

If your application is approved, the letter will show the amount of your benefit, and when your payments start.

If your application isn’t approved, the letter will explain why and tell you how to appeal the determination if you don’t agree with the decision.

What happens if my SSDI Application is Approved?

Your monthly disability benefit is based on your average lifetime earnings. Your first Social Security disability benefits will be paid for the sixth full month after the date your disability began.

Social Security benefits are paid in the month following the month for which they are due.

When do I get Medicare?

Your SSDI benefits also qualify you for Medicare health coverage.

However, your Medicare coverage is not immediate and there is a waiting period. Your Medicare coverage automatically starts after you have received disability benefits for two years.

What happens if my application is denied?

If you disagree with a decision made on your SSDI claim, you can appeal it. The appeal process is explained in detail in this document.

SSDI Benefits Summary

We hope this post on SSDI benefits was helpful.

If you have further questions about SSDI, please let us know in the comments section below.

Be sure to check out our other articles on Social Security including SSI Eligibility and Income Limits and SSDI Benefits Payment Schedule

Comments

comments

Leave a Reply

Your email address will not be published. Required fields are marked *