The Social Security Administration (SSA) administers two programs that award benefits to disabled citizens (and eligible noncitizens) who live in the United States. The two programs have different standards for eligibility and they calculate benefits in different ways.
Social Security Disability Insurance (SSDI) pays disability benefits to people who are “insured” under the Social Security system. The SSDI system is funded by payroll taxes. Individuals who have a sufficient work history are deemed to have paid sufficient payroll taxes to be “insured.” Benefits depend on the worker’s history of earnings, subject to a maximum benefit payment.
Supplemental Security Income (SSI) is an entitlement program that is funded from the government’s general revenues. No work history is needed to qualify, but beneficiaries must have limited assets.
For people who have a strong earnings history, SSDI will probably pay a higher monthly benefit than SSI. However, someone who is insured for SSDI purposes but receives low SSDI benefits and has limited assets might also qualify for SSI.
Three primary factors determine eligibility for SSDI and SSI. One of those factors (insured status versus limited assets) depends on the program to which the disabled person applies. The other two eligibility factors are the same for both programs.
Sufficient Work Credits or Limited Assets
Social Security Disability Insurance benefits are available to disabled individuals who are “insured” by virtue of their work history. People become insured by working and paying payroll taxes. Workers gain a work credit when they earn wages in a defined amount. In 2022, workers need to earn $1,510 to earn a work credit. Workers can earn a maximum of 4 work credits each tax year.
Most individuals are “insured” when they earn 40 work credits, provided they earned 20 credits within the last 10 years before the disability began. Workers who become disabled before the age of 31 need fewer credits to be insured by SSDI.
When workers become “insured,” they are eligible for SSDI if they meet the other two criteria. Since SSDI is not a means-tested program, they can qualify for benefits regardless of the assets they own. They can also have sources of income, including retirement benefits, that are unrelated to their ability to work.
Benefits from SSDI are tied to the amount of income the worker earned before applying for benefits, so workers with a good earnings history receive more benefits than workers who had low earnings. Benefits are nevertheless capped at a maximum amount. That amount changes each year.
Supplemental Security Income benefits are available to disabled individuals regardless of work history. Work credits are not necessary to become eligible for SSI benefits.
Individuals who meet the next two criteria will qualify for SSI if they have limited assets. Under current law, SSI recipients may not own assets worth more than $2,000 (or $3,000 for couples). Assets include cash, bank account balances, investments, land, jewelry, and most personal property. A few assets are not counted, including the individual’s home, household goods, personal effects (such as clothing and a wedding ring), and one vehicle.
Severely Disabling Medical Condition
To qualify for SSDI or SSI, an individual must have a severely disabling medical condition. Both physical and mental conditions can be severely disabling. As we explain in more detail below, the condition must impair physical or mental abilities to a degree that significantly limits the ability to earn income.
Whether a disabling condition is severe is measured by how long it is likely to impair the ability to earn income. A disabling condition is severe if it has lasted or is expected to last for more than a year or to cause death in less than a year. If an individual is expected within a year to recover from the impairment, or to improve sufficiently to regain earning ability, the disability will not be regarded as severe.
Many conditions can be severely disabling. Conditions that limit physical movement or the ability to use arms or legs, conditions that produce serious chronic pain, stroke, heart failure, and serious respiratory conditions are examples of health conditions that the SSA might find to be severely disabling.
Whether, when, and how much the condition is likely to improve will usually be answered by medical evidence. A few medical conditions, including certain fast-growing cancers, are presumed to be severely disabling. Most conditions require the SSA to review medical records for evidence of the degree to which the condition causes physical or mental limitations that impair the ability to work. Lawyers who represent claimants for Social Security disability benefits review medical records and might ask their clients to obtain additional medical evidence, such as a functional capacity evaluation, if the record is insufficient to justify a claim.
Inability to Earn Substantial Income
The final test of eligibility for both SSDI and SSI is that the severely disabling medical condition must make the individual incapable of engaging in substantial gainful activity. For the most part, substantial gainful activity means working for wages for a threshold amount of wages.
With a few exceptions, gainful activity is “substantial” if it pays more than the defined threshold income. In 2022, that threshold is $1,350 a month. The SSA will automatically disqualify most applicants who are earning more than that amount. When applicants are earning less than the threshold income, the SSA will ask whether they are capable of earning the threshold income.
Earning capacity is determined in light of the physical or mental limitations that are shown in medical records. Since the burden is on the applicant to prove an inability to engage in substantial gainful activity, the applicant’s Social Security disability lawyer may want to be sure that medical records include functional capacity evaluations. Those evaluations provide objective evidence of work limitations, including how long a worker can stand or sit, maximum lifting restrictions and how often the worker can lift lighter objects, climbing restrictions, and limitations relating to concentration and other cognitive abilities.
Other evidence, including psychological evaluations, academic records, military records, and work history can contribute to an evaluation of earning ability. Social Security disability attorneys scour all relevant records for evidence of eligibility for SSDI and SSI benefits.