While both Social Security and Medicare are federal government programs, they provide different support. Medicare is healthcare insurance while financial support is covered by Social Security.
Although the two programs are separate, there are some places where they work together.
In this article, we discuss Medicare and Social Security, and examine how they work together.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Social Security and Medicare are two different programs regulated by the federal government. However, the Social Security Administration (SSA) that manages Social Security benefits also handles enrollment for Medicare.
The SSA determines the amount a person pays for their Medicare premium. The premium for original Medicare Part A is a fixed amount and is calculated on how many years a person paid Medicare taxes. The premium for Medicare Part B depends on a person’s income for the previous two years.
When a person is getting Social Security benefits, the Medicare monthly premium is automatically deducted from the benefits.
Original Medicare (Part A and Part B) helps pay for medically necessary health care that meets medical standards of care.
There are two other parts to Medicare, including Part C, also known as Medicare Advantage, which offers alternative coverage to original Medicare, and Part D, which provides coverage for prescription drugs.
Enrollment
If a person gets Social Security benefits, they will be automatically enrolled in Medicare during their initial enrollment period (IEP). A person’s 7-month IEP starts 3 months before the month they turn 65, includes the birthday month, and the following 3 months.
However, a person who does not get Social Security benefits must enroll in original Medicare. A person can get full details about enrollment, including their options, on the SSA website.
For most people, payroll taxes will cover Part A costs, and they will not have to pay a monthly premium. However, if a person has not paid Medicare taxes for at least 40 quarters they will need to pay the Part A premium.
For a person who has paid less than 40 quarters the premiums in 2020 are as follows:
The premium for a person who paid for 30–39 quarters is $252.
The premium for a person who paid for less than 30 quarters will be $458.
Penalties
If a person delays enrolling in Medicare until after their IEP they may pay a late enrollment penalty, which will last as long as they have Medicare coverage.
According to the SSA, about 64 million people in the United States received monthly Social Security benefits as of June 2019. The programs are designed to supplement other retirement income such as savings or employer benefits.
The programs include benefits for retirement, disability, and survivors.
Retirement benefits
Tax money pays for Social Security benefits. During a person’s working life, they pay taxes into Social Security, which is then used to pay benefits.
The benefits are provided for a person who meets one of the following criteria:
- has retired
- is a survivor of a person who died
- is a dependent, such as a child or spouse, of someone who gets benefits
- has a disability
- is a spouse who has divorced from a person who either gets Social Security or is eligible to do so
- is a spouse, who is divorced, and the person who worked has died
- is a parent, who was dependent on the person who worked and who has died
Eligibility
Age is not a factor in eligibility for Social Security benefits, and a person may apply for benefits when they are 62 years old, although they may not then get their full benefit amount.
In general, a total of 40 credits is needed to qualify for benefits. That amount of credits represents 10 years of work.
A person gets Social Security credits, to a maximum of four credits annually, as they pay taxes related to work. For example, in 2020, a person gets one credit for each $1,410 they earn. A person needs to earn $5,640 to get a maximum of four credits.
Benefit amounts
The amount of Social Security benefit a person gets is based on their total earnings and their age when they retire.
The retirement age is gradually increasing. For example, a person born in 1954 reaches their full retirement when they are 66 years old. However, a person born in 1960 has to wait until they are 67 years old to reach full retirement age.
The chart below reflects how the retirement age has gone up, and the percentage of benefits a person will get at different ages.
| Year of birth | Full retirement age |
|---|---|
| 1943 to 1954 | 66 |
| 1955 | 66 and 2 months |
| 1956 | 66 and 4 months |
| 1957 | 66 and 6 months |
| 1958 | 66 and 8 months |
| 1959 | 66 and 10 months |
| 1960 | 67 |
A person can delay taking benefits from Social Security past their full retirement age, and they will get delayed retirement credit that increases their benefit amount. The amount no longer increases after a person is 70 years old.
Taxes are due on the benefits if a person files as an individual and earns more than $25,000, and if a person files a joint return, with annual income above $32,000.
This online tool can help a person check several ways to apply for benefits, including online, by telephone, or through their local Social Security office.
Disability benefits
There are other support programs a person can get through Social Services, including disability benefits.
Eligibility
To be eligible for disability benefits, a person must meet a duration work test and a recent work test. A person’s age is a factor in eligibility, as follows:
| Age in years | Credits needed | Time period in which credits earned |
|---|---|---|
| Under 24 | 6 | 3 years before the start of the disability |
| 24 to 31 | 12 | 3 years of work, which amounts to 12 credits, during the past 6 years |
| 31 and older | 20 | 10 years before the start of the disability |
If a person is legally blind, they do not need to meet a recent work requirement, only the duration of work test.
An additional program called Supplemental Security Income (SSI) helps a person or child who has a disability, limited resources, and limited income. A person who is over 65 years old and who does not have any disabilities, may also qualify for SSI benefits.
A person can check the program details through this online tool.
Survivor benefits
A person who is a widow, a widower, or a dependent of eligible workers may be eligible for Social Security survivors’ benefits.
Eligibility
The maximum amount of credits needed for members of the person’s family to be eligible for survivor benefits is 40. However, the age of the person when they died affects the number of credits needed. In general, the younger the person, the fewer credits are needed.
There is a special rule that allows for benefits to be paid even if the person’s record does not show the required number of credits.
Both Medicare and Social Security are federally regulated. However, the Social Security Administration (SSA) that manages Social Security benefits also handles enrollment for Medicare.
Social Security and Medicare provide help to people through financial support and healthcare insurance.