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SSI - You do not qualify

Discussion in 'Social Security / Disability Benefits' started by Jennannshear, Jan 30, 2010.

  1. Jennannshear

    Jennannshear Registered

    My daughter checked our mail this morning.. I received a letter from SSI. They decided I did not quality for SSI. It stated all the agencies that helped with my claim.. All my doctors were listed. It goes on to state that my condition is not sever enough to keep me from working .. The medical evidence shows that I have some difficulties but does not show a nature that could prevent me from certain kinds of work. Based on my age, my education and experience they feel I can perform light work.. For example a maximum of 25lbs, with out frequent lifting or carrying of objects weighing over that.. A job that would not require me to climb or balance, a job that does not require me to drive or operate machinery and would not expose me to dangerous conditions.. SO my next step is to appeal right? I know some people who can help me with that BUT here is my main issue. W were all covered for health insurance with medicaid due to where our income landed us and then not too long ago my husband was promoted to supervisor and we lost our rental assistance and food stamps and was told as of April we would no longer get medicaid. With his new income he qualified for the children to be covered under child health care plus but we made $90 over the threshold for family health care plus. My husband has what is called a fringe benefit.. So every month on top of his pay his job offers $391 to put 1sttowards health coverage (blue cross blue shield) or if your covered towards other things such as a 401 or insurances and the like.. So come April, my children will have coverage and so will my husband BUT I will no longer have any health coverage. I would have to pay to get coverage OR payout of pocket to cover my medical expenses which are about $500 a month.. Boy amd I crying now.. It looks like I am screwed.:worried:
  2. KarolH

    KarolH Registered

    I am confused as to why your husband and kids will have health benefits but you won't come April, your his wife so why are you not covered?
    OK, with that said it seems you are up against a clock here for time so I would advise you get a attorney immediately and let them fight this for you.
    Attorneys get approval much quicker then we do fighting on our own. You pay nothing up front and when/if you win they take money from your retro check.
    Also, there is a company called Allsup, (spelling?) that offers free help to folks that have been denied.
    I wish you luck moving forward and I am sorry you were denied but somehow it does not surprise me. Most people are denied first time around.
  3. Jennannshear

    Jennannshear Registered

    Hello. : ) Oh well income wise my children will get covered but he makes too much for us to be.. hisjob has insurance that will pay for him OR he can have money taken out for me.. however it is very expensive and I would still have to hit the deductable (sp?) before it covered anything.. UGH. Tomorrow I am going to spend my day figuring this all out. My husband will take a pay cut if he has too.
  4. KarolH

    KarolH Registered

    Well I would still advise you to hire a attorney to fight this.
    Again, I am sorry you were denied, that stinks.
  5. Maia

    Maia Registered

    I would recommend your husband taking the pay cut in order to insure you. When you have a gap in coverage there can be big problems for a variety of reasons. These days, most people will have to have a reduction in pay in order to have coverage for their family so this is really not that unusual. Unfortunate - but not unusual. About the only way for a person with lupus to get health insurance is through work of self of spouse; or getting on SSD/Medicare.

    Towards that end, I am thinking that this is your first response from SSD following your application for disability? A denial is practically inevitable, and you can probably expect one more. Then there will be a hearing/judge and that is where you will most likely be approved. Allsup is not a free service, they will take their slice just like a lawyer would. For those of us on private LTD whose companies use Allsup to get us approved, then it is free in that our LTD company absorbs the cost instead of us. But they do have a very high success rate and are VERY thorough and have a lawyer represent you for the judge as well. Many people will wait to hire a lawyer until after the second denial, but you could hire a lawyer or use Allsup to help you right now.

    Good luck to you.
  6. sam101360

    sam101360 Registered

    Just to clarify...SSI is based on income and need, all you need to qualify is a low enough inco0me for financial support and a qualifying medical condition for Medicaid. Lwayers do not help with SSI as far as I know as the payments are too small for them to be able to charge a fee. Social Security Admin and Family services are the only ones I know of who help you get SSI. SSI is evaluated frequently and you must report income and expenses to the governemnt to continue coverage. With SSI you can get money without medical coverage if you meet the income levels.

    SSDI is insurance that you paid for when you were working. They have a minimum requirement for time worked that must be met to be able to file fo rthis insurance. If you meet the required amount of time worked, then a lawyer is the right way to go to get this coverage. Then you just need to prove the medical need to stop working. If/when approval comes it is retro back to when you first filed. Medicare had a 24 month waiting period, so if you havent been in the system for 2 years you will still have to wait for medical coverage until that period has been met. You will recieve payment based on the highest income you made for the longest time (if at one point you earned 50K a year for 2 years then your salary dropped to 25K a year before you stopped working....your benefit would be based on the 50K as you worked it for 4 quarters).

    Medicade pays for Drs, hospitals, durable medical equipment and prescriptions with no cost to you. Although there are some restrictions.

    Medicare Part A is free (hospitalization - has a small deductible anually). Part B is deducted from your benefit (minimum is $98 a month and is calculated based on annual income from the previous years tax return). Part D is Optional - if you do not have prescrition coverage you will want this...I am unsure of the cost as I have RX coverage. Supplemental plans are availabe for a decent price ( I have seen them from $0 - $150 a month)...these offer a greater range of coverage for services, but usually require a co-pay to defray the additional costs of better coverage...they can also offer a better RX plan and dental/vision coverage as well.

    I am sorry this was so long, but I felt the need to clarify incase you have been persuing an improper route for coverage.

    If I can answer any additional questions or offer any further information, please let me know.

  7. greenhaggis

    greenhaggis Registered

    Thanks for suppying this there a website that can colborate this information, if so can you please supply the links...thanks!

  8. Jennannshear

    Jennannshear Registered

    Thanks.. much needed info! I was denied ssdi because I did not have enough working hours.. so the next step was ssi. I was denied ssi only this one time. I called and spoke with the local ssi and I was told that I could go to the local social services building and apply for what is called AD.. so I called. I was told they will send out my packet and basically that means I am applying for Medicaid only (not cash assistance) and its a different set up from ssi.. since ssi denied me I can send in my medical info that says I have lupus and seizures and that would qualify me for medicaid only.. I would have to recert every year. My husbands income is too much. He makes a few hundred more a month then the cut off for allowance.. (make sense?) LOL
    I feel better about it. It takes up to 30 days bc it has to go to Albany but I am covered until April so I will send tha AD disability packet out asap and also try for ssi again.. wish me luck. AND thanks again for the support!
  9. sam101360

    sam101360 Registered


    This information is a composite of alot of information that I researched for myself and a firend. I am afraid there doesn't seem to be a single site that lays all this out for people.

  10. KarolH

    KarolH Registered

    Jenn sorry I gave wrong info, I thought Allsup was a free service.
    Good luck as you move ahead and fight this.
  11. Jennannshear

    Jennannshear Registered

    I am going to just remain or try to be calm.. go with the flow.. I have a feeling it will all work out.. call it intuition or maybe emotional highs and lows due to decrease in steroids.. ; ) either way I think I will be ok.. I hope.

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