Kidney disease is a debilitating condition that can affect a person’s ability to work and earn an income. The Social Security Administration (SSA) administers two disability benefit programs if you cannot work due to a medical condition: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The following information provides information on the disability programs, eligibility for benefits due to kidney disease, and how to apply for benefits.
What is SSDI and SSI?
Both SSDI and SSI are disability benefit programs available for people who meet the SSA’s definition of disability, which is the inability to engage in substantial gainful activity due to a medically determinable physical or mental impairment(s) that is expected to last a year or more or result in death. The major difference between the two programs is that SSDI provides benefits to people who are disabled and have a qualifying work history, either through their own employment or through a spouse or parent, while SSI is a needs-based program for people with a disability and limited income and resources.
Monthly SSDI benefit amounts are related to your work history and career-average earnings in jobs covered under Social Security. The average monthly benefit amount for a SSDI recipient is $1,122 (as of March 2020).
Monthly SSI benefit amounts are based on the amount of your countable income, such as wages, Social Security benefits, unemployment benefits and pensions, as well as income from a spouse with whom you live. The average monthly benefit amount for an SSI recipient is $574. The maximum federal monthly SSI benefit amount is currently $783 for an individual and $1,175 for a couple, and some states supplement the federal SSI benefit with additional payments. Since SSI is needs-based, if you have income greater than the maximum SSI benefit amount and own countable resources that are worth more than $2,000 for an individual or $3,000 for a couple, you may not be eligible for SSI benefits. Countable resources include cash and financial assets that can be turned into cash, such as stocks, bonds and real estate. But they do not include the home you live in, a vehicle you rely on for transportation, or household goods.
You can qualify for both SSDI and SSI benefits if you meet the work history requirements and have limited income and resources.
Eligibility due to kidney disease
The SSA maintains a Blue Book with a list of impairments that qualify for disability benefits. The list of impairments is just one part of how the SSA determines if you are disabled and eligible for benefits. For adults, they also consider past work experience, severity of medical conditions, age, education, and work skills.
Kidney disease is found at section 6.00 Genitourinary Disorders. For a person’s kidney disease to be considered a disability by the SSA, one of the following must be true. You have:
- Chronic kidney disease and are on hemodialysis or peritoneal dialysis.
- Chronic kidney disease and a kidney transplant less than one year ago.
- Chronic kidney disease, with impairment of kidney function, with A and B:
A. Reduced glomerular filtration evidenced by one of the following laboratory findings documented on at least two occasions at least 90 days apart during a consecutive 12-month period:
- Serum creatinine of 4 mg/dL or greater; or
- Creatinine clearance of 20 ml/min. or less; or
- Estimated glomerular filtration rate (eGFR) of 20 ml/min/1.73m2 or less.
B. One of the following:
- Renal osteodystrophy with severe bone pain and imaging studies documenting bone abnormalities, such as osteitis fibrosa, osteomalacia, or pathologic fractures; or
- Peripheral neuropathy; or
- Fluid overload syndrome documented by one of the following:
- Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg despite at least 90 consecutive days of prescribed therapy, documented by at least two measurements of diastolic blood pressure at least 90 days apart during a consecutive 12-month period; or
- Signs of vascular congestion or anasarca despite at least 90 consecutive days of prescribed therapy, documented on at least two occasions at least 90 days apart during a consecutive 12-month period; or
- Anorexia with weight loss determined by body mass index (BMI) of 18.0 or less, calculated on at least two occasions at least 90 days apart during a consecutive 12-month period.
- Nephrotic syndrome, with A and B
A. Laboratory findings as described in 1 or 2, documented on at least two occasions at least 90 days apart during a consecutive 12-month period:
1. Proteinuria of 10.0 g or greater per 24 hours; or
2. Serum albumin of 3.0 g/dL or less, and
- Proteinuria of 3.5 g or greater per 24 hours; or
- Urine total-protein-to-creatinine ratio of 3.5 or greater.
B. Anasarca persisting for at least 90 days despite prescribed treatment.
- Complications of chronic kidney disease requiring at least three hospitalizations within a consecutive 12-month period and occurring at least 30 days apart. Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
How to apply for SSDI and SSI
Applying for disability benefits can be done online on the SSA’s website or by calling their toll-free number, 1-800-772-1213. SSA representatives can make an appointment for an application to be taken over the telephone or at any convenient Social Security office.
People who are deaf or hard of hearing may call SSA’s toll-free "TTY" number, 1-800-325-0778, between 8:00 a.m. and 5:30 p.m. on Monday through Friday.
The SSA recommends having the following information on hand to make the application process easier:
Information About You
- Your date and place of birth and Social Security number
- The name, Social Security number and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate)
- Names and dates of birth of your minor children
- Your bank or other financial institution's Routing Transit Number [more info] and the account number, if you want the benefits electronically deposited into your bank account
Information About Your Medical Condition
- Name, address and phone number of someone SSA can contact who knows about your medical conditions and can help with your application
- Detailed information about your medical illnesses, injuries or conditions:
- Names, addresses, phone numbers, patient ID numbers and dates of treatment for all doctors, hospitals and clinics;
- Names of medicines you are taking and who prescribed them; and
- Names and dates of medical tests you have had and who sent you for them.
Information About Your Work
- The amount of money earned last year and this year
- The name and address of your employer(s) for this year and last year
- A copy of your Social Security Statement
- The beginning and ending dates of any active U.S. military service you had before 1968
- A list of the jobs (up to 5) that you had in the 15 years before you became unable to work and the dates you worked at those jobs
- Information about any workers' compensation, black lung, and/or similar benefits you filed, or intend to file for. These benefits can:
- Be temporary or permanent in nature;
- Include annuities and lump sum payments that you received in the past;
- Be paid by your employer or your employer's insurance carrier, private agencies, or Federal, State or other government or public agencies; and
- Be referred to as:
- Workers' Compensation;
- Black Lung Benefits;
- Longshore and Harbor Workers' Compensation;
- Civil Service (Disability) Retirement;
- Federal Employees' Retirement;
- Federal Employees' Compensation;
- State or local government disability insurance benefits; or
- Disability benefits from the military (This includes military retirement pensions based on disability but not Veterans' Administration (VA) benefits.)
Documents that the SSA may ask a person to provide include:
- Birth certificate or other proof of birth;
- Proof of U.S. citizenship or lawful alien status if you were not born in the United States [more info];
- U.S. military discharge paper(s) if you had military service before 1968;
- W-2 forms(s) and/or self-employment tax returns for last year;
- Medical evidence already in your possession [more info]. This includes medical records, doctors' reports, and recent test results; and
- Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers' compensation-type benefits you received [more info].
Appealing a decision
If your initial claim for SSDI or SSI benefits is denied, you can appeal the decision. You typically have 60 days from when you receive a notice of the SSA’s decision to file an appeal. There are four levels of appeal, including reconsideration, a hearing with an administrative law judge, a review by the Appeals Council, and a review by a federal court. The SSA’s notice on their decision will include a letter explaining their determination and guidance on which level of appeal you should select.
Many times a claim denial will be due to technical errors in the application process or because of lack of medical evidence. It is important to take your time when completing your application to ensure the information you are submitting is accurate and complete.
Other information resources
All of the above information and more can be found at the SSA’s disability benefits website: https://www.ssa.gov/benefits/disability/