What is the initial requirement for an insured to become eligible for benefits under the Waiver

How You Qualify

To qualify for Social Security Disability Insurance (SSDI) benefits, you must:

• Have worked in jobs covered by Social Security.
• Have a medical condition that meets Social Security's strict definition of disability.

In general, we pay monthly benefits to people who are unable to work for a year or more because of a disability. Benefits usually continue until you can work again on a regular basis. There are also several special rules, called work incentives, that provide continued benefits and health care coverage to help you make the transition back to work.

If you are receiving SSDI benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same.

How Much Work Do You Need?

In addition to meeting our definition of disability, you must have worked long enough — and recently enough — under Social Security to qualify for disability benefits.

Social Security work credits are based on your total yearly wages or self-employment income. You can earn up to four credits each year.

The amount needed for a work credit changes from year to year. In 2022, for example, you earn one credit for each $1,510 in wages or self-employment income. When you've earned $6,040 you've earned your four credits for the year.

The number of work credits you need to qualify for disability benefits depends on your age when your disability begins. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year your disability begins. However, younger workers may qualify with fewer credits.

For more information on whether you qualify, refer to How You Earn Credits.

Remember that whatever your age, you must have earned the required number of work credits within a certain period ending with the time your disability begins. If you qualify now but you stop working under Social Security, you may not continue to meet the disability work requirement in the future.

What We Mean by Disability

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.

We consider you to have a qualifying disability under Social Security rules if all the following are true:

• You cannot do work and engage in substantial gainful activity (SGA) because of your medical condition.
• You cannot do work you did previously or adjust to other work because of your medical condition.
• Your condition has lasted or is expected to last for at least one year or to result in death.

This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings, and investments.

How We Decide If You Have a Qualifying Disability

If you have enough work to qualify for disability benefits, we use a step-by-step process involving five questions to determine if you have a qualifying disability. The five questions are:

1. Are you working?

We generally use earnings guidelines to evaluate whether your work activity is SGA. If you are working in 2022 and your earnings average more than $1,350 ($2,260 if you’re blind) a month, you generally cannot be considered to have a qualifying disability.

If you are not working or are working but not performing SGA, we will send your application to the Disability Determination Services (DDS) office that will make the decision about your medical condition. The DDS uses Steps 2-5 below to make the decision.

2. Is your condition "severe"?

Your condition must significantly limit your ability to do basic work-related activities, such as lifting, standing, walking, sitting, or remembering – for at least 12 months. If it does not, we will find that you do not have a qualifying disability.

If your condition does interfere with basic work-related activities, we go to Step 3.

3. Is your condition found in the list of disabling conditions?

For each of the major body systems, we maintain a list of medical conditions we consider severe enough to prevent a person from doing SGA. If your condition is not on the list, we must decide if it is as severe as a medical condition that is on the list. If it is, we will find that you have a qualifying disability. If it is not, we then go to Step 4.

We have two initiatives designed to expedite our processing of new disability claims:

• Compassionate Allowances: Certain cases that usually qualify for disability can be allowed as soon as the diagnosis is confirmed. Examples include acute leukemia, Lou Gehrig’s disease (ALS), and pancreatic cancer.
• Quick Disability Determinations: We use sophisticated computer screening to identify cases with a high probability of allowance.

For more information about our disability claims process, visit our Benefits for People with Disabilities website.

4. Can you do the work you did previously?

At this step, we decide if your medical impairment(s) prevents you from performing any of your past work. If it doesn’t, we’ll decide you don’t have a qualifying disability. If it does, we proceed to Step 5.

5. Can you do any other type of work?

If you can’t do the work you did in the past, we look to see if there is other work you could do despite your medical impairment(s).

We consider your medical conditions, age, education, past work experience, and any transferable skills you may have. If you can’t do other work, we’ll decide you qualify for disability benefits. If you can do other work, we’ll decide that you don’t have a qualifying disability and your claim will be denied.

Special Situations

Most people who receive disability benefits are workers who qualify on their own records and meet the work and disability requirements we have just described. However, there are some situations you may not know about:

• If You're Blind or Have Low Vision - How We Can Help
• If You Are the Worker's Widow or Widower
• Benefits for Children with Disabilities
• Benefits for Wounded Warriors & Veterans

Special Rules for People Who Are Blind or Have Low Vision

We consider you to be legally blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye. We will also consider you legally blind if your visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight and may be able to read large print and get around without a cane or a guide dog.

If you do not meet the legal definition of blindness, you may still qualify for disability benefits. This may be the case if your vision problems alone or combined with other health problems prevent you from working.

There are several special rules for people who are blind that recognize the severe impact of blindness on a person's ability to work. For example, the monthly earnings limit for people who are blind is generally higher than the limit that applies to non-blind workers with disabilities.

In 2022, the monthly earnings limit is $2,260.

Benefits for Widows or Widowers with Disabilities

If something happens to a worker, benefits may be payable to their widow, widower, or surviving divorced spouse with a disability if the following conditions are met:

• The widow, widower, or surviving divorced spouse is between ages 50 and 60.
• The widow, widower, or surviving divorced spouse has a medical condition that meets our definition of disability for adults and the disability started before or within seven years of the worker's death.

If a widow or widower who is caring for the worker's child(ren) receives Social Security benefits, they are still eligible for disabled widow’s or widower’s benefits. Their eligibility continues if their disability starts before those payments end or within seven years after they end.

Widows, widowers, and surviving divorced spouses cannot apply online for survivors benefits. If they want to apply for these benefits, they should contact Social Security immediately at 1-800-772-1213 (TTY 1-800-325-0778) to request an appointment

To speed up the application process, complete an Adult Disability Report and have it available at the time of your appointment.

We use the same definition of disability for widows and widowers as we do for workers.

Benefits for Children with Disabilities

A child under age 18 may have a disability, but we don't need to consider the child's disability when deciding if he or she qualifies for benefits as a dependent. The child's benefits normally stop at age 18 unless they are a full-time student in an elementary or high school (benefits can continue until age 19) or have a qualifying disability.

Children who were receiving benefits as a minor child on a parent’s Social Security record may be eligible to continue receiving benefits on that parent’s record upon reaching age 18 if they have a qualifying disability.

Adults with a Disability that Began Before Age 22

An adult who has a disability that began before age 22 may be eligible for benefits if their parent is deceased or starts receiving retirement or disability benefits. We consider this a "child's" benefit because it is paid on a parent's Social Security earnings record.

The Disabled Adult Child (DAC) — who may be an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild — must be unmarried, age 18 or older, have a qualified disability that started before age 22, and meet the definition of disability for adults.

Example: A worker starts collecting Social Security retirement benefits at age 62. He has an unmarried 38-year old son who has had cerebral palsy since birth. The son may start collecting a DAC benefit on his father's Social Security record.

It is not necessary that the DAC ever worked. Benefits are paid based on the parent's earnings record.

• A DAC must not have substantial earnings. The amount of earnings we consider substantial increases each year. In 2022, this means working and earning more than $1,350 (or $2,260 if you’re blind) a month.

Certain expenses the DAC incurs in order to work may be excluded from these earnings. For more information about work and disability, refer to Working While Disabled: How We Can Help.

What if the child is already receiving SSI or disability benefits on their own record and turns 18?

A child already receiving SSI benefits or disability benefits on his or her own record should check to see if DAC benefits may be payable on a parent's earnings record when they reach age 18. Higher benefits might be payable and entitlement to Medicare may be possible.

How do we decide if a child over age 18 qualifies for SSDI benefits?

If a child is age 18 or older, we will evaluate his or her disability the same way we would evaluate the disability for any adult. We send the application to the Disability Determination Services (DDS) in your state that completes the disability decision for us.

What happens if the DAC gets married?

If the child receives benefits as a DAC, the benefits generally end if they get married. However, some marriages (for example, to another DAC) are considered protected.

The rules vary depending on the situation. Contact a Social Security representative at 1-800-772-1213 (If you are deaf or hard of hearing, call TTY number at 1-800-325-0778) to find out if the benefits can continue.

At this time, you cannot apply for DAC benefits online. If you wish to file for benefits, contact Social Security immediately at 1-800-772-1213 (TTY 1-800-325-0778) to request an appointment. If you delay, some potential benefits could be lost.

To speed up the application process, complete an Adult Disability Report and have it available at the time of your appointment.

Related Information

• Supplemental Security Income (SSI) for Children
• Family Benefits

Publications

• Disability Benefits
• Disability Starter Kits
• If You Are Blind or Have Low Vision—How We Can Help
• SSI Child Disability Starter Kit (for children under age 18)
• Benefits for Children with Disabilities
• Other Disability Publications