Social Security, SSI, and Medicare Facts for 2013

by Lauren McLarney

From the Editor: Every December we publish the Social Security figures that have been announced for the coming year. Here is the 2013 information as prepared by Lauren McLarney of the NFB Governmental Affairs Department:

A new year means many changes as well as annual adjustments to Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Medicare programs. The changes traditionally include new tax rates, higher exempt earnings amounts, and SSDI and SSI cost-of-living increases, as well as alterations to deductible and coinsurance requirements under Medicare. Below are the updated facts for 2013. The costs of Medicare for 2013 have not been released yet, but those numbers will be reported in the Monitor as soon as they are available.

Tax Rates

FICA and Self-Employment Tax Rates: The FICA tax rate for employees and their employers is a combination of payments to the Old Age, Survivors, and Disability Insurance (OASDI) Trust Fund, and the Hospital Insurance (HI) Trust Fund, from which payments under Medicare are made. For 2011 and 2012 the OASDI tax rate was temporarily reduced 2 percentage points for employees and for self-employed workers, resulting in a 4.2 percent effective tax rate for employees and a 10.4 percent effective tax rate for self-employed workers. Combined with the HI tax rates, the total tax rate for 2012 was 5.65 for employees and their employers and 13.3 for self-employed workers. These lower tax rates meant less tax revenue, and that difference was made up by transfers from the general fund of the Treasury to the OASI Trust Fund. Under current law this temporary reduction expires at the end of December 2012. If Congress does not decide to extend this reduction, the tax rate will go back to the original amount of 7.65% for employees and employers and 15.3% for self-employed workers. One thing is clear for 2013: an additional HI tax of 0.9 percent is assessed on earned income exceeding $200,000 for individuals and $250,000 for married couples filing jointly.

Ceiling on Earnings Subject to Tax: During 2012 the ceiling on taxable earnings for contributions to the OASDI Trust Fund was $110,100. For 2013 the maximum amount of taxable earnings will be $113,700. All earnings are taxed for the HI Trust Fund.

Social Security Disability Insurance

Quarters of Coverage: Eligibility for Retirement, Survivors, and Disability Insurance (RSDI) benefits is partially based on the number of quarters of coverage earned by any individual during periods of work. Anyone may earn up to four quarters of coverage in a single year. During 2012 a Social Security quarter of coverage was credited for earnings of $1,130 in any calendar quarter. Anyone who earned $4,520 in 2012 (regardless of when the earnings occurred during the year) received four quarters of coverage. In 2013 a Social Security quarter of coverage will be credited for earnings of $1,160 during a calendar quarter. Four quarters will be earned with annual earnings of $4,640.

Trial Work Period Limit: The amount of earnings required to use a trial work month is subject to annual increases based on changes in the national average wage index. In 2012 the amount was $720. This amount will increase to $750 in 2013. In cases of self-employment a trial work month can also be used if a person works more than eighty hours, and this limitation on hours worked will not change unless expressly adjusted.

Exempt Earnings: The monthly earnings exemption referred to as Substantial Gainful Activity for blind people who receive disability insurance benefits was $1,690 of gross earned income during 2012. In 2013 earnings of $1,740 or more a month, before taxes, for a blind SSDI beneficiary will indicate Substantial Gainful Activity once any unearned (or subsidy) income is subtracted and all deductions for impairment-related work expenses are applied.

Social Security Benefit Amounts: There will be a 1.7 percent cost-of-living adjustment (COLA) for beneficiaries in 2013. Increased payments to beneficiaries will begin in December of 2012 and will apply to everyone receiving benefits in 2013.

Supplemental Security Income

Standard SSI Benefit Increase: Beginning January 2013, the federal payment amounts for SSI individuals and couples are as follows: individuals, $710 a month; SSI couples, $1,066 a month.

Student Earned Income Exclusion: In 2012 the monthly amount was $1,700, and the maximum yearly amount was $6,840. In 2013 the monthly amount is $1,730, and the maximum yearly amount is $6,960. The SSI program applies strict asset (resource) limits of $2,000 for individuals and $3,000 for SSI couples, which can be changed only by Congress.

Medicare

Medicare Deductibles and Coinsurance: Medicare Part A coverage provides hospital insurance to most Social Security beneficiaries. The coinsurance amount is the hospital charge to a Medicare beneficiary for any hospital stay. Medicare then pays the hospital charges above the beneficiary's coinsurance amount.

The Part A coinsurance amount charged for hospital services within a benefit period of not longer than sixty days was $1,156 in 2012. From the sixty-first day through the ninetieth day, the daily coinsurance amount was $289 a day. Each Medicare beneficiary has sixty lifetime reserve days that may be used after a ninety-day benefit period has ended. Once used, these reserve days are no longer available after any benefit period. The coinsurance amount paid during each reserve day used in 2012 was $578.

Part A of Medicare pays all covered charges for services in a skilled nursing facility for the first twenty days following a three-day in-hospital stay within a benefit period. From the twenty-first day through the one hundredth day in a benefit period, the Part A coinsurance amount for services received in a skilled nursing facility was $144.50 in 2012.

Most Social Security beneficiaries have no monthly premium charge for Medicare Part A coverage. Those who become ineligible for SSDI cash benefits can continue to receive Medicare Part A coverage premium-free for at least ninety-three months after the end of a trial work period. After that time the individual may purchase Part A coverage. The premium rate for this coverage during 2012 was $451 a month.

In 2012 the Medicare Part B (medical insurance) deductible was $140. This is an annual deductible amount. The Medicare Part B monthly premium rate charged to each new beneficiary or to those beneficiaries who directly pay their premiums quarterly for 2012 was $99.90 a month, although higher-income consumers may pay more. For those receiving Social Security benefits, this premium payment is deducted from your monthly benefit check. Individuals who remain eligible for Medicare, but are not receiving Social Security benefits because of working, must directly pay the Part B premium quarterly—one payment every three months. Like the Part A premiums mentioned above, Part B is also available for at least ninety-three months following the trial work period, assuming an individual wishes to have it and, when not receiving SSDI, continues to make quarterly premium payments.

Programs That Help with Medicare Deductibles and Premiums: Low-income Medicare beneficiaries may qualify for help with payments. Assistance is available through two programs—the QMB (Qualified Medicare Beneficiary program) and the SLMB (Specified Low-Income Medicare Beneficiary program). To qualify for the QMB program in 2012, an individual’s monthly income could not exceed $931 and a married couple’s monthly income could not exceed $1,261. The 2013 limits have not been announced.

Under the QMB program states are required to pay the Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums, deductibles, and coinsurance expenses for Medicare beneficiaries who meet the program's income and resource requirements. Under the SLMB program states pay only the full Medicare Part B monthly premium. Eligibility for the SLMB program may be retroactive for up to three calendar months.

Both the QMB and SLMB programs are administered by the Centers for Medicare and Medicaid Services in conjunction with the states. The rules vary from state to state, but the following can be said: Resources, such as bank accounts or stocks, may not exceed $4,000 for one person or $6,000 for a family of two. Resources are generally things you own. However, not everything is counted. The house you live in, for example, doesn't count; and generally one car also doesn't count.

If you qualify for assistance under the QMB program, you will not have to pay:

• Medicare's hospital deductible amount, which was $1,156 per benefit period in 2012;
• The daily coinsurance charges for extended hospital and skilled nursing facility stays;
• The Medicare Medical Insurance (Part B) premium, which was $99.90 a month in 2012, unless you are currently receiving benefits from Social Security and the agency is automatically withholding your Part B premiums;
• The 2012 $145 annual Part B deductible;
• The 20 percent coinsurance for services covered by Medicare Part B, depending on which doctor you go to.

If you qualify for assistance under the SLMB program, you will be responsible for the payment of all of the items listed above except for the monthly Part B premium, depending on your circumstances.

If you think you qualify but you have not filed for Medicare Part A, contact Social Security to find out if you need to file an application. Further information about filing for Medicare is available from your local Social Security office or Social Security's toll-free number (800) 772-1213.

Remember that only your state can decide if you are eligible for help from the QMB or SLMB program and also that the income and resource levels listed here are general guidelines with some states choosing greater amounts. Therefore, if you are elderly or disabled, have low income and very limited assets, and are a Medicare beneficiary, contact your state or local Medicaid office (referred to in some states as the Public Aid Office or the Public Assistance Office) to apply. For more information about either program, call the Centers for Medicare and Medicaid Services (CMS) on its toll-free telephone number (800) 633-4227, or go online to <http://www.cms.hhs.gov/ContactCMS>.