If you are approved for Social Security Disability Insurance (SSDI or SSD) benefits, you may be eligible to receive more than just a monthly cash benefit. You may also qualify for a “lump sum” back payment and Medicare. However, there may be an additional wait time before Medicare starts.[Note: If you have been approved for Supplemental Security Income (SSI) benefits, see our article on SSI benefits.]
The monthly benefit amount for SSDI is determined by the claimant’s work history and the amount he or she contributed though payroll taxes to the Social Security system. Learn more about how much your may receive in SSDI benefits.
Lump-Sum Back Payments
If your claim takes a long time to process, you will not be limited to benefits from the approval date going forward. You are eligible to receive past due benefits, or “backpay,” for the time during your application and appeal period, which is payable in a lump-sum payment.
You can receive back pay from the date you filed your application, plus as many as 12 months of benefits before the application date. Whether you qualify for an additional full year of back pay depends on your “alleged onset date” or when you became disabled. Your disability onset date is the date your disability is determined to have started. This date determines your date of entitlement to benefits. In an SSDI claim, your actual entitlement date is five months after your disability (due to a five-month waiting period for SSDI). So if your disability onset date is 17 months or more before the date of your application, you will receive a full year of backpay benefits. In some cases, the amount of backpay can amount to thousands of dollars simply because disability cases often take so long to be decided. Click here to learn more about backpay in Social Security disability cases.
If you win your claim for Title II disability insurance benefits, then you are eligible for federal Medicare benefits, which may pay some of your medical bills. The one caveat is that there is a long waiting period before these benefits are payable. In short, Medicare benefits begin two years and five months after the disability onset date in disability insurance claims.
Note: This does not necessarily mean that Medicare benefits are available two years after you are approved for SSDI or two years after the payments finally begin. Instead, you will receive Medicare benefits two years after your eligibility for SSDI benefits has been established (in other words, two years after your date of entitlement). Remember, your date of entitlement is your disability onset date plus the five month waiting period.
For example, let’s take someone who stopped working on December 31, 2009 due to a disability. He does not apply for Social Security disability until January 1, 2011, and alleges a disability onset date January 1, 2010 in his claim for benefits. The claim takes two years and is finally approved on January 1, 2013. In this situation, the claimant’s “date of entitlement” is June 1, 2010, which is five months after January 1, 2010. Under these facts, the claimant is also eligible for Medicare as of June 1, 2012. This is two years after the date of entitlement of June 1, 2010 (or two years plus the five-month waiting period that applies to all Social Security disability cases).
In many cases, because the Social Security Administration takes so long to decide cases, you may be approved for Medicare benefits around the same time you are approved for SSDI benefits. In other words, because many claims take two years to get to a judge, you may have already “served” the required two-year wait for Medicare benefits by the time you receive your first Social Security disability check.
In Title XVI Supplemental Security Income claims, you are eligible for state Medicaid benefits. There is no waiting period for Medicaid. A disabled claimant is eligible for Medicaid benefits as of the disability onset date.
In “concurrent claims” where the claimant is eligible for both disability insurance benefits and SSI benefits, then the claimant may be eligible for Medicaid during the first 2 years and 5 months of the disability, and then eligible for Medicare after the 2 year 5 month elimination period.
Auxiliary / Family Benefits
You may be eligible to receive additional benefits for your spouse or minor or disabled children. These are commonly referred to as “auxiliary” SSDI benefits.
For more information on applying for disability benefits or appealing a denial, call Pensacola attorney Nick A. Ortiz at (888) 321-8131 for a free case evaluation.