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