Under the law, all qualified claimants are entitled to receive benefits offered by the Social Security Administration (SSA) depending on a number of factors including work history, age, household income, marital status or medical condition. Ideally, a person may be eligible to receive more than one type of benefit but the SSA generally gives the claimant the one with the higher benefit amount.
Typically, the Social Security Administration offers these benefits to qualified claimants under the following programs:
Disability benefits - This benefit include insurance benefits known as disability insurance benefits (DIB) or Title II benefits which is given to individuals who are unable to work at a “substantial” gainful level and their condition has existed or is expected to exist for at least a 12 month period. By “substantial,” SSA means the claimant would be unable to earn over $900.00 per month because of their disability. This dollar amount increases slightly every year.
To be eligible for this benefit, a claimant must have worked long enough and paid enough into Social Security through their FICA taxes to be “insured.” As a general rule, if a claimant worked at least five of the last 10 years, he would be “insured” for purposes of DIB. How much a claimant receives each month if found disabled and entitled to this benefit is based on how much he contributed during his working life.
Generally, the longer someone has worked and the higher his earnings, the more he would be paid if found disabled. Individuals found disabled and eligible for disability insurance benefits may be awarded retroactive benefits. Retroactive benefits can only go back one year from the date of the initial application. There is a five-month waiting period from the date the claimant is determined to be disabled until entitlement to these benefits begin.
Supplemental Security Income - This program, also known as SSI or Title 16 benefits, is a “needs-based” program in which individuals with little or no resources or assets may receive disability benefits. The medical criteria for SSI eligibility is the same as that used for DIB — a physical or mental impairment which prevents you from working at a “substantial” gainful level, and the condition has existed or is expected to exist for at least a 12 month period.
An SSI claimant will receive a federal maximum amount of $674 from the Social Security Administration, with an additional supplementary amount from the state, which amount may vary depending on which state you live and the claimant’s living situation. There is no retroactive eligibility for SSI benefits: benefits can go back only to the month in which your claim was filed. A claim for SSI benefits can also be filed on behalf of any minor children with a disability; however, similar with Adult SSI claims, to be entitled to SSI benefits the household income must be below certain limits.
Disabled Adult Child - This program provides disability benefits to adult children of deceased or disabled parents. In addition to the medical requirement that you have a physical or mental impairment which prevents you from working at a “substantial” gainful level, and the condition has existed or is expected to exist for at least a 12 month period, you must also show that your condition has existed and has been disabling since before your 22nd birth date.
In addition, you must be the adult child of a parent who is currently receiving disability insurance benefits, or the Adult child of a parent who is deceased and was “insured” for purposes of eligibility for disability insurance benefits. The adult child must not have worked and earned “substantial earnings” for an extended period at any point after turning 22. An adult child already receiving SSI benefits should check to see if benefits may be payable on a parent’s earnings record. Higher benefits might be payable and entitlement to Medicare may be possible.
Disabled Widow's/Widower's Benefits - A disabled widow or widower age 50 or older may be able to receive benefits off his/her spouse’s (or former spouse’s) Social Security record. If you are a widow or widower from a spouse you were divorced from, to be eligible for benefits you need to have been married to your spouse for 10 years or longer and your disability must have started before age 60 and within seven years of the date in which the worker died.
To make a claim for this benefit, a claimant must provide proof of relationship such as marriage certificate or divorce decree, along with the spouse’s death certificate when the claimant files for benefits. If you file a claim for Disabled Widows/Widower’s benefits and disability insurance benefit or SSI benefits, you will receive only the higher monthly benefit amount of the two programs.
Medicare and Medicaid - Once you are found disabled and entitled to Social Security disability benefits, you will also be eligible for medical insurance though Medicare or Medicaid. If you filed a claim for DIB, Disabled Adult Child or Disabled Widow’s/Widower’s benefits, you may be eligible for Medicare.
However, eligibility for Medicare does not start until you have been disabled for 25 months. If you are approved for Social Security benefits under any of the above-listed programs, SSA will contact you approximately two months before your eligibility for Medicare begins. Medicare may also reimbursed expenses if you have already been disabled for 25 months, and has a record of all medical bill.
On the other hand, there is no waiting period for Medicaid; however, your income and resources must be very low to qualify. If you have applied for and have been approved for SSI you probably qualify for Medicaid. Contrary to what some people believe Medicaid and Medicare two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid.
Our Disability Specialties
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Los Angeles, CA 90038
- Tel No: (310) 921- 7050
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