Social Security Disability
The primary alternative to long-term disability insurance for financial and medical insurance is Social Security Disability Benefits. These benefits are provided through the Federal Social Security Administration. There are two Social Security Disability Programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both Social Security programs have the same standard of disability, but differ in their financial eligibility standards and the amount of assistance they each provide.
This article will outline some major elements of the Social Security programs. For more detailed information on the application process, see our comprehensive guide, The Massachusetts ME/CFS & FM Disability Handbook: How to Apply for Social Security Disability Benefits if You Have ME/CFS (PDF).
Required level of disability
The term “disabled” under Social Security regulations means that 1) a person is unable to do any work, even part-time, sedentary work on a predictable basis; and 2) this condition has lasted or is expected to last at least a year. This definition is termed “permanently and totally disabled.” Under this definition a person is unable to perform any “substantial, gainful activity.” This is a more encompassing standard than many long-term disability policies, which may allow for some level of work.
The key phrase for many disabled patients is being able to do any work on a “predictable basis.”
For example, a person with ME/CFS or FM might be able to work 4 hours today on a computer, and 4 hours tomorrow on the phone, but then be unable to work for 3 days due to a relapse. This person would be considered disabled by Social Security. However, if a person could work 5 hours a day, 3 or 4 days a week on an ongoing, predictable schedule week after week, then the person would not be considered disabled.
Financial eligibility standards and benefits
Social Security Disability Insurance (SSDI)
A person qualifies for SSDI if they have worked and paid Social Security payroll taxes for a sufficient period of time prior to becoming disabled. Generally, if a person is over 30 they would have had to have worked 20 quarters (5 years, not necessarily consecutive) over the 10 year period prior to becoming disabled.
There are no income or asset requirements for SSDI. Applicants can have assets of any amount, and can be receiving investment income or other forms of income for which they do not work.
The monthly disability payment will depend on the applicant’s average earnings or salary. The amount may range from a few hundred dollars to over $2000 a month. Applicants can check with your Social Security Office to obtain an estimate of their monthly benefits.
Besides a financial payment, SSDI also provides Medicare medical insurance, but there is a waiting period of 2 years from the date of disability. The Social Security medical insurance programs are discussed in Medical Insurance.
Because Social Security Disability payments are often not enough to pay for all living costs, especially housing costs, many disabled persons find it necessary to apply for other forms of assistance, especially housing assistance, if they have no other source of income. These other forms of assistance are discussed in the section Housing and Other Essential Needs. If your SSDI amount of monthly income is under the SSI payment limit, you will be able to collect from both programs. SSI will supplement your SSDI up to the SSI limit.
Supplemental Security Income
Often people who are chronically ill and disabled have not worked for many years, or have only worked part-time, or even worked at employment where they did not pay Social Security payroll taxes. Therefore they do not have the “quarters paid in” to qualify for SSDI.
For people who do not have the required work credits and are disabled, SSI may be available. However, SSI is a program that has tough income and asset requirements. There is a low income ceiling—that is income from all sources, including income from a spouse. Any income you receive from SSI will be deducted from any other income that a person might have. There is also an asset limit for SSI—beneficiaries cannot have assets of more than $2,000, along with a car and a house.
The amount of SSI monthly payments varies by state, as some states supplement the federal SSI benefit with additional payments.
However, those who do qualify for SSI will be eligible for Medicaid, a comprehensive medical insurance plan, immediately. (See Medical Insurance for more details). SSI recipients also will probably be eligible for food stamps and fuel assistance.
Applying for Social Security Disability
Social Security Disability can be applied for online, or by calling the Social Security office and requesting a telephone appointment.
The application should be clear about the level of disability. Applicants tend to understate the severity of their illness: most people want to be working and are ambivalent about being “disabled.” If Social Security does not know just how severely and chronically ill the applicant is, they have no good reason to grant benefits.
The key to obtaining either SSDI or SSI is the full medical documentation of disability by one or more MD physicians. The doctor(s) must be willing to support the claim and provide the necessary medical reports, physician’s office notes, medical records, etc.
Applying for Social Security Disability can be a daunting and sometimes an extended process. There are normally three stages before a claim is approved, although sometimes a person can be approved at one of the earlier stages. The better and more complete the medical documentation, the higher the chances are for a quicker approval.
Applicants who are disapproved at stage one or two should not give up. Ninety percent of people who receive benefits are approved at stage three. Most people with ME/CFS or FM who are truly disabled are accepted, although there is variation depending on the region of the country.
Working while applying for Social Security Disability, and after
In general, any work during the application period is viewed suspiciously by Social Security as possible “substantial gainful activity,” which disqualifies the applicant from being considered disabled. The best advice is not to work at all while applying for Social Security. Any more than 3 hours a week can put the application in some jeopardy.
Once the application has been accepted, beneficiaries are allowed to work a certain amount without immediately jeopardizing their benefits. The rules for this system are complex, and beneficiaries must learn them thoroughly before doing any work. For more information, see the resources below.
The Massachusetts ME/CFS & FM Association can assist patients with resources and counselling in the area of Social Security eligibility and applications. Please Contact Us.
Resources
Substantial Gainful Activity: How does Social Security Determine Whether a Person is Disabled and Qualified to Receive Benefits? (PDF) This article presents information on how Social Security evaluates whether a person is sufficiently disabled and therefore qualifies for Disability benefits.
Applying for Social Security Disability In this video, join a disability lawyer and MassME’s own Ken Casanova for a conversation about the SSI and SSDI application process.
2014 Social Security Standards for Documenting ME/CFS Disability Claims (PDF) This article provides a comprehensive review and evaluation of the April 3, 2014 Social Security Ruling for the evaluation of medical evidence and work capacity in ME/CFS disability claims.
Providing Medical Evidence for Individuals with ME/CFS (PDF) This fact sheet from the SSA provides guidance for health professionals in providing the kinds of medical evidence needed to evaluate disability claims, and can be used by patients in educating their providers.
Working While Disabled (PDF) This document outlines the Social Security Administration’s rules for working while on benefits.
Long COVID and Social Security Disability (PDF) This document outlines information on applying for Social Security Benefits for Long COVID.
Disclaimer: The Massachusetts ME/CFS & FM Association makes no recommendation regarding the use of professionals whose articles are linked to our site.