SOCIAL SECURITY, SSI, AND MEDICARE FACTS FOR 1995 by James Gashel From the Editor: James Gashel is the National Federation of the Blind's Director of Governmental Affairs. The beginning of each year brings with it annual adjustments in Social Security programs. The changes include new tax rates, higher exempt earnings amounts, Social Security and SSI cost-of-living increases, and changes in deductible and co-insurance requirements under Medicare. Here are the new facts for 1995: FICA and Self-Employment Tax Rates: The FICA tax rate for employees and their employers remains at 7.65%. This rate includes payments to the Old Age, Survivors, and Disability Insurance (OASDI) Trust Fund of 6.2% and an additional 1.45% payment to the Hospital Insurance (HI) Trust Fund, from which payments under Medicare are made. Self-employed persons continue to pay a Social Security tax of 15.3%. This includes 12.4% which is paid to the OASDI trust fund and 2.9% which is paid to the HI trust fund. Ceiling on Earnings Subject to Tax: During 1994 the ceiling on taxable earnings for contributions to the OASDI trust fund was $60,600. The taxable income ceiling for contributions to the OASDI trust fund during 1995 is $61,200. As was true in 1994, there is no ceiling on earnings that are subject to the HI trust fund tax contribution of 1.45% for employees or 2.9% for self- employed persons. Quarters of Coverage: Eligibility for retirement, survivors, and disability insurance benefits is based in large part on the number of quarters of coverage earned by any individual during periods of work. Anyone may earn up to four quarters of coverage during a single year. During 1994 a Social Security quarter of coverage was credited for earnings of $620 in any calendar quarter. Anyone who earned $2,480 for the year (regardless of when the earnings occurred during the year) was given four quarters of coverage. In 1995 a Social Security quarter of coverage will be credited for earnings of $630 during a calendar quarter. Four quarters can be earned with annual earnings of $2,520. Exempt Earnings: The earnings exemption for blind people receiving Social Security Disability Insurance (SSDI) benefits is the same as the exempt amount for individuals age sixty-five through sixty-nine who receive Social Security retirement benefits. The monthly exempt amount in 1994 was $930 of gross earned income. During 1995 the exempt amount will be $940. Technically, this exemption is referred to as an amount of monthly gross earnings which does not show "substantial gainful activity." Earnings of $940 or more per month before taxes for a blind SSDI beneficiary in 1995 will show substantial gainful activity after subtracting any unearned (or subsidy) income and applying any deductions for impairment-related work expenses. Social Security Benefit Amounts for 1995: All Social Security benefits (including retirement, survivors', disability, and dependents' benefits) are increased by 2.8% beginning with the checks received in January, 1995. The exact dollar increase for any individual will depend upon the amount being paid. Standard SSI Benefit Increase: Beginning January, 1995, the federal payment amounts for SSI individuals and couples are as follows: individuals, $458 per month; couples, $687 per month. These amounts are increased from individuals, $446 per month; couples, $669 per month. Medicare Deductibles and Co-insurance: Medicare Part A coverage provides hospital insurance to most Social Security beneficiaries. The co-insurance payment is the charge that the hospital makes to a Medicare beneficiary for any hospital stay. Medicare then pays the hospital charges above the beneficiary's co-insurance amount. The Part A co-insurance amount charged for hospital services within a benefit period of not longer than sixty days was $696 during 1994 and is increased to $716 during 1995. Beginning with the sixty-first day through the ninetieth day, there is a daily co-insurance amount of $179 per day, up from $174 in 1994. Each Medicare beneficiary has sixty "reserve days" for hospital services provided within a benefit period longer than ninety days. The co-insurance amount to be paid during each reserve day is $358, up from $348 in 1994. Part A of Medicare pays all covered charges for services in a skilled nursing facility for the first twenty days within a benefit period. Beginning with the twenty-first day through the one hundredth day within a benefit period, the Part A co- insurance amount for services received in a skilled nursing facility is $89.50 per day. For most beneficiaries there is no monthly premium charge for Medicare Part A coverage. Persons who become ineligible for Social Security Disability Insurance cash benefits can continue to receive Medicare Part A coverage premium-free for thirty-nine months following the end of a trial work period. After that time the individual may purchase Part A coverage. The premium rate for this coverage during 1995 is $261 per month. During 1995 this premium rate is reduced by 30% for individuals who have earned at least thirty quarters of coverage under Social Security covered employment. For such individuals the monthly premium rate for purchasing Medicare Part A coverage during 1995 will be $183. The Medicare Part B (medical insurance) deductible remains at $100 in 1995. This is an annual deductible amount. The Medicare Part B basic monthly premium rate will increase from $41.10 charged to each beneficiary and withheld from Social Security checks during 1994 to $46.10 per month during 1995. Medicare Part B coverage may be continued for persons who complete a trial work period and become ineligible to receive Social Security Disability Insurance cash benefits. This monthly premium rate is $46.10, the same amount paid by Social Security beneficiaries through withholding from their monthly Social Security checks. Programs Which Help with Medicare Deductibles and Premiums: Low-income Medicare beneficiaries may qualify for help with payments. Assistance is available through two programs - QMB (Qualified Medicare Beneficiary program) and SLMB (Specified Low- income Medicare Beneficiary program). 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 ($46.10 in 1995). Eligibility for the SLMB program may be retroactive for up to three calendar months. Both programs are administered by the Health Care Financing Administration (HCFA) in conjunction with the states. The rules vary from state to state; but, in general: An individual may qualify for the QMB program if his or her income is near the national poverty level, approximately $7,596 annually for an individual (about $633 per month) and $10,080 annually for a family of two (or $840 per month). These amounts apply for residents of forty-eight of the fifty states and the District of Columbia. In Alaska the income threshold used to define poverty is approximately $9,444 annually for an individual ($787 per month) and $12,540 annually for a family of two ($1,045 per month). In Hawaii the income threshold used to define poverty is approximately $8,712 annually ($726 per month) for an individual and $11,556 annually ($963 per month) for a family of two. For the SLMB program annual income must be 110 percent or less of the national poverty levels. Under both programs $20 in monthly income is not counted toward the limit. Resources--such as bank accounts or stocks--may not exceed $4,000 for one person or $6,000 for a family of two. (Resources generally are things you own. However, not everything is counted: the house you live in, for example, doesn't count, and, in some circumstances, your car may not count either.) Here's an idea of what the QMB program provides in 1995. Under Part A the hospital insurance deductibles are $716 for the first sixty days of a hospital stay and $179 per day for days sixty-one through ninety in the hospital. However, to qualify for help under the QMB program, you must file an application. 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, only your state can decide if you're eligible for help from the QMB or SLMB program. So, if you're elderly or disabled, have low income and very limited assets, and are a Medicare beneficiary, contact your state or local welfare or social service agency to apply. For more information about either program, call HCFA's toll-free telephone number, (800) 638-6833.