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Social Security Disability Insurance (SSDI): The Basics

updated October 28, 2019
When you work, you pay taxes. Some of these taxes go into the federal government’s Social Security trust fund. Social Security uses this money to pay monthly benefits to retired seniors and to adults with disabilities who can no longer work.

If you or a qualifying family member have paid Social Security taxes for a long enough time and you have to stop working because of a disability, the federal government will pay you monthly cash benefits called Social Security Disability Insurance (SSDI). For SSDI, there are no resource limits — what matters is that you've worked long enough and now have a disability that meets Social Security's standards.

If you qualify, the amount of SSDI benefits you get is based on your Social Security earnings record. The more you’ve worked and the more you’ve paid in Social Security taxes, the higher your benefits will be. After getting SSDI benefits for two years, you automatically become eligible for Medicare health coverage.

More than eight million people under age 65 get SSDI benefits because their disabilities or health conditions prevent them from working.

Don't get SSDI mixed up with other programs

Social Security has two disability benefits programs with very similar names:

  • Social Security Disability Insurance (SSDI) gives cash benefits to people with disabilities who qualify because they used to work or have a parent who worked. SSDI is explained in this article.
  • Supplemental Security Income (SSI) gives cash benefits to people with disabilities who have low income and low resources. You do not need to have worked in the past to get SSI. Learn more in DB101’s SSI article.

Some people qualify for both programs at the same time. If you get benefits from Social Security, but aren't sure which ones you get, order a free Benefits Planning Query (BPQY) at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY).

Get Expert Help

If you have questions about SSDI and need to talk with somebody, call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) or visit your local Social Security office.

If you want to ask about how work might affect your SSDI benefits, try contacting:

SSDI: The Details

Eligibility and Application

Social Security Disability Insurance (SSDI) is a federal program that gives monthly cash benefits to people who have worked, paid Social Security taxes, and now have disabilities that prevent them from working.

If you worked in the past, but now have a disability that prevents you from working at a job that can pay for your monthly expenses, you should consider applying for SSDI benefits. Once you apply, the Social Security Administration (SSA) will look at your case.

You will have to meet these two basic requirements to qualify for SSDI benefits:

  1. You must be insured. SSA will look at your work history and see if you have worked long enough to be covered by SSDI. Because it's an insurance program, you do not have to prove financial need to qualify for SSDI. This is an important distinction between SSDI and Supplemental Security Income (SSI).
  2. SSA must decide that you have a disability. They will look at five different criteria and if you meet all five, SSA will decide that you have a disability.

You must meet both of these requirements to get SSDI benefits; if you only meet one of them, you will not qualify for SSDI benefits. How SSA decides if you are insured and have a disability is described later in this article.

Exceptions to these requirements

There are a few cases where you may qualify for benefits even if you have not worked long enough to be covered by SSDI or if you do not have a disability:

  • If you have not worked because of a disability that you acquired before you turned 22, you may qualify for Childhood Disability Benefits (CDB). CDB is described in greater detail later in this article.
  • If you are under the age of 19, you may qualify if one of your parents gets Social Security retirement or disability insurance benefits, or is deceased. You do not need a disability to get this benefit. You do not get these benefits automatically; you need to apply for them at your local Social Security office. To learn more about these Child’s Benefits, read DB101’s article about Benefits for Young People.
  • If your spouse or ex-spouse qualifies for SSDI benefits or Social Security retirement benefits, or qualified before dying, you may be able to get these benefits as well. You do not get these benefits automatically; you need to apply for them at your local Social Security office.

How to Apply

There are three ways you can apply for SSDI benefits:

  1. You can apply online.
  2. You can call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and the representative will take your application over the phone.
  3. You can visit your local Social Security office and apply in person.

Whichever method you choose, you will need to complete an application form and an Adult Disability Report.

Things you may need when you apply
  • Names, addresses, and phone numbers of all doctors, hospitals, and clinics that have supplied you with medical treatment and the dates of treatment
  • Names of any medications you are taking
  • Copies of any medical records you have
  • Your Social Security Number and the Social Security Numbers of your spouse and any children under the age of 18
  • A certified copy of your birth certificate
  • Proof of U.S. citizenship or legal residency, if you were born in another country
  • A certified copy of your military discharge papers (Form DD 214), if you were in the military
  • Your most recent W-2 Form or if you’re self-employed, your most recent tax return
  • Information on any workers’ compensation you get or have gotten
  • A summary of all your jobs during the past 15 years (names of jobs and dates of employment)

SSA will decide if you are insured and if you have a disability. If you are both insured and have a disability, you may qualify for SSDI.

SSDI: The Details

Are You Insured?

To figure out if you are insured by Social Security Disability Insurance (SSDI), Social Security does two tests that look at your work history. If you pass both of these tests, you are considered insured and may qualify for SSDI benefits if SSA also decides that you have a disability. If you do not pass either one of these tests, it does not matter if you have a disability, because you are not covered by this insurance program.

On this page we’ll explain the two tests Social Security uses to decide whether you have worked enough to be covered by SSDI. On the next page, we’ll explain how Social Security decides whether your disability qualifies you to get SSDI benefits. If Social Security decides that you are both insured and have a disability, you may qualify for SSDI.

Work History Test One: Have You Worked Recently?

This is also called the Recent Work Test. You need to have worked enough recently and paid Social Security taxes to pass this test.

Here’s how it works:

Age your disability began

Years you generally must have worked recently:
Test One: Have You Worked Recently?

Before Age 24

1.5 years during the last three years.

Age 24-30

Half of the time since you turned 21. Example: At age 27, you must have worked three years out of the six years since you turned 21.

Age 31 or older

Five years during the last ten years

If you don’t pass the Recent Work Test, you are not insured and do not qualify for SSDI benefits.

Work credits

Social Security doesn’t actually count the number of years you work. Instead they count the number of “work credits” you have. They give you up to four work credits per year. So, if you are 31 or older, you need to have earned 20 work credits (worked five years) in the last ten years. We have simplified it here to just show how many years you generally must have worked.

Work History Test Two: How Long Have You Worked?

This test is also called the Duration of Work Test. To pass this test, you need to have worked a certain number of years during your entire lifetime (between 1.5 and 9.5 years, depending on your age).

Here’s how it works:

Age your disability began

Total years you generally must have worked in your lifetime:
Test Two: How Long Have You Worked?

Before Age 43

Same as recent work test (1.5-5 years of work, depending on your age)

Age 44

5.5 years of work

Age 46

6 years of work

Age 48

6.5 years of work

Age 50

7 years of work

Age 52

7.5 years of work

Age 54

8 years of work

Age 56

8.5 years of work

Age 58

9 years of work

Age 60

9.5 years of work

Note: If you have worked in another country, Social Security may count the years that you worked in another country when evaluating your eligibility for SSDI. Read more about these “totalization” benefits.

If you don’t pass the Duration of Work Test, you are not insured and do not qualify for SSDI.

Check if you are insured on the Social Security website

You can access your Social Security earnings and benefit information on the Social Security website. The online statements can tell you if you will be eligible for SSDI if you become disabled and can give you an estimate of the benefits you would get. The online statement also provides a convenient way to determine whether your earnings are accurately posted to your Social Security records. Check your Social Security statement online.

SSDI: The Details

Do You Have a Disability?

If Social Security says that you have worked enough to be insured, then they will decide whether you have a disability that meets their criteria. To figure this out, Social Security, in collaboration with Ohio’s Learn more about Social Security’s rules on blindness.

Step 1: Are You Working at a Level of Substantial Gainful Activity?

If you are working and your monthly earnings before taxes are deducted are higher than the Substantial Gainful Activity (SGA) level, you will not have a disability according to Social Security and you will not qualify for SSDI benefits. In Current-Year, SGA is SGA-non-blind.

If you are not working or if your earnings are less than the SGA level, Social Security will move on to the next step to decide if you have a disability.

Example
Rose earns $$=([SGA-non-blind]+100)/60 per hour and works 60 hours per month. Her gross monthly earnings are $=[SGA-non-blind]+100 ($$=([SGA-non-blind]+100)/60 x 60), though after taxes are deducted, her actual paycheck is only $=[SGA-non-blind]-100.
Even though Rose only gets $=[SGA-non-blind]-100 per month in checks, Social Security counts all of her $=[SGA-non-blind]+100 in gross monthly earnings. Since $=[SGA-non-blind]+100 is more than the SGA limit (SGA-non-blind), Social Security says she does not have a disability.

Note: If you are self-employed, your income is calculated differently when it is compared to SGA. Learn about self-employment and SSDI.

Some SSDI deductions may lower your countable gross income below the SGA level

If you have a job, but your disability limits how much you can earn, you can still apply for SSDI benefits. If your income is over the SGA limit, there are some rules that might lower how much of your income Social Security counts. These are called deductions. The most common deductions during the disability determination process are Impairment Related Work Expenses (IRWEs) and subsidized earnings.

You have to document these deductions when you apply for SSDI. They may help you qualify for SSDI when you would not qualify otherwise. They are explained in greater detail in the Extended Period of Eligibility portion of this article.

Step 2: Is Your Medical Condition Severe?

For Social Security to say you have a disability, your medical condition must be expected to either:

  • Significantly limit your ability to perform basic work activities for at least 12 consecutive months, or
  • Result in death.

If it does not, you will not be considered to have a disability and will not qualify for SSDI benefits.

If your disability meets this standard, Social Security will move on to the next step to decide if you have a disability.

Step 3: Is Your Medical Condition on Social Security’s List of Impairments?

Social Security’s List of Impairments includes many mental and physical disorders. If your condition is on the list, Social Security will decide that you have a disability and will skip steps four and five.

If your condition is not on the list, Social Security will decide whether your condition is as severe as a condition that is on the list. If it is, Social Security will decide that you have a disability and will skip steps four and five.

If your condition is not as severe, Social Security will move on to the next step to decide if you have a disability.

Step 4: Can You Do the Same Work You Did Before?

If your condition doesn’t stop you from doing the work you did before, Social Security will say you do not have a disability and do not qualify for SSDI benefits.

If your medical condition does stop you from doing the same work you did before, Social Security will move on to the final step to decide if you have a disability.

Example

Wilson was a construction worker. He fell off his motorcycle one day and severely injured his knees. Because he has limited mobility and can no longer stand for long periods of time, he can’t do construction anymore.

Wilson cannot do the same work he did before and SSA will continue to look into whether he has a disability.

Step 5: Can You Do Any Other Type of Work?

If you can’t do the work you used to do, Social Security will look at your skills and your condition to see if there is other work you could do.

If your condition doesn’t prevent you from doing other work and earning at the SGA level, you won’t be considered to have a disability and will not qualify for SSDI benefits.

Example

While Wilson’s injury prevents him from doing construction on site, he could still manage construction projects from a desk, so Social Security might say he doesn’t have a disability.

If your medical condition does stop you from doing other work and earning at the SGA level, Social Security will say that you have a disability, as long as you have met the other four criteria.

If you are insured and have a disability, you may qualify for SSDI benefits.

SSDI: The Details

Disability Determination Notice

How long it takes for the Social Security Administration (SSA) to decide if someone has a disability can vary widely from applicant to applicant. In some cases, SSA may make a decision within a month or two. On average it takes about six months and in some cases, it may take a year or longer. When you get your disability determination notice, it will tell you whether your claim has been approved or denied.

If you’re waiting for a disability determination from Social Security and need immediate financial assistance, you should consider using your job's sick pay or vacation pay. If your company has a short-term or long-term disability insurance plan, you should look into that too.

Filing an Appeal

Many people are denied SSDI benefits. If you are denied benefits and you feel that Social Security’s decision is incorrect, you have the right to appeal. The appeals process takes time, but in the end, many appealed denials are reversed.

If you decide to file an appeal:

  • File your appeal quickly. After you get a denial letter, you have 60 days to file an appeal. If you don’t appeal within 60 days, you may not be able to appeal.
    • If you were already getting SSDI and are appealing an overpayment notice, appeal within 30 days to avoid having your benefits withheld while your appeal is reviewed.
    • Note: Social Security figures that you get a letter within five days after they sent it.
  • If you are denied SSDI benefits for medical reasons, you can file your appeal online or call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and ask them to send you an appeal form. If you file online, you need to mail or deliver any new information to Social Security about your medical condition, including updates on any treatment, tests, or doctor visits.
  • If you are denied SSDI benefits for nonmedical reasons, you can request a review from your local Social Security office or by calling Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).

Note: If your application for SSDI benefits is denied and you disagree with the decision, file an appeal. Do not just fill out the application forms again — that would be refiling.

The appeal process

There are four levels to the appeal process. If you are not satisfied with the result at each level, you can appeal to the next. The four levels are:

  1. Reconsideration: A person at Social Security who wasn’t involved in the first decision looks at your application. This is a paper appeal, so you don’t have to go in front of a judge. Give Social Security any new information you have about your case.
  2. Hearing: If the reconsideration is denied, you can ask for a hearing before an Administrative Law Judge. You can bring witnesses to help make your case. Consider having an attorney or representative help you.
  3. Appeals Council: Social Security’s Appeals Council will review your case if you appeal the Administrative Law Judge’s decision. The Council can accept the judge’s decision, decide the case for itself, or send it back to a different Administrative Law Judge for another hearing.
  4. Federal Court: If the Appeals Council decides against you, you can file a lawsuit in federal court.

For any level beyond the reconsideration, you may want to get help from a lawyer. NOSSCR is an association of attorneys and paralegals who represent people who think they’ve been unfairly denied Social Security benefits. You can reach NOSSCR at 1-800-431-2804.

When Social Security Checks to See if Your Situation Has Changed

Occasionally, Social Security will do two different types of Continuing Disability Review (CDR) to make sure you still qualify for SSDI benefits:

If Social Security contacts you, make sure to read everything they send you and follow any instructions they give. If you have trouble filling out a form or getting documentation, ask for help at your local Social Security office or talk to a benefits planner.

SSDI: The Details

The SSDI Benefit

If Social Security approves your SSDI benefits application, your monthly SSDI cash benefits will be based on your Social Security earnings record. The Social Security Administration (SSA) uses a complicated formula to figure out what your monthly SSDI benefits amount will be. Generally, the more you’ve worked and the more you’ve paid in Social Security taxes, the higher your SSDI benefits will be.

Dependents' Benefits

When you qualify for SSDI benefits, your children under age 19 may also qualify to receive benefits based on your record. It doesn't matter whether the child has a disability. Your spouse may also be able to get benefits if age 62 or older, or if caring for a child under 16. Social Security has more information about these benefits.

Your qualifying child or spouse will get these benefits in any month you get an SSDI benefit. Read more about what months you and your dependents will get a benefit in SSDI and Work.

When Will My SSDI Benefits Start?

If you become eligible for SSDI benefits, you won’t get SSDI cash benefits for the first five full months after the onset of your disability. This is called the waiting period.

Once you have gotten SSDI benefits for two years, you automatically become eligible for Medicare, even if you are under age 65. We’ll discuss the connection between SSDI and Medicare later in this article.

Example

If SSA decides that your disability began on January 15 (your onset date), February, March, April, May, and June would be your five-month waiting period.

You would be paid your first SSDI benefits payment for the month of July, but because Social Security benefits are paid in the month after they are due, you would get your July benefits payment in August. Two years later, in July, you'd start having Medicare health coverage.

You would continue to get SSDI benefits payments and Medicare coverage as long as you meet all SSDI work and eligibility requirements and Social Security continues to consider you to have a disability.

SSDI: The Details

Childhood Disability Benefits (CDB)

Adults who have a disability that began before they turned 22 can get other benefits through Social Security called Childhood Disability Benefits (CDB). These benefits are based on the taxes their parents paid into the Social Security system. Unlike SSDI benefits, you do not need to have worked to qualify for CDB.

To be eligible for CDB, one of your parents must:

You can also get CDB if you had a disability before turning 18 and you were getting benefits based on your parent’s Social Security earnings record. These benefits are discussed in DB101’s Benefits for Young People article.

The Social Security Administration (SSA) uses the same disability determination criteria for CDB that it uses for SSI and SSDI benefits. If Social Security decides that you cannot work and earn above the Substantial Gainful Activity (SGA) level and that your disabling condition meets Social Security’s medical definition of disability, you can qualify for CDB.

For more information on CDB and other benefits that young people with disabilities can qualify for, read DB101’s Benefits for Young People article and take a look at SSA’s publication on Benefits for Children with Disabilities.

CDB and Medicare

If you get CDB, you can also get health coverage through Medicare after a 24-month waiting period. To learn more, talk to a benefits planner.

SSDI: The Details

SSDI and Work

If you’re on SSDI benefits, it’s because your disability prevents you from going to work and earning enough to cover your expenses. However, a lot of people on SSDI benefits want to give work a chance. They think that maybe if they just had a bit of time and knew that they wouldn’t lose their benefits, they could succeed at a job.

On SSDI? Get a quick estimate of how working may affect your income
Try It!

That’s why the Social Security Administration (SSA) has made program rules and incentives that can help you work without having to worry that you’ll lose the benefits you need. For most people who get SSDI benefits, these work incentives function like a three-stage process that begins when you get a job:

  1. The Trial Work Period lets you work and get benefits at the same time, no matter how much you make.
  2. When the Trial Work Period ends, the three-year Extended Period of Eligibility (EPE) lets you work and get benefits for every month that you earn less than the Substantial Gainful Activity (SGA) level ($1,220 in 2019).
  3. For the first five years after you stop getting benefits, Expedited Reinstatement means that if your income drops below the SGA level, you can quickly get back on SSDI benefits without having to completely re-apply.

These three incentives mean that you can get a job and see how it goes. If it goes well, you’ll be in a better financial situation than before. If it doesn’t go well, you will be able to get SSDI benefits and be in the same situation as you were before you tried out working.

Here we’ll explain the Trial Work Period, Extended Period of Eligibility, and Expedited Reinstatement in more detail. See DB101's SSDI Work Rules FocusPopup Link for a detailed example of how the SSDI work rules work.

Record and report changes in your earned income

Income recording: It is very important for you to keep track of your earned income, because Social Security will periodically ask to verify it. This means that you should keep all of your pay stubs and documentation of work incentives, such as receipts for your Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs), in one place. A good way to do this is to get a binder and add this documentation to your binder each month. You can also put any letters you get from Social Security in your binder, take it with you whenever you go to a Social Security office, and take notes every time you communicate with Social Security.

Income reporting: For Social Security Disability Insurance (SSDI), you must tell Social Security right away if:

  • You start or stop work
  • You reported your work, but your duties, hours, or pay change; or
  • You start paying expenses for work because of your disability.

If you don’t, you risk getting an overpayment and you may have to pay back those benefits to Social Security.

To report changes, contact your local Social Security office and ask how and when you should report your earnings. You may be able to report:

Note: If you get SSDI benefits and also get Supplemental Security Income (SSI) benefits, you must report your income to SSDI and SSI separately. Learn more about SSI income reporting in DB101's SSI article.

SSDI: The Details

Trial Work Period (TWP)

If you get SSDI benefits, you can work for up to nine months in a five-year window without losing your benefits. This is called the Trial Work Period (TWP). During the nine months of your TWP, you can work and earn any level of income while still keeping your full SSDI benefits. This is a great way for you to get a job without having to worry about losing your SSDI benefits.

Trial Work Month

Each month your gross earnings (your earnings before taxes) are greater than $880 (in 2019) is called a Trial Work month. The five-year period in which you are allowed nine Trial Work months without losing your SSDI benefits is called the five-year window. Your nine Trial Work months may occur one right after the other or at irregular intervals within the five-year window.

If you earn more than $880 in a month, you’ve used up one Trial Work month. If you earn less than $880, you haven’t. Either way, you continue to get full SSDI benefits until you have used up all nine Trial Work months.

Example

Carolyn gets SSDI benefits and recently started working part-time in a flower shop. Her hours vary from month to month. Her gross monthly earnings for the first four months of 2019 were:

Carolyn's Earnings

January:

$400

February:

$1,150

March:

$620

April:

$970

In February and April, Carolyn used up Trial Work months, because she earned more than $880. January and March weren’t Trial Work months, because she earned less than $880.

She got full SSDI benefits in all four months, because she still hasn’t used up all nine Trial Work months.

Note: Before you start working, you should check with Social Security or a benefits planner to see if you've already used up any Trial Work months. You may have used up some or all of your Trial Work months in the past and not realize it.

Count Your SSDI Trial Work Months:

SSDI: The Details

Extended Period of Eligibility (EPE)

Once you’ve used up all nine Trial Work months during a five-year window, your Trial Work Period is over and your three-year Extended Period of Eligibility (EPE) begins the following month.

During your EPE, you will continue to get SSDI benefits as long as your gross monthly earnings don’t go above the Substantial Gainful Activity (SGA) limit ($1,220 per month in 2019, $2,040 if you’re blind).

Once your earnings reach the SGA level in one month, a three-month Grace Period begins. During that time, you will continue getting SSDI cash benefits regardless of your wages. After your Grace Period ends, however, your SSDI benefits will be zero in any month that you earn above the SGA limit. If your income drops below the SGA limit again, you can call Social Security and get your benefits reinstated. Until your EPE ends, you will continue to be able to get your SSDI benefits for any month during which you earn less than the SGA limit.

At the end of the three-year EPE, if you are earning less than the SGA limit, you will continue to get your SSDI cash benefits. If you earn more than SGA, your SSDI cash benefits may end. If you earn more than the SGA limit one month and your income drops below the SGA limit the next month, you may no longer automatically be able to get reinstated and get SSDI benefits – you may have to request benefits through Expedited Reinstatement, which is described later.

Example

Tony’s EPE begins in March. He earns $600 per month in March, April, and May. Because $600 is less than the SGA limit, Tony gets SSDI benefits in each of these months.

In June, however, Tony earns $1,350. Because $1,350 is more than the SGA limit ($1,220), his June earnings cause his Grace Period to begin. Tony gets SSDI benefits in June and in the following two months because he’s in his three-month Grace Period.

In September, Tony earns $1,300. Because he’s now used up his Grace Period and his earnings are above the SGA limit, Tony doesn’t get SSDI benefits that month. In October, his earnings dip below the SGA limit again. He contacts Social Security and requests that his benefits be reinstated. They reinstate his benefits and send him a check. In November, he earns more than the SGA limit and doesn’t get benefits.

This pattern will continue for the rest of Tony’s EPE. Every month he earns less than the SGA limit, he asks for reinstatement and gets SSDI benefits. Every month he earns more than the SGA limit, he doesn’t.

Note: Tony needs to make sure he reports any changes in his work and income to Social Security to avoid overpayments. This is very important.

Overpayments

Social Security may send you SSDI benefits even when you shouldn't be getting any. That's called an overpayment and you will have to repay any overpayments you get.

That's why it's important for you to report to your local Social Security office things like changes in your earned income, marital status, or address. By reporting these things to Social Security, you can lower the odds of an overpayment.

Sometimes, even if you report these changes, Social Security may send you an overpayment. For example, they might keep sending you SSDI benefits during the EPE even if you are earning more than SGA, because Social Security hasn't yet done a work Continuing Disability Review (CDR) for you.

If you think Social Security may have sent you an overpayment, it is very important that you talk to a benefits planner so you can get expert advice for your situation.

Deductions

During your Extended Period of Eligibility (EPE), there are some ways to lower your gross monthly earnings so that Social Security won’t count everything you make. These are called deductions. Here we’ll talk about the most common deductions that can help you lower your gross monthly earnings below the SGA limit, so that you can work and keep getting your SSDI benefits.

Note that you can also use these deductions when you apply for benefits and during the period of Expedited Reinstatement, but you cannot use these deductions during the Trial Work Period.

Impairment Related Work Expenses (IRWEs)

Impairment Related Work Expenses (IRWEs) are costs related to your disability that you have to pay to do your job. IRWEs must be expenses that you pay for, not your health insurance or anyone else. Keep your receipts for all expenses you think are IRWEs. You need to include them with your pay stub or other earnings information when you report your earnings to Social Security.

Examples of IRWEs include money you spend on:

  • Personal Care Assistance (PCA) services that you use on the job
  • Special equipment related to your disability that you purchase for your job
  • Copayments for additional prescription drugs that you need because you are working

Subsidized Earnings

An employer may pay workers with serious medical conditions more in wages than their work is actually worth. When this occurs, the excess pay is regarded as a subsidy rather than earnings.

SSDI Countable Earnings with IRWEs and Wage Subsidy (during EPE):
Example

Jamie's gross earnings for the month are $1,360. She spends $50 each month on Personal Care Assistance at her job, which counts as an IRWE. She also gets a $200 wage subsidy from her employer, who is paying her as much as he paid her before she acquired her disability, even though she doesn’t get as much work done as she used to.

Social Security would calculate her monthly earnings like this:

SSDI Countable Earnings with IRWEs and Wage Subsidy:

Because her countable gross monthly earnings are less than the SGA limit ($1,220), Jamie would get SSDI benefits for the month.

Your SSDI Countable Earnings:

SSDI: The Details

Expedited Reinstatement

If you have already completed your Trial Work Period and your Extended Period of Eligibility (EPE), you can still get SSDI benefits if your income drops below the Substantial Gainful Activity (SGA) level. This method of getting SSDI benefits is called Expedited Reinstatement.

Expedited Reinstatement allows former SSDI beneficiaries whose EPE ended within the five previous years to get up to six months of temporary SSDI cash benefits if their income drops below the SGA level. As with the EPE, during your period of Expedited Reinstatement, you can deduct Impairment Related Work Expenses (IRWEs) and employer subsidies from your gross monthly earnings to help you qualify for SSDI benefits.

During the six months you are on temporary benefits, the Social Security Administration (SSA) will conduct a medical review to figure out whether or not you still meet SSA disability requirements. If Social Security decides that you still have a disability, you will keep getting benefits without having to reapply for SSDI. If they decide that you no longer have a disability, your SSDI benefits will stop.

You can request Expedited Reinstatement any time within five years after you stopped getting benefits. If you have questions about Expedited Reinstatement, Extended Periods of Eligibility, or any other Social Security work incentives, talk to a benefits planner.

SSDI: The Details

Self-Employed Workers and Substantial Gainful Activity

Note: This page is only for people who are self-employed. If you are not self-employed, you can skip this page.

If you’re self-employed, Social Security may use different methods to figure out whether or not the work you do is above the level of Substantial Gainful Activity (SGA).

Social Security does not consider your income alone because the amount of money you actually get from your business may depend on many different factors. Instead, they use three tests.

If Social Security decides that you have not engaged in SGA using all three tests, you may qualify for SSDI benefits (assuming you meet all other eligibility requirements).

Self-Employed: Test 1

If you supply services that are significant to the operation of your business and you get substantial income from the business, Social Security will likely decide that you have done SGA and you will not qualify for SSDI benefits.

What does Social Security mean by significant services and substantial income?

Significant services
  • If you operate a business (other than a farm) all by yourself, your services are considered significant.
  • If you and at least one other person run the business, your services are considered significant if you supply more than half of the management time. So, if it takes 60 hours a month to manage your business and you manage it for 45 of those hours, your services are considered significant.
Substantial income

Social Security will deduct your business expenses and the value of unpaid help, Impairment Related Work Expenses (IRWEs), and unincurred business expenses from your net income to figure out your net countable income. If that figure is greater than $1,220 per month, your income will be considered substantial.

If Social Security decides that you have not engaged in SGA under Test 1, Social Security will move on to Test 2.

Self -Employed: Test 2

Social Security will examine the work you do to see if it counts as SGA. They will look at things like hours worked, skills needed, responsibilities, and effort involved.

If the work you do is about the same as the work of nondisabled people who are in similar businesses in your community, Social Security will decide that you have engaged in SGA and you will not qualify for SSDI benefits.

If Social Security decides that you have not engaged in SGA under Test 2, Social Security will move on to Test 3.

Self-Employed: Test 3

Social Security will examine your monthly work. If your work is worth at least $1,220 per month in its impact on your business, or if you’d have to pay someone at least $1,220 per month to do that work, you’ve engaged in SGA.

If Social Security decides that you have not engaged in SGA under Test 3, you may qualify for SSDI benefits, if you meet all other program requirements.

People who are blind or over 55

If you are self-employed and blind, or if you are self-employed and over age 55, special SGA rules will apply to you. For more information, talk to a benefits planner.

SSDI: The Details

SSDI and Other Disability Benefit Programs

Many people who get SSDI benefits also qualify for other disability benefits programs like Medicare. It’s important to understand how different programs interact, as benefits from one program may impact eligibility for another.

If you have questions about how programs interact with each other, talk to a benefits planner. You can also use the DB101 Benefits and Work Estimator for estimates on how working may impact your SSDI benefits and other benefits.

Medicare

Medicare and SSDI are linked. If you’ve been getting SSDI benefits for 24 months, you automatically qualify for Medicare. Because of the five-month waiting period when you first start SSDI, you actually have to wait 29 months from the time you meet the SSDI eligibility criteria (disability onset) to qualify for Medicare.

Learn more about Medicare in DB101's How Health Benefits Work article.

Example

Silvio became eligible for SSDI benefits on April 22, 2018, but he had to wait five months (May, June, July, August, and September) until he got his first payment. He was eligible for his first SSDI payment in October 2018, but because SSDI makes payments one month after they are due, he actually didn’t get his first payment until November 2018. He’ll have to wait another 24 months, until October 2020, to become eligible for Medicare.

While he’s waiting for his Medicare coverage to begin, Silvio should apply for health coverage on Healthcare.gov, where he might qualify for Medicaid. Once he becomes eligible for Medicare, Silvio can continue getting coverage via Medicare for at least 93 months (seven years, nine months) after his SSDI Trial Work Period ends.

Medicaid

Medicaid is Ohio’s Medicaid program. It helps pay for medical expenses for people with disabilities and others who qualify.

Remember that if you’re eligible for SSDI, you will eventually become eligible for Medicare (if you aren’t already on it). So you need to consider how Medicare and Medicaid interact when making decisions about your health care coverage.

Medicaid as a Bridge to Medicare

During the 29 months between the onset of your disability and your eligibility for Medicare, you may be able to get Medicaid coverage if your income is low enough.

Learn more about Medicaid in DB101's How Health Benefits Work article.

Medicaid Once You’re On Medicare

Once you’re on Medicare, you won’t qualify for Medicaid under income-based rules, unless you’re pregnant or caring for a child. However, since you’re on SSDI, you have a disability determination from Social Security – and may qualify for Supplemental Security Income (SSI).

If you get SSI benefits in addition to SSDI benefits, you automatically qualify for disability-based Medicaid. If you used to get SSI benefits, you may also get disability-based Medicaid if you qualify for SSI 1619(b), which gives Medicaid coverage to people who stop getting SSI benefits when their earned income goes up. If you do not get SSI benefits and do not qualify for 1619(b), you probably don't qualify for disability-based Medicaid, though there are some exceptions for people with severe mental illness.

If you get Medicaid coverage at the same time as Medicare, you automatically qualify for the Part D Low Income Subsidy, making your prescriptions very cheap. If you are in this situation, make sure to sign up for a Part D plan.

If you are getting SSDI and working, you may want to consider Medicaid Buy-In for Workers with Disabilities. It covers the same things as standard Medicaid and all you pay is a monthly premium and small copayments. Being on Medicaid Buy-In for Workers with Disabilities also automatically qualifies you for the Part D Low Income Subsidy.

If you have a lot of prescription drug costs, the Low Income Subsidy is a very important benefit. It could save you a lot of money each month in prescription drug costs.

Learn more about Medicaid in DB101's How Health Benefits Work article.

Supplemental Security Income (SSI)

Many people confuse SSI with SSDI. SSI stands for Supplemental Security Income; SSDI stands for Social Security Disability Insurance.

They’re both Social Security programs. You must pass the disability determination process from Social Security to qualify for either one.

SSI is a needs-based program. You can only qualify for SSI if your countable monthly income and total resources are below certain levels. SSDI, on the other on hand, is based on your work history. If you have worked and contributed enough money in Social Security taxes, you will qualify for SSDI (assuming you meet all other eligibility criteria).

There is nothing preventing you from being on both SSI and SSDI at the same time. However, if you are getting SSDI, the SSI program will consider your SSDI payments unearned income. This means that if your monthly SSDI benefits amount is $791 or more (the SSI countable income limit for a single person plus $20), you won't qualify for SSI benefits.

If your monthly SSDI benefits amount is less than $791 and you’re not getting income from any other source, you may qualify for SSI benefits. Typically, in this situation, you would get a total of $791 in benefits between the two programs. So if your SSDI payment was $300, your SSI benefits amount would be $491.

Section 301

Under Social Security’s Section 301 program, you can continue to get SSI or SSDI benefits even if you have medically recovered and your disability no longer meets Social Security’s disability standards.

Under Section 301, you can continue to get benefits as long as you are participating in an approved Vocational Rehabilitation (VR) program that is expected to help you become self-supporting. Note: You must have been participating in such a program before Social Security reviewed your medical situation and determined that you no longer had a disability.

Programs and providers that are usually approved for Section 301 include:

To find out if a specific provider or program is approved under Section 301, talk to a benefits planner or visit your local Social Security office. You can also call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).

SSDI: Example

Kevin’s Story

Kevin was 38 years old when a car accident left him paralyzed from the waist down.

He had about $10,000 in savings when he returned home from the hospital and he knew that money would not last forever. He also knew he’d be unable to return to his old job as an auto mechanic, and he did not have any short-term or long-term disability insurance to help pay the bills.

Fortunately, Kevin had learned about Social Security Disability Insurance (SSDI) benefits in the hospital. SSDI is a program that gives income to people who are no longer able to work because of a disability.

Applying for SSDI would be a three-step process.

  1. He’d need to fill out an application, an Adult Disability Report, and supply any other necessary documentation about his income, work history, and disability.
  2. Social Security would have to check his work history to be sure he’d contributed enough in Social Security taxes to qualify for SSDI benefits.
  3. Social Security would have to decide that he has a disability.

SSDI Eligibility

Kevin was fairly sure he’d meet all the eligibility criteria for SSDI:

  1. He was not earning any income from work, so his earnings were well below the Substantial Gainful Activity (SGA) level.
  2. His disabling condition was severe and could be expected to last longer than 12 months.
  3. His disabling condition was listed on Social Security’s List of Impairments.
  4. He would not be able to return to work at his old job. And given his condition and skills, he did not think he would be able to work at another job and perform at the SGA level.
  5. He started working and paying Social Security taxes when he was 22, so he was sure he’d collected enough work credits to qualify for SSDI benefits.

Approval

Kevin applied for SSDI benefits and two months later, he got a letter in the mail. He’d been approved for a monthly SSDI benefits amount of $1,500.

He had to wait another five months before he actually got his first SSDI benefits payment, but when he did, it was a great relief. The monthly cash benefit was a huge help with rent, groceries, and other expenses.

One Year Later

A little more than a year after his SSDI payments began, Kevin started thinking about going back to work. However, he had some concerns.

First and foremost, would he be able to work again? Being an auto mechanic was out. But maybe there was some other way he could earn a living.

Second, how would work and a higher income affect his SSDI benefits? If a new job worked out, that was great. But what if it didn’t? Would he have to re-apply for Social Security benefits? Kevin talked to a benefits planner to get some answers.

SSDI Work Incentives

To Kevin’s delight, he learned that Social Security offers many incentives to help people return to work.

First of all, Social Security gives every SSDI beneficiary a nine-month Trial Work Period. During that period, you can work and earn any level of income while still keeping your full SSDI benefits. This gives beneficiaries a chance to test the waters and see if working is a good option for them.

Once you’ve used up your Trial Work Period, you get a three-year Extended Period of Eligibility (EPE), during which you can continue to get SSDI benefits as long as your gross countable monthly earnings don’t exceed the Substantial Gainful Activity (SGA) level ($1,220 per month in 2019, $2,040 if you’re blind).

After your EPE ends, a five-year period of Expedited Reinstatement follows. During this period, you can apply for reinstatement of benefits and get up to six months of temporary SSDI benefits while Social Security conducts a medical review. If, during that review, Social Security decides that you still meet their disability requirements, you’ll be placed back on benefits without having to reapply for SSDI.

With all these safeguards, Kevin decided to give working a shot. He got a job as a sales representative for an auto parts manufacturer and it turned out to be a great fit. Ultimately, he became one of the top salesmen in Hamilton County. SSDI had served him well while he was unable to work, and the program’s work incentives had given him the confidence to try working again.

Social Security Disability Insurance (SSDI): FAQs

What is Social Security Disability Insurance (SSDI)?

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Social Security Disability Insurance (SSDI) is a federal program that helps replace lost income for people with disabilities who can no longer work. To qualify, the Social Security Administration (SSA) must determine you have a disability and you also must also have worked long enough while paying Social Security taxes.

Note: SSDI is sometimes called "DI" or "Title II" (Title II of the Social Security Act). Some people just call it "Social Security disability benefits," or "Social Security benefits," but that can cause confusion with other Social Security programs.

What is the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)?

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Social Security has two disability benefits programs with very similar names:

Some people qualify for both programs at the same time. If you get benefits from Social Security, but aren’t sure which ones you get, order a free Benefits Planning Query (BPQY) at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY).

Who can I call to ask questions about SSDI?

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If you have questions about SSDI and need to talk with somebody, call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) or visit your local Social Security office.

If you want to ask about how work might affect your SSDI benefits, try contacting:

Who is eligible for Social Security Disability Insurance (SSDI)?

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To qualify for SSDI, Social Security must decide that you have a disability. You also need to have worked a certain amount of time and have contributed enough in Social Security taxes to qualify.

The amount of time it takes Social Security to decide if you have a disability can vary widely from applicant to applicant. In some cases, it may only take a month or two. The average is around six months and in some cases it takes a year or longer.

Social Security uses a series of tests to decide if you are eligible. As a general rule, if you've accumulated enough work credits and your disabling condition is severe enough to keep you from engaging in any Substantial Gainful Activity (SGA), you'll qualify for SSDI benefits.

How is my SSDI benefit calculated?

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Your SSDI benefits amount is based on your average earnings from work over your lifetime. Small changes will be made to your benefits amount each year to account for changes in the cost of living.

Your SSDI benefits amount may be reduced if you’re getting Workers' Compensation payments or income from other sources, such as government pensions.

Is there any health coverage that comes with SSDI?

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Yes. If you’re on SSDI benefits, you will automatically be eligible for Medicare after you’ve been eligible to get SSDI cash benefits for 24 months. You will continue to be eligible for Medicare as long as you’re getting SSDI cash benefits, and for up to 93 months (seven years, nine months) after your SSDI Trial Work Period ends.

Learn more about Medicare in DB101's How Health Benefits Work article.

How do I apply for Social Security Disability Insurance (SSDI)?

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You can apply for SSDI:

What sort of information will I have to give Social Security when I apply for SSDI?

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You may need to give all of the following when you apply for SSDI:
  • Names, addresses, and phone numbers of all doctors, hospitals, and clinics that have given you medical treatment. You will also need to give dates of treatment
  • Names of any medications you are taking
  • Copies of any medical records you have
  • Your Social Security Number and the Social Security Numbers for your spouse and any children you have who are minors
  • A certified copy of your birth certificate
  • Proof of U.S. citizenship or legal residency, if you were born in another country
  • A certified copy of your military discharge papers (Form DD 214), if you were in the military
  • Your most recent W-2 Form, or if you’re self-employed, your most recent federal tax return
  • Information on any workers’ compensation you get
  • A summary of all jobs you have had during the past 15 years (name of jobs and dates)

What is Substantial Gainful Activity (SGA)?

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Substantial Gainful Activity (SGA) is one of the measures that Social Security uses to figure out whether or not you have a disability and therefore qualify for Social Security benefits.

If your countable monthly income is greater than the SGA level ($1,220 per month in 2019, $2,040 if you’re blind), you will not be considered disabled.

Note: You may be able to reduce your countable monthly income if you get a wage subsidy or have Impairment Related Work Expenses (IRWEs).

If you are self-employed, Social Security may not consider your income alone to figure out whether or not you’ve reached the SGA limit. Instead, they may use three different tests that examine a variety of factors (for example, hours worked, skills needed, management time, and responsibilities) to figure out whether or not you’ve reached SGA.

Will the money I have in the bank or my other resources affect my eligibility for SSDI?

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No. SSDI does not have any resource limit. You can have unlimited resources and still qualify for SSDI benefits.

How do I know if my disability qualifies me for SSDI?

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Your disabling condition must be on Social Security’s List of Impairments for you to qualify. If your disability is not on the list, Social Security has to decide that your condition is as severe as a condition that is on the list for you to qualify.

What is the Trial Work Period (TWP)?

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Social Security wants to encourage Social Security Disability Insurance (SSDI) beneficiaries to return to work if they can. That's why there are program rules and work incentives to make it easier for people to work. One of these is the Trial Work Period (TWP).

Social Security gives everyone on SSDI benefits a nine-month TWP to test the waters and see if they’re able to re-enter (or more fully enter) the workforce. During your TWP, you can work and earn any level of income while still keeping full SSDI benefits.

Your TWP is made up of nine Trial Work months within a five-year window. A Trial Work month is any month within your TWP during which your gross earnings (earnings before taxes are deducted) are greater than $880. If you earn more than $880 in a month, you’ve used up one Trial Work month. If you earn less than $880, you haven’t. Either way, you continue to get full SSDI benefits.

What is the Extended Period of Eligibility (EPE)?

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Once you’ve used up your Trial Work Period (TWP), a three-year Extended Period of Eligibility (EPE) begins.

During your EPE, you will continue to get monthly SSDI benefits as long as your countable monthly earnings don’t exceed the Substantial Gainful Activity (SGA) level ($1,220 per month in 2019; $2,040 if you’re blind). Your SSDI benefits amount will be zero in any month that you earn above the SGA limit.

Once your countable monthly earnings reach the SGA limit, a three-month Grace Period begins. During that time, you will continue getting SSDI cash benefits regardless of your wages. After your Grace Period ends, however, your SSDI cash benefits will be stopped for any month your countable earnings are over SGA.

What is Expedited Reinstatement?

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Expedited Reinstatement allows former SSDI beneficiaries who have gone back to work and used up their Trial Work Period and Extended Period of Eligibility to get up to six months of temporary SSDI cash benefits if their income drops below the Substantial Gainful Activity (SGA) level.

During those six months, Social Security will conduct a medical review to figure out if the beneficiary still meets Social Security's disability requirements. If they do, they’ll be placed back on benefits without having to reapply for SSDI. If they don't, their SSDI benefits will stop.

To be eligible for Expedited Reinstatement, you must request it within five years of when you stopped getting benefits.

Do I need to let Social Security know if I go back to work?

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Yes. For Social Security Disability Insurance (SSDI), you must tell Social Security right away if:
  • You start or stop work
  • You reported your work, but your duties, hours, or pay change; or
  • You start paying expenses for work because of your disability.

If you don’t, you risk getting an overpayment and you may have to pay back those benefits to Social Security.

To report changes, contact your local Social Security office and ask how and when you should report your earnings. You may be able to report:

Note: If you’re on Medicaid or any other public health care program, be sure to report changes in your income to your local County Department of Job and Family Services (CDJFS) office.

Keep Records

It is very important for you to keep track of your earned income, because Social Security will periodically ask to verify it. This means that you should keep all of your pay stubs and documentation of work incentives, such as receipts for your Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs), in one place. A good way to do this is to get a binder and add this documentation to your binder each month. You can also put any letters you get from Social Security in your binder, take it with you whenever you go to a Social Security office, and take notes every time you communicate with Social Security.

How often do I need to report my income to Social Security?

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If you go back to work or if your earned income changes for any other reason, contact a claims representative at your local Social Security office and ask how and when you should report your earnings for SSDI. You may be able to report in writing or online. If you don’t, you risk getting an overpayment and you may have to pay back those benefits to Social Security.

Note: If you get SSDI benefits and also get Supplemental Security Income (SSI) benefits, you must report your income to SSDI and SSI separately. For SSI, you may have to report your income and other changes in your situation each month. Learn more about SSI income reporting in DB101's SSI article.

If Social Security denies my application for SSDI benefits, can I appeal the decision?

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Yes. If your application is denied (which is not unusual), you can appeal the decision. More than half of all appealed denials are reversed.

The appeals process may take several months. If your application is denied for medical reasons and you want to appeal it, you need to submit an Appeal Request and Appeal Disability Report. The report will ask you for updated information about your medical condition and any treatment, tests, or doctor visits you've had since Social Security made their decision.

If your application is denied based on nonmedical reasons, you should contact your local Social Security office to request a review. You can also call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) to request a review.

If you would like help with your appeal, you can contact the National Organization of Social Security Claimants Representatives (NOSSCR) at 1-800-431-2804. NOSSCR is an association of attorneys and paralegals who represent people who think they’ve been unfairly denied Social Security benefits.

What are Childhood Disability Benefits (CDB) benefits?

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Childhood Disability Benefits (CDB) benefits are similar to SSDI. Adults who have a disability that began before they turned 22 can receive CDB benefits based upon the taxes their parents paid into the Social Security system. Unlike SSDI, you do not need to have worked to qualify for a CDB benefit.

Social Security Disability Insurance (SSDI): Pitfalls

Not knowing which Social Security benefits you get

Social Security has two disability benefits programs with very similar names:

Some people qualify for both programs at the same time. If you get benefits from Social Security, but aren’t sure which ones you get, order a free Benefits Planning Query (BPQY) at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY).

Not Reporting Your Earnings

You need to report your earnings to Social Security and your local County Department of Job and Family Services (CDJFS) office. If you don’t, you may get benefits that you shouldn’t. This is called an overpayment and you may have to pay those benefits back. To avoid this, be sure to report all of your income and any changes in income to Social Security and your County Department of Job and Family Services (CDJFS) office right away.

To report changes, contact your local Social Security office and ask how and when you should report your earnings. You may be able to report:

Lack of Documentation

The more specifically you document your medical condition, the easier it will be to support a claim for SSDI benefits. Documenting in a daily medical journal can be of great value. If you can't make the journal entries yourself, a friend or relative can log the entries. This journal can also supply you with a way to inform providers about your medical condition.

Not sharing information with your medical provider

Many people do not clearly discuss their plans to apply for benefits with their doctors and other medical providers. Ideally, you and your medical providers should share all information to assess the duration and severity of your disabling condition. If you don't do this, you may end up with an application for disability benefits that does not reflect how long you have had your disabling condition or how it affects your day-to-day activities.

Social Security Disability Insurance (SSDI): Next Steps

Learn More About SSDI
Social Security Online

You’ll find more information about SSDI:

You can use Social Security's online statements to see information about your earnings record and benefits eligibility.

Apply for SSDI
There are three ways to apply for SSDI:
  • You can apply online
  • You can call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) and apply by telephone, or
  • You can apply in person at your local Social Security office

Talk to an SSDI Expert
If you have questions about SSDI and need to talk with somebody, call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY) or visit your local Social Security office.

If you want to ask about how work might affect your SSDI benefits, try contacting:

Ticket to Work
Social Security’s Ticket to Work Program helps people with disabilities who get Social Security benefits re-enter the workforce and become more independent. The Ticket to Work Program offers free access to employment-related services, such as training, transportation, and vocational rehabilitation.