SSDI and Other Disability Benefit Programs
Many people who are on SSDI benefits are also eligible for other disability benefits programs like Medicare or the Arizona Health Care Cost Containment System (AHCCCS). It’s important to understand how these different programs interact as benefits from one program may impact eligibility for another.
If you have questions about how programs interact with each other, talk to a Work Incentive Consultant. You can also use the DB101 Benefits and Work Calculator for estimates on how working may impact your SSDI benefits and other benefits.
Medicare and SSDI are linked. If you’ve been getting SSDI benefits for 24 months, you automatically qualify for Medicare. Because of the 5-month waiting period when you first start SSDI, you actually have to wait 29 months from the time you meet the SSDI eligibility criteria (disability onset) to become Medicare eligible.
Silvio became eligible for SSDI benefits on April 22, 2013, but he had to wait 5 full months (May, June, July, August, and September) until he got his 1st payment. He was eligible for his 1st SSDI payment in October 2013, but because SSDI makes payments 1 month after they are due, he actually didn’t get his 1st payment until November 2013. He’ll have to wait another 24 months, until October 2015, to become eligible for Medicare.
While he’s waiting for his Medicare coverage to begin, Silvio should apply for health coverage on Healthcare.gov, where he might qualify for AHCCCS. Once he becomes eligible for Medicare, Silvio can continue getting coverage via Medicare for at least 93 months after his SSDI Trial Work Period ends.
To learn more about how Medicare pays for medical services and prescription drug coverage, read the DB101 article on Medicare.
AHCCCS is Arizona’s Medicaid program. It helps pay for medical expenses for people with disabilities and others who qualify.
Remember that if you’re eligible for SSDI, you will eventually become eligible for Medicare (if you aren’t already on it). So you need to consider how Medicare and AHCCCS interact when making decisions about your health care coverage.
AHCCCS as a Bridge to Medicare
During the 29 months between the onset of your disability and your eligibility for Medicare, you may be able to get AHCCCS coverage if your income is low enough. To learn more, read DB101’s article on AHCCCS.
AHCCCS Once You’re On Medicare
Once you’re on Medicare, you won’t qualify for AHCCCS under income-only rules, unless you’re pregnant or caring for a child. However, since you’re on SSDI, you have a disability determination from Social Security – and may qualify for AHCCCS under disability rules.
If your monthly SSDI cash benefit is less than 100% of the Federal Poverty Guidelines ($973 per month for an individual, $1,311 for a couple) and you have little or no other income, you may qualify for AHCCCS for people with disabilities.
You could decide to opt out of prescription drug coverage under Medicare Part D, but that would be a mistake. By enrolling in AHCCCS and Medicare Parts A or B, you automatically qualify for the Part D Low Income Subsidy, making your prescriptions very cheap. If you decline Part D coverage, AHCCCS won’t give you prescription drug coverage.
Bottom Line: If you're on both AHCCCS and Medicare, enroll in Medicare Part D.
If you are getting SSDI and working, you may want to consider AHCCCS Freedom to Work. It covers the same things as standard AHCCCS and all you pay is a monthly premium and small copayments.
Being on AHCCCS Freedom to Work also automatically qualifies you for the Part D Low Income Subsidy. If you have a lot of prescription drug costs, the Low-Income Subsidy is a very important benefit. It could save you a lot of money each month in prescription drug costs.
Supplemental Security Income (SSI)
They’re both Social Security programs. You must pass the disability determination process from Social Security to qualify for either one.
SSI is a needs-based program. You can only qualify for SSI if your countable monthly income and total resources are below certain levels. SSDI, on the other on hand, is based on your work history. If you have worked and contributed enough money in Social Security taxes, you will qualify for SSDI (assuming you meet all other eligibility criteria).
There is nothing preventing you from being on both SSI and SSDI at the same time. However, if you are getting SSDI, the SSI program will consider your SSDI payments unearned income. This means that if your monthly SSDI benefits amount is $741 or more (the Federal Benefit Rate plus $20), you won't qualify for SSI benefits.
If your monthly SSDI benefits amount is less than $741 and you’re not getting income from any other source, you may qualify for SSI benefits. Typically, in this situation, you would get a total of $741 in benefits between the 2 programs. So if your SSDI payment was $300, your SSI benefits amount would be $441.
Under Social Security’s Section 301 program, you can continue to get SSI or SSDI benefits even if you have medically recovered and no longer meet Social Security’s criteria for being disabled.
Under Section 301, you can continue to get benefits as long as you are participating in an approved Vocational Rehabilitation (VR) program that is expected to help you become self-supporting.
Programs and providers that are usually approved for Section 301 include:
- Ticket to Work providers
- Vocational Rehabilitation agencies that use individualized plans for employment
- Support services that use individualized written employment plans
- A Plan for Achieving Self-Support (PASS)
- An Individualized Education Program (IEP) for young persons (ages 18 - 21)
To find out if a specific provider or program is approved under Section 301, talk to a Work Incentive Consultant or visit your local Social Security office. You can also call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).