Three groups of persons can get SSI benefits:
- Persons older than 18 but younger than 65, with disabilities and limited income and resources. This article focuses on persons between 18 – 65.
- Persons who are 65 years old or older, with limited income and resources.
- Qualifying children and youth under 18 with disabilities. A different definition of disability applies to persons under 18. To learn more about SSI for persons under 18, read DB101’s article on Benefits for Young People.
You do not have to have worked at all to get SSI benefits.
If you’re between 18 – 65, to qualify for SSI benefits, you need to:
- Meet certain citizenship and residency requirements;
- Meet income and resource limits; and
- Have a disability that prevents you from working.
To be eligible for SSI benefits, you must show that you have a disability that prevents you from working. Social Security has very specific rules about what is and is not a disability. Social Security uses the same definition of disability for all its programs.
- You must be able to show medical reports that confirm that you have a severe physical or mental disability. If no reports are available, Social Security will send you to a doctor to confirm your condition.
- Your condition must have lasted or be expected to last at least a year or be expected to result in death.
- If you have a visual impairment, Social Security uses special rules to decide if you are blind.
Unable to Work
Your disability must also prevent you from working. Social Security has a standard way of defining work. The term Substantial Gainful Activity (SGA) is used to describe a level of work activity or earnings. In 2016, if you are earning more than $1,130 per month (or $1,820 if you’re blind), Social Security says your earnings are Substantial Gainful Activity.
Note: You may be able to reduce your countable monthly income if you get a wage subsidy, have Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs). Also, when Social Security figures out if your work activity is SGA, Social Security does more than just look at your earnings. If you are self-employed, for example, Social Security uses up to 3 different tests and analyzes things like hours worked and responsibilities to decide if your work counts as SGA. To find out more information, visit the Social Security Administration’s website.
When Social Security looks at your application, the agency asks a series of questions to figure out if your disability prevents you from working.
Social Security calls this set of questions the Functional Assessment:
If you are working above the SGA level, you are considered able to work, and therefore not disabled and not eligible for SSI benefits. Otherwise…
If your condition is on the Listing of Impairments (Blue Book), and the condition is severe enough, you are automatically considered disabled. If not…
Social Security figures out if you could do your old job, even if you’re not working now. If so, you are not disabled. If not…
Social Security figures out if you could do any other kind of work, considering your medical condition, age, and background. If so, you are not disabled. If not…
- You are disabled.
- Social Security figures out if you could do any other kind of work, considering your medical condition, age, and background. If so, you are not disabled. If not…
- Social Security figures out if you could do your old job, even if you’re not working now. If so, you are not disabled. If not…
- If your condition is on the Listing of Impairments (Blue Book), and the condition is severe enough, you are automatically considered disabled. If not…
Example: Mimi has a severe and life-threatening lung disease. She is still working and earning $1,500 a month working part-time in a flower shop. Social Security decides that her earnings are above $1,130, the current SGA level. Mimi is therefore not disabled according to Social Security because of her earnings.
Example: Floria injured her spine in a fall. She fractured 2 vertebrae and damaged some nerve roots. She is not working now. Social Security finds that her condition is listed in the Blue Book and that it’s severe enough to be disabling. Floria is therefore disabled according to Social Security and may qualify for monthly benefits.
Your disability has to prevent you from earning above the SGA level not just in your old job, but in any job. Social Security looks at your age, education, work experience, and any skills that could be used in other jobs. (If you’re over 55, the rules are less strict.)
Example: Luigi had been working as a longshoreman until he ruptured a disc in his back in a game of touch football. He is not working now, so his actual earnings are below the SGA level. The back injury is long-term and serious, but not listed in the Blue Book as an automatically disabling condition.
Luigi wouldn’t be able to do his old job, with all the heavy lifting, but Social Security decides that with his experience, he could be able to work at a desk as a dock dispatcher. Because he would be able to work, Luigi is not disabled according to Social Security.
When you apply for SSI benefits, you have to list money and property that you own. If you have money or property that you could sell to support yourself, Social Security wants to make sure that you do that first before you get help.
- Resources are cash and other property that you own and could convert to cash.
Excluded resources are resources that don’t count towards SSI’s resource limit. The most important excluded resources are:
- The home you live in
- One car that you use to get to work or medical appointments
- Here is a complete list of excluded resources.
- Countable resources are all resources that aren’t excluded.
You must have less than $2,000 in countable resources ($3,000 for a couple) to qualify for SSI benefits.
Example: Billy has $5,000 in a savings account, set aside for a rainy day. Even though he has no plans to spend this money and doesn’t want to, it does count as a resource. Billy is not eligible for SSI benefits.
- Lawfully Admitted for Permanent Residence (LAPR) in the U.S.
- Refugees admitted to the U.S. under Section 207 of the Immigration and Nationality Act (INA)
- Persons granted asylum under section 208 of the INA
Qualified aliens must also meet certain other conditions to be eligible for SSI benefits. Some groups of immigrants and refugees will only be able to get SSI benefits for 7 years after their date of entry into the U.S. If they think they will continue to need SSI benefits, they need to become U.S. citizens before that time is up. If you are unsure of your immigration status or how it affects SSI, you should contact the Social Security Administration or U.S. Citizenship and Immigration Services (USCIS). See the Social Security Administration's website for more information.
You can apply for SSI benefits at your local Social Security Office or by calling Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY). Papers will be mailed to you to fill out. If you apply in person or by phone, it will help to fill out the online Adult Disability Report first.
The initial application process will take some time, sometimes up to 4 months. If you need urgent help, call your DES/Family Assistance Administration office right away. If you’re eligible, they can get you health coverage and Nutrition Assistance (formerly Food Stamps). Depending on your need and circumstances, they may also be able to help you with emergency cash assistance and/or housing.
When you apply for SSI, you’ll need to give Social Security:
- Basic facts (name, date of birth, etc.)
- Identification and birth certificate
- Naturalization papers, if applicable
- Social Security Number
- Documentation of your medical condition
- Names of doctors, hospitals, clinics and professionals who have treated you, including complete addresses and phone numbers
- Prescriptions and results of medical tests
- Documentation explaining all aspects of how your medical condition affects your daily life
Be ready to:
- Sign release forms so Social Security can get copies of your medical records
- Fill out forms about how your disability affects you in your daily life
- Give SSA permission to contact your employer, friends, or family to get information about how your disability affects you
- Documentation of your income
- A list of the types of jobs you’ve done for the past 15 years; for example, carpenter, dishwasher, etc.
- Copies of tax records or W-2 forms for any work you’ve done
- Information about any other benefits you’re on
- School records, if you’re under 22
- To qualify for SSI, your monthly earned income must be below SGA ($1,130, or $1,820 if you are blind).
- Documentation of your resources
- Copies of bank statements
Be ready to:
- Answer questions and give proof about any real estate, savings and retirement accounts, stocks, bonds, etc. that you own
- The SSI asset limit is $2,000 for single people, $3,000 for a couple
- Your own home doesn’t count
- Your first vehicle doesn’t count, particularly if you use it to get to medical appointments
Social Security will also ask you to sign up to get your check through direct deposit into your bank account.
More application information is available on the Social Security site. Don’t delay your application just to round up the documents; Social Security can help you.
It’s important to apply right away if you think you’ll need SSI. Even though it will take a while for Social Security to process your application, your benefits will be paid retroactively to your application date.
Social Security usually takes from 3 to 6 months to decide on your application if you’ve supplied all the documentation needed. At this point, you should get either an award letter or a denial letter.
- The amount you’ll get in monthly benefits
- When the benefits will be paid
- The benefits amount you’ll get in retroactive (past) benefits, based on the date you applied for SSI benefits
- The date Social Security will review your medical condition — usually 3 to 7 years after you started getting benefits
Award letters can be hard to read. If you have questions about your new benefit, you can call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY), or you can call a DES/Family Assistance Administration office. More information is available on Social Security’s website.
Denial and Appeal
Some applicants get a denial letter, telling them that their claim for SSI benefits has been turned down.
The most common reasons for SSI to deny claims are:
- Medical: This is the most frequent reason for denied claims. Often Social Security doesn’t have enough medical documentation of your health condition, or Social Security doesn’t believe your medical condition is bad enough to keep you from working.
- Resources: Social Security believes that you have more resources than the allowed limit of $2,000 ($3,000 for a couple)
- SGA: Social Security believes that you are earning more than the Substantial Gainful Activity limit of $1,130.
Note: When you apply for SSI benefits, Social Security must first check to see if you’re eligible for Social Security Disability Insurance (SSDI). If you get a denial letter from SSDI, it does not mean you’ve been turned down for SSI benefits. Check the letterhead on the denial letter. An actual SSI denial letter will say Supplemental Security Income at the top.
You don’t have to accept Social Security’s decision. If you feel that the decision is unfair or incorrect, you have the right to file an appeal.
- You have 60 days from the date the denial letter was sent to file an appeal. Do it quickly. If you file an appeal within 10 days, you may continue to get your SSI benefits at the same level until Social Security has made a decision about your appeal. If you miss the 60-day window, you may lose the right to appeal at all.
- Refiling is not the same as appealing. If your application for SSI benefits is denied and you disagree with the decision, you should file an appeal; you should not fill out the application forms again (that would be refiling). If you appeal and win, your benefits will be paid back to your original application date. If you refile, Social Security will start all over and you will give up any claim to past benefits you might have gotten.
- To file an appeal, call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and ask them to send you an SSI appeal form. You can also request your appeal using this online form. If you file online, you will need to mail or deliver any new information about your situation to Social Security.
- You have the right to have a lawyer or other qualified person (familiar with you and with the SSI program) represent you during the appeal process. Or you may choose to deal with it yourself.
There are 4 levels to the appeal process. If you are not satisfied with the result at each level, you can appeal to the next. The 4 levels are:
- Reconsideration: In a reconsideration, somebody inside Social Security who wasn’t involved in the first decision looks at your application again from scratch. You can supply more information if you want. This is a paper appeal and means that you don’t have to go in front of a judge. You should supply Social Security with any new information you have about your case.
- Hearing: If the reconsideration is denied, you can ask for a hearing before an administrative law judge. You can bring witnesses to help make your case. You should consider having an attorney or representative help you with the hearing.
- Appeals Council: Social Security’s Appeals Council will review your case if you appeal the decision of the administrative law judge. The Council can accept the decision of the judge, decide the case for itself, or send it back to an administrative law judge for an additional hearing.
- Federal Court: If the Appeals Council decides against you, you can file a lawsuit in federal court.
For any level beyond the reconsideration, it would be a good idea to have a lawyer working for you.