Disability

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.

Video: Understanding SSDI & SSI

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Watch: Your Complete Insider Guide to Disability Benefits

This video covers all the sections on this page and provides additional insider tips to help you understand your options and maximize your benefits.

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Understanding Disability Benefits

To qualify for Social Security disability benefits, you need to meet specific medical and non-medical requirements established by the Social Security Administration.

SSDI: For Workers Who Paid In

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.

  • Based on your work history and earnings
  • Must have enough work credits
  • Includes Medicare after 24 months
  • Average benefit: $1,537/month (2025)

SSI: For Those with Limited Resources

Supplemental Security Income (SSI) is a needs-based program for people with limited income and resources who are disabled, blind, or 65 or older.

  • No work history required
  • Must have limited income and resources
  • Includes Medicaid in most states
  • Maximum benefit: $967/month (2025)
What's the difference between SSDI and SSI?
Key Differences Between SSDI and SSI

Feature

SSDI

SSI

Funding Source
Social Security taxes paid by workers and employers
General tax revenues
Eligibility Basis
Work credits and disability
Financial need and disability, blindness, or age 65+
Health Insurance
Medicare (after 24-month waiting period)
Medicaid (in most states)
Benefit Amount
Based on lifetime earnings
Fixed maximum amount
Resource Limits
No resource limits
$2,000 individual/$3,000 couple (2025)

Insider Tip

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."

How does Social Security define disability?
Social Security's Definition of Disability
Social Security uses a strict definition of disability. To be considered disabled, you must meet all of these conditions:
  • You cannot do work that you did before because of your medical condition.
  • You cannot adjust to other work because of your medical condition.
  • Your disability has lasted or is expected to last for at least one year or to result in death.
Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.

Important to Know

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.

Eligibility for 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.

SSDI Eligibility

To qualify for SSDI, you must:

  • Have worked in jobs covered by Social Security
  • Have earned enough work credits based on your age
  • Have a medical condition that meets Social Security's definition of disability
  • Be unable to perform substantial gainful activity (SGA)

SSI Eligibility

To qualify for SSI, you must:

  • Have limited income and resources
  • Be disabled, blind, or age 65 or older
  • Be a U.S. citizen or qualified alien
  • Live in one of the 50 states, District of Columbia, or Northern Mariana Islands

Amyotrophic Lateral Sclerosis (ALS) and Disability Benefits

If you or a loved one is facing ALS, here’s what you need to know about getting help:

I’ve been diagnosed with ALS. Does this mean I automatically get Social Security disability benefits?

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.

I heard there’s usually a five-month wait for SSDI benefits. Does that apply to ALS?

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.

What about Medicare? How quickly can I get that if I have ALS and am approved for SSDI?

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.

What kind of financial help can I expect with SSDI?

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.

End-Stage Renal Disease (ESRD) and Disability Benefits

If you’re dealing with ESRD, requiring dialysis or a kidney transplant, here’s some information on benefits:

I have End-Stage Renal Disease (ESRD) and need regular dialysis. Can I get Social Security disability 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.

How does having ESRD help me get Medicare? Is there a waiting period?

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.

What about the money side? What kind of Social Security benefits can I get with ESRD?

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.

I keep hearing about Medicare Part B for ESRD. Do I have to sign up for it? What’s the deal?

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. 

What are Social Security Work Credits?

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.

Two different insured requirements?

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:

  • Sufficient Work Over Your Lifetime: You need to have worked long enough and earned enough credits over your working years. For many people, being fully insured is part of this, which can mean having up to 40 credits (roughly 10 years of work). The exact number of credits needed for fully insured status depends on your age.
  • Recent Work: It's not just about how long you've worked in total;  you also need to have worked recently. A common rule is that you must have earned at least 20 of your credits in the 10 years immediately before your disability started. This shows you     have a recent connection to the workforce.

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. 

How many work credits do I need for SSDI?
Work Credits for SSDI

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.

Work Credits Needed Based on Age

Age Disabled

Credits Needed

Years of Work

24 or younger
6 credits in 3-year period before disability
1.5 years
24-31
Credits for half the time between age 21 and disability
Varies
31-42
20 credits
5 years
44
22 credits
5.5 years
44
24 credits
6 years
48
26 credits
6.5 years
50
28 credits
7 years
52
30 credits
7.5 years
54
32 credits
8 years
56
34 credits
8.5 years
58
36 credits
9 years
60
38 credits
9.5 years
62 or older
40 credits
10 years
What are the resource limits for SSI?
SSI Resource Limits

For 2025, the resource limits for SSI are:

  • $2,000 for an individual
  • $3,000 for a couple

Resources include:

  • Cash
  • Bank accounts
  • Stocks, bonds, and investments
  • Real estate (other than your primary residence)
  • Vehicles (beyond one)
  • Anything else that could be converted to cash

Some resources are not counted, including:

  • Your primary home
  • One vehicle used for transportation
  • Household goods and personal effects
  • Life insurance policies with face values of $1,500 or less
  • Burial plots and burial funds up to $1,500
  • Property essential for self-support

Insider Tip

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.

What types of disabilities?
Qualifying Medical Conditions

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:

  • Musculoskeletal disorders (back problems, arthritis)
  • Special senses and speech (vision and hearing loss)
  • Respiratory disorders (COPD, asthma)
  • Cardiovascular conditions (heart failure, coronary artery disease)
  • Digestive disorders (liver disease, IBD)
  • Genitourinary disorders (kidney disease)
  • Hematological disorders (blood disorders)
  • Skin disorders
  • Endocrine disorders (diabetes)
  • Congenital disorders affecting multiple body systems
  • Neurological disorders (MS, Parkinson's, epilepsy)
  • Mental disorders (depression, anxiety, schizophrenia, autism)
  • Cancer
  • Immune system disorders (HIV, lupus, rheumatoid arthritis)

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.

Important to Know

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.

Benefit Calculation

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 Benefit Calculation

SSDI benefits are based on your average lifetime earnings before your disability began. The formula is complex, but generally:

  • Higher lifetime earnings result in higher benefit amounts
  • Benefits are adjusted annually for cost-of-living increases
  • The average SSDI benefit in 2025 is $1,537 per month
  • The maximum SSDI benefit in 2025 is $3,822 per month

SSI Benefit Calculation

SSI has a fixed maximum federal benefit rate (FBR) that may be reduced by other income:

  • The maximum federal SSI payment in 2025 is $967 per month for an individual
  • For couples, the maximum is $1,415 per month
  • Your actual payment may be less if you have other income
  • Some states add a supplement to the federal SSI payment
Does Workers Comp reduce my disability benefits?
This guide is for you if you have been approved for SSDI benefits and are also receiving, or expect to receive, Workers' Compensation. It is designed for individuals who want to understand why their SSDI benefits might be reduced and how the process works. This information can also be helpful for your loved ones or anyone assisting you with your benefits.
Why is understanding the SSDI and Workers' Compensation off set important?
Understanding the offset is crucial for your financial planning. If you are eligible for both SSDI and Workers' Compensation, the total amount you receive might be less than the sum of the individual benefits. Knowing about the offset rules helps you anticipate your actual income. It also helps you understand communications from the Social Security Administration (SSA) regarding your benefit amounts. This knowledge empowers you to ask the right questions and ensure your benefits are calculated correctly.
Why does Workers’ Compensation (a public disability benefit) offset SSDI benefits?
The primary reason for the offset is to prevent what Congress considered a potential overpayment or "duplication" of benefits. The law intends for the total amount of public disability benefits you receive (from SSDI and Workers' Compensation combined) not to be excessive and to maintain an incentive for people to return to work if they are able. The Social Security Act was amended in 1965 to include this offset provision.
Is there a limit to how much my SSDI benefits can be reduced?
Yes, there is a limit. Your SSDI benefits (plus those of your family, if applicable) combined with your Workers’ Compensation or other public disability benefits cannot exceed 80% of your Average Current Earnings (ACE) before you became disabled. If the total exceeds this 80% limit, your SSDI benefit is reduced by the excess amount. However, your SSDI benefit will not be reduced to zero due to the offset, unless the Workers' Compensation itself is very high. The offset only reduces the SSDI payment; it doesn't eliminate it entirely if there's still a payable amount after the reduction.
How does the SSA calculate my Average Current Earnings (ACE)?
The SSA uses one of three methods to determine your ACE, selecting the one that is most advantageous to you:

1. The average monthly wage on which your unindexed disability primary insurance amount (PIA) is based.
2. The average monthly earnings from covered employment and self-employment during the highest 5 consecutive years after 1950.
3. The average monthly earnings in the calendar year of highest earnings from covered employment during the 5 years ending with the year in which your disability began.

Total earnings, including those above the Social Security taxable maximum, are used to determine average current earnings. The SSA will use the method that results in the highest ACE, which in turn means a higher 80% limit and potentially a smaller offset.
When does the offset apply? Does it start immediately?
The offset can apply for any month you receive both SSDI and Workers’ Compensation (or another applicable public disability benefit). It generally applies to disabled workers under the age of 65. The offset typically begins once the SSA is aware that you are receiving Workers' Compensation payments. It's crucial to report these payments to the SSA promptly to avoid overpayments that you would have to pay back.
Will my family’s SSDI benefits also be affected by the offset?
Yes. If you receive SSDI benefit sand have eligible family members (like a spouse or dependent children) also receiving benefits on your record, their benefits are considered part of the total amount when calculating the 80% ACE limit. The offset is applied to the total family benefit. Benefits for a worker's spouse or dependent children are offset before the offset is applied to the worker's benefit.
Are all types of public disability benefits subject to this offset?
No, not all. The offset applies to SSDI benefits when you also receive payments from Workers’ Compensation or other public disability benefits provided under federal, state, or local laws or plans. Examples include state temporary disability benefits or civil service disability benefits.

However, benefits like Veterans Administration (VA) benefits, Supplemental Security Income (SSI),and benefits from private insurance or private pensions do not cause an offset of SSDI benefits.
I received a lump-sum settlement from my Workers' Compensation claim. Will this affect my SSDI benefits?
Yes, a lump-sum settlement from your Workers' Compensation claim can affect your SSDI benefits. If the lumpsum is a substitute for periodic payments (meaning it's paying you in one go what you might have otherwise received over time), it is generally subject to the same offset rules as periodic Workers' Compensation payments.
How does the SSA handle lump-sum settlements when calculating the offset?
When you receive a lump-sum settlement, the SSA will typically prorate it. This means they will convert the lump-sum amount into a monthly equivalent to determine how it affects your SSDI benefits over a period. The SSA will determine a monthly rate based on the terms of your settlement agreement or, if not specified, often based on the periodic rate you were receiving before the settlement, or a rate based on state Workers' Compensation maximums or your life expectancy.

For example, if you receive a$20,000 lump sum, and the SSA determines this represents $500 per month for 40 months, then $500 per month will be considered as your Workers' Compensation payment for the purpose of calculating the SSDI offset for those 40 months.
Are there any parts of my lump-sum settlement that are NOT counted for the offset (e.g., medical expenses, legal fees)?
Yes, certain amounts included in your lump-sum settlement may be excluded from the offset calculation if they are properly identified and documented in the settlement agreement. These typically include amounts specifically designated for:

1. Future medical expenses related to your work injury.
2. Legal fees (attorney fees) paid in connection with your Workers' Compensation claim.
3. Other specific non-disability related expenses as allowed by SSA rules.

It is very important that your Workers' Compensation settlement agreement clearly itemizes these amounts. If they are not clearly specified, the SSA may count the entire lump sum (or a larger portion of it) towards the offset, potentially reducing your SSDI benefits more than necessary.
What should I do if I receive a lump-sum Workers' Compensation settlement?
You must report any lump-sum Workers' Compensation settlement to the Social Security Administration immediately. Provide them with a copy of the settlement agreement and any related documents. Prompt reporting helps ensure your benefits are calculated correctly and can prevent large overpayments that you would have to repay. It is also advisable to discuss with your attorney how the settlement is worded to best protect your SSDI benefits, if possible, by clearly identifying excludable expenses.
I also have a private long-term disability (LTD) insurance policy. Will those benefits affect my SSDI?
Generally, disability payments you receive from private sources, such as a private long-term disability(LTD) insurance policy or a private pension, do not affect your Social Security Disability Insurance (SSDI) benefits. The SSDI offset rules we have discussed primarily apply to public disability benefits like Workers’ Compensation and certain other governmental disability payments.
Can my private disability insurance benefits be reduced if I receive SSDI or Workers’ Compensation?
This is a separate issue from the SSDI offset. While your private disability benefits typically do not reduce your SSDI, your private disability insurance policy itself may have provisions that reduce your private LTD benefit amount if you receive SSDI or Workers’ Compensation benefits. Many private LTD policies are designed to coordinate with other disability income. This means the private insurance company might reduce the amount they pay you by the amount you receive from SSDI or, in some cases, Workers’ Compensation. You need to carefully review the terms of your specific private disability insurance policy or contact your insurance provider to understand how it interacts with other benefits. This is a contractual matter between you and your private insurer and is not governed by Social Security law.
What happens if my Workers’ Compensation payments change or stop?
If your Workers’ Compensation payments increase, decrease, or stop entirely, you must report this change to the Social Security Administration (SSA) immediately. Any change in the amount of your Workers’ Compensation can affect the amount of your SSDI offset. Reporting changes promptly helps ensure your SSDI benefits are calculated correctly and can prevent overpayments or underpayments.
Do I need to report my Workers’ Compensation benefits to the SSA?
Yes, absolutely. You are responsible for reporting to the SSA if you start receiving Workers’ Compensation or other public disability benefits, or if there are any changes to those benefits. This includes reporting lump-sum settlements. Failure to report can lead to incorrect SSDI payments and potential overpayments that you will be required to pay back.
Can the offset ever stop?
Yes, the offset of your SSDI benefits due to Workers’ Compensation or other public disability benefits typically stops when:

You reach your full retirement age (as defined by Social Security).
Your Workers’ Compensation or other public disability benefits stop.
Once the offset stops, you should begin receiving your full SSDI benefit amount, assuming you are still otherwise eligible.
What are the key takeaways about the SSDI and Workers’ Compensation offset?
Yes, absolutely. You are responsible for reporting to the SSA if you start receiving Workers’ Compensation or other public disability benefits, or if there are any changes to those benefits. This includes reporting lump-sum settlements. Failure to report can lead to incorrect SS Here are the most important points to remember:

Receiving Workers’ Compensation or other public disability benefits can reduce your SSDI benefits due to an offset.

The total of your SSDI and Workers’ Compensation benefits generally cannot exceed 80% of your Average Current Earnings (ACE) before disability.

Lump-sum Workers’ Compensation settlements are usually prorated and can also cause an offset.

Private disability insurance benefits typically do not offset SSDI, but your private policy may reduce its payout based on SSDI.

It is crucial to report all Workers’ Compensation payments and any changes to the SSA immediately.

Understanding these rules can help you manage your finances and interact more effectively with the SSA.DI payments and potential overpayments that you will be required to pay back.
How does Social Security calculate my SSDI benefit amount?
SSDI Benefit Calculation Process
Social Security uses a three-step process to calculate your SSDI benefit:
  • Calculate your Average Indexed Monthly Earnings (AIME): Social Security adjusts or indexes your lifetime earnings to account for changes in average wages over time, then calculates your average monthly earnings over your 35 highest-earning years.
  • Determine your Primary Insurance Amount (PIA): Your PIA is the base amount of your benefit. For 2025, the formula applies these percentages to your AIME:
    90% of the first $1,174 of your AIME, plus
    32% of your AIME between $1,174 and $7,078, plus
    15% of your AIME over $7,078
  • Apply any reductions or increases: Your benefit may be reduced if you receive certain government pensions or workers' compensation benefits.
Many states add a supplement to the federal SSI payment. The amount varies by state and living arrangement. Contact your state's Social Security office or visit their website to find out if your state offers a supplement and how much it might be.

Insider Tip

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.

How does other income affect my SSI payment?
How SSI Payments Are Reduced by Other Income
SSI is a needs-based program, so your payment is reduced if you have other income. Here's how it works:
  • Start with the maximum federal benefit rate (FBR): $967 for an individual or $1,450 for a couple in 2025.
  • Subtract countable income: Social Security doesn't count all income. They apply these exclusions:
    The first $20 of most income received in a month.
    The first $65 of earnings and half of earnings over $65 received in a month
    Food stamps and housing assistance
    Tax refunds
    Loans that you have to repay
  • The result is your SSI federal payment: Maximum FBR minus countable income.
  • Add any state supplement: Some states add money to the federal SSI payment.
Example SSI Calculation
Maria receives $300 per month in SSDI and has no other income. Her SSI payment would be calculated as follows:
  • $300 SSDI - $20 general income exclusion = $280 countable income
  • $967 (2025 FBR) - $280 = $687 SSI payment
  • Total monthly income: $300 SSDI + $687 SSI = $987

Application Process

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.

How do I File for Disability Benefits?

Filing for Social Security Disability benefits involves several key stages. Knowing what to expect can help you prepare a more robust application. You can apply for benefits online (often the most convenient method), by calling the Social Security Administration (SSA) at 1-800-772-1213 to make an appointment, or by visiting your local Social Security office (though an appointment is still recommended).

Before starting your application, it is highly advisable to gather all necessary information and documentation. This will not only streamline the process but can also help prevent unnecessary delays. Key information you will likely need includes:

●  Your Social Security number and proof of age (e.g., birth certificate).
●  Names, addresses, and phone numbers of all medical providers (doctors, therapists, hospitals, clinics) who have treated you for your condition, along with dates of treatment.
●  A complete list of all medications you are taking, including dosages.
●  Any medical records you already have in your possession (though SSA will also request them).
●  Laboratory and test results.
●  A detailed summary of your work history for the past 15 years (names of employers, job titles, duties performed, dates of employment, and rates of pay).
●  Your most recent W-2 form or, if self-employed, your federal tax returns for the past year. When you apply, the SSA will first verify your non-medical eligibility requirements, such as your work credits for SSDI or income and resources for Supplemental Security Income (SSI). If these basic requirements are met, the SSA forwards your case to the Disability Determination Services (DDS) office in your state. The DDS is responsible for the medical determination.

It is absolutely crucial to be as detailed, accurate, and honest as possible in your application. Avoid vague answers; provide specific examples of how your condition limits your daily activities and ability to work. Never leave questions blank, as this can lead to processing delays or even denials. While it might feel like you need to overstate your case, the SSA is experienced in identifying inconsistencies, so honesty is always the best policy.

Many disability attorneys and advocates recommend applying for benefits as soon as you stop working or reduce your work below SGA levels due to your disability. As mentioned, your insured status for SSDI is time-sensitive.

Throughout the process, keep meticulous copies of everything you submit to or receive from the SSA. Maintain a log of all communications, including dates, times, and the names of SSA personnel you speak with. This can be invaluable if discrepancies arise or if you need to appeal an unfavorable decision.

What Happens Once I File for Disability Benefits?

After you submit your application for Social Security Disability benefits, the Social Security Administration (SSA) initiates a multi-stage review process. Understanding these stages is key, as the determination can often take a considerable amount of time.

Initially, the SSA field office or teleservice center will review your application to confirm you meet the basic non-medical eligibility requirements. This includes verifying your age, insured status (work credits for SSDI), and, if you also applied for Supplemental Security Income (SSI), your income and assets. If these initial criteria are satisfied, your application moves forward.

Your case is then electronically transferred to the Disability Determination Services (DDS) office in your state. The DDS is a state agency funded by the federal government that works with the SSA to make decisions on disability claims. At the DDS, your claim will be assigned to a disability examiner. This examiner, in conjunction with a medical consultant (a doctor or psychologist employed by DDS), will review your medical records and all other information you provided.

During this phase, the DDS may require additional information to make an informed decision. They might contact your doctors, hospitals, or other medical sources directly to obtain more detailed records or clarification. It is also quite possible that the DDS will ask you to attend a Consultative Examination (CE). This is a medical examination paid for by the SSA. A CE is typically requested if your existing medical records do not provide sufficient, current, or specialized information for the DDS to make a determination. You will be notified by mail if a CE is required, and it is absolutely crucial to attend this appointment. Failure to do so without a compelling reason can result in your claim being denied based on insufficient evidence.

Throughout this period, you can check the status of your application. The most convenient way is usually online through your personal “my Social Security” account on the SSA website (www.ssa.gov). You can also call the SSA’ stoll-free number. However, be prepared for the process to take several months –the national average processing time for initial applications often hovers around 3 to 6 months, but can be longer depending on the complexity of your case, the speed at which medical evidence is received, and the DDS workload in your state.

Once the DDS has made a medical decision on your claim, they will return your case file to the SSA field office. The SSA will then complete any final administrative processing and will send you a written notice by mail informing you of their decision. This letter will clearly state whether your claim has been approved or denied and will explain the reasons for the determination. If your claim is approved, the letter will also provide information about your benefit amount, your date of entitlement (when your benefits begin), and any past-due benefits you might receive. If your claim is denied, the letter will explain your right to appeal the decision and the timeframe for doing so.

What’s the difference between a Medical vs. Technical denial?

When a Social Security disability claim is denied, it is vital to understand the basis for the denial, as this will shape your next steps. Denials generally fall into two main categories: technical denials and medical denials.

Technical Denials occur when an applicant fails to meet the non-medical eligibility requirements for benefits. These denials often happen before a full medical review of your condition is even undertaken by the DDS. Common reasons for a technical denial include:
● Insufficient Work Credits (for SSDI): Social Security Disability Insurance (SSDI) requires a specific number of work credits, earned by paying Social Security taxes. If you haven’t worked enough ,or recently enough, to meet the date last insured (DLI) requirements, you maybe technically denied. This is a frequent reason for denial, especially for younger individuals or those with sporadic work histories.
● Substantial Gainful Activity (SGA): If you are working and your earnings exceed the current SGA level (this amount is updated annually by SSA), you will generally be found not disabled, leading to a denial.
●  Income or Asset Limits Exceeded (for SSI):Supplemental Security Income (SSI) is a means-tested program. If your countable income or assets are above the stringent limits set by the SSA, you will be technically denied for SSI.    
● Failure to Cooperate: If you do not provide requested information, fail to attend a scheduled Consultative Examination (CE)without a good reason, or cannot be located by the SSA, your claim can be technically denied.
● Application Issues: Sometimes, problems with the application itself, such as missing signatures or critical information that is not subsequently provided despite requests, can lead to a technical denial.

A Medical Denial, conversely, means that while you may have met the non-medical requirements, the Social Security Administration (SSA), through the DDS, has determined that your medical condition does not meet their strict definition of disability. The DDS uses a 5-step sequential evaluation process to assess medical eligibility. Reasons for a medical denial can include findings that:
1. You are engaging in Substantial Gainful Activity (SGA) (this step is also a technical screen).
2. Your impairment or combination of impairments is not severe enough to cause more than minimal limitation in your ability to perform basic work-related activities.
3. Your impairment is severe, but it does not meet or medically equal the criteria of one of the conditions in SSA’s Listing of Impairments (the “Blue Book”).
4. You are still able to perform your past relevant work (PRW) despite your impairment(s).
5. Considering your age, education, work experience, and Residual Functional Capacity (RFC), you are able to perform other types of work that exist in significant numbers in the national economy.

Other reasons for medical denial can include your condition not being expected to last for at least 12 continuous months or result in death, insufficient medical evidence to support your claim, your disability being primarily due to drug addiction or alcoholism (DAA) that is material to the finding of disability, or your failure to follow prescribed treatment that could restore your ability to work, without a good reason.

It is also possible to receive a subsequent technical denial after an initial medical allowance if, for instance, it is discovered that you returned to SGA-level work before the disability determination was finalized or did not actually meet a non-medical requirement.

Understanding whether your denial was technical or medical is crucial because it dictates the focus of your appeal. A technical denial requires addressing the specific non-medical issue (e.g., providing proof of income, or explaining work activity). A medical denial requires providing further medical evidence or arguing how your condition, in  fact, meets SSA’s disability criteria, often focusing on the 5-step sequential evaluation.

What about filing in my 60s?

Age is a significant factor in how the Social Security Administration (SSA) evaluates disability claims, particularly for older individuals. Many applicants wonder if it becomes easier or harder to qualify as they approach or enter their 60s, and what the implications are if they are already past their Full Retirement Age (FRA).

Is it More or Less Difficult to Get Disability Benefits in Your 60s?

Generally, for individuals aged 50 and older, the SSA’s rules, specifically the Medical-Vocational Guidelines (often called the “grid rules”), can be somewhat more favorable. These guidelines consider a claimant’s age, education, work experience(including whether job skills are transferable), and their Residual Functional Capacity (RFC) – an assessment of what they can still do despite their physical and /or mental limitations.

● Claimants aged 50-54 (Closely Approaching Advanced Age): The grid rules begin to offer more defined pathways to a disability finding, especially if they are limited to sedentary or light work and have skills that are not readily transferable to other jobs.
● Claimants aged 55-59 (Advanced Age): The rules become even more accommodating. It can be easier to be found disabled if you are limited in your ability to perform physical work (e.g., restricted to less than a full range of sedentary work) and have little or no transferable work skills.
● Claimants aged 60 and over (Closely Approaching Retirement Age): The grid rules are often at their most lenient for this age group. If an individual aged 60 or older has a severe impairment that prevents them from doing their past work, and they have limited education or work skills that do not transfer to other jobs, the likelihood of being found disabled under the grid rules increases significantly. The SSA acknowledges that it is generally more difficult for older workers to adjust to different types of work.

So, while you must still prove a severe,medically determinable impairment that prevents Substantial Gainful Activity(SGA), being in your 60s can, in certaincircumstances, make it less challenging to meet the vocational aspect of thedisability criteria due to these age-specific rules. However, thefundamental medical requirements – proving a severe impairment with objectivemedical evidence – remain the same regardless of age.

Can I File for Disability After My Full Retirement Age (FRA)?

This is a common point of confusion. Social Security Disability Insurance (SSDI) benefits are, in essence, a form ofearly retirement benefit for those who can no longer work due to a disability. When an individual receiving SSDI benefits reaches their Full Retirement Age (FRA) – which varies depending on your year of birth – their disability benefits automatically convert to retirement benefits. The monthly payment amount typically remains the same; you just transition from being a “disability beneficiary” to a “retirement beneficiary.” Because of this automatic conversion:

● If you are already at or past your FRA, you would generally apply for Social Security retirement benefits, not disability benefits. The financial outcome is usually identical, as your disability benefit would not exceed your full retirement benefit amount at FRA.
● If you become disabled before reaching your FRA but do not apply for disability benefits until after you have reached FRA, the situation is more nuanced. You might still be eligible for a closed period of disability benefits. This means you could receive past-due disability benefits for the time you were disabled before reaching FRA, assuming you met all eligibility criteria (including insured status and medical severity) during that period. However, for ongoing benefits from FRA forward, you would receive retirement benefits.

It is important to note that Supplemental Security Income (SSI) disability benefits do not automatically convert to retirement benefits, as SSI is a needs-based program separate from the work-credit-based retirement and SSDI systems. However, eligibility for SSI can also be affected by the receipt of retirement benefits, as retirement benefitsare counted as income for SSI purposes.

If you are approaching or past your FRA and have questions about whether to file for disability versus retirement benefits, it is always best to discuss your specific situation with the Social Security Administration or a knowledgeable disability advocate or at torney. They can help you understand the implications for your specific circumstances.

What is a Consultative Examination (CE)?
A Consultative Examination (CE) is a medical examination or test that the SSA pays for. It is requested by the DDS when your own medical records do not contain enough recent or detailed information for them to make an informed decision about your disability. The CE can be a physical exam, a psychological or psychiatric evaluation, or specific diagnostic tests like X-rays or blood work. It is critically important to attend any scheduled CE, as failure to do so without a valid reason can lead to your claim being denied based on insufficient evidence. The CE is performed by an independent medical source contracted by the SSA, though occasionally your own treating physician might be asked to perform it if they have the necessary equipment and are willing to do so under SSA guidelines.
Do I need to provide my medical records, or does SSA get them?
You should provide copies of any medical records you already have in your possession when you apply, as this can expedite the process. However, the SSA (through the DDS) is also responsible for making reasonable efforts to obtain records directly from your doctors, hospitals, and clinics that you identify on your application. You will be asked to sign medical release forms (Form SSA-827) authorizing your healthcare providers to release information to the SSA. While the SSA attempts to gather these records, staying proactive by ensuring your providers respond promptly or by obtaining and submitting records yourself can be beneficial. Some attorneys advise clients to request their own records to ensure completeness and accuracy and to provide them directly to SSA.
Is there Expedited Processing? Compassionate Allowances and Terminal Illness Cases
Navigating the Social Security disability benefits system can be a lengthy process .However, the Social Security Administration (SSA) recognizes that individuals with certain severe medical conditions require an accelerated review. For these situations, specific procedures are in place to expedite the processing of disability claims. 

One such mechanism is the Compassionate Allowances (CAL) program. This initiative is designed for applicants whose medical conditions are so severe that they inherently meet Social Security 's strict definition of disability. The SSA maintains a list of CAL conditions, which includes various aggressive cancers, adult brain disorders, and a number of rare diseases, particularly those affecting children. When an application involves a condition on the CAL list, it is identified early in the process and receives expedited handling. This can significantly reduce the waiting time for a decision, often to a matter of weeks rather than many months, ensuring that individuals with the most serious disabilities receive support more quickly. 

In addition to Compassionate Allowances, the SSA also has procedures to accelerate claims involving a Terminal Illness(TERI). If an individual's medical condition is untreatable and is expected to result in death, their disability claim is designated as a TERI case. While not a separate program like CAL, this designation ensures that the claim receives priority processing. The objective is to provide financial assistance and support to individuals and their families during an exceptionally challenging time, minimizing delays in accessing benefits. Both the CAL program and TERI case processing reflect the SSA's commitment to addressing the urgent needs of applicants facing the most critical health circumstances.
What if I try to go back to work?
The SSA has several work incentives designed to allow individuals receiving disability benefits to test their ability to return to work without immediately jeopardizing their benefits. Key programs include:

Trial Work Period (TWP): This allows you to work for up to nine months (not necessarily consecutive) within a rolling 60-month period while still receiving your full disability benefits, regardless of how much you earn. A month is counted as a trial work month if your gross earnings exceed a certain annually adjusted amount (for 2025, this would be $1,110, but always verify the current years figure on SSA.gov).

Extended Period of Eligibility (EPE): After your TWP concludes, you enter a 36-month EPE. During this time, you can still receive benefits for any month your earnings are not considered “Substantial Gainful Activity” (SGA). SGA is an earnings threshold that also changes annually (for 2025, SGA is generally $1,620 a month for non-blind individuals, or $2,700 if you are blind, but always verify current figures).

Expedited Reinstatement (EXR): If your benefits stop because you are working at the SGA level after completing your EPE, you have up to five years to request that your benefits be restarted without filing a new application if you have to stop or reduce work again due to the same or a related disability. It is absolutely critical to report all work activity and earnings to the SSA promptly and accurately.
How long does it typically take to get a decision on a disability application?
The time it takes to get an initial decision on a disability application can vary significantly. On average, an initial decision can take 3 to 6 months, but it can be shorter or, unfortunately, much longer. Factors influencing this timeframe include the complexity of your medical condition(s), how quickly the SSA receives your medical records from all sources, whether a Consultative Examination is needed, and the current backlog of cases at the DDS in your specific state. You can check the status of your application online through your “my Social Security” account.
What happens if my disability claim is approved?
If your claim is approved, you will receive a written award notice from the SSA. This notice is important and will detail:

The date your disability was determined to have begun (your established onset date).
Your monthly benefit amount.
The amount of any past-due benefits (back pay) you are owed and how they will be paid.

Information about when you will become eligible for Medicare (typically 24 months after your date of entitlement to disability benefits, which is usually five full calendar months after your onset date). You will also bein formed about your responsibilities as a beneficiary, such as reporting changes in your condition, work activity, or living situation. Your case will also be subject to periodic Continuing Disability Reviews (CDRs) to ensure you continue to meet the disability requirements.
What happens if my disability claim is denied?
If your claim is denied, you will receive a written denial notice from the SSA explaining the reasons for the denial. Crucially, this notice will also explain your right to appeal the decision and the deadline for doing so. It is important not to be discouraged; a significant percentage of disability claims are initially denied. Many applicants who are initially denied are later approved through the appeals process.
What are my appeal rights if my claim is denied?
If your disability claim is denied, you have the right to appeal the decision through several levels. The standard levels of appeal are:

1. Reconsideration: You request the SSA to have a different examiner and medical consultant (who were not involved in the initial decision) review your case again. You can submit new evidence at this stage. This must be filed within 60 days of receiving your denial notice.

2. Hearing by an Administrative Law Judge (ALJ): If you disagree with there consideration decision, you can request a hearing before an ALJ. This is often considered the most critical stage of appeal, as you (and your representative, if you have one) can present your case in person, provide testimony, and call witnesses. New evidence can also be submitted. This must also be filed within 60 days of the reconsideration denial.

3. Review by the Appeals Council: If you disagree with the ALJ’s decision, you can ask the Appeals Council to review it. The Appeals Council can deny your request for review if it finds no error, decide your case itself, or send it back to an ALJ for further action. This appeal must be filed within 60 days.

4. Federal Court Review: If you disagree with the Appeals Councils decision (or if they decline to review your case), your final option is to file a civil lawsuit in a U.S. District Court. This must be filed within 60 days. There are strict deadlines for filing appeals, typically 60 days (plus 5 days for mailing, if the notice was mailed) from the date you receive the notice of denial. It is highly recommended to consider seeking qualified legal representation, especially if you plan to appeal to the ALJ hearing level or beyond. 

Appeals Process

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.

Four Levels of Appeal

There are four levels in the appeals process:

Reconsideration: A complete review by someone who didn't take part in the first decision
Hearing: A hearing before an administrative law judge
Appeals Council: A review by the Social Security Appeals Council
Federal Court: A lawsuit in federal district court

Most people who win on appeal do so at the hearing level.

Appeal Success Rates

Understanding success rates can help set expectations:

Reconsideration: About 13% approved
Hearing: About 50% approved
Appeals Council: Less than 3% approved (most cases are remanded)
Federal Court: About 2% approved (many are remanded)

Having representation significantly increases your chances of winning, especially at the hearing level.

What happens at a disability hearing?
The Disability Hearing Process
A disability hearing is less formal than a court trial but is still an official legal proceeding. Here's what to expect:
  • Setting: The hearing usually takes place in a small conference room with the administrative law judge (ALJ), you, your representative (if you have one), a hearing assistant, and possibly expert witnesses.
  • Duration: Most hearings last 30-60 minutes.
  • Questions: The ALJ will ask you questions about:
    Your medical conditions and symptoms
    Your treatment history
    Your daily activities
    Your work history and skills
    Your limitations and restrictions
  • Expert Testimony: The ALJ may call upon:
    A medical expert to give opinions about your medical conditions
    A vocational expert to testify about jobs you might be able to perform
  • Your Testimony: This is your opportunity to explain how your conditions affect your ability to work. Be honest, specific, and thorough.
  • Decision: The ALJ usually doesn't announce a decision at the hearing. You'll receive a written decision by mail, typically within 30-90 days.

Insider Tips for Hearings

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.

Should I get a lawyer for my disability appeal?
The Benefits of Professional Representation
While you can represent yourself, having a disability attorney or advocate can significantly improve your chances of winning your appeal. Here's why:
  • Experience with the process: Representatives understand how the system works and what evidence is most persuasive.
  • Help gathering evidence: They know what medical evidence is needed and can help obtain it from your healthcare providers.
  • Preparation for hearing: They can prepare you for questions the judge might ask and help you explain your limitations effectively.
  • Cross-examination of experts: They can question vocational and medical experts at your hearing.
  • No upfront cost: Representatives work on contingency, meaning they only get paid if you win. Their fee is limited to 25% of your backpay or $9,200, whichever is less.

When to Get Representation

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.

Continuing Disability Reviews

If you receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you will periodically undergo a Continuing Disability Review (CDR). This is a routine process the Social Security Administration (SSA) uses to ensure you still meet the medical requirements for disability benefits. 

The purpose of a CDR is to see if your medical condition has improved to the point where you might be able to return to work. The law requires the SSA to conduct these reviews. It is important to understand that a CDR is a standard part of receiving disability benefits. 

How often you receive a CDR can vary. It depends on how likely the SSA believes your condition is to improve. Your initial award notice from the SSA usually tells you when to expect your first review. Generally, if your health has not improved and your disability still prevents you from working, your benefits will continue. This guide will help you understand what a CDR is, what to expect, and how to navigate the process.

What is a Continuing Disability Review (CDR)?
A Continuing Disability Review (CDR) is a periodic review conducted by the Social Security Administration (SSA). Its purpose is to determine if you still meet the medical eligibility requirements for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)benefits. Essentially, the SSA wants to see if your health condition has improved enough that you might be able to work.
When will I receive a CDR?
The timing of your CDR depends on the SSA's expectation of your medical improvement:
  • If medical improvement is expected, your first review will typically be 6 to 18 months after your benefits start.
  • If medical improvement is possible, reviews usually occur every 3 years.
  • If medical improvement is not expected, reviews are generally conducted every 5 to 7years.
Your initial award letter from the SSA should indicate when you can expect your first review.
What can trigger a CDR outside of the scheduled time?
While most CDRs are scheduled, certain situations can trigger an earlier review. These include:
  • Returning to work and earning over a certain amount (known as Substantial Gainful Activity or SGA).
  • Reports from you or your doctor indicating that your medical condition has improved.
  • Information suggesting you are not following your prescribed medical treatment without a goodreason.
  • The availability of new treatments that could significantly improve your condition.
I heard that even if I am scheduled for a CDR, I might not get one. Is this true?
Yes, this can happen. The SSA offices operate on a budget determined by Congress. If a local SSA office does not have sufficient funding or staffing, scheduled CDRs might be delayed or not conducted as frequently as planned. The SSA prioritizes reviews based on available resources and other factors.
What are the main forms used for a Continuing Disability Review (CDR)?
The SSA primarily uses two forms for CDRs:
  • The Disability Update Report (Form SSA-455), often called the short form.
  • The Continuing Disability Review Report (Form SSA-454-BK), often called the long form.
Who receives the short form (SSA-455)?
The short form (SSA-455) is typically sent to individuals whose medical condition is not expected to improve. It is a shorter, simpler form, usually only two pages long. Its main purpose is to quickly check if there have been any significant changes in your condition or work activity.
How do I fill out the short form (SSA-455)?
When filling out the SSA-455, it is important to be truthful and accurate. The form will ask about:
  • Recent doctor visits or hospitalizations.
  • Any work you have done.
  • How your health condition affects your dailyactivities.
Answer the questions directly. If your condition has not improved, or has worsened, state that clearly. You can now complete the Disability Update Report (SSA-455) online through your my Social Security account on the SSA website, or you can fill out and mail back the paper form.
Who receives the long form (SSA-454-BK)?
The long form (SSA-454-BK) is more detailed and is usually sent if:
  • The SSA believes your medical condition was expected to improve or could improve.
  • Your answers on the short form (SSA-455) indicate a possible medical improvement or a return towork.
  • You are selected for a more in-depth review.
Your initial award letter from the SSA should indicate when you can expect your first review.
How do I fill out the long form (SSA-454-BK)?
TheSSA-454-BK requires more detailed information. You will need to provide information about:
  • All your medical treatments, doctor visits, hospitalizations, and tests since your last review or approval.
  • Your medications, including dosage and prescribing doctor.
  • How your daily activities are limited by your condition.
  • Any work activity.
  • Any vocational rehabilitation or job training you have received.
Key tips for filling out either form:

Be honest and complete: Provide accurate and thorough information.
Be specific: Give details about your medical treatment and how your condition limits you.
Do not exaggerate, but do not downplay your condition: Describe your situation as it truly is.
Keep copies: Always keep a copy of any forms you submit to the SSA for your records.
Respond promptly: Mail the completed form back by the deadline, or complete it online if that option is available for the form you received.
Update your address: Ensure the SSA always has your current mailing address so you receive these important forms.

If you have difficulty understanding or completing the forms, you can ask a friend or family member for help. However, do not ask your healthcare provider to complete the report for you. A Social Security Representative can also assist you if you contact the SSA.
What happens after I submit my CDR forms?
After you submit your Continuing Disability Review (CDR) forms (either the short form SSA-455 or the long form SSA-454-BK), the Social Security Administration (SSA)will review the information you provided. 

If you submitted the short form (SSA-455) and your answers do not indicate a likelihood of medical improvement or significant work activity, the SSA may decide to continue your benefits without further action. Many people who receive the short form will have their review completed at this stage. 

If you submitted the long form (SSA-454-BK), or if your answers on the short form trigger a more detailed review, your case will be sent to your local state Disability Determination Services (DDS) office. The DDS is the state agency that makes disability decisions for the SSA.
How does the SSA (or DDS) make a decision?
The DDS will review your submitted forms and all medical evidence in your file. They will look for evidence of medical improvement related to your ability to work. Specifically, they will consider:

● Your current medical condition: Has it improved, stayed the same, or worsened since your last favorable decision?
● Your medical treatment: Are you continuing to receive regular medical care for your condition? Are you following your prescribed treatment?
● Your ability to work: Even if there has been some medical improvement, does your condition still prevent you from performing Substantial Gainful Activity (SGA)?

The SSA will compare your current condition to how it was at the time of your last favorable decision. To stop your benefits, the SSA must generally show that your medical condition has improved and that this improvement allows you to work.
What is a Consultative Examination (CE), and will I need one?
If the DDS does not have enough recent medical information to make a decision, they may ask you to attend a Consultative Examination (CE). This is a medical exam paid for by the SSA and performed by an independent doctor contracted by the SSA.

 The purpose of the CE is to get up-to-date information about your medical condition. You might be sent for a physical exam, a psychological exam, or specific medical tests, depending on your disabling condition. It is very important to attend any scheduled CE. Failure to attend without a good reason can lead to your benefits being stopped. 
How long does the CDR process take?
The time it takes to complete a CDR can vary significantly.

● If you only fill out the short form (SSA-455), you might hear back from the SSA within 1 to 3 months.
● If your case goes to a full medical review (often involving the long form SSA-454-BK), the process can take 3 to 6 months, or even longer, especially if a CE is needed or if the DDS needs to gather extensive medical records. TheSSA will notify you by mail of their decision.
What should I do while waiting for a decision?
While waiting for a decision on your CDR: 

Continue your medical treatment: Keep seeing your doctors and following their prescribed treatments. This is crucial for your health and for your disability case.
Keep the SSA informed of any changes: Notify the SSA if you move, change doctors, orif your medical condition significantly changes.
Respond to any SSA requests promptly: If the SSA asks for more information or schedules an exam, respond by the deadline.
Is the Continuing Disability Review (CDR) process different for Supplemental Security Income (SSI) recipients?
The medical part of the Continuing Disability Review (CDR) is generally the same for both SSI and SSDI recipients. The Social Security Administration (SSA)uses the same medical standards to decide if your condition has improved and if you can work. However, there are some key differences for SSI recipients:

Non-Medical Eligibility (Redeterminations): SSI has strict income, resource (asset), and living arrangement requirements. In addition to medical CDRs, SSI recipients undergo periodic reviews of these non-medical factors. This is called a redetermination.

A redetermination can happen at the same time as a medical CDR or separately. If your income, resources, or living situation change in a way that makes you no longer eligible for SSI, your benefits can stop, even if you still meet the medical disability requirements.

CDRs for Children on SSI: There are specific rules for children receiving SSI benefits:

1. If a child is found disabled based on low birth weight, the SSA will generally conduct a CDR by age 1. However, if medical improvement is considered unlikely by age 1, the CDR may be scheduled later.

2.  For children whose medical condition is expected to improve, CDRs are typically done at least every 3 years.

3. When a child receiving SSI benefits turns 18, their eligibility is re determined using the adult disability criteria. This is a critical review, as the definition of disability for adults is different from that for children.

Representative Payee Responsibilities: If a child has a representative payee, the SSA may ask the payee during a CDRto provide evidence that the child is receiving medically necessary andappropriate treatment. Failure to provide this without good cause could leadthe SSA to look for a new payee or, if the child is old enough, pay thebenefits directly to them.
So, if I receive SSI, I might have more reviews than someone on SSDI?
Potentially, yes. While the frequency of medical CDRs is based on the likelihood of your medical improvement (similar to SSDI), SSI recipients also have the separate redeterminations of their non-medical eligibility (income, resources, living arrangements). These redeterminations are typically done every 1 to 6 years, depending on your situation. 

In summary, while the medical evaluation during a CDR is consistent, SSI recipients face additional scrutiny regarding their financial and living situations, and there are special considerations for children on SSI.
Do I still get Continuing Disability Reviews (CDRs) if I am in my 60s?
Yes, you will generally continue to have CDRs even if you are in your 60s, as long as you are receiving Social Security Disability Insurance (SSDI) benefits and have not yet reached your full retirement age (FRA). The Social Security Administration (SSA)is still required to periodically review your medical condition. 

However, the frequency of these reviews often changes as you get older. For individuals over 50, and particularly those over 55, the SSA generally schedules medical CDRs less frequently, often in the every 5 to 7 years category, especially if your medical condition is not expected to improve. 

The SSA also considers age as a vocational factor. Under the Medical-Vocational Guidelines (often called “grid rules”), the SSA acknowledges that it becomes more challenging for older individuals to adjust to different types of work if their disability prevents them from doing their past work. This can sometimes make it more difficult for the SSA to determine that an older individual is no longer disabled, even ifthere has been some medical improvement.
Will I get CDRs after I reach my full retirement age?
No. Once you reach your full retirement age (FRA), your SSDI benefits automatically convert to Social Security retirement benefits. At this point, you will no longer be subject to Continuing Disability Reviews. Your retirement benefits are not based on disability, so medical reviews are no longer necessary. 

Your FRA depends on your year of birth. For example, for people born between 1943 and 1954, FRA is 66. For those bornin 1960 or later, FRA is 67.
Does being older make it easier to pass a CDR?
While there isn't a specific rule that makes it automatically "easier," the SSA's rules do take age into account. As mentioned, the Medical-Vocational Guidelines can be more favorable to older claimants (typically age 50 and above, with increasing consideration at ages 55 and 60). These guidelines consider age, education, work experience, and residual functional capacity (what you can still do despite your limitations). 

If the SSA finds that your medical condition has improved, they must then determine if you can perform any of your past work or adjust to other work. For older individuals, the ability to adjust to other work is considered more limited. However, you still need to cooperate with the CDR process and provide requested information. The primary factor for continuing benefits is still whether your medical condition prevents you from engaging in Substantial Gainful Activity (SGA).
What happens if the SSA decides to stop my benefits after a CDR?
If the Social Security Administration (SSA) determines that your medical condition has improved enough that you no longer meet the disability requirements, they will send you a written notice that they plan to stop your benefits. This notice will explain:

● The reason for their decision
● How to appeal if you disagree
● The deadline for filing an appeal
● Whether you can request to continue receiving benefits during the appeal.

It's important to know that less than 2% of CDRs result in benefits being terminated. Most people pass their reviews and continue to receive benefits.
What appeal rights do I have if my benefits are denied after a CDR?
You have the right to appeal a decision to stop your benefits. The appeals process has several levels:

Reconsideration: This is the first level of appeal. A complete review of your case is done by someone who did not take part in     the first decision. You can submit new evidence at this stage.

Hearing by an Administrative Law Judge (ALJ): If you disagree with the reconsideration decision, you can request a hearing     before an ALJ. This gives you the opportunity to present your case in person.

Appeals Council Review: If you disagree with the ALJ's decision, you can request a review by the SSA's Appeals Council.

Federal Court Review: If you disagree with the Appeals Council's decision, you can file a civil action in a federal district court.
Can I continue receiving benefits while I appeal?
Yes, but you must act quickly. If you want your benefits to continue during the appeal process, you must request this within10 days of receiving the notice that your benefits will stop. This is called "continuation of benefits" or "payment continuation." Important things to know about continuing benefits during an appeal:

● Your request must be in writing.
● If you lose your appeal, you might have to payback the benefits you received during the appeal process. However, the SSA may waive this repayment in some circumstances.
● Even if you miss the 10-day deadline for continuing benefits, you still have 60 days from receiving the notice to file an appeal of the decision itself.
What should I do to prepare for an appeal?
To strengthen your appeal: 
Gather updated medical evidence: Collect recent medical records that show your condition still prevents you from working.
Get statements from your doctors: Ask your treating physicians to provide statements about your limitations and inability to work.
● Document your daily limitations: Keep a journal of how your condition affects your daily activities and ability to function.
Consider legal representation: An attorney who specializes in Social Security disability can significantly improve your chances of winning an appeal. Many disability attorneys work on a contingency basis, meaning they only get paid if you win your case.
How long does the appeal process take?
The appeal process can be lengthy:

● Reconsideration typically takes 3 to 5 months.
● If you need to go to a hearing before an ALJ, the wait can be 6 to 18 months or longer, depending on the backlog in your area.
Appeals Council reviews can take another 1 to 2 years.
Federal Court cases can add several more months or years to the process. The timeline varies significantly by location and current SSA workloads.

Working While Receiving 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!

Important Note

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 Calculator
The Trial Work Period (TWP) – Testing the Waters
What is the Trial Work Period?

The 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!

How the TWP Works:
  • Triggering a TWP Month:
    How does Social Security know if a month counts as one of your 9 TWP months? For 2025, a month counts if:
    1. Your gross monthly earnings (the amount before taxes are taken out) are more than $1,160.
    2. OR, if you are self-employed, you work more than 80 hours in that month.
    3. (Just meeting one of these is enough to use a TWP month.)*
  • Tracking TWP Months: These 9 months don't have to be back-to-back. Social Security keeps track of them over a rolling 60-month (5-year) period. Once you use your 9th month within that 5-year window, your TWP is complete.
  • Benefits During TWP: You receive your full SSDI benefit for all 9 TWP months, no matter how high your earnings are. This gives you a chance to see if working is right for you without worrying about losing your check immediately.
Example:

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.

What Happens After the TWP?

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).

The Extended Period of Eligibility (EPE) – The Safety Net
What is the Extended Period of Eligibility?

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:

  • What is SGA? SGA refers to a level of work activity and earnings that Social Security considers "substantial." Earning above the SGA level shows you might be able to support yourself.
  • SGA Earnings Limits for 2025:
    $1,620
    per month for non-blind individuals.
    $2,700 per month for blind individuals.
  • What are "Countable Earnings"? This is the amount SSA looks at to see if you are over the SGA limit. It's usually your gross earnings (before taxes), but it can sometimes be lowered by certain deductions. A common deduction is for Impairment-Related Work Expenses (IRWEs). These are costs for items or services you need specifically because of your disability in order to work (like special transportation, assistive devices, or co-pays for medical services needed to manage your condition for work). Always talk to SSA about your work expenses to see if they qualify as IRWEs and can lower your countable earnings.

Receiving Benefits During the EPE (36 Months):

Here's how your earnings affect your SSDI check during the 36-month EPE:

  • Earnings AT or BELOW SGA: If your countable monthly earnings are at or below the SGA level ($1,620 / $2,700 in 2025), you will receive your SSDI benefit check for that month (as long as you still meet SSA's disability rules).
  • Earnings ABOVE SGA: If your countable monthly earnings go above the SGA level:

    1. Grace Period (First Time Only!): The very first month your earnings go above SGA during the EPE, you enter a special "Grace Period." You will still receive your SSDI check for that first month and the following two months, giving you a total of 3 months of benefits even though your earnings are over SGA. This helps you adjust.

    2. After the Grace Period: For any month after the 3-month Grace Period ends, if your earnings are still above the SGA level, your SSDI cash benefits will be suspended. This means you won't receive an SSDI check for that specific month.
  • Benefits Can Restart! If your benefits are suspended because you earned over SGA, but your earnings later drop back down to or below the SGA level within the 36-month EPE, your benefits can restart automatically! You do not need to file a new application. Just make sure you report the change in earnings to SSA promptly.

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.

  • August 2025: You earn $1,500 (countable). This is below SGA. You get your SSDI check.
  • September 2025: You earn $1,800 (countable). This is above SGA for the first time during the EPE. You get your SSDI check because this is the start of your 3-month Grace Period.
  • October 2025: You earn $1,900 (countable). This is above SGA. You get your SSDI check (Grace Period month 2).
  • November 2025: You earn $1,850 (countable). This is above SGA. You get your SSDI check (Grace Period month 3).
  • December 2025: You earn $1,700 (countable). This is above SGA, and your Grace Period is over. Your SSDI check is suspended for December.
  • January 2026: You earn $1,550 (countable). This is below SGA again, and you are still within the 36-month EPE. Your SSDI check restarts automatically for January!

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.

After the Extended Period of Eligibility (EPE)
What Happens When the 36-Month EPE Ends?

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:

  • Earnings AT or BELOW SGA: If your countable monthly earnings continue to be at or below the SGA level ($1,620 / $2,700 in 2025), your SSDI benefits will continue. You can keep receiving your monthly check indefinitely, as long as you still meet Social Security's disability requirements.
  • Earnings ABOVE SGA: The first month your countable earnings go above the SGA level after the 36-month EPE has ended, your eligibility for SSDI benefits terminates. This means your SSDI cash benefits stop effective that month. Unlike during the EPE, there is no Grace Period or automatic restart if earnings drop later.

Example:

Let's say your 36-month EPE ended in July 2028. You are not blind (SGA = $1,620).

  • August 2028: You earn $1,500 (countable). This is below SGA. You get your SSDI check.
  • September 2028: You earn $1,700 (countable). This is above SGA, and your EPE has already ended. Your SSDI benefits terminate effective September 2028. You will not receive an SSDI check for September or future months based on this work level.

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 (EXR) – Getting Back on Benefits Quickly
What is Expedited Reinstatement?

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:

  • Your previous SSDI benefits stopped because your work earnings were over the SGA level.
  • You are no longer able to work at the SGA level (meaning your countable earnings drop below $1,620 / $2,700 in 2025) because of the same medical condition (or a related one) that allowed you to get SSDI benefits before.
  • You make the request for EXR within 5 years (60 months) from the month your benefits stopped.

How EXR Works:

  • Requesting EXR: Contact Social Security and let them know you stopped working at the SGA level due to your disability and want to request Expedited Reinstatement.
  • Provisional (Temporary) Benefits: While SSA reviews your medical condition to make a final decision (which can take a few months), you can receive up to 6 months of temporary SSDI cash benefits. This helps bridge the gap.
  • Medicare/Medicaid During Provisional Period: Your previous Medicare coverage should also restart during this provisional period. If you were eligible for Medicaid before, you might be eligible again, but this depends on your state's specific Medicaid rules and your current income/resources – check with your local Medicaid office.
  • SSA's Decision: If SSA approves your EXR request, your benefits are fully reinstated without needing a new application process.
  • If Denied: If SSA finds you don't meet the requirements (e.g., your condition improved, or it's past the 5-year window), the provisional benefits you received might have to be paid back.

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.

What About Medicare Coverage?
What Happens When the 36-Month EPE Ends?

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:

  • Premium-Free Part A Continues: Even if your SSDI cash benefits stop because your work is over the SGA level, your premium-free Medicare Part A (Hospital Insurance) coverage will continue for at least 93 months. That's 7 years and 9 months after your 9-month Trial Work Period (TWP) ends!
  • Total Coverage: When you add the 9-month TWP, this gives you at least 8.5 years of continued Medicare coverage from the time you start working, as long as you still meet Social Security's rules for being disabled.
  • Part B Continues (If You're Enrolled): If you are enrolled in Medicare Part B (Medical Insurance), this coverage also continues during this extended period. Important: You (or someone on your behalf) must continue to pay the monthly Part B premium.
    1. If you're still receiving SSDI checks, the premium is usually deducted automatically.
    2. If your SSDI checks stop due to work, Medicare will send you a bill for your Part B premiums, usually every 3 months.

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:

  • Buying Part A: You can choose to buy Medicare Part A. There's a monthly premium for this. The amount depends on how long you or your spouse worked and paid Medicare taxes. (Contact Medicare directly at 1-800-MEDICARE or visit Medicare.gov for the current premium amounts).
  • Buying Part B: If you choose to buy Part A, you can also continue to buy Part B (you'll still pay the monthly Part B premium).
  • Eligibility to Purchase: To be eligible to purchase Medicare under this rule, you must generally be under age 65 and continue to have the disabling impairment that allowed you to get SSDI in the first place.

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:

  • Qualified Medicare Beneficiary (QMB): Helps pay Part A premiums (if any), Part B premiums, and other cost-sharing like deductibles and coinsurance.
  • Specified Low-Income Medicare Beneficiary (SLMB): Helps pay Part B premiums.
  • Qualifying Individual (QI): Helps pay Part B premiums.
  • Qualified Disabled and Working Individuals (QDWI): Helps pay th (Content truncated due to size limit. Use line ranges to read in chunks)

Glossary of Terms (Used in this Guide)

  • EPE (Extended Period of Eligibility): A 36-month safety net period after the TWP ends.
  • EXR (Expedited Reinstatement): A way to quickly restart benefits if they stopped due to work, requested within 5 years.
  • IRWE (Impairment-Related Work Expense): Costs for items or services related to your disability that you need to work, which can sometimes be deducted from your earnings when SSA calculates SGA.
  • MSP (Medicare Savings Program): State programs (like QMB, SLMB, QI, QDWI) that help eligible individuals with limited income/resources pay for Medicare costs.
  • NESE (Net Earnings from Self-Employment): Your gross self-employment income minus allowable business expenses.
  • SGA (Substantial Gainful Activity): A level of work activity and earnings that SSA considers substantial. Earning over the SGA limit can affect your SSDI cash benefits after the TWP.
  • SSA (Social Security Administration): The U.S. government agency that manages Social Security benefits.
  • SSDI (Social Security Disability Insurance): Benefits paid to individuals who have worked and paid Social Security taxes long enough and have a qualifying disability.
  • TWP (Trial Work Period): A 9-month period allowing you to test work while receiving full SSDI benefits, regardless of earnings.

Medicare & Medicaid Coverage

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.

Expert Help with Medicare & Medicaid for Disability.
Navigating Medicare and Medicaid options

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Medicare with SSDI

SSDI recipients qualify for Medicare after receiving benefits for 24 months. Medicare includes:

  • Part A (Hospital Insurance): Usually premium-free
  • Part B (Medical Insurance): Monthly premium ($185.00 in 2025)
  • Part D (Prescription Drug Coverage): Optional, additional premium

You can also choose a Medicare Advantage plan (Part C) instead of Original Medicare.

Medicaid with SSI

In most states, SSI recipients automatically qualify for Medicaid. Medicaid typically covers:

  • Doctor visits
  • Hospital care
  • Long-term care
  • Prescription drugs
  • Preventive care
  • Many services not covered by Medicare

Coverage and eligibility rules vary by state.

What if I can't afford Medicare premiums?
Help Paying for Medicare
If you have limited income and resources, you may qualify for programs that help pay Medicare costs:
  • Medicare Savings Programs (MSPs):
    Qualified Medicare Beneficiary (QMB): Pays Part A and B premiums, deductibles, and coinsurance
    Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premiums only
    Qualifying Individual (QI): Pays Part B premiums only (higher income limit than SLMB)
    Qualified Disabled and Working Individual (QDWI): Pays Part A premiums for certain disabled working people
  • Extra Help (Low-Income Subsidy):
    Helps pay Part D prescription drug costs
    Reduces premiums, deductibles, and copayments
    Eliminates the coverage gap ("donut hole")
Apply for Medicare Savings Programs through your state Medicaid office and for Extra Help through Social Security.

Insider Tip

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.

What if I'm not eligible for Medicaid with SSI?
Other Medicaid Eligibility Pathways
In most states, SSI recipients automatically qualify for Medicaid. However, there are exceptions and alternative pathways:
  • 209(b) States: Some states (CT, HI, IL, MN, MO, NH, ND, OK, VA) use more restrictive Medicaid eligibility criteria than SSI. In these states, you need to apply for Medicaid separately, even if you receive SSI.
  • Medicaid Buy-In Programs: Many states offer programs that allow people with disabilities who work to "buy into" Medicaid by paying a premium, even if their income is above regular Medicaid limits.
  • Medically Needy Programs: Some states allow people with high medical expenses to "spend down" their income to qualify for Medicaid.
  • Home and Community-Based Services (HCBS) Waivers: These programs provide Medicaid coverage and services to help people with disabilities live in the community instead of institutions. Income limits are often higher than for regular Medicaid.
  • Medicaid Expansion: In states that expanded Medicaid under the Affordable Care Act, adults with income up to 138% of the federal poverty level may qualify.

Where to Get Help

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.

Frequently Asked Questions

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.

Can I receive both SSDI and SSI at the same time?
Yes, it's possible to receive both SSDI and SSI simultaneously. This is called "concurrent benefits." To qualify for both:
  • You must meet the medical criteria for disability
  • You must have worked enough to qualify for SSDI
  • Your SSDI benefit must be less than the federal benefit rate for SSI ($967 in 2025)
  • You must meet the income and resource limits for SSI
If your SSDI benefit is less than the SSI federal benefit rate, SSI may supplement your income up to that amount, assuming you meet all other SSI eligibility criteria.
How long does it take to get a decision on a disability application?
The time it takes to get a disability decision varies at each level of the process:
  • Initial Application: 3-5 months on average
  • Reconsideration: 3-5 months on average
  • Hearing: Wait times for a hearing date vary by location, ranging from 6-18 months
  • Appeals Council: 1-2 years on average
  • Federal Court: 1 year or more
Some claims qualify for expedited processing through programs like Compassionate Allowances, Terminal Illness Program, Presumptive Disability (for SSI), or Quick Disability Determination.
Can children receive disability benefits?
Yes, children can receive disability benefits in two ways:
  • SSI for children: Children under 18 with disabilities from low-income families may qualify for SSI. The child must have a physical or mental condition that results in "marked and severe functional limitations" and is expected to last at least 12 months or result in death. The family's income and resources are considered when determining eligibility.
  • SSDI dependent benefits: Children may receive benefits based on a parent's Social Security record if the parent is:
    Receiving SSDI or Social Security retirement benefits, or
    Deceased but worked long enough under Social Security
When children with disabilities turn 18, they must requalify under adult disability rules to continue receiving benefits.
Will my private disability insurance affect my SSDI benefits?
Private disability insurance generally does not affect your SSDI benefits. Social Security will pay your full SSDI benefit regardless of other private disability payments you receive.
However, the reverse is often not true. Many private disability insurance policies include "offset" provisions that reduce your private benefits by the amount you receive from SSDI. This is why private insurers often require you to apply for SSDI.

It's important to note that while private disability insurance doesn't affect SSDI, it may affect SSI eligibility since SSI is needs-based and considers your income from all sources.
Can I get disability benefits for a mental health condition?
Yes, you can qualify for disability benefits based on mental health conditions. Social Security recognizes many mental disorders as potentially disabling, including:
Depression and bipolar disorder
Anxiety and obsessive-compulsive disorders
Schizophrenia and other psychotic disorders
Autism spectrum disorder
Intellectual disability
Post-traumatic stress disorder (PTSD)
Neurocognitive disorders (like dementia)
Eating disorders
Personality disorders
As with physical conditions, you must show that your mental health condition prevents you from working at the SGA level and has lasted or is expected to last at least 12 months or result in death.

Medical documentation from mental health professionals (psychiatrists, psychologists, therapists) is crucial for mental health disability claims.
What happens to my disability benefits when I reach retirement age?
When you reach full retirement age (currently between 66 and 67, depending on your birth year):
  • SSDI benefits automatically convert to retirement benefits. The amount stays exactly the same—only the classification changes.
  • SSI benefits continue unchanged if you still meet the income and resource limits. Age is a qualifying factor for SSI, so you no longer need to meet the disability criteria.
This conversion from SSDI to retirement benefits is seamless and requires no action on your part. You'll continue to receive the same monthly payment, and your Medicare coverage will continue unchanged.
Can I receive disability benefits if I've never worked?
If you've never worked or don't have enough work credits for SSDI, you may still qualify for disability benefits through these programs:

  • SSI: If you have limited income and resources, you may qualify for SSI based on disability, regardless of work history.
  • Disabled Adult Child Benefits: If you became disabled before age 22, you may qualify for benefits on a parent's Social Security record if the parent is:
    Receiving retirement or disability benefits
    Deceased but worked enough under Social Security
  • Disabled Widow(er) Benefits: If you're at least 50 years old, have a disability, and your deceased spouse worked enough under Social Security, you may qualify for benefits on their record.
These programs provide options for people with disabilities who haven't built up their own work credits.
What Happens to My Medicare Coverage?
When your Social Security disability benefits stop following a Continuing Disability Review (CDR), what happens to your Medicare coverage depends heavily on why your benefits ended. It's a bit like asking, "If I stop getting my allowance, can I still use the family car?" Well, it depends if you stopped getting the allowance because you got a high-paying job or because you, uh, borrowed the car without asking one too many times.

If Benefits Stop Due to Medical Improvement.


If Social Security determines through a CDR that your medical condition has improved enough that you're no longer considered disabled under their rules, here's the typical outcome for your Medicare:
  • Coverage Usually Ends: Generally, if the medical reason for your disability benefits is gone, your entitlement to Medicare based on that disability also ends. Both your Hospital Insurance (Part A) and Medical Insurance (Part B) will likely stop.
  • Timing is Key: Don't panic immediately! Your coverage doesn't vanish overnight. It usually continues for a short period after your cash benefits stop. Social Security and Medicare will send you official notices explaining the exact date your coverage will end. Read these carefully!
  • Appealing the Decision: You absolutely have the right to appeal Social Security's decision that you're no longer disabled. If you appeal within the specified timeframe (usually 10 days of receiving the notice), you can request that your disability benefits and your Medicare coverage continue while your appeal is pending. Heads up: If you choose to continue benefits and Medicare during the appeal but ultimately lose, you might have to repay the disability benefits you received. Also, if your cash benefits aren't continued during the appeal, you'll likely need to pay the Part B premiums yourself to keep that coverage active.
If Benefits Stop Due to Work and Earnings (SGA)

Now, for the good news! If your disability benefits stop only because you've successfully returned to work and your earnings are above the Substantial Gainful Activity (SGA) level, but your underlying medical condition still meets Social Security's definition of disability, you get some significant Medicare protections. This is thanks to a work incentive called the Extended Period of Medicare Coverage (EPMC).

  • Extended Coverage is Real: Think of it as a long safety net. Your premium-free Medicare Part A coverage will continue for at least 93 months (that's 7 years and 9 months!) after the end of your 9-month Trial Work Period (TWP). This means you get a minimum of 8.5 years of continued Medicare coverage after you first return to work, provided your disabling condition persists.
  • Part B Continues (But You Pay): Your Medicare Part B (Medical Insurance) coverage also continues during this extended period. The catch? Once your monthly Social Security disability cash benefits stop due to your work, you'll become responsible for paying the monthly Part B premium directly. Medicare will typically bill you every three months. (Of course, if you have other insurance or assistance that pays your Part B premium, that arrangement might continue).
  • What Happens After the EPMC? Eventually, the premium-free Part A coverage under the EPMC will end (after at least 93 months post-TWP). If you still have your disabling impairment at that point, you won't be left completely high and dry. You'll generally have the option to buy Medicare Part A coverage by paying a monthly premium. If you choose to buy Part A, you can also keep (or buy) Part B by paying its premium. For folks worried about the cost, especially if income is limited, look into Medicare Savings Programs (like QMB, SLMB, or QI) or the Qualified Disabled and Working Individual (QDWI) program. These state-run programs can help pay Medicare premiums and sometimes other costs if you qualify.
Insider Tip: Navigating these rules can feel like trying to assemble IKEA furniture in the dark. Always read notices from Social Security and Medicare very carefully. If you're unsure how these rules apply to your specific situation, don't guess – contact Social Security (1-800-772-1213) or Medicare (1-800-MEDICARE) directly. They have the map for this particular maze!

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