Understand SSA’s Decision

The Social Security Administration (SSA) may take six months or more to decide if you have a disability. If you have a disability and are insured, you qualify for Social Security Disability Insurance (SSDI) benefits.

Social Security sends you a letter called a disability determination notice, which tells you whether they approved or denied your application.

Note: If you are an adult and your disability began before you turned 22, you may qualify for Childhood Disability Benefits (CDB) even if you do not have a work record.

If You Are Approved for SSDI

If you are approved for SSDI:

  • SSDI benefits start at least five full months after your disability began. This is called the waiting period.
    • Note: If you are approved for SSDI more than five months after your disability began, you may get a retroactive benefits payment that covers the months since the five-month waiting period ended. Example: You are approved for SSDI eight months after your disability began, so you get a one-time payment that covers your SSDI benefits for the last three months (since the fifth month after your disability began).
  • The amount you get depends on your Social Security earnings record. Generally, the more you worked and paid in Social Security taxes, the more you get in SSDI benefits.
  • Your SSDI benefits go into your bank account automatically each month. If you don’t have a bank account, you can have your SSDI benefits put onto a Direct Express debit card that you can use in stores to make purchases.
  • Your children under age 19 may also qualify to get benefits based on your work record in any month you get SSDI benefits. Your spouse may also get benefits if age 62 or older or if caring for a child under 16. It doesn't matter whether they have disabilities. Learn more about these benefits.
  • Medicare health coverage automatically starts after you get SSDI or CDB benefits for two years (24 months). Learn more about Medicare in DB101's How Health Benefits Work article.
Example

Silvio’s disability begins on April 22, 2018, but he has to wait five months (May, June, July, August, and September) until his SSDI benefits begin. His first SSDI payment is for October 2018, but SSDI sends payments one month after they are due, so he doesn’t get his first payment until November 2018.

Silvio has to wait another two years, until October 2020, for Medicare coverage. While he’s waiting for Medicare, Silvio applies for Medicaid.

Medicare and Medicaid if you get SSDI

If you are approved for SSDI, you get Medicare two years after your SSDI benefits begin. During these two years, you may be able to get Medicaid coverage.

Once your Medicare coverage begins, there are a couple of ways you may qualify for Medicaid.

  • APA-related Medicaid is for people with disabilities, including people on SSDI. For APA-related Medicaid, you must have low income and low resources.
  • The Working Disabled Medicaid Buy-In program is for people with disabilities who have higher earned income and resources.

If you qualify for Medicare and Medicaid (or the Working Disabled Medicaid Buy-In) at the same time, you have lower overall medical expenses, because Medicaid covers some medical expenses that Medicare doesn’t cover; you may also pay less for Medicare premiums and deductibles.

Learn more about Medicare, APA-related Medicaid, and Working Disabled Medicaid Buy-In in DB101's How Health Benefits Work article.

If You Are Denied SSDI Benefits

You may be denied benefits if Social Security says you are not insured or you do not have a disability. If you are not insured, you may still qualify for another Social Security benefit for people with disabilities called Supplemental Security Income (SSI). Learn more about SSI in DB101’s SSI and APA article.

Appeals

You have the right to file an appeal if you feel that Social Security made an incorrect decision about things like the disability determination, a Continuing Disability Review (CDR), or an overpayment:

  • After you get a denial letter, you have 60 days to file an appeal. Do it quickly. If you don’t appeal within 60 days, you may lose the right to appeal.
    • If you are appealing an overpayment, appeal within 30 days to avoid having your benefits withheld while your appeal is reviewed.
    • Note: Social Security figures that you get a letter within five days after they sent it.
  • If you are denied SSDI benefits for medical reasons, you can file your appeal online or call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and ask them to send you an appeal form. If you file online, you need to mail or deliver any new information to Social Security about your medical condition, including updates on any treatment, tests, or doctor visits.
  • If you are denied SSDI benefits for nonmedical reasons, you can request a review from your local Social Security office or by calling Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).

File an appeal as quickly as possible. Once you file your appeal, it may take several months to resolve.

Note: If your application for SSDI benefits is denied and you disagree with the decision, file an appeal. Do not just fill out the application forms again — that would be refiling.

The appeal process

There are four levels to the appeal process. If you are not satisfied with the result at each level, you can appeal to the next.

The four levels are:

  1. Reconsideration: A person at Social Security who wasn’t involved in the first decision looks at your application. This is a paper appeal, so you don’t have to go in front of a judge. Give Social Security any new information you have about your case.
    • Note: In Alaska, if you appeal a disability determination, there is no reconsideration. You skip straight to a hearing.
  2. Hearing: If the reconsideration is denied, you can ask for a hearing before an Administrative Law Judge. You can bring witnesses to help make your case. Consider having an attorney or representative help you.
  3. Appeals Council: Social Security’s Appeals Council reviews your case if you appeal the decision the Administrative Law Judge made. The Council can accept the judge’s decision, decide the case for itself, or send it back to a different Administrative Law Judge for another hearing.
  4. Federal Court: If the Appeals Council decides against you, you can file a lawsuit in federal court.

For any level beyond the reconsideration, you may want to get help from a lawyer. NOSSCR (1-800-431-2804) is a national association of attorneys who represent people who think they’ve been unfairly denied Social Security benefits. The Disability Law Center of Alaska (1-800-478-1234) and Alaska Legal Services are statewide legal resources that can help.