The annual COLA adjustment is widely treated as a lifeline — a corrective measure that keeps Social Security and disability payments in step with inflation. For the unpaid family members quietly paying out of pocket to cover what federal benefits leave behind, a slightly larger check for a disabled loved one often barely registers against costs that keep rising anyway.
When I sat down with Monique Washington at a diner near her east Baltimore apartment in early March 2026, she had just finished a 10-hour route. She was tired in a way that had nothing to do with driving. Before going home, she needed to stop at a medical supply store to pick up catheter supplies her brother Marcus needed — $47, out of pocket, not reimbursable. She mentioned it the way you mention stopping for gas.
A Brother, a Crash, and a Life That Became Hers by Default
Marcus Washington was 25 years old when another driver ran a red light and hit his car head-on. The accident left him with a spinal cord injury requiring daily personal care assistance, accessible housing, and specialized medical equipment. He applied for SSDI and was approved within eight months. He has been receiving benefits for 16 years.
Their parents died within three years of each other — first their mother, then their father. By the time the second funeral was over, the family’s informal caregiving structure had collapsed. Monique, then in her mid-thirties with a decade of UPS seniority, absorbed the responsibility without being asked. “There was no conversation about it,” she told me, with the flat delivery of someone who stopped expecting acknowledgment a long time ago. “My parents were gone. It just became mine. That’s what happens when you’re the one who stays.”
What “staying” looks like, in dollar terms: Marcus receives approximately $967 per month in SSDI as of early 2026, a figure that reflects his limited work history before the accident and the SSA’s formula for calculating lifetime earnings. Maryland Medicaid covers his physician visits and some in-home aide hours. It does not cover accessible van transportation for non-emergency trips, medical supplies his plan only partially reimburses, or the steady out-of-pocket costs Monique has absorbed for years without tracking them — until recently.
What the SSDI Check Actually Covers — and the List of What It Doesn’t
SSDI benefits are calculated based on a worker’s earnings record, which means people disabled early in their careers often receive lower monthly payments than those disabled later in life. According to the Social Security Administration, the average SSDI benefit in early 2025 was approximately $1,537 per month. Marcus’s benefit falls well below that average — a direct consequence of how little he had earned before age 25.
Maryland’s Medicaid program covers his physician visits, some in-home aide hours, and a portion of his durable medical equipment. But the gaps are specific, recurring, and expensive. Monique listed them without hesitating:
- Accessible van transportation for non-emergency medical trips: approximately $120–$160 per month
- Catheter and wound care supplies beyond Medicaid’s reimbursement cap: $90–$110 per month
- Over-the-counter medications and nutritional supplements not covered under his plan: $80–$100 per month
- Backup personal care aide hours when the assigned aide cancels: $150–$200 per month
- Home equipment maintenance not classified as durable medical equipment: $60–$80 per month on average
That math adds up to roughly $500–$650 every month, every month, for 16 years. Monique has never been reimbursed for any of it.
The 2025 COLA: $24 More Each Month, $180 More in Costs
The SSA announced a 2.5 percent COLA for 2025, which took effect with January 2025 payments. According to SSA’s COLA information page, the adjustment was based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) for the third quarter of 2024 — the standard measurement metric used every year.
For Marcus, the 2.5 percent adjustment translated to roughly $24 more per month. In that same period, his accessible transportation costs rose by approximately $15. His supply costs increased again. Monique estimates her total out-of-pocket spending on his care climbed by roughly $180 since the start of 2025 — driven by the same inflation that generated the COLA in the first place.
“I don’t blame the COLA,” Monique told me, measured and deliberate. “I understand what it’s trying to do. I just know that for Marcus’s situation, it was never going to be enough. The number they’re adjusting was never enough to begin with.”
This is a structural problem, not a rounding error. SSDI benefits for people disabled early in their careers compound on a low base. A 2.5 percent increase on $943 is very different from a 2.5 percent increase on $1,537 — and neither closes a $620 supplemental gap that was already there before January.
The Wednesday Deposit She Plans Her Entire Week Around
Marcus’s SSDI payment arrives on the second Wednesday of each month. That schedule is determined by his birth date: per SSA policy for beneficiaries who enrolled after May 1997, those born on the 1st through the 10th of the month receive payment on the second Wednesday, those born on the 11th through the 20th on the third Wednesday, and the 21st through the 31st on the fourth Wednesday.
Monique told me that Wednesday is not just a deposit date — it is a planning anchor. She times her supply runs, backup aide bookings, and van reservations around it. When the deposit shifts — which happened twice in 2024 when federal holidays pushed the scheduled date earlier — her coordination breaks down. Service providers don’t always adapt quickly.
“One time the payment came three days early because of a holiday. I didn’t even know it was coming,” she said, almost laughing. “The deposit hit and I thought there was a mistake. I actually called SSA to check. That’s how rarely something goes in my favor.”
The Retirement She Stopped Contributing To
Monique earns approximately $85,000 a year as a senior UPS driver with full union benefits. By any standard measure, she should be building toward a stable retirement. She is not. She stopped contributing to her 401(k) four years ago when Marcus’s care costs surged following a secondary infection that required additional in-home aide hours for nearly eight months. She has not restarted.
She hasn’t taken a real vacation in six years. She can’t change her shift, because her current hours align with Marcus’s aide schedule. She can’t relocate for a better cost of living, because his Maryland Medicaid enrollment is state-specific and rebuilding his care network would take years. She is, in the quiet language of workforce research, care-locked — fully employed but structurally constrained in ways her W-2 doesn’t capture.
A 2020 report by the National Alliance for Caregiving estimated that approximately 53 million Americans provide unpaid or under-reimbursed care to a family member or friend. The financial exposure embedded in that number — retirement contributions that stop, careers that stall, spending that never gets counted — appears in no SSDI statistic and no COLA calculation.
When I asked Monique what she most wants people to understand about her situation, she was quiet for a long time. She looked out the diner window. Then she said: “People think because you’re employed and your family member is on benefits, that means everything is covered. That some system caught you. Nothing caught us. I caught us.”
Before I left, Monique told me she had started logging her expenses in a notebook. Not to submit a claim, she clarified immediately. Not for taxes. Just to know the number. “After 16 years,” she said quietly, “I think I deserve to at least know the number.”
I drove back across Baltimore thinking about that notebook. About the math she couldn’t finish. About a federal system that sends a $967 check, adds $24 to it once a year, and marks the account as covered — while someone in east Baltimore stops at a medical supply store after a 10-hour shift, pulls out her own wallet, and gets back in her truck.
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