SSDI and SSI: What’s the Difference?

Are you unable to work because of a serious medical condition? If so, there’s a good chance you qualify for monthly payments and free health insurance from the U.S. government. We’ll help you figure out which program is right for you.

Millions of disabled Americans get benefits from Social Security. For patients and their families, this help can be life-saving. But not everyone with a serious condition is eligible, and government rules can make qualifying a nightmare. At Atticus, we help cut through the red tape and get you the benefits you need. We’ll explain what programs are available, help you decide if one is right for you, then tell you how to qualify.

What are disability benefits?

Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) are both government programs that support Americans who can’t work due to a medical condition. When someone says they’re “on disability,” they usually mean they are getting benefits from one of these programs.

Together these programs are huge: About 20 million Americans receive some form of disability benefits administered by the Social Security Administration. Although both programs provide monthly checks and health insurance to disabled adults, the qualifications and benefit amounts are different. It is possible to receive both SSDI and SSI at the same time, but most people qualify for one or the other. This article will help you decide which program is right for you, and what benefits you can get.

Who qualifies?

SSDI and SSI both serve disabled people under 66 who cannot work for at least a year because of their medical conditions. However, SSDI is designed for disabled people who have worked most their lives and paid taxes (regardless of how much money they have now), while SSI is designed for disabled people that don’t have much money (regardless of work history).

To qualify for SSDI or SSI, the social security administration must determine that you are “disabled” under their rules. They will determine that you are disabled if you cannot hold a job for at least a year because of your medical condition. If they determine you are disabled, you still need to meet the “non-medical” (sometimes called “technical”) qualifications. These qualifications are different for each program.

Who qualifies for SSDI?

In order to qualify for SSDI, you must:

1. Be “disabled” under government rules. The government has a very specific definition of “disability;” it will consider you disabled if you cannot hold a job for at least a year because of a medical condition. To prove you meet this requirement you’ll need lots of specialist treatment.
2. Have worked and paid taxes for years. The government has complicated calculations to determine if you’ve worked enough, but here’s a good rule of thumb: If you’ve worked at least five of the last ten years and paid taxes, you probably meet this qualification.

Who qualifies for SSI?

In order to qualify for SSI, you must:

1. Be “disabled” under government rules. The government has a very specific definition of “disability;” it will consider you disabled if you cannot hold a job for at least a year because of a medical condition. To prove you meet this requirement you’ll need lots of specialist treatment.
2. Have very few assets. If you have less than $2,000 (or $3,000 if you are married), you probably qualify. You should count any money you have and other large assets (like a retirement account). You never need to count your home, one vehicle, or a few other unusual assets.
3. Have very little income from any source. Every dollar you or your spouse make in income will decrease the amount you will receive from SSI. The government counts almost anything it can as income, including some help you may be getting that’s not in cash (like if you live with friends and don’t pay them rent). As a general rule, if you don’t have much cash coming in, and you aren’t getting a huge amount of help from others, you’ll probably qualify.

Qualifying for either program is never easy: The government treats claims with suspicion, and rejects most applicants. But if you meet the criteria above, you can likely get benefits with the right help

What are the benefits?

Both programs offer a monthly check and health insurance. SSDI provides a higher monthly check and benefits through Medicare, but imposes wait periods, while SSI provides a lower monthly check and benefits through Medicaid, but there are no wait periods.

What are SSDI benefits?

SSDI provides:

• A monthly check of between $500 and $2,900 after a waiting period. The exact amount depends on how much you paid in taxes, and figuring it out can be complicated. Luckily, the SSA website provides estimated benefit amounts.
• Health insurance through Medicare after a waiting period. Medicare provides terrific health coverage for 44 million disabled and elderly Americans. However, Medicare coverage doesn't start until 29 months after the date the government determines you became disabled.
• Other Benefits. Increased social security retirement payouts, because the government won't count against you the years that you don't work (as it would under normal circumstances).

SSDI benefits are subject to both retroactive payments and waiting periods, which can get confusing. The bottom line is this: if you apply shortly after you become disabled and are approved quickly you'll have to wait to get your benefits. But if you became disabled a long time ago, or your application takes a long time to process, you will be entitled to retroactive payments. At most, you could be paid for the time it took to process your application, plus one year of benefits before you filed.

What are SSI Benefits?

SSI provides:

• A monthly check of up to $750. If you have other income or assets, the SSA will reduce the amount of the monthly check.
• Health insurance through Medicaid. Almost 79 million Americans rely on Medicaid for health coverage. In some states, low-income individuals can also receive Medicaid without being disabled.

You will start receiving your SSI benefits as soon as you are approved (there’s no waiting period). You will also get reimbursed for any benefits you should have gotten between the time you applied and the time your application was approved.

Who should apply?

If you are eligible for one or both of the programs, you should apply. Applying is free. You can keep your health insurance, or get government health insurance for free. It is true that you might lose some other benefits, but only if you get more from Social Security. For example, if you are getting $200 in food stamps, and you are awarded $1,000 in disability benefits, you may lose your food stamps. But you won’t end up with less money each month.

Is there a reason to apply for both at the same time?

Yes. If you are eligible for both programs you should apply for both. There are two advantages:

• You might get more in monthly payments.
• There are waiting periods for SSDI but not for SSI. This means that if you are awarded benefits right away, you may still have to wait for your first check from SSDI. If that happens, getting a check for SSI in the meantime can be a lifesaver.

Is there a right time to apply?

You should apply as soon as it is clear that your condition is going to last a full year and you have the evidence to prove it. Sometimes that takes a while to figure out: your doctor may need to run tests and try a variety of treatment before they know how long your condition will last. Other times it is clear right away that a disability is long lasting. Once your doctor is pretty sure that your condition is going to keep you out of work for a full year, there is no reason to wait.

How does the application process work?

Atticus exists to help to people navigating this process — so the easiest thing to do is get free advice tailored to your situation via our online tools or caring staff. (People love us, and we don’t charge anything for our help.)

Applying for disability takes preparation. You can win, but this system doesn’t make it easy. So it’s worth taking some time to understand how things work.

The first step is to make a choice: Do you want to (a) Apply on your own, or (b) Get a professional to handle the process for you? Most successful applicants hire a professional. But not everyone needs to, and not everyone who wants to can. We’ll explain both paths and help you decide.

How the process works

The government fears that people will exaggerate their medical problems in order to get free money. So it puts every applicant under a microscope. To win, you have to prove — beyond a doubt — that your medical condition is severe and disabling. There are two major stages in the process, and most people will need to go through both:

1. Initial Application: You submit a lengthy written application, details on past work and treatment, and copies of your medical records. A government staffer reads your file and makes a decision. (Only 20% of people win at this stage; the large majority are denied.)
2. Appeals: If you lose, you appeal your denial and eventually get a hearing with a judge. At the hearing, you get to submit additional evidence, speak to the judge directly, and cross-examine government experts. (Among people who make it to this stage, about 50% win. If you lose, there are several more stages of appeal.)

Unfortunately, the process takes time: 3-6 months to get an initial decision, and 1-2 years (or more) to get a hearing. Even a small mistake or omission (like a doctor failing to send in records, or bad answer on a form) can doom an application. The good news is that once you win – even if it takes a long time and several appeals – you get “back pay” (retroactive benefits) for the time you should have been getting benefits.

Who needs a lawyer?

Because the process is so complicated, most successful applicants get a lawyer (or trained non-lawyer representative) to help. Lawyers will pull together your medical records, write your application, advise you on getting proper medical treatment, submit all the paperwork, and (if needed) argue your case before a judge.

There are two big upsides to hiring a lawyer: (1) They do almost all the work for you and hold your hand through the process. (2) They increase your chance of winning. (Government studies show that at the appeal stage, people with a lawyer are three times as likely to qualify.)

The only downside is cost. Lawyers aren’t allowed to charge any up-front fee so it doesn’t matter if you can afford one right now. If they win your case, they get 25% of any back pay (retroactive benefits) that they win for you. This is worth it for almost everyone — you only pay if you win (if you lose, you pay nothing), you only pay once, and the cost pales in comparison to the amount you get.

Should I hire a professional?

Most applicants should hire a lawyer or other professional. (There are exceptions — see, for example, our articles on Huntington’s disease or pancreatic cancer.)

Why? The government treats all but the most serious conditions with a lot of skepticism. Having assistance from an expert can make all the difference. There are only a handful of situations where we tell people to consider applying on their own:

1. If your condition is so severe that no one — not even the most skeptical judge — would believe you could hold a job. (This is the case if you have a terminal condition, or you’re seeing a specialist often, and still have extremely serious limititaitons, and need a lot of help in your daily life, and you haven’t worked in years.) If this is the case you can likely win on your own, as long as you feel comfortable with government paperwork (about the same as filing your taxes) and requesting medical records.
2. If you can’t convince a lawyer to take your case. Sadly, this can happen; if your case is quite hard to win, it can be difficult to find a lawyer to represent you. (Though we recommend trying our service before you give up!) In this case, you can apply on your own, and then try again to find a lawyer once you’ve been denied once — at which point it’s often easier. For more information, see our full article: How to apply for disability on your own.

How Atticus can help

Atticus is a new kind of law firm that helps you navigate the early stages of a disability claim. We help you choose the right approach, hire the right lawyer, and get on with your life. We won’t charge you a dime for our services, so there’s no cost to you.