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Get the facts about disability benefits and make informed decisions about your options. Learn about eligibility, benefit calculations, application processes, and strategies to navigate the system successfully.
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This video covers all the sections on this page and provides additional insider tips to help you understand your options and maximize your benefits.
Understanding eligibility requirements for both SSDI and SSI
How to navigate the application and appeals process
Working while receiving disability benefits
Medicare and Medicaid coverage for disability recipients
To qualify for Social Security disability benefits, you need to meet specific medical and non-medical requirements established by the Social Security Administration.
Social Security Disability Insurance (SSDI) is for people who have worked and paid Social Security taxes. It provides monthly benefits if you become disabled before reaching retirement age and are unable to work.
Supplemental Security Income (SSI) is a needs-based program for people with limited income and resources who are disabled, blind, or 65 or older.
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Some people can qualify for both SSDI and SSI if their SSDI benefit is low enough and they meet the SSI resource limits. This is called "concurrent benefits."
Social Security's definition of disability is different from other programs like workers' compensation or Veterans Affairs. You might qualify for those programs but not for Social Security disability benefits.
To qualify for disability benefits, you need to meet specific requirements. For SSDI, you need enough work credits and a qualifying disability. For SSI, you need limited income and resources along with a qualifying disability. Understanding these requirements can help you determine which program might be right for you.
To qualify for SSDI, you must:
To qualify for SSI, you must:
Dealing with a serious illness like Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD) is tough enough without having to wrestle with complex government benefits. This FAQ is designed to give you straight answers about Social Security disability benefits and Medicare, in plain English, to help you and your family understand your options.
If you or a loved one is facing ALS, here’s what you need to know about getting help:
Pretty much, yes. ALS is considered a Compassionate Allowance condition by Social Security. This means that if your medical records clearly show an ALS diagnosis, your application for Social Security Disability Insurance (SSDI) should be processed much faster than many other conditions. You still need to meet the non-medical requirements for SSDI(like having enough work credits), but the medical approval for ALS is generally expedited.
Great news here! Thanks to the ALS Disability Insurance Access Act, the five-month waiting period for SSDI benefits is waived for individuals with ALS. This means your SSDI payments can start as soon as your application is approved, which is a huge relief.
More good news! If you have ALS and are approved for SSDI, you are eligible for Medicare Parts A and B immediately, starting the very same month your SSDI benefits begin. There’s no separate waiting period for Medicare like there is for many other disabilities.
The amount of your monthly SSDI benefit is based on your average lifetime earnings before you became disabled. It’s not a fixed amount for everyone. If you have very limited income and resources, you might also be eligible for Supplemental Security Income (SSI) in addition to or instead of SSDI, though SSI has different financial and resource limits.
If you’re dealing with ESRD, requiring dialysis or a kidney transplant, here’s some information on benefits:
Yes, individuals with ESRD who require ongoing dialysis or have had a kidney transplant generally meet Social Security’s medical requirements for disability. If you also meet the non-medical requirements (like work history for SSDI, or income/resource limits for SSI), you can receive monthly disability benefits.
Medicare has special rules for people with ESRD. You can become eligible for Medicare based on ESRD, even if you’re not yet 65. The timing depends on your situation:
● If you’re on dialysis at a facility: Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments.
● If you’re in a home dialysis training program: Medicare can start as early as the first month of dialysis, provided you started training before the third month and are expected to self-dialyze.
● If you’ve had a kidney transplant: Medicare coverage can begin the month you’re admitted to the hospital for the transplant (if the transplant takes place that month or the following month), or even earlier if you were already on dialysis.
Similar to ALS, if you have ESRD and can no longer work, you might qualify for:
● Social Security Disability Insurance (SSDI): If you’ve worked and paid Social Security taxes, your benefit amount will be based on your earnings record.
● Supplemental Security Income (SSI): If you have very limited income and resources, regardless of your work history, you might qualify for SSI. It’s possible to receive both in some cases if your SSDI is low.
Medicare Part B (which covers doctor’s services, outpatient care, and durable medical equipment, including many dialysis services and supplies) is really important for ESRD patients. While you can technically decline or delay Part B, it’s generally not recommended without very careful consideration. If you delay Part B, you might face a lifelong penalty on your premium, and there could be gaps in your coverage, especially for things like immunosuppressive drugs after a transplant.
When dealing with Social Security, you might hear about being disability insured or currently insured. Let's break down what these mean in a simple way, focusing on what's generally needed for disability benefits.
First, it's helpful to know about work credits. You earn these by working and paying Social Security taxes. You can earn up to four credits each year. These credits help determine if you qualify for benefits.
To get Social Security Disability Insurance (SSDI) benefits if you can no longer work due to a medical condition, you generally need to be "disability insured." This usually means two things:
To get Social Security Disability Insurance (SSDI) benefits if you can no longer work due to a medical condition, you generally need to be "disability insured." This usually means two things:
In simple terms: To be disability insured, you generally need a history of consistent work, including work in the years leading up to when you became disabled. This is the main path to qualifying for your own disability payments.
In 2025, you earn one credit for every $1,810 in covered earnings, up to a maximum of 4 credits per year.
Generally, you need 40 credits (about 10 years of work), with 20 credits earned in the last 10 years ending with the year your disability begins. This is called the 20/40 rule.
Younger workers may qualify with fewer credits based on their age at the time of disability.
For 2025, the resource limits for SSI are:
Resources include:
Some resources are not counted, including:
Some states supplement the federal SSI payment with additional money, which may increase your benefit amount. Check with your local Social Security office to see if your state offers supplemental payments.
Social Security maintains a Listing of Impairments (often called the Blue Book) that describes medical conditions considered severe enough to prevent a person from working. Some of the major categories include:
Even if your condition is not in the listing, you may still qualify if your condition is medically equivalent to a listed impairment or prevents you from working.
It's not just the diagnosis that matters, but how severely your condition affects your ability to work. Medical documentation is crucial to proving your disability.
SSDI and SSI benefits are calculated differently. SSDI is based on your lifetime earnings, while SSI has a fixed maximum amount that can be reduced by other income. Understanding how your benefits are calculated can help you plan your finances and know what to expect if you're approved.
SSDI benefits are based on your average lifetime earnings before your disability began. The formula is complex, but generally:
SSI has a fixed maximum federal benefit rate (FBR) that may be reduced by other income:
You can get an estimate of your SSDI benefit by creating a my Social Security account at ssa.gov and viewing your Social Security Statement.
Applying for disability benefits involves gathering medical evidence, completing forms, and sometimes attending consultative exams. The process can take several months, but being prepared and organized can help things go more smoothly. Learn what to expect and how to strengthen your application.
You can apply for disability benefits in three ways:
The application process includes completing several forms about your medical condition, work history, and daily activities.
Before applying, gather these documents and information:
About 65-70% of initial disability applications are denied, often due to insufficient medical evidence or paperwork errors. Consider getting help from a disability advocate or attorney, especially if you need to appeal a denial.
If your disability claim is denied, don't give up. Many people who are initially denied benefits later win on appeal. The appeals process has multiple levels, and understanding each step can help you navigate the system effectively. You have 60 days from receiving a denial notice to file an appeal.
There are four levels in the appeals process:
Most people who win on appeal do so at the hearing level.
Understanding success rates can help set expectations:
Having representation significantly increases your chances of winning, especially at the hearing level.
Dress neatly but comfortably. Speak clearly and answer questions directly. Don't exaggerate your symptoms, but don't minimize them either. Describe your "bad days" as well as your "good days." If you don't understand a question, ask for clarification. Consider having representation—statistics show represented claimants are more likely to be approved.
It's best to get a representative as early in the appeals process as possible, ideally at the reconsideration stage. This gives them time to develop your case properly. However, it's especially important to have representation for the hearing level, where most cases are won or lost.
After you're approved for disability benefits, Social Security periodically reviews your case to verify you still meet the disability requirements. These Continuing Disability Reviews (CDRs) happen every 3-7 years, depending on your condition. Understanding what to expect can help you maintain your benefits.
How often your case is reviewed depends on the expected improvement of your condition:
Your notice of award should indicate which category applies to you.
During a CDR, Social Security will:
Most people pass their reviews and continue receiving benefits.
Social Security uses a different standard for continuing eligibility than they do for initial applications. They must find "medical improvement" in your condition that enables you to work. This "medical improvement review standard" makes it somewhat easier to keep benefits than to get them initially.
Consider getting representation for a CDR appeal. The standard for continuing benefits (medical improvement) is different from the standard for initial applications, and a representative familiar with CDRs can help make the strongest case for continuing your benefits.
Returning to work while receiving Social Security Disability Insurance (**SSDI**) can feel complicated, but don't worry! Social Security has special rules called "Work Incentives" designed to help you test your ability to work without immediately losing your benefits. This guide breaks down the main rules in a simple, step-by-step way using 2025 figures.
Download Work Incentives Guide for FREE!This guide provides a simplified explanation. It's crucial to always report your work and earnings to the Social Security Administration (SSA) and consult them directly for official guidance specific to your situation. You can find more information at SSA.gov/work or by calling SSA.
SSDI & Work CalculatorThe Trial Work Period, or TWP, is a fantastic work incentive from Social Security. It lets you test your ability to work for 9 months while still receiving your full SSDI benefit check. The best part? During these 9 months, it doesn't matter how much you earn!
Let's say you earn $2,000 gross in June 2025. Since this is over the $1,160 limit for 2025, June counts as one of your Trial Work Period months. You still get your full SSDI check for June.
Once you have used up all 9 of your TWP months within the 60-month (5-year) window, your Trial Work Period ends. Don't worry, there's another safety net! You then move into the next phase, called the Extended Period of Eligibility (EPE).
After your 9-month Trial Work Period (TWP) is complete, you enter the Extended Period of Eligibility, or EPE. Think of this as a 36-month (3-year) safety net that starts the very next month after your TWP ends.
How the EPE Works:
During this 36-month EPE, whether you receive an SSDI check each month depends on if your work is considered "Substantial Gainful Activity" (SGA).
Understanding Substantial Gainful Activity (SGA) for 2025:
Receiving Benefits During the EPE (36 Months):
Here's how your earnings affect your SSDI check during the 36-month EPE:
Example:
Let's say your 9-month TWP ended in July 2025. Your 36-month EPE starts in August 2025. You are not blind, so the SGA limit is $1,620.
What Happens After the EPE?
Once the 36-month EPE safety net period is over, the rules change slightly. Let's look at Step 3.
The 36-month Extended Period of Eligibility (EPE) provides a significant safety net. But what happens once those 36 months are over?
Social Security will continue to look at your work activity and countable earnings each month compared to the Substantial Gainful Activity (SGA) level.
How Earnings Affect Benefits AFTER the EPE:
Example:
Let's say your 36-month EPE ended in July 2028. You are not blind (SGA = $1,620).
What if I Have to Stop Working Again After Benefits Terminate?
Losing benefits after the EPE can feel final, but Social Security has one more important safety net if your disability prevents you from continuing to work at the SGA level. Let's look at Step 4.
Expedited Reinstatement, or EXR, is another valuable safety net. It allows you to potentially restart your SSDI benefits quickly if they ended because your work and earnings were over the Substantial Gainful Activity (SGA) level. The great thing about EXR is that you usually don't have to file a whole new disability application.
Who Might Be Eligible for EXR?
You might be able to use EXR if all the following are true:
How EXR Works:
What Happens After EXR is Approved?
If your EXR is approved and your benefits restart, you get a new chance to test your work abilities down the road. You'll eventually get a new Trial Work Period (TWP) and a new Extended Period of Eligibility (EPE) if you return to work again.
EXR provides peace of mind, knowing that if you try working but find you can't sustain it due to your disability, there's a faster way back onto benefits within that 5-year window.
Okay, so you're exploring work using Social Security's work incentives. We've talked about how your SSDI cash benefits might be affected by earnings, especially related to Substantial Gainful Activity (SGA). A really important question is: "What happens to my Medicare?"
Good news! Social Security and Medicare understand that ongoing healthcare is vital. Thanks to special rules, your Medicare coverage doesn't just disappear when your SSDI checks stop because of work.
Extended Medicare Coverage – A Very Long Safety Net
If you receive SSDI, you usually become eligible for Medicare after a 24-month waiting period from the date Social Security decided your disability began (your date of entitlement).
Once you have Medicare and you return to work, here’s how your coverage is protected:
Think of this extended coverage as a very long runway, allowing you to focus on work without the immediate worry of losing your essential health insurance.
After the Extended Coverage Period Ends What happens after those 93 months (7 years, 9 months) of extended premium-free Part A are over?
If your SSDI cash benefits stopped because of your work, and you are still disabled but under age 65, you don't necessarily lose Medicare entirely. You may have the option to purchase Medicare coverage:
Social Security will notify you before your premium-free Part A coverage ends, explaining your options for purchasing coverage.
Help with Medicare Premiums?
Paying Medicare premiums can be a concern. If you have limited income and resources, there are Medicare Savings Programs (MSPs) run by your state Medicaid agency that might help:
Healthcare coverage is a crucial benefit for people with disabilities. SSDI recipients get Medicare after a waiting period, while most SSI recipients get Medicaid immediately. Understanding your health coverage options can help you access the care you need and plan for medical expenses.
Or, call Dr. Ed's Trusted Partner, Chapter Medicare, NOW: at 352-841-0632
SSDI recipients qualify for Medicare after receiving benefits for 24 months. Medicare includes:
You can also choose a Medicare Advantage plan (Part C) instead of Original Medicare.
In most states, SSI recipients automatically qualify for Medicaid. Medicaid typically covers:
Coverage and eligibility rules vary by state.
If you qualify for both Medicare and Medicaid (dual eligible), most of your healthcare costs will be covered. Medicaid will pay your Medicare premiums and fill most coverage gaps. Look into Special Needs Plans (SNPs), which are Medicare Advantage plans specifically designed for dual eligibles.
Contact your state Medicaid office or a State Health Insurance Assistance Program (SHIP) counselor for personalized help understanding your options. Benefits counselors at Centers for Independent Living or disability rights organizations can also provide guidance.
Here are answers to common questions about Social Security disability benefits. These FAQs address issues not covered in other sections and provide quick answers to questions we hear most often from people navigating the disability benefits system.
Before he became the go-to guru for government benefits on his YouTube channel, MyGovExpert, Dr. Ed was a District Manager for the Social Security Administration. That's right, he wasn't just reading the rulebook; he was living it, managing the folks who make the decisions. If you've ever felt like SSA speaks a different language, Dr. Ed is your translator. He's seen it all, heard it all, and now he's here to share that invaluable insider experience with you, cutting through the red tape with a healthy dose of common sense (and maybe a terrible joke or two).
Buthis journey didn't start there. Long before navigating bureaucratic hall ways, Dr. Ed served his country with distinction as a Sergeant in the United States Marine Corps. Semper Fi! That discipline and commitment to service are still a core part of who he is today.
His dedication to public service also led him to a role as a Family Services Specialist with the Department of Social Services, giving him a broad perspective on the challenges many people face. And because he apparently doesn't believe in free time, Dr. Ed has also been shaping young minds as a University Adjunct Professor.
With a PhD to his name and a wealth of real-world experience, Dr. Ed Weir isn't just an expert; he's your expert. He's passionate about helping people understand their benefits and get what they're entitled to. So, if you're looking for some one who can explain complex government stuff in plain English, with a bit of humor and the authority that only comes from having been there, you've found your guy.
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