Benefits &Financial
Social Security and Health Benefits
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After an individual sustains a brain injury, one of the most confusing areas for individuals and their families is accessing Social Security and other benefit programs. There are two types of Social Security Benefits as well as two healthcare programs (Medicaid and Medicare) available to people with disabilities.
Social Security manages two different programs that provide cash benefits. These programs are SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income). Although some of the same concepts apply to both programs, there are many important differences regarding eligibility.
To be eligible for SSDI, the person with brain injury must:
• Have worked and paid Social Security taxes for enough years to be covered;
• Be the widow/widower of someone who has worked and paid taxes;
• Be the disabled adult child of someone who has worked and paid taxes.
Generally, Social Security looks for five years of employment but this can vary with age and type of disability. In addition, that person must meet Social Security’s definition of disability. The Social Security office will request records from doctors and hospitals that have treated the person with brain injury. Finally, they look at whether or not that person is working and earning under what is called a “substantial gainful activity” level. In 2003 this gross monthly amount is $800.
Typically, the person with brain injury must be disabled for five months before SSDI cash benefits will start. The amount of the check is based on the worker’s lifetime average earnings covered by Social Security. After receiving cash benefits for 24 months, that person becomes eligible for MEDICARE insurance. Medicare consists of hospital insurance (Part A) and medical insurance (Part B).
To be eligible for SSI based on a medical condition, persons with brain injury must meet Social Security’s definition of disability. In addition they must have limited income and resources. If working, their earnings must be under the substantial gainful activity level ($800 monthly gross in 2002). The resource limit for an individual is $2000 (this could include bank accounts, stocks, business assets or property).
There is no waiting period for cash benefits once Social Security determines a person meets the eligibility requirements for SSI. Cash benefits are based on the Federal Benefit Rate ($552 in 2003) and will be adjusted to take into account any other income and support the person with brain injury receives. In addition, Georgia does not require a separate application for MEDICAID, the health insurance program that generally covers people who receive SSI. Medicaid will start the same month that person becomes eligible for SSI.
To apply for SSI AND SSDI, call the Social Security’s toll-free number 1-800-772-1213 Monday through Friday 7am to 7pm.
A claims representative will take information over the phone and start the application. They may also make an appointment for the person with brain injury at a local Social Security office. It is important to start the application process as soon as possible! Social Security will review eligibility for both SSDI and SSI and let the person know what they are eligible for. If someone is not sure about eligibility, it’s always best to go ahead and file!! A social worker or case manager may be able to help with the process.
Start a folder or file of information, as it is important to keep track of all communication with Social Security, verbal and written.
More Information: www.ssa.gov
Sally Atwell has been employed at the Shepherd Center, a rehabilitation hospital in Atlanta, Georgia, for the past seventeen years. Currently she is the Project Director for the Benefits Navigator project, a Social Security Benefits Planning, Assistance and Outreach grant. Ms. Atwell received the Social Security Administration Regional Commissioner’s Citation Award for the Southeast region in 1999.
Curtis Rodgers is a vocational rehabilitation specialist. He currently serves as Assistant Director of the Benefits Navigator program, which is designed to assist people with disabilities (who receive either SSI or SSDI) become informed consumers when considering return to work options. Curtis recently received the Advocate of the Year Award for 2002 from The Governor's Council On Developmental Disabilities.