Impairment-Related Work Expenses: What You Can Deduct

An impairment-related work expense, called an IRWE, is a cost you pay out of pocket for something your impairment requires you to have in order to work. When SSA decides whether your work is substantial gainful activity (SGA), it subtracts these costs from your gross earnings first, which lowers your countable earnings. That subtraction can be the difference between keeping your SSDI check and losing it, because the SGA level in 2026 is $1,690 per month in countable earnings for nonblind beneficiaries.

The rule is federal regulation 20 CFR 404.1576. It applies whenever SSA measures your earnings against SGA, including during the extended period of eligibility after your trial work period, and SSA's Red Book confirms the deduction works for SSDI and SSI alike. Here is how the deduction works and what it covers.

The Conditions Every Deduction Must Meet

SSA will not subtract a cost just because it is disability-related and job-adjacent. Under 20 CFR 404.1576(b), all of the following must be true.

The item or service must be needed because of your impairment, and its severity must actually require you to purchase or rent it in order to work. It must enable you to work, meaning it is connected to holding the job, not just to daily life in general.

You must pay the cost yourself. No deduction is allowed to the extent another source has paid, or will pay, or could reimburse you, whether that is Medicare, Medicaid, private insurance, or an employment network under the Ticket to Work program. The regulation's own example is that when an agency or plan reimburses part of the cost of crutches, only the unreimbursed remainder is deductible.

You must pay in a month you are working, and you must pay in cash, meaning money, checks, or payment cards. Payment in kind, such as giving someone room and board in exchange for attendant care, does not count. Finally, the Red Book adds that the cost must be reasonable, meaning it reflects the standard charge for the same item or service in your community.

The Deductible Categories

The regulation and the Red Book's IRWE table list what SSA will subtract. The main categories follow.

Attendant care services. This covers help with personal functions like eating, dressing, bathing, or toileting at work or in preparing for work and recovering from it, plus help with work-related functions like reading or communicating. It also covers travel assistance to and from work. Payments to a family member count only if that person suffered an economic loss by quitting work or cutting hours, and only the portion of pay attributable to the care is deductible.

Medical devices and prosthetics. Wheelchairs, canes, crutches, braces, dialysis equipment, respirators, traction equipment, and pacemakers are the regulation's own examples. Artificial replacements of arms, legs, hips, and other body parts are deductible, though prosthetics that are purely cosmetic are not.

Prescription drugs and medical services needed to control your impairment. Anticonvulsants, antidepressants, psychotropic medication, blood level monitoring, radiation treatment, chemotherapy, corrective surgery for spinal disorders, and related physician fees all appear as examples in 20 CFR 404.1576(c)(5). Co-payments and insurance deductibles for these treatments count, per the Red Book, which also notes that hemp products containing no more than 0.3 percent THC, such as CBD oil, have been deductible since December 20, 2018, while medical marijuana remains non-deductible under federal law.

Transportation. Costs of structural or operational modifications to a vehicle that your impairment requires count, though the vehicle itself does not. Driver assistance, taxicabs, paratransit, or other hired transportation you need because of your disability rather than because public transit is unavailable is deductible, along with an approved mileage rate for trips to and from work.

Work equipment and assistive technology. One-hand typewriters, vision and sensory aids, telecommunication devices for deaf users, and tools specifically designed around an impairment are the regulation's examples. The Red Book adds assistive software and computer support services used for employment because of a disability.

Residential modifications. If you work outside the home, only exterior changes that get you to your transportation, such as ramps, railings, and pathways, are deductible. If you are self-employed and work at home, modifications that create an accessible workspace inside the home count, but nothing you also deduct as a business expense can be deducted twice.

Other items. Service animal costs, including purchase, training, food, licenses, and veterinary care, are deductible, as are expendable medical supplies like catheters, bandages, and elastic stockings, diagnostic procedures tied to your impairment, and, in unusual cases your physician must verify, non-medical appliances essential to controlling your disabling condition, such as an electric air cleaner for severe respiratory disease. Costs of installing, maintaining, and repairing any deductible item are deductible too.

What SSA Will Not Deduct

The exclusions are just as clear. Routine annual physicals, routine dental exams, and optician visits unrelated to a disabling visual impairment are not deductible, nor are allergy treatments or allergy testing. Health insurance premiums are excluded, as is exercise equipment kept for general fitness.

The vehicle itself, decorative modifications like paint, commuting costs unrelated to an impairment, housekeeping help, and attendant services performed on non-workdays do not count. Any portion of a cost that is reimbursable by any source is out, and a family member's unpaid-level help with no economic loss to them cannot be converted into a deduction.

When the Deduction Is Taken

Timing rules in 20 CFR 404.1576(d) and (e) matter as much as the list. Generally, you deduct an expense in the month you pay it, and you must be working that month. Recurring payments, like monthly attendant care or installment purchases including interest, are deducted in each month paid.

For a one-time purchase paid in full, 404.1576(e)(2) gives you a choice: deduct the entire amount in the month paid, or spread it across 12 consecutive months starting with that month. That choice matters when a large one-time cost would otherwise be wasted in a month you were already below SGA. Payments made in the 11 months before you started working can also count in part, under 404.1576(e)(4).

Where IRWE Makes the Difference

The deduction applies wherever SGA is measured: work reviews after entitlement, the extended period of eligibility after your trial work period, and initial determinations. If you also receive SSI, the Red Book explains that SSA excludes IRWE from earned income when figuring the monthly SSI payment, so the same receipts protect both programs.

One place the deduction does not reach is the trial work period itself. Under 20 CFR 404.1576(f)(2), IRWE is not deducted when SSA decides whether a month counts as a trial work service month, so keep the receipts through the whole work journey, not just the first nine months.

Proof SSA Expects

Under 20 CFR 404.1576(g), SSA verifies both your need for each item or service and the amount you paid, and it can ask you to prove payment. Keep receipts, canceled checks or card statements, prescriptions, and a simple monthly log of what you paid and why. Tell SSA about your expenses whenever you report work, because a deduction SSA never hears about is a deduction you never get.

Frequently Asked Questions

What are the conditions for an impairment-related work expense deduction? Under 20 CFR 404.1576(b), the item or service must be needed because of your impairment, enable you to work, be paid by you in cash in a month you are working, and not be reimbursable by another source. SSA's Red Book adds that the cost must be reasonable, meaning the standard charge in your community.

Can I deduct impairment-related work expenses during my trial work period? No. Under 20 CFR 404.1576(f)(2), these expenses are not deducted when SSA decides whether a month is a trial work service month. They are deducted when SSA makes substantial gainful activity decisions.

Does an IRWE apply to self-employment income too? Yes. Under 20 CFR 404.1575(c)(1), when SSA figures the countable income of a self-employed person, it deducts impairment-related work expenses that were not already deducted in arriving at net income.

This article is general information about Social Security disability benefits, not legal advice. Program rules, earnings thresholds, and work incentives change over time, and every situation is different. Consult a qualified representative or contact the Social Security Administration directly for guidance on your specific case.