Frequently Asked Questions (FAQs)
- How do I become eligible for Social Security Disability?
- Can my child become eligible for Social Security Disability?
- What are the requirements to receive Medicare?
- How do I report fraud?
- Why do I need to attend a special examination to prove my disability?
The definition of disability in the Social Security law is a strict one. To be eligible for benefits, a person must be unable to do any kind of substantial gainful work because of a physical or mental impairment (or a combination of impairments), which is expected either:
- to last at least 12 months, or
- to end in death.
If, because of a medical condition, a person cannot do the work that they performed in the past, then age, education, and past work experience must be considered in determining whether the person can do other work. If the evidence shows that the person can do other work, even if it involves different skills or pays less than their previous work, they cannot be considered disabled for Social Security purposes.
You should be familiar with the process we use to determine if you are disabled. It's a step-by-step process involving five questions. They are:
- Are you working? If you are and your earnings average more than $700 a month, you generally cannot be considered disabled.
- Is your condition severe? Your impairments must interfere with basic work-related activities for your claim to be considered.
- Is your condition found in the list of disabling impairments? We maintain a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step.
- Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.
- Can you do any other type of work? If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.
You may obtain a copy of Disability Evaluation Under Social Security ("The Blue Book") (1/01; SSA Publication No. 64-039) which contains the medical criteria that SSA uses to determine disability. It is intended primarily for physicians and other health professionals.
If you believe that you meet the qualifications for Social Security disability benefits, see our instructions for applying for disability benefits at http://www.ssa.gov/disability.html
Your child may be eligible for assistance under the Supplemental Security Income (SSI) program. SSI provides monthly payments to people who are age 65 or older, blind, or disabled and have limited income and impairment must have lasted or be expected to last for a continuous period of at least 12 months or be expected to result in death. To meet this definition, the child may not be working at a job that we consider to be substantial work.
Children under age 18 can qualify for SSI if they meet the definition of disability and their income and resources are within the allowed limits.
To be found disabled under the SSI program, a child must have a medically determinable impairment that causes marked and severe functional limitations.
Please read our material on "children and SSI" in the booklet, "Understanding SSI "
Because SSI is a needs-based program, a person's income and resources must be counted in determining eligibility and the payment amount. When a child under age 18 is living with his or her parents, we must count a portion of the parents' income in determining the child's eligibility and payment amount. In this process, called "deeming," the law recognizes that part of the parents' income and resources normally are used to support the children.
Generally, to be eligible for SSI, an individual also must be a resident of the United States and must be a citizen or a noncitizen lawfully admitted for permanent residence. Also, some noncitizens granted a special status by the Immigration and Naturalization Service may be eligible.
There are many ways to qualify for Medicare. There are two parts of Medicare, each of which has its own requirements:
Hospital Insurance (also known as Part A)
If You Are 65 or Older
Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own or their spouse's employment.
You are eligible at 65 if you:
- receive Social Security or railroad retirement benefits;
- are not getting Social Security or railroad retirement benefits, but you have worked long enough to be eligible for them;
- would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 (your spouse does not have to apply for benefits in order for you to be eligible based on your spouse's work) ;or
- worked long enough in a federal, state, or local government job to be insured for Medicare.
If You Are Under 65
Before age 65, you are eligible for Medicare hospital insurance if you:
- get Social Security disability benefits and have amyotropic lateral sclerosis (Lou Gherig's) disease;
- have been a Social Security disability beneficiary for 24 months; or
- have worked long enough in a federal, state, or local government job and you meet the requirements of the Social Security disability program.
If you receive a disability annuity from the Railroad Retirement Board, you will be eligible for hospital insurance after a waiting period. (Contact your railroad retirement office for details.)
Eligibility For Family Members
Under certain conditions, your spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when he or she turns 65, based on your work record.
Also, disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare, usually after a 24-month qualifying period. (For disabled widows/widowers, previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period.)
If You Have Kidney Failure
There are special rules for people with permanent kidney failure. Under these rules, you are eligible for hospital insurance at any age if you receive maintenance dialysis or a kidney transplant and:
- you are insured or are getting monthly benefits under Social Security or the railroad retirement system; or
- you have worked long enough in government to be insured for Medicare.
In addition, your spouse or child may be eligible, based on your work record, if she or he receives continuing dialysis for permanent kidney failure or had a kidney transplant, even if no one else in the family is getting Medicare.
If You Do Not Qualify Under These Rules
Certain aged people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium. They must also always enroll in medical insurance (Part B) to get this coverage. Certain disabled people who lost premium-free hospital insurance due to work can get Medicare hospital insurance again by paying a premium.
Medicare Medical Insurance (also known as Part B)
Almost anyone who is 65 or older or who is under 65 but eligible for hospital insurance can enroll for Medicare medical insurance by paying a monthly premium. Aged people don't need any Social Security or government work credits for this part of Medicare.
SSA Fraud Hotline
PO Box 17768
Baltimore MD 21235
After you apply for Social Security or Supplemental Security Income disability benefits, sometimes you need to have special medical examinations or tests before we can make a decision on whether you qualify.
The Disability Determination Services in your state is currently reviewing your disability claim. The state agency makes the disability decision for Social Security. The employees there need more information before they can decide if you are disabled under Social Security law. So, they are asking you to have a special exam or medical test that we will pay for. We also will pay for certain related travel expenses.
If a doctor who is not your regular doctor performs your exam or test, we can send a copy of the results of the exam or test to your doctor if you ask us.
What should I do?
It is your responsibility to take the exam or test and cooperate with the doctor examining you. If you cannot keep the appointment we made for you, let the state agency know right away. (The phone number and address are provided with the letter you receive notifying you about the exam or test.) If you do not let the state agency know that you cannot keep the appointment, it will make a decision based solely on the information already available in your case. This may result in a decision that you are not disabled.
What will the doctor do?
The doctor (or other medical person) who sees you is conducting the exam or test to get specific information requested by the state agency. The doctor will not take part in deciding whether you are disabled, and he or she will not prescribe treatment or medication for you. The doctor will send a report of the exam or test to the state agency.
What will the state agency do?
The state agency will review the doctor's report, along with all of the other information in your case, and make a disability decision. We will send you a letter to tell you about the decision made by the state agency.
What if I do not agree with the decision?
If you do not agree with the decision, you have the right to appeal. Your letter will tell you how to appeal the decision.