TEN THINGS TO KNOW ABOUT THE EFFECT OF MARRIAGE ON SOCIAL SECURITY AND MEDICARE BENEFITS FOR INDIVIDUALS WITH DISABILITIES
by: Begley Law Group
- What is Social Security? Social Security is a federally funded social insurance program designed to protect individuals with disabilities and also to provide income replacement for retirees, as well as survivors of deceased workers. It is intended to be a safety net rather than a comprehensive personal savings plan. Supplemental Security Income (SSI) recipients could be children with disabilities or married couples with disabilities.
- How is Social Security Funded? Current workers pay payroll taxes to fund benefits for current retirees. The taxes are not placed into a personal account under the individual’s name but rather are paid into a massive pool. Social Security is funded through the Federal Insurance Contributions Act (FICA). Under FICA employers and employees each pay 6.2% of the employee’s wages. Self-employed individuals pay 12.4%. Taxes are only levied on a specific earnings limit. In 2026, the maximum taxable earnings limit is $184,500.
- Social Security Retirement. Social Security Retirement pays about 40% of the average American’s retirement income. It is based on how much the individual has paid into the system. Workers who have reached at least 62 years of age and earned enough work credits, usually 10 years of work, are eligible for retirement benefits. However, the full retirement age is 67 for anyone born in 1960 or later. The maximum age to delay benefits is 70. There is an 8% increase for each year the receipt of Social Security Retirement is delayed from age 62 to age 70,
- SSI. SSI is a public benefit program that pays to disabled individuals who have little or no income. The monthly payment for 2026 is $994. In addition, New Jersey has a supplement of $31.25. Individuals need not have paid into the Social Security system to receive this benefit. To receive SSI, an individual must be disabled. The amount of the SSI payment depends on the amount paid into the system. SSI recipients may experience a net overall deduction in payments upon marriage, whether or not the marriage is to another SSI recipient or person with disabilities.
- Social Security Disability Insurance (SSDI). SSDI is another public benefit. A side benefit of SSDI is that after two years, the recipient receives full Medicare benefits.
- Disabled Adult Child (DAC) Benefits. A DAC child is an adult who has a qualifying disability that began before the age of 22. This classification allows them to receive financial benefits through a deceased, retired or disabled parent. The child must be 18 years of age or older and have a disability that started before age 22. The child must be unmarried and one of their parents must be receiving Social Security Retirement or disability benefits or have passed away. If a DAC receiving SSI loses the SSI because of receipt of Social Security, the child still receives Medicaid.
- Medicare. Medicare is a federally funded health insurance program. Individuals over age 65 automatically qualify.
- Types of Medicare. There are four types of Medicare. They are:
- Medicare Part A. Medicare Part A is basically a hospital insurance program covering in-patient medical services when one is formally admitted to a healthcare facility. It covers semi-private rooms, meals, nursing care, drugs and lab tests. It also covers rehabilitation services following a three-day hospital stay. It provides limited skilled care for homebound individuals. There is generally no premium for Medicare Part A.
- Medicare Part B. There is a monthly premium for Medicare Part B, and it is dependent on income. Medicare Part B covers out-patient care, preventive services, doctors’ visits, and durable medical equipment. It generally pays approximately 80% of approval medical costs after meeting an annual deductible. Medicare Supplemental Insurance is available to pay all or a part of the remaining 20%
- Medicare Part C. Medicare Part C is private insurance, not Medicare. Companies offering the insurance must be approved by Medicare. These plans combine Medicare Part A, B and typically include D along with extra benefits like vision, dental and hearing. The disadvantage is that most of these plans operate using networks like HMOs or PPOs. The individual has to stay in network for non-emergency care.
- Medicare Part D. Medicare Part D is an optional insurance for prescription drugs. It’s optional and covered by Medicare or private insurance companies approved by Medicare.
- Medicare Eligibility. To receive Medicare, an individual must be age 65 or over or, if receiving SSDI, Medicare is automatic after two years.
- Difference Between Medicare and Medicaid. If an individual has both Medicare and Medicaid, Medicaid is the payer of last resort. There are many programs for Medicaid and it is administered jointly by the federal and state governments. Medicare is managed by the federal government.