At DECO Recovery Management, we help uninsured or underinsured patients become eligible for healthcare programs, particularly programs which are government-sponsored. These programs exist to provide patients with the means to access healthcare and make sure healthcare establishments, such as hospitals, get compensated for the care they provide. Two such programs are offered through the Social Security Administration (SSA): Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). These two programs specifically provide assistance to individuals with disabilities.
What Are SSI and SSDI?
While they are similar in many ways, SSI and SSDI are separate programs with different qualifying requirements and different levels of benefit. Knowing their similarities and differences is important to understanding who is eligible for them and how they assist the individual financially.
Supplemental Security Income
SSI is a need-based program for people with disabilities (disabilities which must meet the SSA’s disability criteria). Provided to individuals based not on work history but on severe financial need, it is funded through general fund taxes, not the SSA Disability Trust Fund. Eligible individuals must have less than $2,000 in assets, and couples must have less than $3,000, with a limited income. These individuals are also usually eligible for Medicaid and SNAP.
This program is reserved for those who are aged, blind or otherwise disabled in such a way that they cannot physically work. However, it provides only limited funds to those in need, providing for basic food, clothing and shelter needs. As of 2019, the maximum amount paid monthly to these individuals per the Federal Benefit Rate (FBR) is $771 for individuals and $1,157 for couples. This amount is quite flexible because it is based on how much money the person with a disability makes through other income sources. The individual may also qualify for a small state supplement, depending on which state they live in. But as its name suggests, SSI is only meant to be a supplemental source of income. However, it does provide the potential for the patient to obtain access to Medicaid.
Social Security Disability Insurance
SSDI is a bit different. While SSI eligibility doesn’t rely on work history requirements, SSDI eligibility does. Also, SSDI is paid through the SSA Disability Trust Fund, which the individual with a disability would have paid into through taxes when they were still working. This is part of the reason why SSDI benefits are sometimes known as “worker’s disability”. The individual with a disability must also meet the SSA’s disability criteria, as in the case of SSI.
In order to qualify, the individual with a disability must also be younger than 65 with quantifiable work experience. Evidence of this work background is established through a system of “work credits.” These work credits indicate that they did in fact hold a job for a SSA-specified period of time before becoming disabled. The individual with a disability will have earned up to four work credits per year—one per calendar quarter—and they will qualify by having a set number of those credits that matches up with their age. For example, if they become disabled at the age of 50, they must have 28 work credits, or at least seven years of work history.
In order to qualify for SSDI, the individual must also show that they are unable to perform “substantial gainful activity” for at least one year. As of 2019, this is defined as making less than $2,040 per month for blind individuals and less than $1,220 per month for any other individual with a disability. SSDI is for those who have what is considered “long-term” or permanent disability—individuals who will be unable to go back to work as a result of their disability. However, a waiting period of at least five months is required before the individual can begin receiving their benefits, along with the potential for needing to appeal an application. These individuals can then become eligible for Medicare after twenty-four months (following the beginning of receiving benefits). However, if they qualify for SSDI, their spouse and children may qualify as well, though children must be over the age of 18 to receive these auxiliary benefits.
The Effect of SSI/SSDI On Healthcare Compensation
At DECO, our job is to get in the middle of the revenue and compensation process to help the patient on behalf of the healthcare establishment. If a patient will be unable to sufficiently pay for their care due to lack of or insufficient insurance, we meet with them, gather their information, and begin the process of helping them apply for assistance with their medical bills. Usually, we complete the necessary government care applications and documents for the patient, because the whole application process can often be overwhelming and confusing.
If you have low-income patients who have SSA-standard disabilities, such as blindness, they could be eligible for SSI and eventually Medicaid. If you have patients below retirement age who have been working, but their disability now prevents them from doing so, they may be eligible for SSDI and eventually Medicare. Some patients may be eligible for both SSI and SSDI, so we will help them apply to see if they can get both, an arrangement called concurrency. We will help determine their eligibility and guide them step-by-step through the application process, with a compassionate attitude. Because the applications for these programs take time and effort, and even appeals, we will walk right alongside your patients through every detail to get them the benefits they deserve.
Since both SSI and SSDI include eligibility for Medicaid and Medicare, respectively, this is good news for your healthcare organization. It means that when individuals with disabilities and severely limited incomes come to your organization for treatment, you can provide the care that they deserve with confidence.
The DECO Difference
Healthcare eligibility can be a fickle and confusing topic. But we’re here to help you understand it and to assist your uninsured patients in obtaining it. That way, you can rest assured that your patients are getting the treatment they deserve while your establishment is also getting compensated for the care they have provided. If you would like more information about SSI/SSDI or have questions about eligibility, contact DECO Recovery Management today!