Social Security Disability Insurance 5-Year Rule: What Is It?

Disabilities are more common than many of us realize, even for successful medical professionals. The Social Security Disability Five-Year Rule is essential to understand if you want to tap into your Social Security benefits if you can’t work before retiring. Here’s a look at the Social Security Disability Five-Year Rule and what everyone should know if they’re planning for a scenario where they’re disabled.

What Is the Social Security Disability 5-Year Rule?

While we firmly believe it’s important to maintain private disability insurance, particularly long-term disability insurance, most working Americans with a full-time income are covered by Social Security Disability Insurance (SSDI). SSDI is a social safety net providing disability insurance to qualifying individuals with enough recent work history if they are deemed unable to work due to a qualifying disability.

The so-called “Social Security Disability Five-Year Rule” states that a person must have worked at least five of the last 10 years to qualify for SSDI in most cases.

The five-year rule isn’t an official rule, but there’s a rule people refer to as the five-year rule. Here’s how it works:

Most Americans working a full-time job earn four “credits” per year–or one every three months. To earn SSDI, you’ll need to have earned at least 20 credits over the last 10 years. That effectively means you would have had to work full-time for at least five of the last 10 years to qualify for SSDI.

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How Do Social Security Disability Benefits Work?

SSDI benefits are provided to eligible workers who have not yet reached retirement age and cannot work for an extended period due to a physical disability. SSDI is funded by Social Security taxes, which are automatically deducted from your payroll if you’re a W-2 employee or part of your self-employment taxes if self-employed.

Aside from younger workers, you’ll generally need to have worked at least five of the last 10 years to qualify for SSDI. You’ll need a condition that’s considered severe enough that you can’t work and lasts at least one year.

If you believe you have a qualifying disability, you apply through the Social Security Administration (SSA), providing evidence of your work history and medical condition. You’ll receive monthly benefits based on your average lifetime earnings if approved. In some cases, dependents, such as children or a spouse, are also eligible for benefits. The SSA may periodically review your condition to confirm you’re still disabled.

If your disability ends and you need to apply for benefits again, another five-year rule kicks in. In this case, the rule applies to Expedited Restatement (EXR). In this case, if you apply for benefits within five years of last receiving benefits, you can be automatically approved for six months of coverage while the SSA reviews your new application.

It’s also important to note that SSDI typically lasts up to two years. After that, you’ll receive Medicare benefits, even if you’re under 65.

How Much Will I Get from SSDI Benefits?

SSDI benefits are based on your lifetime earnings before your disability, not your current financial need. Here’s a simple breakdown of how the SSA determines your monthly benefit:

Average Indexed Monthly Earnings (AIME): The SSA adjusts your past earnings for inflation to reflect current wage levels. It takes your highest-earning years (usually the top 35 years) and finds the average—adjusted for the number of months worked in those years—to determine your AIME.

Primary Insurance Amount (PIA): The SSA applies a formula to your AIME to calculate your benefit. For 2025, the formula is:

• 90% of the first $1,226 of your AIME.
• 32% of your AIME between $1,226 and $7,391.
• 15% of your AIME above $7,391.

Adjustments: Your benefit may increase with annual cost-of-living adjustments (COLA), but deductions (like taxes or child support) could lower it.

Example SSDI Calculation:

Let’s say your AIME is $4,000 (as a doctor, your AIME may be significantly higher).

• 90% of the first $1,226 = $1,103.40
• 32% of the next $2,774 ($4,000 – $1,115) = $887.68
• Total Monthly Benefit = $1,991.08

This estimated benefit provides financial support when you can no longer work due to a qualifying disability. It likely won’t replace your entire income, but it can help cover the bills while you recover.

How Do I Apply for Disability Benefits?

The easiest way for most people to apply for SSDI benefits is online at the Social Security Administration website. You can also apply by phone at 1-800-772-1213.
Prepare by logging into the Social Security website and downloading your most recent statement showing your annual earnings if you don’t have the paper version handy. Then, get your medical records together, possibly including a letter from your doctor explaining your disability status. You’ll likely need information from both to gain approval for SSDI benefits.

More information here: 

What Are the Different Types of Disability Insurance?

What About Private Disability Insurance?

As we mentioned above, SSDI isn’t the only type of disability insurance. As it’s likely not enough to maintain your lifestyle while not working, consider these additional types of disability insurance.

Employer and Private Disability Insurance

As the names imply, you may find disability insurance through an employer or independently. Each has pros and cons to consider.

Employer-based disability coverage is often heavily subsidized, meaning the employer pays a large portion of the monthly premium to keep the policy active. However, the policy is gone if you leave your employer. The plans are take-it-or-leave-it with little flexibility. You can typically get coverage based on a multiple of your annual salary. Since your employer is paying your premiums, your disability insurance payout will be subject to income tax.

Individual coverage comes directly from an insurance company. It’s likely more flexible, and you may find higher limits. Plus, you can keep it even if you change jobs or become self-employed. However, as you pay the entire cost, it’s usually more expensive than employer-based coverage. If you ever have to get paid out because of a disability, it comes to you tax-free.

Short-Term and Long-Term Disability Insurance

Another place where the name clearly explains what it’s about: short-term disability insurance is intended for a shorter period after you’re injured or become ill, and long-term disability kicks in a little later but lasts much longer.

Short-Term Disability Insurance

• Coverage duration: This typically lasts 3-6 months, though some policies may extend up to 12 months.
• Elimination period: There’s usually a waiting period before benefits begin, often 7-14 days after your disability starts.
• Purpose: It's designed to cover temporary conditions like surgery recovery, maternity leave, or short-term illnesses.

Short-term disability insurance is less important if you have enough savings to cover the waiting period before a long-term disability insurance policy starts providing benefits.

Long-Term Disability Insurance

• Coverage duration: Depending on the policy, coverage usually lasts from two years to the rest of your life.
• Elimination period: There’s usually a longer waiting period (often 90-180 days) before benefits start. Many people use short-term disability or savings during this time.
• Purpose: It provides financial protection for severe, long-term conditions like cancer, chronic illnesses, or disabling injuries.

Long-term disability insurance is more important for medical professionals, as the costs of a long-term disability can be extensive. And the lack of income for many months or years can be financially devastating, even for high-income earners.

More information here: 

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The Bottom Line

Disability insurance is a critical protection for most people, including doctors, nurses, and other high-income professionals. If you’re wondering about the five-year rule and disability coverage, understanding the entire process of getting SSDI and other disability coverage will help you reach your goals.

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