Complications during pregnancy can be debilitating, rendering the patient unable to engage in or retain employment. As Social Security Disability Insurance (SSDI) is intended for individuals whose disability prevents them from working, you may wonder how pregnancy can affect SSDI benefits.
Unfortunately, it is not possible to get SSDI for pregnancy alone. However, if you have developed a long-term, debilitating condition during your pregnancy, then you may be eligible for SSDI benefits.
Keep reading below for more information on how pregnancy affects SSDI benefits.
SSDI Overview and Eligibility
The Social Security Disability Insurance (SSDI) program is a government initiative that provides assistance in the form of monthly payments to individuals who have worked and paid Social Security taxes but who are now suffering from disabilities that restrict their capacity to work.
For SSDI, there are two main requirements:
- You need to be “insured.” To qualify for SSDI benefits, you must have worked for a certain amount of time in a job that paid into Social Security taxes.
- You need to be disabled according to Social Security’s guidelines. There are five criteria that are considered in the disability determination process.
Therefore, in order to qualify for Social Security Disability Insurance benefits, you must fulfill both of these requirements. But there are other scenarios in which you can be eligible for similar Social Security benefits:
- You may be able to get Childhood Disability Benefits (CDB) as an adult if you were disabled before you turned 22.
- If you are under the age of 19 and a parent is receiving Social Security disability income or retirement benefits or is deceased, you may be eligible for child benefits. You don’t need to be disabled.
- You might be able to get disabled widow(er) benefits if your partner or ex-spouse is eligible for SSDI or Social Security retirement benefits or was eligible before they died.
The total amount that you receive every month from SSDI or any of these additional benefits is determined by your Social Security earnings history or the earnings history of your parent or spouse, if you are eligible.
Your benefit amount is directly proportional to your work history and Social Security tax contributions. Medicare health coverage is automatically granted after receiving benefits for two years.
Is Being Pregnant a Disability?
No, pregnancy is not viewed as a disability by the Social Security Administration, which oversees the SSDI and Supplemental Security Income (SSI) programs. According to the Social Security Administration, a person is considered disabled if they are unable to work due to a medical condition that has lasted for a full year or more, is expected to last for a full year, or will result in death.
In most cases, pregnant women cannot apply for disability benefits through Social Security because not even the most severe pregnancy-related symptoms are expected to last for a full year.
But you might be able to get coverage for pregnancy-related conditions through a short-term disability insurance policy.
When Pregnancy Can Qualify for SSDI
The body goes through a lot of changes while pregnant. Some people’s bodies are able to make the change with ease, while others have difficulty.
Since pregnancy is a temporary condition, it is not enough to get Social Security disability payments. In order to be eligible for disability benefits, your condition must be expected to last for a period of at least one year.
Postpartum Depression
Postpartum depression is probably something you’re familiar with. These are the feelings of guilt and sadness that some moms have after giving birth, which can lead to depression. The difference, though, is whether the sadness is mild and temporary, like the so-called “baby blues,” or severe and debilitating.
If the postpartum symptoms are just the temporary “baby blues,” then they do not constitute a disability. But if the symptoms continue and worsen over time, you could be able to get disability benefits.
It can be very challenging to receive benefits due to this condition; therefore, you must visit a physician and a psychiatrist regularly. This will not only verify that your postpartum depression has become long-term, but it will also potentially enable you to receive the care that is required to avoid the disability altogether (if that is even possible).
Physical Conditions
The majority of people know that giving birth is an extremely taxing physical experience. But it might also cause further problems for the mother. Diabetes can render you disabled, and for women, pregnancy can make this disability more complicated, worse, or even cause it.
Even if gestational diabetes does not last forever, it does increase your chances of developing type 2 diabetes later in life. So, if you were pregnant and then developed diabetes, you might be eligible for SSDI.
There are also other health risks besides the risk of getting diabetes. If the mother sustains an injury or other long-term damage as a result of the pregnancy, then there is a risk that the mother will develop a permanent disability. If a mother sustains a disabling injury as a result of a breech birth or another complication, then she may be eligible for disability benefits and get compensation for her injuries.
Having said that, we want to reiterate that long-term pregnancy-related disabilities are quite uncommon. It’s not completely impossible, but it is unlikely. Pregnancy alone is not a qualifying condition for SSDI.
Can the FMLA Help?
It is commonly believed that SSDI short-term benefits can be obtained through the FMLA (Family and Medical Leave Act). However, the FMLA guarantees that an employee can return to their job after fulfilling family obligations during an unpaid break, not that they should receive benefits.
In most cases, a mother can only take up to twelve weeks of leave to give birth or care for a newborn. Those twelve weeks will not be compensated in any way. This is terrible news for many new parents because they will not only have to pay more for a child but also lose a source of income.
Despite popular belief, the Family and Medical Leave Act does not offer the protections that many workers need.
Other Disability Benefit Programs for Pregnancy
Even if you are not eligible for SSDI due to a pregnancy, you may be able to obtain other disability benefits in the form of:
Short-Term Disability Benefits
There is a misconception that Short-Term Disability (STD) insurance only applies to injuries that happen on the job. In addition to covering those injuries, short-term disability insurance generally includes disability insurance for pregnancy and offers substitute income in the event that you are unable to work because of a variety of illnesses or injuries, regardless of whether they happened on the job or not.
If a doctor certifies that a pregnant woman is unable to work because of her pregnancy, delivery, or recovery, she may be eligible for payments under a short-term disability plan. Depending on the type of delivery, a woman who has a short-term disability via her employment may be eligible to receive 50 to 70 percent of her pay for six to eight weeks following the birth.
In some cases, a pregnancy complication can be treated like an illness so that the coverage time could be longer. Make sure you know what your policy covers before you go on leave because different policies have different requirements. You should also see your HR manager for guidance on how to file claims for either private or public disability insurance properly.
Long-Term Disability Insurance
Since long-term disability insurance plans usually have a longer elimination period, they will not cover a normal pregnancy and recovery, whether you have it via your employer or as an individual policyholder.
But just like with STD coverage, complications can arise, and if one of those complications leaves you unable to work, Long-Term Disability (LTD) will often cover it as long as the disability meets the benefit waiting period.
Pregnancy can also exacerbate other health issues, including diabetes or multiple sclerosis, that were previously manageable. Even if you’ve never had a mental health problem before, taking time off work due to postpartum depression may be covered by your LTD policy.
A word of caution with LTD coverage: the elimination or waiting time before benefit payments begin is usually somewhat longer than with short-term disability. There is usually a two-week waiting time for an STD plan and an elimination period of sixty to ninety days (or perhaps a full year) for an LTD plan.
It is possible for an individual to obtain their insurance policy, or an employer may do it on the individual’s behalf. Disability insurance, in contrast to many other forms of employer-provided disability benefits, usually pays out regardless of whether the injury occurred at work or not; hence, it commonly covers medical expenses associated with pregnancy.
How to Tackle a Pregnancy-Related Disability Insurance Denial
When a disability claim, including a pregnancy, is denied, it is usually because the disability will not prevent the individual from working for at least one year. The majority of impairments caused by pregnancy typically resolve within 12 weeks. But there are always cases in which someone can get disability benefits based on their pregnancy.
Individuals may be eligible for SSDI if they are informed by their healthcare providers or medical team that they are unable to work for longer than a year. This usually happens to pregnant women who are dealing with complicated or high-risk pregnancies.
Naturally, someone who is pregnant and on SSDI will always face very unique problems. If your medical team told you that you would not be able to work, you might need to talk to an SSDI lawyer.
Other Ways to Financially Prepare for Pregnancy
The decision to have a child is a significant financial commitment. However, you can alleviate some of the financial strain you’re experiencing with just a little bit of preparation.
Begin Saving Immediately
Begin putting money down for maternity leave as soon as you can, preferably before you become pregnant. In fact, it’s a good idea to start saving with the initial income. Separate your funds into two accounts: one for immediate expenses and another for savings and investments.
For instance, maternity leave is an excellent example of the type of short-term savings that every expectant parent needs to be prepared for.
Learn More About Your Employer-Funded Benefits
Take a look at your employer’s insurance options; they may include more than just short- or long-term disability coverage. As an example, hospitalization indemnity insurance is a common and inexpensive benefit provided by employers that can help with the cost of hospital stays that may be necessary due to birth or pregnancy-related issues.
Make sure you are well-versed in the particular benefits offered by your company before enrolling, as the coverage and reimbursement amounts differ substantially among plans.
Save Your PTO
For extra paid leave days, try not to take as many sick days, personal days, and vacations as you can. Prior to your maternity leave, it is recommended that you save up to 20 Paid Time Off (PTO) days. This will allow you to enjoy a month of pay without having to resort to savings or rely on benefits.
Put Money into Your HSA or FSA
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are specialized accounts that you can use for out-of-pocket medical expenses with pre-tax dollars. FSAs offer you more leeway to use your savings for extras like child care. You can use these to cover the cost of pregnancy-related items, including prenatal vitamins, as well as some of the costs associated with breastfeeding, such as nursing bras, nursing pads, and a pump.
Keep in mind that HSAs and FSAs differ in one important way: unused funds from an HSA can be carried over to the following year, whereas funds from an FSA cannot be saved. You shouldn’t put more money into an FSA than you expect to use that year, but an HSA can be overfunded without consequence.
Conclusion
To sum it up, it is not possible to qualify for SSDI based on your pregnancy alone. Proving a disability due to pregnancy or injuries sustained during childbirth can have its own challenges. In such cases, it may prove helpful to consult a disability attorney who can assist with your application.
