Her Glucose Sensor Cost $1,200 a Year. Social Security Subtracted It From One Work Test and Ignored It in Another.
The same glucose sensor, the same paycheck, and two Social Security rules that treat her out-of-pocket medical costs in completely opposite ways. Knowing which rule applies could determine whether she keeps her benefits.
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A $100 Expense That Changes One Calculation
Picture a woman in her fifties who works a regular job while managing a serious chronic condition. Staying employed depends partly on a glucose sensor she pays for herself. Insurance leaves her with $100 a month out of pocket, or $1,200 a year.
Under one Social Security work rule, that $100 can be subtracted from her earnings before the Social Security Administration (SSA) decides whether she earned too much. Under another, Social Security acts as though she never spent it. Same paycheck. Same medical device. Two different calculations.
Disability Rules Recognize What Working Costs Her
For someone receiving Social Security Disability Insurance (SSDI), continued work can eventually be measured against substantial gainful activity (SGA). In 2026, the SGA level for a nonblind person is $1,690 a month. After applicable SSDI work-incentive periods, earnings above that level can affect whether disability cash benefits remain payable.
Social Security does not always start that calculation with gross wages. It can subtract qualifying impairment-related work expenses (IRWEs), meaning out-of-pocket costs for items or services a person needs because of an impairment and needs in order to work. The worker must pay the expense without reimbursement, and the amount must be reasonable.
Suppose she earns $1,760 a month. On wages alone, she sits $70 above the 2026 SGA level. If Social Security approves her $100 monthly sensor cost as an IRWE, countable earnings fall to $1,660. In one program, that $100 can keep her below the work threshold. In the other, she can spend every dollar of it just to stay employed and Social Security still counts the paycheck before the expense.
Retirement Uses a Different Definition of Earnings
Now put that same medical expense beside the Social Security retirement earnings test. Someone who claims retirement benefits before full retirement age (FRA) can have benefits withheld when wages or net self-employment earnings exceed the annual limit. For someone under FRA throughout 2026, that limit is $24,480. Social Security withholds $1 in benefits for every $2 earned above it.
There is no comparable IRWE subtraction for an employee’s medical expenses. If an early retiree earns $25,200 in wages and spends $1,200 of it on a glucose sensor needed to keep working, Social Security still sees $25,200 of wages for the retirement earnings test. The expense does not turn that figure into $24,000.
Under the disability rules, the agency asks what it effectively costs her to work because of her impairment. Under the retirement rule, ordinary personal medical expenses do not reduce wages. That is a meaningful difference for someone trying to decide how much work a Social Security check can tolerate.
The Device Does Not Have to Be Work-Only
The IRWE rules are wider than specialized workplace equipment. Social Security says qualifying expenses can include medicines, medical services, attendant care, service animals and other items or services related to the impairment. An expense can still qualify even when the person also needs the item outside work.
But merely buying a medical device is not enough. The expense must be connected to the impairment, needed to enable the person to work, paid out of pocket and not reimbursed. Social Security ultimately determines whether the deduction qualifies.
That makes documentation unusually valuable. Before wages approach a work threshold:
- Keep receipts for the device, supplies, medications or services and records showing what insurance actually reimbursed.
- Document why the expense is connected to the impairment and necessary for work. Medical support can help establish that connection.
- Identify which Social Security rule applies. An IRWE that reduces countable earnings for an SSDI determination does not reduce gross wages under the early-retirement earnings test.
The $100 leaving her bank account never changes. Under SSDI, Social Security can recognize that it costs her money to stay employed. Under early retirement, it counts the wages and leaves the medical bill to her.
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