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​SSA: What is Disability?

Various federal and state agencies define the term “disability" differently. It is important to understand how SSA defines disability for the purpose of determining SSI/SSDI eligibility.

Disability and Work

The Social Security Administration (SSA) recognizes that a person can have a serious illness or condition yet still be able to work. For example, many people with serious mental illnesses in recovery are able to work and enjoy the benefits of employment, including:

• An income that goes beyond meeting the most basic needs
  
• A sense of accomplishment and identity
• The satisfaction of being productive members of their communities

 
SOAR helps people to access SSI/SSDI in the hope that they will eventually be able to enjoy these benefits.

SSA's Definition of Disability

The Social Security Administration (SSA) defines disability as:

• The inability to engage in substantial gainful activity (SGA)
• Because of medically determinable physical or mental impairment(s)
• That has lasted or is expected to last for a continuous period of at least 12 months OR is expected to result in death

 
Substantial gainful activity (SGA)

• SGA is a term used by SSA to describe a level of work activity and earnings.
• Work activity is:
• "Substantial" if it involves doing significant physical and/or mental activities
• “Gainful" if performed for pay or profit, even if profit is not realized
• Earnings: SSA annually sets an amount of gross monthly earnings that is considered SGA. In 2025, SGA is $1,620/month.
• To determine SSI/SSDI eligibility, SSA and DDS need to know: Can the person perform work at levels of SGA?

 
Medically determinable

• Physical or mental health conditions
• Must be documented with clear evidence by an Acceptable Medical Source (AMS) as defined by SSA.

 
Impaired functioning

• For SSA to consider a person “disabled," the person's illness must result in impairments of functioning that meet SSA criteria.
• These impairments must affect their ability to work at SGA levels.
• It is essential to describe and document the severity of these impairments fully.

 
Providing the Evidence

It may seem apparent to some that an individual is disabled and unable to work. However, for SSA and DDS to make a disability determination, the application must:

• Document the illness(es) and condition(s)
• Demonstrate that the illness(es) impairs functioning
• Show how these impairments affect the person's ability to work
  

​​​Overview of Social Security Disability Programs: SSI and SSDI

SSI and SSDI: A Comparison
The Social Security Administration (SSA) administers two disability income benefit programs: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). These programs have many similarities and some important differences.

Similarities

• Medical and functional disability criteria: Both programs use the same medical criteria for determining disability based on medical evidence and functional abilities.
• Application process: Although there are different forms, both programs utilize the same application process and share one disability determination.
• Health insurance: Each program has an associated health insurance program.

 
Differences

• The key difference is the non-medical eligibility criteria.
• SSI is based on need.
• SSDI is based on contributions by employees and employers to the Social Security trust fund as authorized by the Federal Insurance Contributions Act (FICA)
• See other differences below.

 
Comparison of SSI and SSDI

 
If an applicant has never worked, should they only apply for SSI?
In the SOAR model, case workers help individuals apply for both SSI and SSDI for every application. There may be circumstances in which an individual can be eligible based on someone else's earnings record (e.g., parent or spouse), such as Disabled Adult Child (DAC) benefits. Always check with your local Social Security office representative for clarification on individual cases.

Disabled Adult Child (DAC)
An adult who becomes disabled before age 22 may be eligible for “child's" benefits if a parent is deceased or starts receiving retirement or disability benefits. Social Security considers this a child's benefit because it is paid on a parent's Social Security earnings record.

• Applicants must meet the SSA disability criteria for adults and must be unmarried.
• Since benefits are paid based on the parent's earnings record, it is not necessary for the adult child to have ever worked.
• A disabled adult child already receiving SSI benefits should still check to see if benefits may be payable on a parent's earnings record. Circumstances may have changed (e.g. parent's death, retirement or disability status) since the initial application. Higher benefits might be payable, and entitlement to Medicare may be possible.
• SSDI DAC benefits continue as long as the individual remains disabled.
  

Yes, You Can Work!

Individuals are encouraged to work and seek employment while applying for SSI/SSDI benefits. SOAR providers play a critical role in helping bust myths about working during the application process.

Working and Seeking Employment while Applying for SSA Benefits

The Myth
One of the most common and long-standing myths about applying for Social Security disability benefits (SSI/SSDI) is that an applicant will be denied if they are working or seeking employment during the application process. This myth is especially harmful because of its negative consequences on applicants.

Employment is especially beneficial to people with disabilities. The benefits go far beyond the monetary gains. Employment gives people a sense of purpose and meaning to their days, opens gateways to social interactions, and brings a connection to the community.

The Facts!
People can work during the application process. In fact, information gathered from work activity can help strengthen the SSI/SSDI application by documenting any functional limitations an individual experiences at work. SSA looks at the type and amount of work completed to see if an individual can maintain substantia​l gainful activity (SGA). If an applicant can work but not at a substantial gainful level, they can still be found eligible for SSI/SSDI benefits. 

Work and Recovery
Many people in recovery from behavioral health disorders describe the process of becoming employed as pivotal or central to their recovery as opposed to something they sought only after reaching other milestones. Pro-employment models such as Individual Placement and Support (IPS) Supported Employment, a SAMHSA Evidenced-Based Program, recommend that people begin seeking employment right away rather than waiting until certain conditions in their lives improve (i.e., reduction in symptoms).

People seeking SSA benefits are encouraged to work or seek employment either independently or with the help of professional support like Supported Employment Programs. Case workers are encouraged to support individuals in pursuing their vocational goals, both before and after submitting an SSI/SSDI application.

Work Incentives
For more information about the many SSA work incentive programs available for people who choose to go back to work (or continue working!) after receiving SSA benefits, please see the SSA Redbook – A Guide to Work Incentives and Employment Supports and SSI/SSDI and Employment: A Brief Overview of SSA Work Incentives below.

SSI/SSDI and Employment: A Brief Overview of SSA Work Incentives

Working While Applying for SSI/SSDI
Individuals can work during the SSI/SSDI application process. In fact, information gathered from work activity can help strengthen the SSI/SSDI application by documenting any functional limitations experienced. SSA looks at the type and amount of work completed to see if an individual can maintain “substantial gainful activity (SGA)."

Working While Receiving SSI/SSDI: Cash Benefits

Supplemental Security Income (SSI)
SSI is a needs-based program, so an individual's check will likely reduce when they start working. SSA first applies a few exclusions and then counts $1 for every $2 of income from employment.

• General Income Exclusion: SSA will exclude the first $20 of earned or unearned income a person receives.
• Earned Income Exclusion: SSA will exclude the first $65 a person earns from working.
• Plan to Achieve Self-Support (PASS): allows an SSI recipient to save money for an educational or vocational goal in a separate account, which is not counted as a resource or countable income when determining their SSI payment (e.g., saving $100/month towards tuition for a training program).
• Impairment Related Work Expense (IRWE): an out-of-pocket expense that enables the person to go to work. The expenses must be related to the disability, such as medication co-pays, special equipment, and special transportation (e.g., five medication co-pays of $10 each = $50).
• Student Earned Income Exclusion (SEIE): available to particular SSI recipients under the age of 22 who are regularly attending school. Allows the student to exclude a specified amount of gross earned income per month up to a maximum annual exclusion, thus decreasing the amount of countable earned income.
• In 2025, the exclusion is $2,350 per month, up to a yearly maximum of $9,460.

*Based on 2025 SSI Federal Benefit Rate of $967

Social Security Disability Insurance (SSDI)
SSDI is the program you pay into when you work, and the benefit amount is based on past earnings. Because of this, SSA has some work incentives that encourage individuals to try working again.

• Trial Work Period (TWP) – 9 months in a rolling 5-year period, during which a person can work as much as they are able and still keep their full SSDI check.
• After the TWP, there is an Extended Period of Eligibility (EPE), a 3-year period during which, in any month that a person is not able to earn over SGA, they are eligible to receive their full SSDI check.
• Subsidy – a value put on the extra support that an employer provides, such as a job coach or reduced workload for an individual with disabilities.
• Subsidies, along with IRWEs, can be used by SSDI recipients to reduce countable income during the EPE.  If earnings can be reduced below SGA, benefit payments would continue.

 
Working While Receiving SSI/SSDI: Health Insurance

• Medicaid (SSI) – Individuals may retain Medicaid eligibility even if SSI payments stop due to earnings from work if those earnings are below a certain threshold under federal rule 1619b. This threshold is different in each state and varies widely.
• Medicare (SSDI) – Coverage continues for 93 months after SSDI payments stop due to earnings from work. After this, Medicare can be purchased under certain conditions, and Part A premiums would apply.

 
Expedited Reinstatement of Benefits
This is a five-year safety net after cash benefits end due to earnings from work that allows an expedited return to cash and medical benefits if someone is unable to continue earning above SGA due to their disabling condition.

• Social Security will review the request to determine if the disabling condition is the same as, or related to, the impairment in the original claim, and applicants can receive up to six months of provisional benefits while the decision is processed.

 
Social Security's Ticket to Work Program
A free program available to all SSI/SSDI beneficiaries. SSA has specialists who can connect individuals to employment supports in their area, such as career counseling, training, and job placement. Also, they can explain in detail how going back to work will impact on a person's benefits.

The Choose Work! website has links to local employment resources and offers free training webinars for beneficiaries and service providers.

Additional Resources

• The Red Book - A Guide to Work Incentives. Social Security Administration's guidebook on work incentives. 
• SSA Work Incentives Overview below.
  

SSA Work Incentives: Overview

There are a number of myths and misconceptions about returning to work after disability benefits begin. Work can be an essential part of the recovery process, and SOAR can assist in this effort.

Encouraging Employment
When Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) benefits begin, lifelong employment goals do not end. Illness may interfere with the ability to maintain employment, but this may not be permanent.
In the spirit of SOAR as a stepping stone to recovery, people who receive SSI/SSDI should be encouraged to seek employment and employment services throughout the application process and after benefits are obtained. The challenge is to maintain hope that employment is possible and worth the effort, especially after so much time and energy has been expended to obtain SSI/SSDI. A solid, working knowledge of these supports and programs can help promote the idea of employment to people who may be fearful of losing hard-won benefits. SOAR case managers should work closely with SSA Work Incentive Coordinators when assisting applicants returning to work.
 
Return to Work Myths
There are many myths surrounding SSI/SSDI and employment, including:

• MYTH: Benefits end immediately when returning to work
• MYTH: Beneficiaries can only work 20 hours per week while receiving disability
• MYTH: Health insurance ends immediately when returning to work
• MYTH: If SSA knows a beneficiary is working, they will say he/she is not disabled

 
Dispelling Myths

• Many old myths have survived for decades, and new myths keep evolving
• People from all walks of life have helped to create and perpetuate myths about employment and SSI/SSDI
• It is always best to check with SSA to ensure that the information the case manager provides is correct
• Misinformation can reduce the likelihood that a person will attempt to return to work
• By creating unnecessary fear in the SSI/SSDI beneficiary
• By creating unnecessary concern in front-line staff assisting with this transition

 
The Importance of Work
Employment is not solely about income, although it is undoubtedly a key factor. Employment has additional benefits; it can:

• Define a role for the person in the community
• Help develop self-worth (self-esteem, confidence, problem solving, pride in a job well done)
• Foster a connection to others through working on a shared task or cause
• Add structure and organize time and space
• Create purpose by offering a consistent framework of goals and expectations
• Help improve the standard of living through increased income

 
SSA Assistance
 
Ticket to Work (TTW)
TTW is designed to help beneficiaries maintain their benefits while exploring employment.

• Through TTW, beneficiaries receive free and voluntary vocational and employment services
• Services are delivered through Employment Networks and state vocational rehabilitation agencies
• More information about how Employment Networks operate is found in SSA's 2-page guide: Employment Networks in Social Security's Ticket to Work
• For more information on TTW, visit their website.

 
Work Incentives
Work Incentives are additional SSA rules that allow SSI/SSDI beneficiaries to maintain their healthcare and cash benefits while working.

• The programs are different for SSI and SSDI
• SSI benefit amounts can change with earnings from work
• SSDI beneficiaries are either eligible or not for their full check; there are no partial benefits
• Reporting work and earnings to SSA is required

 
SSI & SSDI Work Incentive Programs

*See the Social Security Administration's Red Book for a full list of SSA Work Incentives​.

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