Title II Old-Age, Survivors, and Disability Insurance

Next Topic: Title XVI Supplemental Security Income

  • Title II Programs are “insurance” programs to replace income lost to a family through the retirement, death, or disability of a worker.
  • The Old-Age and Survivors Insurance (OASI) program provides benefits to retired workers and their dependent family members and to survivors of deceased workers.
  • The Disability Insurance (DI) program provides benefits to disabled workers, their spouses, and children (whether or not disabled).
  • The OASDI program and the Medicare program are primarily financed through the collection of payroll taxes under the Federal Insurance Contributions Act (FICA).

Disability Insurance Benefit (DIB commonly called SSDI)

  • Must be fully insured.
  • Must also meet a Disability Insured Status requirement:
    • must have worked in covered employment for at least 5 of the 10 years (20 out of 40 quarters) before the onset of disability or
    • for persons who are blind or became disabled before age 31, a less restrictive insured status requirement must be met.

20 CFR 404.110, 404.120, 404.130

Definition of Disability

The medical standards for disability are the same for all three Title II groups and SSI for individuals age 18 or older.

Definition of Disability - Child

There is a separate definition of disability under SSI for children from birth to age 18.

Definition of Disability - Adult

"The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Medically determinable physical or mental impairment

  • The disability can be documented by a qualified medical examiner
  • Based on the definition of disability, a sequential evaluation process involving five distinct steps is applied in making the disability decision

Substantial Gainful Activity

“The performance of significant physical and/or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit, regardless of the legality of the work.”

  • $1,170 per month in 2017 for an individual with a disability other than blindness.
  • $1,950 per month in 2017 for a person who is blind.
    • Individuals who are blind and applying for SSI do not need to meet an SGA test but rather a test to ascertain level of blindness.
  • Individuals cannot be working at the time of application or, if working, cannot be earning more than the substantial gainful activity level or SGA.

Medicare

  • Medicare is a nationwide health insurance program for the aged and certain disabled persons. For more detailed information, see Medicare & You 2017.
  • Automatic enrollment after receiving Title II disability benefits for 24 months. (Exception: no wait for those with ERSD and ALS.)
  • Automatically enrolled in Medicare with RIB at Full Retirement Age (not w/Early Retirement).
  • The program consists of four parts
    • Part A, hospital insurance (HI),
    • Part B Medical Insurance,
    • Part C Medicare Advantage Plans,
    • Part D Medicare Prescription.