Common Concerns

Dennis W. Fox & Associates

" Representing individuals before the Social Security Administration." Call 314-241-9666

Disability

COMMON CONCERNS

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How much work do you need? How to determine disability If you are divorced If you are married If you have kidney failure If you have never been employed If your claim is denied What can cause benefits to stop? What documentation will you need? What is Medicare?	What is SSI? What does Social Security mean to you? What will happen to your benefits? What you will need when applying for child benefits? Who can get child benefits? Who can get medicare and how to sign up 65 and older Who can get Social Security Benefits? Who can get SSI? Who can receive benefits? Who decides if you are disabled?

How much work do you need?
In order to receive social security disability benefits, you must have worked long enough and recently enough under the current laws. For each year you work, you can earn up to four credits, maximum. Each credit is based on a certain amount of money earned; the amount of earnings required for a credit usually increase each year, as general wage levels increase.

So how many work credits will you need, to qualify for disability benefits? That depends on the age at which you became disabled. The older you are, the more credits required. In most cases, you would need at least 20 credits earned in the last ten years. However, younger workers may qualify with fewer credits. For example, those disabled before age 24 need only six credits, earned in the three-year period before their disability starts.

To get a chart showing the credits needed at various ages, contact the social security office.

How to determine disability?
The disability determination services team goes through a series of questions, to decide whether you are disabled. First, they ask if you're working. If so, and you make over $700 per month, you usually won't be considered disabled. Next, they ask if your condition is severe. Does it impair your ability to perform basic work-related tasks? Third, they'll look for your condition on the list of disabling impairments, as maintained by social security. Certain impairments are so severe, they automatically qualify you as disabled. If your condition is not listed, the D-D-S will have to judge if it's as severe as others on the list. If it is, your claim is approved. If not, the team then asks a fourth question: can you do the work you did before? If not, your claim will proceed to the fifth and final step. Here, the team will evaluate if you can do any other kind of work. They take into account your age, education, experience, and skills. If you can't do any other type of work, your claim is approved. If you can, your claim will be denied.

If you are divorced
Today, nearly every American has social security protection, either as a worker or as a dependent of a worker. If you are divorced, you may be eligible for retirement benefits based on your ex-spouse's social security record, if he or she gets social security, or is deceased. However, you will need to meet certain conditions: your marriage lasted ten years or more; you are currently unmarried; and you are age 62 or older. If your spouse is deceased, the requirements may vary.
In that case, you can start collecting benefits at age 60, or at 50 if you become disabled. You may also be able to get benefits on his or her record, even if you were married less than ten years, if you are now unmarried; or, if you are caring for your deceased spouses' child, who is under 16 or disabled, and is also your natural or adopted child. Some people choose to receive social security benefits on their ex-spouse's record, if those benefits are higher than their own.

If you are married
If you are married and have worked under social security, you may qualify for retirement benefits either on your own work record, or your spouse's record. People who are eligible for benefits on more than one work record usually get the higher amount; you cannot draw on both.
Reduced retirement benefits are available at age 62. Currently, those who wait till age 65 can receive full benefits; however, this age will increase in the future. Even if you've never been employed, you may still be eligible for spouse's benefits, just by being married. In that case, you could receive benefits when your spouse retires, becomes disabled, or dies. Generally, the spouse benefit is 50 percent of your husband or wife's total benefit.

If you have kidney failure
In some situations, an individual may be eligible for medicare hospital insurance before age 65.
This includes some people with permanent kidney failure. If you receive maintenance dialysis or a kidney transplant, are insured or are getting monthly social security benefits, or have worked long enough in government, you can qualify for hospital coverage at any age. Medicare hospital insurance, also called "part a" medicare, helps pay for short-term hospital stays, skilled nursing facilities, home health care, and hospice care. Your spouse or child with permanent kidney failure may also qualify for coverage, based on your work record, even if no other family members are receiving medicare. If kidney failure and/or other conditions interfere with your ability to work, you may also be eligible for disability benefits. To find out more about benefits for people with kidney failure, contact the nearest social security office. Or, visit the health care financing administration website, at www.hcfa.gov.

If you have never been employed
If you're married, you may be eligible for social security benefits through your spouse, even if you've never been employed. These are called spouse's benefits. Typically, you are entitled to benefits when your spouse retires, becomes disabled, or dies. You can also receive benefits if you are caring for a child who is under 16 or disabled, and entitled to benefits. If you're not caring for a child, you must be at least 62 to draw benefits, when your spouse becomes disabled or retires. However, those who start drawing benefits before age 65 will receive a permanently reduced amount. By waiting till age 65, you will qualify for the full spouse benefit, which is half the amount your husband or wife is entitled to at 65. Assuming your spouse is eligible, you will also have medicare hospital insurance at age 65.

For more information about benefits for persons who have never been employed, contact your local social security office.

If you claim is denied
If you file a claim for disability or S-S-I, and that claim is denied, you have the right to appeal the decision. There are four levels of appeal. If you disagree with the decision at one level, you may appeal to the next level. The social security office can help you complete all the necessary paperwork. Or, if you wish, you have the right to be represented by an attorney or other person of your choice. However, there are certain rules about who may represent you; for details, ask for the fact sheet titled "your right to representation." From the time you receive your decision, you have 60 days to file an appeal to the next level. Social security assumes you get the decision five days after the postmarked date, unless you can show that you received it later. To find out more about appealing a denied claim, contact the social security office, at 1-800-772-1213.

You may also want to ask for their publication, "the appeals process."

What can cause benefits to stop?
If you are getting social security disability benefits, or ssi disability, there are two conditions that can cause your benefits to stop. First, they will stop if you are doing work that is considered to be substantial. In most cases, substantial means any job where your average earnings are $700 or more per month. However, there are special incentives for disabled persons who want to work; these include a nine-month trial work period, during which your earnings, no matter how much they are, will not affect your benefits. After the trial period, if your earnings average $700 or more, you will still receive benefits for an additional three months, before they stop. However, you may still be able to keep your Medicaid coverage, if you depend on it to work, and don't make enough to pay for comparable medical care. The second way benefits will stop, is if your medical condition improves to the point that you are no longer disabled. Usually, this decision is made following a disability review.

For more details on what can cause benefits to end, call or visit the social security office.

What Documentation will you need?
If you are applying for social security disability, you will need documentation that supports your claim. You should have the social security number and proof of age for each person applying for benefits. This includes your spouse and children, if they are also applying. Write down the names, addresses and phone numbers of the doctors or clinics that gave you medical care, and the dates you were there. List the names of any medications you're taking. Call your doctors, therapists and hospitals, and get copies of your medical records. Include laboratory and test results. Take a copy of your w-2 form, or your federal tax return, if self-employed. If your spouse is applying, give the dates of any prior marriages. By gathering this type of information in advance, you can usually speed up the claim process. For a complete list of the items you'll need when applying for benefits, contact the social security office. However, you're advised not to delay filing, just because you don't have all the information yet. The social security office will be glad to help you get the remaining documentation.

What is Medicare?
Medicare is the nation's federal health insurance program. Through taxes deducted from your paycheck, you contribute to the Medicare program during your working years. Then, usually at age 65, you are eligible for coverage. Medicare is designed to provide basic assistance with health care costs; but it does not cover all medical expenses, nor the cost of long-term care.
Medicare has two parts: part a is hospital insurance. It helps pay for a hospital stay, skilled nursing facility, home health care, and hospice care. Everyone who has paid into Medicare while working can get part a, at no cost. Part b Medicare is medical insurance; to receive this, you must pay a monthly premium. However, you do not have to take part b; it's your option. The medical insurance portion covers doctor's fees, x-rays, ambulance services, and other items not covered by part a Medicare. To get specific costs for Medicare part b, such as premium amounts, deductibles, and coinsurance payments, contact social security. These figures change each year, and are published in their fact sheet, titled "social security update."

What is SSI?
S-S-I stands for supplemental security income. Some people confuse S-S-I with social security disability, because both are handled by the social security administration. However, the programs are not the same. Social security disability insurance is funded by workers and employers; you qualify based on your work history. S-S-I is financed by general tax revenues, and is not dependent upon your work record. You may be eligible for S-S-I benefits if you have a disability, don't own much, and have limited income. Under S-S-I, income can include many items, such as cash, checks, gifts, inheritances, and food, shelter or clothing given to you by an individual.

The property you own will also affect your ability to qualify for S-S-I benefits. Generally, a single person can own up to $2,000 worth of goods; a couple can have up to $3,000 worth.
But not everything you own is counted. For example, your home and the land it's on do not count. Household goods, personal property and a car may not count, depending on how valuable they are.

However, the government does count things like bank accounts, stocks and bonds. To find out more about S-S-I, contact the social security office, at 1-800-772-1213. Or, visit their website, at www.ssa.gov.

What does Social Security Mean To You?
If you're relatively young and healthy, you may have never stopped to think about social security. Chances are, you're paying taxes that help fund the system. Yet you may not know exactly what social security does, and who it can help. Basically, social security was developed to provide protection for retired workers, and for workers and their families who suffer loss of income due to disability or death. There are three major types of social security benefits available. Survivors benefits are paid to the family members of a deceased worker. For the average family, these monthly survivors' payments are about $1400 per month. Social security also offers disability benefits; the coverage is comparable to having a $201,000 disability policy for your family. This is especially valuable, since most workers don't have private, long-term disability insurance.

Finally, the most familiar part of social security is retirement benefits. 90 percent of retirees qualify for retirement pay. Though social security is not meant to completely fund your retirement, it can make it more comfortable. Monthly retirement benefits may range anywhere from about $550 per month for a single, low-wage earner, to $1900 a month, for a couple with high lifetime earning.

What will happen to your benefits?
Recently, there has been concern that the social security program will eventually run out of money. Because people are living longer, and the elderly population is increasing, greater demands are being placed on social security funds. Basically, the number of people collecting social security is increasing much faster than the number of workers contributing to it. However, our government is already addressing this vital issue. Over the next few years, the nation is expected to have a federal budget surplus. Most politicians feel that some of these extra funds should be used to strengthen social security. One measure already underway is the raising of the retirement age; it will gradually increase from 65, to 67. Some people have debated whether to raise this age still further. Others have speculated on raising the minimum age of early retirement, which is currently 62. Though there are no easy answers, social security is too important, for solutions not to be sought. With certain reforms, the social security program should be able to continue covering all eligible citizens in the future.

What you will need when applying for child benefits?
The items you'll need when applying for a child's benefits are basically the same things you need when applying for any social security claim. However, you're also likely to need the child's birth certificate or other such documents. If you're seeking disability benefits for a child, you'll have to produce medical evidence of their disability. These items might include a complete list of medical personnel who treated the child, and the dates of treatment; copies of their medical records; names of any prescription drugs they are taking; and test results. For a child to receive dependents benefits, you must show that they are under 18, or in high school full time and under age 19. If applying for the child's survivor benefits, their parent's death certificate or other proof will be required, in addition to basic information like the child's social security number, proof of age, and address. For more information on child's benefits, ask social security for the booklets "S-S-I," and "Benefits for Children with Disabilities.

Who can get child benefits?
Many parents may not be aware that certain benefits are also available for their children who qualify. Typically, child's benefits apply to those under age 18, though there are exceptions.

Children who are disabled, and come from homes with limited resources, may be eligible for ssi disability benefits. A child is considered disabled if he or she has a mental or physical condition that can be medically proven; the condition must cause severe functional limitations. In addition, their disorder must be expected to last at least 12 months, or be terminal. A child may also qualify for social security dependents benefits, if their parent is collecting retirement or disability benefits, or if their parent has died. In the case of dependents and survivors benefits, the child does not have to be disabled to collect. Finally, there are social security benefits for adults disabled since childhood. These apply to a children whose disability began before age 22, and whose parent is getting social security benefits, or has died.

For more information on child's benefits, ask social security for the booklets "S-S-I," and "Benefits for children with disabilities.

Who can get medicare and how to sign up 65 and older?
Most people age 65 or older can get Medicare hospital insurance, also called "part a" Medicare.
They may qualify for Medicare based on their own work record, or their spouse's. If you receive social security or railroad retirement benefits, you are automatically eligible for Medicare. You may qualify under other conditions, too: for example, if you are not getting social security or railroad retirement, but have worked long enough to be eligible for them. You may also be able to get Medicare if you would be entitled to social security benefits through your spouse or ex-spouse, and that person is at least 62. Finally, you may qualify for Medicare if you worked long-term in a government job. Here's how to sign up. If you're already receiving social security benefits, the social security office will contact you a few months before you turn 65, and send you an application. If you aren't already drawing social security or railroad retirement, you should contact the social security office. It's best to start about three months before your 65th birthday.

You will also have the option to enroll in part b Medicare, which is medical insurance, for a monthly premium.

Who can get Social Security Benefits?
Basically, social security benefits are available under three major conditions: when you or your spouse retires; when you become disabled; or if you are a dependent of someone who becomes disabled or dies. Full retirement benefits begin at age 65, though reduced retirement can be drawn as early as 62. Social security retirement benefits are available to anyone who has worked long enough and recently enough, in a job that paid social security taxes.

You may also qualify as the spouse of someone who worked. Social security disability, however, is available at any age, should you become disabled, and cannot work. In addition, some of your family members may qualify for benefits as your dependents. For example, children under 18 may be eligible, if their parent receives disability checks, or has died. A widower can receive survivors benefits if they are caring for children under age 18. Widows' benefits may apply in other cases as well. Parents who are 62 or older when you die, they may also qualify for payments.

Who can get SSI?
S-S-I is short for supplemental security income. It's available to those with a disability, who have a financial need. To qualify for S-S-I benefits, you must meet the same medical requirements as for social security disability. Both programs use the same standards to determine if you have a disability. However, S-S-I is not dependent upon your work record. Instead, you must meet certain conditions, such as having limited income, and few resources. In general, a single person can own $2,000 worth of items other than their home and the lot it's on. A couple is allowed $3,000 worth of goods. However, many things don't count towards your S-S-I limit: your furniture, personal property and car may not count, depending on how much they're worth. However, stocks, bonds, and all bank accounts do figure in to the limit. If you receive cash, groceries, free rent or other gifts, these can also affect your eligibility for S-S-I benefits.

To find out more about what's allowed, and if you might qualify for S-S-I, contact the social security office

Who Can receive benefits?
A variety of individuals are eligible for benefits through social security. Retirement benefits, survivors benefits, disability benefits, and medicare benefits are available to those who meet specific stipulations. Full retirement benefits require that you've been working for ten years, and are payable currently at age sixty-five, though the age for eligibility may be higher in the future.
Reduced benefits begin at age sixty-two, with permanent reductions made for each month early you retire. If you opt to delay your benefit payment and by doing so increase your ultimate payment amount. For those that survive their spouse, survivors benefits can be paid if the widow is sixty or over, fifty or over if they are disabled, or any age if they have a child whose is younger than sixteen or disabled. Survivor benefits can also be available to children who are unmarried and under eighteen, under nineteen and still in school, or if they are eighteen or older but severely disabled. If you have a physical or mental impairment that is expected to keep you from working a year or more or result in death, you may be eligible for disability benefits. Benefits depend on the amount that you have worked in the past year and your age. Medicare benefits may be obtainable depending on age, past disability benefits or special kidney conditions.

Who decides if you are disabled?
Your application will first be screened by the social security office. They'll take into account such factors as your age, and if you've worked long enough and recently enough to qualify. Next, your application will go to the disability determination services office, or D-D-S. It is the D-D-S team who decides if you are disabled, according to social security guidelines. The D-D-S team is usually made up of a doctor, or psychologist, and a disability evaluation specialist. They will study all the medical information you provide, including your medical records. They will also look at forms your doctors filled out, describing your condition, when it began, how it limits your activities, and what treatment you've received. In some cases, the D-D-S team may examine reports from other agencies, if you have made claims to those agencies as well. However, the final decision will be made according to social security definitions of disability. Once a decision is reached, the social security administration will notify you by mail. If your claim is approved, the notice will show the amount of your benefit and when payments start. If denied, it will explain why.