By Deanna Power, Community Outreach Manager, Social Security Disability Help
Hearing loss is one of the most common disabilities in the United States. In fact, according to the Hearing Loss Association of America, nearly one in five Americans report some form of hearing loss.
If you are considering getting a cochlear implant, or if you already have one, there could be financial assistance available to you.
The Social Security Administration (SSA) offers benefits for those who are disabled and unable to work, and it is very important to apply for these benefits as early as possible through the Social Security Administration.
What Forms of Disability Benefits are there?
The SSA offers two types of benefits for people with disabilities. Medical qualifications are the same, but each form of benefits has its own technical requirements applicants must meet.
The first form of disability benefits is called Social Security Disability Insurance, or SSDI. SSDI is only available to adults aged 18-65 who have worked throughout their lives. You can look at a chart describing how many years you need to have worked to qualify on the SSA’s website. Older applicants will be expected to have worked much longer than a 20-year-old who has recently been diagnosed with a severe to profound hearing loss or who has received a cochlear implant.
SSDI recipients can receive up to $2,663 per month in 2015, although the average beneficiary receives around $1,100. Your payment will depend on how high your income was throughout your career.
The second form of disability benefits is called Supplemental Security Income, or SSI. SSI is for people of all ages, but there are strict financial limits for SSI recipients. An adult applying for SSI cannot have more than $2,000 in assets, which include cash, savings, stocks, or life insurance.
Parents applying for benefits on behalf of a child will have their household income and asset levels evaluated. Although the limits are not as strict, many children are disqualified from receiving SSI benefits due to living in a higher-earning household.
SSI recipients can receive up to $733 per month in 2015. Your payment will depend on external financial factors such as household income or monetary support from family members.
Because SSDI benefits are awarded based on your own work record and how much in taxes you paid, a spouse’s income will NOT affect your eligibility. But for SSI applicants, a spouse’s income will affect eligibility because SSI is a strictly needs-based program.
How to Medically Qualify for SSA Benefits with a Severe to Profound Hearing Loss
Whenever the SSA receives an application for disability benefits, it evaluates the applicant’s disability based on its medical guide known as the Blue Book. The Blue Book lists hundreds of disabilities that qualify for both SSDI and SSI benefits. It also describes exactly which test results or symptoms must be present for an applicant to be approved for benefits.
Disability Benefits Before a Cochlear Implant
If you require a cochlear implant but have not received one yet, you can still qualify for disability benefits based on your hearing loss. There are two ways in which you can qualify:
- You have an average air conduction hearing threshold of 90 decibels or greater, plus an average bone conduction hearing of 60 decibels or greater. You will need to have your doctor or someone from Disability Determination Services averages your hearing thresholds at 500, 1000, and 2000 Hertz.
- You recognize 40% or less standardized, phonetically balanced monosyllabic words in your better ear.
Disability Benefits after a Cochlear Implant
Fortunately, the Blue Book listing for a cochlear implant is very straightforward. You can find the listing in Section 2.11, which covers special senses. If you receive a cochlear implant, you will be considered medically disabled for at least 12 months.
After 12 months, the SSA will revaluate your claim. If your hearing loss is still severe and you experience a word recognition score of 60% or less on the HINT exam, you will still qualify for benefits. The HINT (Hearing in Noise Test) is a standard test that measures your ability to hear speech in both quiet and noisy settings.
Children under the age of 18 will medically qualify in a similar fashion. A cochlear implant is considered disabling until age 5, or one year after surgery, whichever is later.
After your child reaches age 5, or 12 months have passed since the surgery (whichever is later), the SSA will revaluate the claim. Children also need to receive 60% or less on the HINT or the children’s version known as the HINT-C to continue to qualify for SSI benefits.
Medical Expense Assistance and Disability Benefits
Cochlear implants can be overwhelmingly expensive. New sound processors for cochlear implants can cost around $10,000. The price from evaluation to actual implant activation can cost $150,000 or more.
Fortunately, applicants who are approved for SSDI or SSI benefits are also eligible for Medicare and Medicaid, respectively. You will be expected to cover just 20% of the payment Medicare agrees upon, saving families well over $100,000. The caveat is that SSDI recipients will only be eligible for Medicare two full years after approval for benefits. Implant centers are often aware of the financial hardship, so many may work with candidates to make ends meet.*
Medicaid, which is available for SSI beneficiaries, should cover the majority of the costs of a cochlear implant. Most US states currently use the SSA’s eligibility criteria. This means that if you are approved for SSI, you will also be automatically enrolled into Medicaid.
About a dozen states have the same Medicaid eligibility criteria as the SSA, but require a separate application. The only states that have their own Medicaid eligibility criteria are Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.
*Information gratefully supplied by Tom Hannon of Cochlear Implant Help
How to Apply for Disability Benefits
If you are applying for SSDI benefits with a severe to profound hearing loss or with a cochlear implant you will be able to complete the entire application online. If you are applying for SSI benefits for yourself or on behalf of a child, you will need to stop by your local SSA office to conduct an interview in person.
The average SSDI or SSI applicant waits around 5 months to be approved. The SSA does have a computer-automated system that can quickly approve disabilities that clearly qualify, such as someone who recently was diagnosed with severe to profound hearing loss or received a cochlear implant. Be sure to keep in contact with your local SSA office to see how far along the application process is and to supply any additional information as necessary.
Appealing a Denial of Benefits
Oftentimes a denial of benefits is caused by improperly completed claim forms, a lack of sufficient medical evidence, or some other error on the part of the applicant. An initial denial of benefits should not sway you from appealing the SSA’s decision, as many current disability recipients have had their benefits awarded through the process of a disability appeal. In fact, 70% of applicants are initially denied, but nearly half of them receive benefits after appealing either online or in front of a judge.
If you are denied benefits for any reason, you have 60 days from the date of the notice to appeal the SSA’s decision. You can appeal the initial denial online. If you are denied again, you can still appeal, but you will need to defend your case in front of a judge.
For more information on the entire application and appeals process, visit the SSA’s website or call them toll-free at 800-772-1213.
About the Author
The above information has been provided by Deanna Power, Community Outreach Manager for Social Security Disability Help. Deanna initially started working with people with disabilities through Best Buddies in college, and now helps people of all ages get through every stage of the Social Security disability application process. If you’d like more help with your claim or have any additional questions, please contact Deanna Power at firstname.lastname@example.org. She can also be reached at 857-366-762.
CochlearImplantHELP.com does not endorse the advocates or attorneys with the Social Security Disability Help website (DisabilityBenefitsCenter.org).