I took myself and my sons to a new dentist recently. I had to fill out the usual new-patient paperwork. On the list of questions besides the usual ones like “Are you allergic to any medications?” and “Have you had x-rays taken in the last 12 months?” the new practice wanted to know “Are you dissatisfied with your teeth alignment? Would you like the dentist to talk to you about Invisiline® braces?” and “Are you satisfied with the color of your teeth? Would you like the dentist to talk to you about in-office teeth whitening?”
The first set of questions was irrelevant to me. I’ve been through braces twice already—my teeth are as aligned as they are going to get. But we might need to explore them for my sons. On the other hand, though my older son occasionally complains that his teeth are not white enough, they look fine to me. It is my teeth, which have endured decades of coffee consumption, that would really benefit from this particular procedure. The dentist’s forms are designed the way they are because it is easier to hand the same form to each new patient, even if some of the questions are irrelevant.
The same might be said of the Social Security Disability Benefits online application. Most of us, who are familiar with disability benefits, are aware that there are two types of cash benefits available to people who meet the Social Security definition of “having a disability”. One is Supplemental Security Income (SSI) which requires a person to have few financial resources, and the other is Social Security Disability Insurance (SSDI), which requires the accumulation of sufficient credits within a certain period of time prior to application.
After working together for a while, my clients know clearly whether they (or their family member(s)) is/are eligible for SSI or SSDI or, occasionally, both concurrently. They complete the application process and wait with hope for the Social Security Administration to determine their eligibility for the appropriate benefit and disbursements to begin. They are pleasantly surprised to receive a letter only a few weeks later—and distraught when the letter reveals that they have been DENIED. They call me up flustered and upset and we review the letter with haste only to discover that the applicant has been denied for a benefit for which they were never eligible and for which they did not think they were applying in the first place. They leave the meeting relieved, but also confused, to wait for a response on the applicable benefit. Why does this happen?
The Social Security Administration website (ssa.gov) has a very clear “Apply” section. The first option is “Apply for benefits”. Once you click this option, you are asked 1) Whether you are applying for a child under age 18 or for an adult age 18 or over and 2) For which of a list of possible benefits you are applying. The list includes both SSDI and SSI for disability (as opposed to SSI for age 65+). Back on the ssa.gov home page, we see that “Apply for SSI” is listed as a self-contained option. It asks first whether you want to apply for a child under the age of 18 or an adult age 18 or over. If you select the latter (as most of my clients do), you reach a screen that asks which category of SSI eligibility you need and also whether you want to apply for any additional benefits which list includes—you guessed it—SSDI. The application process starts out the same for both, and diverges as the process moves forwards, generating a denial letter whenever a fork reaches a dead end. Here is how the process works (credit to SSA POMS, summarized by me).
The applicant is required to provide information on her/his current employment. If the applicant is employed and her/his earnings are already above the Substantial Gainful Activity (SGA) level, which is $1,550/month in gross-earned income for 2024, the applicant is ineligible for either SSI or SSDI and will receive denial letters for both. The Social Security Administration (SSA) then reviews financial eligibility for each program. If the applicant has more than the $2,000 of countable resources (mainly cash-type equivalents held directly in her/his own name), then s/he is financially ineligible for SSI and receives a denial letter for SSI. There is also a countable income criteria for SSI, but that is usually covered in the first step of SGA determination. Concurrently, the SSA researches whether the applicant has sufficient credits to be fully insured for SSDI. The number of credits varies according to the age of the applicant—the younger the applicant, the less credits required. If the applicant has insufficient credits, s/he receives a denial letter for SSDI. It is only at this point, after passing judgement on financial eligibility, that the SSA begins to look at whether the applicant’s medical and related conditions actually meet their definition of “having a disability”.
I frequently work with youth with disabilities who have just turned 18 and are applying for benefits for the first time under the adult criteria. Like most of their teenage peers, these youth have had almost no work experience and have, therefore, insufficient work credits to be eligible for SSDI. At the same time, since we have prepared for the process, they have carefully limited their countable resources to under $2,000. They apply for benefits being both confident that they are eligible for SSI and clear that they are ineligible for SSDI. Shortly after applying, they receive an SSDI denial letter based solely on financial ineligibility. Some months later, they are approved for SSI, the only benefit for which they were eligible in the first place.
I less frequently work with adults old enough to have accumulated the necessary credits to be insured for SSDI and expecting an SSDI benefit that is large enough to preclude concurrent SSI eligibility. Shortly after applying, they receive an SSI denial letter based solely on financial ineligibility. Since SSDI puts no limit on countable resources, and since they have been working, they have more than $2,000 in the bank and in retirement accounts. Some months later, they are approved for SSDI, the only benefit for which they were eligible in the first place.
Of course, there are cases where an applicant passes both sets of financial criteria and the numbers work out so that they are eligible for both SSI and SSDI. This happens when the SSDI plus countable earned income falls below the SSI maximum plus the respective unearned and earned income exclusions. Then there are some applicants who make it through the financial eligibility screening for either or both benefits and then have to fight their way through the medical disability determination. But that is a story for another blog.
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