Benefits
& Insurance
Public
Benefits (SSI,
SSDI) Fact Sheet
Table of Contents
SOCIAL
SECURITY
The SSA oversees two disability programs:
- Social
Security Disability Insurance (SSDI, Title
2), and
- Supplemental
Security Income (SSI, Title 16).
Both of the above
are long-term disability programs.
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How
Does SSA Define Disability?
According
to Social Security, a disability is an ailment, physical
or mental, that prevents you from doing any kind of
work for at least one year. Both severe HIV symptomatic
and AIDS diagnoses (based on infections) may qualify.
SSDI and SSI will review your medical records and supplementary
testimony to substantiate your disability. A T-cell count of below 200 is no longer considered a disabling condition.
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SOCIAL
SECURITY DISABILITY INSURANCE (SSDI)
SSDI
is your Social Security retirement fund which you may
receive under age 65 if you are disabled. To be eligible:
- You
must meet SSA's definition of total disability.
- You
must also have paid into the Social Security
Trust Fund through F.I.C.A. payroll taxes:
- You
must have paid FICA taxes for at least
five of the 10 years preceding your disability
if you are over 31.
- Under
31, your pay-in must be for at least half
the years between your current age and
age 21, i.e. at 29 you must have paid in
for at least four years.
You
can check your eligibility and the amount of your
award by filing a "Request for Earnings and
Benefit Estimate Statement" (available from
SSA or APLA), or by calling SSA at 800.772..2213.
Starting in 2000, SSA is automatically sending
one to everyone each year, about three months prior
to their birthday.
SSDI
awards range from one dollar to about $1,700 (2007)
per month, and are based on the amount of pay-in
during your entire work history. The average award
for people with HIV-based claims is around $1200
(2008) per month. Applications take up to three months
or longer.
You
will be notified of SSA's decision by letter. People
with health insurance on 18-month COBRA extensions
should submit a copy of the award letter within
60 days to their COBRA administrator to qualify
for an additional 11-month OBRA extension.
There
is a five-month wait before SSDI payment begins, dating
from the onset of disability. The onset date is
when you were no longer able to work due to your
disability. The first SSDI payment would be for
the sixth month.
SSDI
claims can be backdated if you left work and filed
later, or backdated over periods when you were
collecting State Disability, or even over periods
when you worked but missed a lot of time because
of your health. Your medical records must support
your backdated onset of disability. SSDI can pay
retroactive benefits for up to 12 months, even
though claims can be backdated farther. You can
apply for and collect SSDI together with State
Disability.
SSDI
recipients receive Medicare 29 months after being
found disabled, or 24 months after payments begin (including retroactive payments).
You will be sent notice of your Medicare option
and a Medicare card a month or so before you are
eligible.
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Supplemental
Security Income (SSI)
Supplemental
Security Income (SSI) is a needs-based program for
disabled people with little or no income, and assets
valued under $2,000 ($3,000 for couple).
To
be eligible:
- You
must meet SSA's definition of total disability.
- You
must also have a "financial need" as
defined by the SSA.
Financial
need is defined by SSA as follows:
- Your
assets must be less than $2,000 (if you are single
-- $3,000 for couples).
- Your
monthly "income" must be less than
the benefit amount ($900 per month in the year
2007).
One
vehicle and one residence are excluded. Assets may
include: bank accounts, pensions, IRA's, property,
life insurance or burial plans with cash values
in excess of $2,000, etc. SSI currently pays $870
(2008 per month for single individuals.
Your income must be under the maximum payment.
Awards are higher for people without cooking facilities,
or the blind. SSI claims cannot be backdated. Processing
time is up to three months or longer (see Presumptive
Eligibility).
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Presumptive
Eligibility
SSI
can "presume" you are disabled and begin
payment immediately if you meet the income and asset
requirements and have a doctor's statement testifying
to your disability (specifically a "Medical Report
on Adult with Allegation of HIV Infection," available
from SSA or
APLA's Benefits office). SSI can pay up to six
months of "presumptive" while they review
your medical records and financial eligibility for
SSDI, SSI or both. You will receive Medi-Cal automatically
with presumptive. If your medical records do not support
your doctor's statement, or you fail to complete your
application, payment may stop. You will not have to
repay the money. District offices can write checks
on the day of application; branch offices can get checks
quickly. Immediate presumptive payment is at the discretion
of the office and the claims representative. If you
are in need of immediate assistance, be prepared to
present a case of compelling need and ask for (do not
demand) "emergency advance" payment. Emergency
advances are pro-rated over a month. If you are applying
at the end of one month, you might be better off waiting
until the start of the next.
During
the SSI application process you will be asked about "other
income," including assistance from family
and friends. If your monthly expenses exceed the
payment level, SSI may ask how you meet your bills.
Loans are not considered income; gifts are. If
someone helps with your support (cash, food, or
rent assistance), SSI may consider this "income
in kind" and deduct a set amount from your
benefit. If you are being loaned money, SSI may
ask for signed statements from people loaning you
funds. If your assets exceed $2,000, you can "spend
down" prior to application to meet the eligibility
requirements. After filing, you may be asked to
document spend downs. In either case, document
spending down with receipts for home repairs, loans
paid back, medical bills taken care of, canceled
checks, etc.
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The Application Process
You
can apply for SSDI and SSI by phone and mail or
in person. To schedule an appointment at your local
office, call 800.772.1213. Or you could apply at
the Hollywood office, which is very familiar with
HIV claims, by calling 323.965.3943 (SSI) or 323.965.3900
(SSDI). Applicants for Presumptive SSI at the Hollywood
office only should have their Medical Reports faxed
to Social Security by their physicians before or
on the day they apply. Hollywood's fax is 323.965.3854. If other conditions
affect your ability to work, like chronic back pain, file an HIV claim
with complications. HIV claims always move faster
through the SSA process.
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If you have questions
about APLA, becoming a client or about
any of the services we offer, call
us at 213.201.1600 during normal business
hours or send
an e-mail. We are happy
to help.
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