Navigating Social Security Disability: Understanding Waiting Periods and Medicare Eligibility

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are vital lifelines for individuals unable to work due to medical conditions. Understanding the nuances of these programs, including waiting periods and Medicare eligibility, is crucial for those seeking support.

SSDI Waiting Period:

For SSDI applicants, there’s a five-month waiting period before receiving benefits. This waiting period, however, doesn’t apply to SSI recipients. The waiting period begins on your alleged onset date, the day you claim your disability began. If proven, this date marks the start of the five-month waiting period. Should your onset date precede your application, the SSA subtracts five months from your past due benefit amount.

Certain conditions, like ALS or Lou Gehrig’s disease, waive the waiting period. Additionally, if you attempt to return to work and then find yourself unable to continue due to your disability, benefits can be reinstated without another waiting period, provided it’s within five years. Moreover, if you’re applying as the child of a disabled worker, you’re exempt from the waiting period.

Medicare Waiting Period:

Those receiving SSDI must satisfy a two-year waiting period for Medicare coverage, unless they’re 65 or older. For instance, if approved for SSDI at 64, Medicare coverage will commence at 65. However, if applying at any other age, the full two-year wait is necessary. Exceptions exist for life-threatening conditions like ALS or End-Stage Renal Disease (ESRD), where the waiting period is waived, and coverage begins sooner. These exceptions recognize the urgent need for medical care in such cases.

For legal assistance with a pending Social Security Disability Appeal, call attorney D. Scott Gordon at 804-440-6557 or visit

What is the Role of Disability Determination Services (DDS) in Social Security Disability Claims?

Social Security disability claims usually begin at the local Social Security Administration (SSA) field office where the applicant lives. The SSA field office collects and processes applications for disability benefits through various channels, including in-person, mail-in and online applications. SSA field offices first verify non-medical eligibility requirements, such whether the applicant has acquired enough prior work credits to receive SSDI benefits or whether an applicant’s current earnings exceed the threshold for gainful employment.

Once non-medical eligibility is verified, the SSA field office forwards the case to a separate Disability Determination Service office (DDS) for medical evaluation of disability. Though federally funded, DDSs operate as State agencies. In Virginia, Virginia Disability Determination Services partners with SSA and the Virginia Department of Social Services to review and make initial decisions on eligibility for SSDI, SSI, and Medicaid programs. Local DDS offices serve as critical gatekeepers in the disability evaluation process. Their primary responsibility is to assess medical evidence and make the initial determination as to whether a claimant is disabled or blind under the law.

At the initial application stage, DDSs seek and acquire evidence from the claimant’s identified medical providers, relieving the applicant of the burden and expense of ordering their own medical records. If that evidence is insufficient, DDS may order and require a consultative examination (CE) to obtain additional medical assessments and opinions. DDS then forwards the cumulative file information to reviewing physicians to evaluate the evidence and make recommendations regarding the severity of the applicant’s condition and their residual functional capacity. After making a final determination, DDS returns the case to the local SSA field office for appropriate administrative action.

If DDS determines that the claimant is disabled, SSA proceeds to compute and pay-out the subject benefits. If the DDS finds the claimant not disabled, the claimant may appeal the adverse decision though several stages. Following the first appeal, DDS will reevaluate the claim on Reconsideration. If DDS upholds its denial, a claimant may appeal again and then receive an evidentiary hearing before an SSA Administrative Law Judge.

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Can You Return To Work If You Receive Social Security Disability Benefits?

Navigating a return to work can be challenging when you’re receiving Social Security Disability (SSDI) benefits. However, the Social Security Administration (SSA) offers programs that allow beneficiaries to work without immediately losing their benefits. In general, you must report work and any income earned while you are receiving SSDI benefits, including workers’ compensation benefits. If you earn more than $1,050 in gross income per month, you must report these wages through your Social Security account. Failure to report income can result in the termination or suspension of your benefits and action by SSA to recoup overpayments.

Trial Work Period (TWP): The TWP allows you to test your ability to work for at least 9 months. During this period, you’ll receive your full SSDI benefits regardless of how much you earn, as long as you report your work activity and continue to have a disabling impairment. In 2024, any month where you earn over $1,110 before taxes counts toward your TWP.

After the TWP, you enter a 36-month extended period of eligibility (EPE). During this time, you still can receive benefits for any month your earnings are below the substantial gainful activity (SGA) limit, currently set at $1,550, or $2,590 if you’re blind for 2024.

Medicare Coverage: During the TWP and for 93 months thereafter, you can typically retain your Medicare Part A coverage at no cost. If you have Part B, you can keep it by continuing to pay the premium.

Ticket to Work Program: The SSA’s Ticket to Work program is designed to help SSDI recipients find suitable employment and attain financially independence. The program is offered at no cost and participation is voluntary. This program aims to help people with disabilities move towards financial independence by connecting them with employment services and support for success in the workforce.

Additional information and resources can be found by visiting the Choose Work website.

For legal assistance with a pending Social Security Disability Appeal, call attorney D. Scott Gordon at 804-440-6557 or visit

Update: Social Security Disability Rate Adjustments for 2024

The Social Security Administration has announced adjustments in various disability benefits and thresholds for 2024. Here’s what you need to know:

Substantial Gainful Activity (SGA): For individuals with disabilities (excluding blindness), the SGA amount is now $1,550 per month1. For those who are blind, the SGA is $2,590 per month.

Trial Work Period (TWP): The monthly earnings threshold for TWP months has been set at $1,1102.
Federal Benefit Rate (FBR): The 2024 FBR for Supplemental Security Income (SSI) is $943 for an individual and $1,415 for a couple3.

Student Earned-Income Exclusion (SEIE): SSI beneficiaries under age 22 can earn up to $9,230 a year without affecting their eligibility or benefits.

For assistance with your Social Security Disability Claim, call 804-440-6557 or visit

Can You Qualify for Social Security Disability Benefits with Epilepsy?

Living with epilepsy poses unique challenges, especially when it hinders the ability to maintain employment. Social Security Disability benefits can provide crucial financial support for individuals grappling with the impact of epilepsy on their daily lives.

Proving Your Claim:

To be considered for Social Security Disability benefits due to epilepsy, you must present medical documentation demonstrating that your epilepsy prevents you from working at a gainful employment level. Additionally, you need to have accumulated enough work credits through your employment history. Relevant medical conditions would include timing and frequency of seizures; post-seizure Issues, such as impaired thinking, fatigue, or disruptions to daily activities; and continued seizures despite medication.

Understanding Epilepsy Under SSA Listing 11.02:

The Social Security Administrations Blue Book serves as a comprehensive guide that outlines the conditions that qualify automatically for Social Security Disability benefits. As characterized in the Blue Book, epilepsy is a pattern of recurrent and unprovoked seizures that are manifestations of abnormal electrical activity in the brain. There are various types of generalized and “focal” or partial seizures. The most common potentially disabling seizure types are generalized tonic-clonic seizures and dyscognitive seizures. Generalized tonic-clonic seizures are characterized by loss of consciousness accompanied by a tonic phase. Dyscognitive seizures are characterized by alteration of consciousness without convulsions or loss of muscle control. To meet the automatic qualification criteria for this listing, you must demonstrate:

A diagnosis of epilepsy, as documented by a detailed description of a typical seizure and characterized by A, B, C, or D below:

A. Generalized tonic-clonic seizures occurring at least once a month for at least 3 consecutive months despite adherence to prescribed treatment.


B. Dyscognitive seizures, occurring at least once a week for at least 3 consecutive months despite adherence to prescribed treatment.


C. Generalized tonic-clonic seizures, occurring at least once every 2 months for at least 4 consecutive months despite adherence to prescribed treatment; and a marked limitation in one of:
-Physical functioning;
-Understanding, remembering, or applying information;
-Interacting with others;
-Concentrating, persisting, or maintaining pace; or
-Adapting or managing oneself


D. Dyscognitive seizures occurring at least once every 2 weeks for at least 3 consecutive months despite adherence to prescribed treatment ; and a marked limitation in one of the following:
-Physical functioning;
-Understanding, remembering, or applying information;
-Interacting with others;
-Concentrating, persisting, or maintaining pace; or
-Adapting or managing oneself.

Successfully navigating the Social Security disability benefits process for epilepsy requires a nuanced understanding of the specific criteria outlined in Listing 11.02 and alternative argument for qualification. By providing detailed documentation and adhering to the prescribed treatment, individuals with epilepsy can enhance their chances of qualifying for benefits. Please contact my office directly should you wish assistance with you claim.

SSDI: What Is My Last Insured Date?

When applying for Social Security Disability benefits, your “last insured date” is a key factor that initially dictates whether you are eligible to apply for benefits. The last insured date is the date on which your eligibility for Social Security Disability Insurance (SSDI) benefits ends. When you apply for SSDI benefits, the Social Security Administration (SSA) will look at your work history to determine your last insured date. To receive SSDI benefits, you must prove that your disability onset date occurred before your last insured date.

To be eligible for SSDI benefits, you must have earned a predetermined number of quarterly work quarters. Once you have earned enough credits to qualify for SSDI, you become “insured” for disability benefits. To earn credit for a work quarter, an individual must have earned a minimum amount of money during that quarter. For example, the amount of earnings required for a quarter of coverage in 2023 is $1,640.

Generally, an individual over 31 years of age needs to have earned 40 work quarters in total. Also, 20 of the work quarters must have been earned in a 10 year look-back period immediately before the onset of your disability. (i.e. did you work in 20 of the past 40 quarters?). Based on this math, if you have not worked for more than 5 years (20 quarters) then you likely will no longer be insured for SSDI purposes. You still can apply for benefits, but you must prove that your disability began prior to the last insured date.

Younger individuals may be eligible with fewer work quarters. If you are under 24, you only need to earn 6 credits in the 3 year period before the onset of disability. If you are between ages 24 and 31, you need to earn credits for working half the quarters between age 21 and the onset of disability.

Based on these formulas, if you no longer are able to work due to a permanent disability, it is important to initiate your application for SSDI benefits in a timely manner.

Social Security Disability Benefits: Compassionate Allowances

Waiting for the Social Security Administration (SSA) to approve Social Security Disability Insurance (SSDI) benefits can be a frustrating process, even more so if you have life-threatening medical issues. Compassionate Allowances (CAL) can speed up the approval process for those with the most debilitating and terminal conditions. The amount of benefits available for a Compassionate Allowance is the same as the regular SSDI or SSI benefit, but the time frame for review and approval is significantly shortened.

The Social Security Administration (SSA) adopted compassionate allowances in response to complaints that the SSDI application procedure was too drawn-out and cumbersome. CAL identifies specific medical illnesses that are so serious that they unquestionably meet the SSA’s disability requirements. Currently, there are over 240 conditions on the Compassionate Allowances list, including various types of cancer, genetic disorders, and neurological disorders. The SSA adds new conditions intermittently. The current list can be found at

CAL provides much-needed financial support to those who are facing immense medical and financial challenges. For those facing terminal illnesses, the expedited approval process under CAL is intended to provide access to benefits during one’s lifetime.

To be considered for a Compassionate Allowance, the applicant should advise SSA of their qualifying medical condition when applying for benefits. SSA reviews the application and medical records to determine if the applicant meets the Compassionate Allowance criteria. If qualified, SSA will then expedite the Claimant’s application.

Will Your Children Receive Additional Benefits if You Qualify for Social Security Disability?

Social Security Disability Insurance (SSDI) provides financial assistance to individuals who have become disabled and are no longer able to work. If you become eligible for SSDI your dependent children also may also be eligible to receive additional family benefits based on your SSDI eligibility.

Your eligible child can be your biological child, adopted child, step-child or a dependent grandchild. To qualify, your child must be unmarried and either:

under the age of 18;

between the ages of 18 and 19 and still in high school; or

over the age of 18 and have a disability that started before the age of 22.

The amount of the dependent benefit is based on your own SSDI benefit amount. A child may receive up to 50% of your SSDI benefit. However, there is a limit to the amount of money in dependent benefits that can be paid out to any single family, which is known as the family maximum. The family maximum is typically between 150% and 180% of your SSDI benefit amount.

Normally, dependent benefits continue a child reaches age 18 (unless they also are disabled). However, if the child remains a full-time student, benefits may continue until the child graduates or until two months after the child becomes age 19, whichever is first.

Can you draw both SSDI and SSI Disability Benefits?

The two most common types of disability benefits in the United States are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). While both programs are administered by the Social Security Administration (SSA), they have different eligibility requirements and provide different types of assistance.

One question that frequently arises is whether it is possible to receive both SSDI and SSI benefits at the same time. The answer is yes, but it is not common.

SSDI is a federal program that provides benefits to individuals who have worked and paid Social Security taxes for a qualified number of years but are now unable to work due to a disability. To be eligible for SSDI, a person must have a disability that is expected to last at least 12 months and prevent them from doing any substantial gainful activity. The amount of the monthly benefit is based on the person’s earnings and contributions over their working life.

SSI is a needs-based program that provides financial assistance to disabled individuals with limited income and resources. To be eligible for SSI, a person must have a disability that prevents them from doing any substantial gainful activity and meet strict household income and asset requirements.
If a person’s SSDI benefit falls below the federal maximum for SSI, they may be eligible to receive both benefits. This is known as “concurrent” SSDI/SSI benefits. However, it is important to note that receiving both SSDI and SSI benefits is not common. If a person is eligible for concurrent benefits, their SSI cannot exceed the federal benefit rate (FBR), which has been set at $914 for 2023. Accordingly, if someone’s SSDI payment falls below the FBR, they might qualify for additional SSI benefits up to that amount, provided they otherwise are eligible based on financial need requirements.

What is the difference between SSDI and SSI disability benefits?

The Social Security Administration (SSA) administers two types of disability benefit programs” Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). While both programs provide financial assistance to individuals with disabilities, they have different eligibility criteria and benefits.


The eligibility criteria for SSI and SSDI differ based on the applicant’s work history, income, and assets. SSDI benefits are available to individuals who have worked and paid Social Security taxes for a certain number of years. To qualify for SSDI, an applicant must have earned enough Social Security credits through their work history. The number of credits required depends on the applicant’s age at the time they became disabled. Generally, an applicant must have worked for at least five of the last ten years and earned a total of 20 quarterly credits to be eligible for SSDI. Your benefits are not limited by your assets or other household income.

For those individuals that lack work credits under SSDI, SSI benefits are available to persons with limited income and resources who are unable to work in any capacity due to a disability. Under SSI eligibility criteria, the SSA considers an applicant’s income and resources, including other household income, savings, investments, family contributions and property.


The benefits provided by SSI and SSDI also differ. SSDI benefits are based on the applicant’s work history and the amount of Social Security taxes they have paid over time. The amount of the monthly benefit payment varies based on the applicant’s earnings history.

In contrast, SSI benefits are based on a maximum federal benefit rate. As of 2022, the SSI cap is $794 per month for an individual. However, the actual benefit payment amount may be reduced based on an applicant’s other household income and resources.

If you’re your application for benefits has been denied, it is important to consult with an experienced disability attorney to determine your appeal options. My offices offers free case evaluations for Virginia residents. Call 804-440-6557 to schedule an initial consultation.