Chapter Two Eligibility Requirements
Basic Benefits
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
Basic Benefits
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
Basic Benefits
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
click to go to section
Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
Basic Benefits
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
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Retirement Benefits- Sect. 202
Disability Benefits - Sect. 203
Spouse's Benefits - Sect 204 & ff.
Child's Benefits - Sect. 205 & ff.
Parent's Benefits - Sect. 206
Lump Sum Death Benefit- Sect. 208
§ 201 In General
§ 202 Retirement Benefits
§ 203 Disability Benefits
§ 204 Spouse's Benefits
§ 204.1 Spouse Age 62 and Over
§ 204.2 Spouse Benefits; With Child in Care
§ 204.3 Divorced Spouses Benefits
§ 204.4 Widow(er): Age 60 and Over
§ 204.5 Mothers/Fathers Benefits: With Child in Care
§ 204.6 Disabled Widow(er)s' Benefits: Age 50 through 59
§ 204.7 Divorced Widow(er)s' Benefits
§ 205 Child's Benefits
§ 205.1 Under Age 18
§ 205.2 High School Student
§ 205.3 Disabled Adult Child
§ 205.4 Grandchildren
§ 206 Parents' Benefits
§ 207.1 Medicare Generally
§ 207.2 Hospital Insurance
§ 207.3 Medical Insurance
§ 208 The Lump Sum Death Payment
§ 209 Being Age 62 "Throughout the Month"
§ 210 The Marriage Requirement
§ 211 Exceptions to the One-Year Duration of Marriage Requirement
For Spouse's Benefits
§ 212 Exceptions to the
Nine Month Duration of Marriage
Requirement for Widow(er)s' Benefits
§ 213 The "Child in Care"
Requirement
§ 214 The Child Relationship Requirement
§ 215 Dependency Requirements: Children and Grandchildren
Section 201 - In General
The Social Security Act provides for the payment of many different types of social security benefits. The benefits usually referred to as social security benefits are provided under the basic programs known as Retirement Insurance, Survivors Insurance, Disability Insurance, (RSDI) and Health Insurance, better known as Medicare. These benefits are funded by taxes on earnings, the F.I.C.A. taxes that are deducted from paychecks. There are many other social insurance and welfare programs in the United States, some administered by the Social Security Administration (SSA) and some administered by the states. This book discusses only social security benefits, although we briefly discuss the Supplemental Security Income (SSI) program in Chapter 14, Miscellaneous Provisions.
Many people confuse SSI with Social Security, because the SSI program provides payments for the aged and the disabled and both are administered by SSA. Some social security beneficiaries whose benefit amounts are low are eligible to receive additional payments under the SSI program. To really muddle it, all the double-S acronyms confuse even lawyers and accountants, so it is not surprising that most people get mixed up.
In a nutshell, social security benefits are based on the taxed earnings of workers, and paid to them, their dependents and survivors. It is called an entitlement program and pays "benefits." Supplemental Security Income (SSI) is a federally administered (by SSA) welfare program for the elderly, the disabled and the blind. The SSI program makes "payments" to supplement the income of the needy recipient. If the recipients income exceeds certain levels, which can vary by state, then SSI payments are suspended. Unlike SSI, social security benefits are entitlements, so the beneficiary is paid regardless of income. The exceptions to that are in the cases of earned income which may indicate that a disabled worker is not in fact disabled, or a retired worker is not retired. Unearned income, such as pensions, dividends, interest, annuities, etc. do not affect eligibility for social security benefits.
Each social security benefit has specific eligibility requirements which a claimant must meet in order to receive it. Even though a person becomes entitled, a benefit may not be paid, often because earnings are in excess of the applicable limits, but there may be several other reasons as well. This chapter deals only with the basic eligibility requirements. Earnings as they affect the payment of benefits will be discussed in Chapter 8, Earnings Limitations.
Additionally, almost all benefits require an application to be filed by the claimant. Application requirements are discussed in full in Chapter 4. Each type of benefit requires that the worker on whose record the benefits are based have what is called an "insured status." This means that he or she has enough work credits. There are different kinds of insured status. Some require more work than others. These different types of insured status will be discussed in detail in Chapter 6. The amount of the actual benefit the beneficiary receives is discussed in detail in Chapter 7, Benefit Amounts.
Spouses, young children and disabled adult children of disabled and retired workers are paid monthly benefits if they meet the specific eligibility requirements discussed in this chapter. Surviving widows, widowers, young children and disabled adult children of deceased workers may also be eligible for benefits.
Benefits are also payable to certain divorced wives/husbands and divorced widows/widowers and to certain parents of covered workers. There are many different kinds of monthly benefits. We have categorized fifteen different types of benefits in this chapter. Eligibility requirements for each are listed separately. In addition to monthly benefits, the Social Security Act also provides for Medicare. This is officially called Health Insurance and has two parts - Hospital Insurance and Medical Insurance. This is discussed more fully in Chapter 12 - Medicare. We list in this chapter the eligibility requirements.
We do not discuss eligibility requirements for other programs that are administered by Social Security such as Supplemental Security Income (Section 1401) or Black Lung benefits (Section 1402).
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Section 202 - Retirement Benefits
Other Names: Old Age Insurance Benefits; Retirement Insurance Benefits.
Beneficiary Identification Code (Section 1407) : A
Requirements:
1. You are at least age 62 throughout the month. Usually you are not eligible until the month after your 62nd birthday, see Section 209.
2. You have enough work covered by Social Security to be "fully insured." Generally, this means that you have worked for at least 10 years, see Section 602.
3. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.2.
Benefit Amount: 100% of the Primary Insurance Amount (PIA) at Full Retirement Age, reduced for age before Full Retirement Age. Benefits vary greatly depending on the work record. Low average earnings may yield a PIA of $721, maximum average earnings can result in a PIA of $1784, for 2004. See Chapter 7 for a full discussion.
Termination: Entitlement ends with the month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
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Section 203 - Disability Benefits
Other Names: Disability Insurance Benefits; Disabled Worker Benefits.
Beneficiary Identification Code (Section 1407) : HA
Requirements:
1. You are under Full Retirement Age (at Full Retirement Age the benefit is converted to an unreduced retirement benefit, even if you are still disabled).
2. You have enough work covered by Social Security to meet the special disability insured status (Section 604). Generally, you must have worked at least 5 years within the preceding 10 year period.
3. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.6.
4. You are totally and permanently disabled for any employment. "Permanent" means that the disability is expected to last at least a year, or result in death. See Section 502.
5. You have been totally disabled for at least five months (Section 507).
Benefit Amount: 100% of the Primary Insurance Amount.See Chapter 7 for a full discussion of computations of benefits. The disability benefit is not reduced for age but is subject to offset in some cases. See Sections 511 - 512 for the effect of workers compensation benefits or other disability benefits.
Termination: Entitlement ends with:
1. The month before you reach Full Retirement Age. (You then are switched automatically to Retirement benefits).
2. The second month after the disability ceases. See Section 513 for a discussion of the payment rules at the time of cessation of disability.
3. The month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
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Section 204 - Spouse's Benefits
§ 204.1 Spouse Age 62 and Over
§ 204.2 Spouse Benefits; With Child in Care
§ 204.3 Divorced Spouses Benefits
§ 204.4 Widow(er): Age 60 and Over
§ 204.5 Mothers/Fathers Benefits: With Child in Care
§ 204.6 Disabled Widow(er)s' Benefits: Age 50 through 59
§ 204.7 Divorced Widow(er)s' Benefits
Section 204.1 - Spouse's Benefits: Age 62 and Older
Other Names: Wife's Benefits; Husband's Benefits , Aged Spouse, Aged Wife, Aged Husband.
Beneficiary Identification Code (Section 1407): B (or HB if the worker received disability benefits)
Requirements:
1. You are the wife or husband of a worker entitled to retirement or disability benefits. Note: the marriage may be "deemed valid" by SSA even if it is not legally recognized, see Section 210.
2. Your marriage lasted for at least one year. See Section 211 for exceptions to this requirement.
3. You are at least age 62 throughout the month. Usually you are not eligible until the month after your 62nd birthday, see Section 209.
4. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.5.
5. You are not entitled to a higher retirement or disability benefit on your own earnings record. (You may be entitled to some spouses benefits even if you are entitled on your own record, if your benefit is lower than one-half of your spouses Primary Insurance Amount (see Section 302).
Benefit Amount: one-half of your spouses Primary Insurance Amount (Section 702.1) at Full Retirement Age reduced for age before Full Retirement Age (Section 703.1) unless you have a child in your care (Section 213); reduced by your own benefit (see Section 302); and subject to the family maximum. See Chapter 7 for a full discussion.
Termination: Entitlement ends with:
1. The month before you become entitled to a higher benefit on your own account (see Section 302).
2. The month before you become divorced (you may be able to switch over to divorced spouses benefit - Section 204.2).
3. The month before the spouse on whose earnings you receive benefits dies or is no longer disabled [in the event of death you may switch to a widow(er)s benefit (see Section 204.4 for requirements and see Section405 for automatic conversion from spouses to widow(er)s benefits].
4. If your benefits are based on a "deemed" marriage, (see Section 210), the month before you marry someone else or the legal wife of the worker becomes entitled on his account.
5. The month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
Other: Spouses benefits are now gender neutral. You may be eligible either as the husband or the wife of the worker. Whenever the term wifes benefits is used in this book, you may substitute husbands benefits if applicable.
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Section 204.2 - Spouse's Benefits: With Child in Care
Other Names: Young Wife; Young Husband; Young Spouse
Beneficiary Identification Code (Section 1407): B2 (or HB2 if the worker receives disability benefits)
Requirements: The requirements are the same as an aged spouse, (Section 204.1), with one exception. You may collect at any age as long as you have a child of the worker in your care (Section 213) who is entitled to child benefits on the workers account and who is either under age 16 or a disabled child of any age for whom you are rendering substantial personal services (Sections 205.1 - 205.4 for who qualifies as children).
Benefit Amount: 50% of the spouses Primary Insurance Amount (Section 702). There is no reduction for being under Full Retirement Age. The benefit is subject to reduction for the family maximum (see Chapter 7 for a full discussion of computations).
Termination: Occurs the same as for aged spouses benefits (see Section 204.1), and the month before the month the youngest child turns 16 (see Section 213).
Other: Spouses benefits are gender neutral. You may be entitled whether you are the wife or the husband of the covered worker.
Note: the benefits may be suspended for any month you do not have a child in your care (Section 213, "Child in Care" and Section 1008, Suspension of Benefits).
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Section 204.3 - Spouse’s Benefits: Divorced Spouse
Other Names: Divorced Wife, Divorced Husband.
Beneficiary Identification Code (§1407) : B6
Requirements:
1. Your ex-spouse (the worker) is entitled to retirement or disability benefits. A divorced spouse may be “independently entitled” if divorced at least two years. This means the divorced spouse may receive benefits even though the worker has not yet filed, or his benefits are being suspended because of excess earnings. The two year requirement is designed to avoid any incentive for divorce solely to take advantage of this provision. If the ex-spouse has not filed, he or she must be “eligible”; he or she must be “insured” (see Chapter 6) and age 62 or disabled. NOTE: The worker's earnings will have no effect on the ex-spouse's benefits under the Work Test (§801) if the worker's first month of entitlement is prior to the month the divorce becomes final. If the worker first becomes entitled in or after the month of divorce, then his or her earnings in excess of the work test may affect the ex-spouse's benefits payment, but only for two years.
2. You are the wife or husband of the worker as defined by SSA (§210).
3. You had been married to the worker for at least ten years immediately before the divorce became final. This requirement is met even if this period was interrupted by a prior divorce from the same spouse, provided the remarriage took place in the calendar year of the divorce or the calendar year immediately following. The marriage must be in existence in each of the 10 years before the divorce in order for the claimant to be entitled. You may also qualify based on a 10-year marriage immediately before a prior divorce.
4. You file an application (see Chapter 4).
5. You are age 62 throughout the month (§209). You cannot be entitled as a divorced wife if you are under age 62 even if you do have a child in your care.
6. You are not entitled to a higher retirement or disability benefit on your own account (§302).
7. You are unmarried.
Benefit Amount : same as aged spouse (§204.1), but not subject to the Family Maximum.
Termination: Entitlement ends with:
1. The same conditions for an aged wife (§204.1).
2. When you re-marry. However, you may continue to be eligible if you re-marry certain other Social Security beneficiaries (§904).
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Section 204.4 - Spouse's Benefits: Widow/Widower, Age 60 and Over
Other Names: Widow's Insurance Benefit, Widower's Insurance Benefit, Aged Widow, Aged Widower.
Beneficiary Identification Code (Section 1407): D
Requirements:
1. The worker to whom you were married died fully insured (see Chapter 6).
2. You were "married" to the worker. This may include other than legal marriages. See Section 210, The Marriage Requirement.
3. You were married for at least nine months before the worker died (see Section 212 for exceptions to this requirement).
4. You file an application., See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.6. See also Section 405, for automatic conversion from spouse to widow(er).
5. You are at least age 60. The special "throughout the month" rule for retirement and spouse benefits discussed in Section 209 does not apply to widow(er)'s benefits.
6. You are not actually entitled to a higher retirement or disability benefit on your own account (Section 303).
7. You are not married (if you re-marry after age 60 then you are not married for Social Security purposes).
NOTE: Even though a widow(er) could meet all the requirements, entitlement is precluded if (1) the widow(er) was convicted of the felonious and intentional homicide of the worker, or (2) the Railroad Retirement Board has jurisdiction of the survivor's claim.
Benefit Amount: 100% of the workers Primary Insurance Amount plus delayed retirement credits. The benefit amount is reduced if you take it before Full Retirement Age, but cannot be reduced below 71%. Also subject to other reductions, see Chapter 7. The benefit amount cannot exceed the workers benefit amount paid during his/her life. See Section 703.5 . See Chapter 3 if you also worked on your own account, especially Section 303.
Termination: Entitlement ends with:
1. The month before you become entitled to a higher retirement or disability benefit on your own account (see Section 303 for a discussion of dual entitlement).
2. If you are entitled based on a deemed marriage (Section 210) benefits will end if another person becomes entitled as the legal widow or widower.
3. The month before the month of death (Section 1009).
Other: Widows benefits are gender neutral.
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Section 204.5 - Spouse's Benefits: Mother/Father with Child in Care
Other Names: Young Widow, Mother's Benefits, Father's Benefits.
Beneficiary Identification Code (Section 1407): E
Requirements:
1. The worker died fully or currently insured (see Chapter 6).
2. You were "married" to the worker (Section 210).
3. You file an application (see Chapter 4, especially Section 405).
4. You are unmarried.
5. You are not entitled to a higher widows benefits on another account or to a higher retirement or disability benefit on your own account (see Chapter 3, Dual Entitlement).
6. You have a "child in your care" (Section 213).
Benefit Amount: 75% of the workers Primary Insurance Amount (Section 702) subject to the family maximum (see Chapter 7).
Termination: Entitlement ends with the month before the month in which any of the following occur (see Section 1009 for a general discussion of termination of benefits):
1. You become entitled to a higher benefit on another account.
2. The child in your care turns 16 unless the child is disabled and you are rendering services for that child (see Section 213, The Child in Care Requirement). If you are entitled because you have a disabled adult child in your care, the benefits will end if the child is no longer disabled.
3. You re-marry (for exceptions if you re-marry another Social Security beneficiary, see Section 904).
4. If your entitlement is based on a deemed marriage (Section 210), and another person becomes entitled on the account as the legal widow.
5. The month before the month of death.
Other: If your benefits end because you have re-married they may be reinstated if the subsequent marriage is terminated (Section 904). Benefits are sex neutral.
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Section 204.6 - Spouse's Benefits: Disabled
Widow(er)'s Benefits; Age 50 to 59
Other Names: Disabled Widow's Insurance Benefit, Disabled Widower's Insurance Benefit.
Beneficiary Identification Code (Section 1407) : W
Requirements: the requirements are the same as for an aged widow (Section 204.4) except that instead of being 60 you meet the following requirements:
1. You are at least age 50.
2. You are totally disabled (Section 502).
3. The disability started not later than seven years after the workers death or seven years after you were last entitled to mothers benefits (Section 204.5) or disabled widows benefits, if you were previously entitled.
4. The disability lasts for more than five months (Section 507) and is expected to last at least one year (Section 502).
Benefit Amount: 71% of the workers Primary Insurance Amount (Section 702). See Chapter 7 for a full discussion of computations of benefits.
Termination: Entitlement ends with the same events as the Widow (Section 204.4), and when the disability ends (see Section 513). Note that for the Disabled Widow, re-marriage after age 50 is not considered for Social Security purposes.
Other: Disabled Widows benefits are sex neutral.
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Section 204.7 - Spouse's Benefits: Divorced
Widow(er)'s Benefits
Other Names: Surviving Divorced Wife, Surviving Divorced Husband, Divorced Widower, Divorced Mother, Divorced Father.
Beneficiary Identification Code (Section 1407): D6 (divorced aged widow); E1 (divorced young widow - child in care); W6 (disabled divorced widow).
Requirements:
1. The worker died fully insured, or in the case of a young widow; currently insured. See Chapter 6 for a discussion of insured status.
2. You were legally married. Note that the "deemed valid" marriage discussed in Section 210 is not sufficient.
3. The marriage lasted for at least ten years immediately before the divorce.
4. You file an application. (See Chapter 4).
5. You are age 60, or disabled (Section 502), or have a child of the worker in your care (Section 213).
6. You are not entitled to a higher retirement or disabled benefit on your own account (Section 303).
7. You are unmarried.
Benefit Amount: Same as for a non-divorced widow, but not subject to the Family Maximum (Section 703.7).
Termination: Entitlement ends under the same conditions described in Section 204.4 for an aged widow, Section 204.6 for a disabled widow, or Section 204.5 for a young widow.
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§ 205.1 Under Age 18
§ 205.2 High School Student
§ 205.3 Disabled Adult Child
§ 205.4 Grandchildren
Section 205 - Child's Benefits Introduction
Social Security benefits are payable to certain children of retired, deceased or disabled workers. The most common situation is for the child under age 18. These benefits can be extended if the child is still in high school through the end of the semester or quarter in which the child turns age 19. No benefits are payable after that even if the child continues on to college.
Benefits for children in college were eliminated many years ago. Benefits are also payable to adult children who become disabled before age 22. Benefits are also payable to the grandchildren of covered workers provided that the parents are either deceased or totally disabled at the time the worker became eligible for benefits. The requirements for these benefits are discussed in detail in the following sections.
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Section 205.1 - Child's Benefits: Under Age 18
Other Names: Surviving Child, Dependent Child.
Beneficiary Identification Code (Section 1407): C (HC if the worker receives disability benefits)
Requirements:
1. The worker is entitled to retirement or disability benefits, or, in the case of survivors, died either fully insured (Section 602) or currently insured (Section 603).
2. You are the child of the worker as defined in Section 214 below. Under certain circumstances this can include stepchildren, illegitimate children, adopted children, and grandchildren.
3. You are dependent on the worker at the time he or she becomes eligible for retirement or disability benefits or dies (Section 215). Note that if you are the natural child of the worker, you are deemed dependent.
4. You file an application (see Chapter 4).
5. You are unmarried.
6. You are under age 18 (see Section 205.2 for students and Section 205.3 for disabled adult children).
Benefit Amount: Children entitled on a living workers account receive 50% of the Primary Insurance Amount (Section 702.1). Children entitled on a deceased workers account receive 75% of the Primary Insurance Amount. In all cases it is subject to the family maximum (see Chapter 7 for a full discussion of computations).
Termination: Entitlement ends with the month before any of the following events occur (Section 1009):
1. You turn 18 (unless you are a student or disabled, see Section 205.2 and Section 205.3).
2. You marry.
3. The workers entitlement ends for a reason other than death. If the worker dies, you will be converted to a survivor benefit as a child.
4. You die.
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Section 205.2 - Child’s Benefits: High School Student
Requirements:
1. The requirements are the same as for a child under age 18, except that you do not have to be under age 18.
2. You must be no older than age 19. Benefits may continue for up to three months after age nineteen if you turn 19 during the school quarter or semester.
3. You must be a full time student in an approved elementary or secondary school, or an approved home school program. A high school level program taken in a college, community college, vocational, or technical school qualifies if the program is approved as a secondary level school program by the Board of Education or State.
4. You must not be paid by your employer to attend school.
Benefit Amount: Same as for a child under 18 (§205.1).
Termination: Same as for a child under 18 (§205.1); or if you are no longer a full time student; or you start to be paid by your employer to attend school.
Note: A school is considered approved if it is accredited by the state in which it is located and its primary purpose is to provide secondary or elementary education. “Full time” means twenty hours per week and at least a 13-week course. Home schooling qualifies if the student meets the Federal standards for full-time attendance (20 hours per week for 13 weeks, not a correspondence course); the State recognizes home school as an educational institution and the program meets all the State requirements, even after age 16 when some states no longer require compulsory education.
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Section 205.3 - Child's Benefits: Disabled
Adult Child
Other Names: Childhood Disability Beneficiary, Adult Disabled Child.
Requirements:
1. The requirements are the same as Section 205.1, except that you must be age 18 or older.
2. You become totally disabled before you reach age 22 (Section 502). Note that if your benefits stop when you turn age 18, they may be re-established if you become disabled before age 22.
Benefit Amount - same as for children under age 18 (Section 205.1).
Termination: Entitlement ends with:
1. Under the same conditions described in Section 205.1 for children under age 18, except the age requirement. In some cases, marriage to another Social Security beneficiary does not terminate disabled childs benefits (Section 1009).
2. When the disability ceases (Section 513). If you become disabled again after the disability ceases, the benefit may resume if you become disabled for the second time within seven years after the month in which your disabled child benefits ended.
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Section 205.4 - Child's Benefits:
Grandchildren
Other Names: These are referred to as Child's Benefits even though the entitlement is based on a grandchild relationship.
Requirements:
Grandchildren may be eligible for benefits if they meet the requirements for children's benefits discussed in the preceding sections and in addition meet these requirements:
1. You are the child of the covered worker's child (Section 214).
2. Your parents were both either deceased or totally disabled (Section 502) at the time the grandparent first became entitled to retirement benefits, disability benefits, or died. If the grandparent died after becoming entitled to benefits, you must have met the requirements as of the date he or she became entitled to benefits.
3. The grandchild is dependent on the grandparent (Section 215).
Benefit Amount: The benefit amount of grandchildren's benefits is the same as for regular child's benefits.
Termination: The benefits end under the same conditions as they end for other types of child's benefits.
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Section 206 - Parent's Benefits
Note that these benefits are payable only to surviving parents of deceased workers. They are not payable if the worker is alive.
Beneficiary Identification Code (Section 1407): F
Requirements:
1. The worker died fully insured (Section 602).
2. You are the natural parent of the worker according to the laws of the state where the worker had a permanent home. If you adopted the worker, you must have adopted him or her before he or she was 16. If you are a stepparent you must have married the workers natural parent before the worker became 16 years old.
3. You are at least age 62.
4. You have not married since the worker died.
5. You file an application (see Chapter 4).
6. You are not entitled to a retirement or disability greater than the parents benefit amount.
7. You received at least one half of your support from the worker at the time he died or became disabled if the disability continued up to the time of death. Note that proof of support must be filed with the Social Security Administration (SSA) within two years of the death of the worker or the date he became eligible for benefits. If this proof is not filed within two years of the workers death or disability whether or not you are eligible to start receiving benefits at that time, you cannot be eligible at a later date, unless you can establish good cause for not filing it timely. You may also be eligible for an exception provided by the Soldiers and Sailors Civil Relief Act of 1948. It would be wise to consult an attorney if the proof of support was not filed within two years of the workers death or disability.
Benefit Amount: The amount of the parents benefit depends on whether there are one of two parent entitled on the account. If there is one eligible parent, the benefit is 82% of the workers Primary Insurance Amount (Section 702.1). If there are two eligible parents, it is 75% of the workers Primary Insurance Amount, payable to each parent. It is subject to reduction for the family maximum (see Chapter 7 for a full discussion of computation of benefits).
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Section 207.1 - Medicare Generally
In this section we will discuss only the basic eligibility requirements for Medicare. Coverage provisions (what Medicare pays for) are discussed in Chapter 12 and application requirements are discussed in Chapter 4.
Medicare has three parts: Hospital Insurance (Part A), Medical Insurance (Part B), called Original Medicare, and Prescription Drug Coverage (Part D), which is optional for those who are eligible for Medicare, and is provided by private companies. Medicare Advantage Plans, referred to as Part C, are another option available in some areas of the country.
The Medicare Advantage plans provide hospital, medical and drug coverage through Health Maintenance Organizations (HMOs), Preferred Provider Plans (PPOs) and several other types of arrangements. Hospital Insurance primarily pays for in-patient care and Medical Insurance covers doctor bills. Both parts A and B also cover other charges as well (see Chapter 12). Drug coverage is available through some Medicare Advantage Plans or Part D.
There are limits for filing an application for Medicare coverage. If you do not file timely you may lose coverage and have to pay an extra premium for Medical Insurance (§407), and for Part D Prescription Drug Coverage (§1203.2). You may enroll in Part D Prescription Drug Coverage if you are eligible for either Part A or Part B. Part D enrollment is made directly to the private company you choose for this coverage. See §1203.1.
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Section 207.2 - Hospital Insurance
There are three groups of individuals eligible for Medicare Hospital Insurance. The first group are those age 65 or older who either:
a) Receive any Social Security monthly benefit or Railroad Requirement Board monthly benefit or are eligible for them. An application must be filed for Medicare even if you are still working (§404.3); or
b) Are federal employees with sufficient quarters of coverage (federal employees started having Medicare tax withheld from their paychecks effective January of 1983). There are special provisions to grant credit for those employees for work performed before 1983, if they were employed by the Federal government in January 1984; or
c) Pay a monthly premium and who are either U.S. citizens or lawfully admitted resident aliens who have resided in the United States for five continuous years or more.
The second group eligible for Hospital Insurance are those individuals who are entitled to monthly Social Security disability benefits (including disabled adult children and disabled widows) or disabled federal employees with enough work covered for Medicare purposes. The coverage for these groups begins with the twenty-fifth month of disability benefits entitlement, not counting the waiting period (§507). For those disabled with a primary or secondary diagnosis of Amyotrophic Lateral Sclerosis (ALS), also called Lou Gerhig's Disease, Medicare coverage begins with the first month of disability benefits entitlement.
The third group are those individuals who suffer from End Stage Renal Disease (kidney failure) and who undergo a regular course of dialysis or have a kidney transplant and are either fully or currently insured (§§602 and 603); or are the spouse or former spouse (married at least ten years) of someone who is fully or currently insured; or, if under age twenty-five when kidney failure occurs, the child of a worker who is fully or currently insured.
Note: the spouse or parent of the kidney patient need not be eligible for or collecting Social Security benefits. For example, a wage earner who is age 50 and working full time is not eligible for monthly Social Security benefits but his spouse, or children under 25, can still be entitled to Medicare on his record under this provision.
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Section 207.3 - Medical Insurance
There are three groups of people who are eligible for Medicare Medical Insurance.
The first group are those people age 65 or over who are U.S. citizens (or legal aliens admitted for permanent residence and who have resided in the country for five continuous years or more) and who pay the monthly premium. You do not have to be eligible for Hospital Insurance or any other Social Security benefit to be eligible for medical insurance.
The second group of people are those eligible for Hospital Insurance on the basis of disability (see above) who pay the monthly premium.
The third group are those entitled to Medicare Hospital Insurance for the End Stage Renal Disease (see above), and who pay the monthly premium.
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Section 208- The Lump Sum Death Payment
A lump sum in the amount of $255.00 is payable to certain survivors of a worker who died fully or currently insured (see Chapter 6). A benefit is paid to only one person (with the exception of children, discussed below) according to the following order of priority:
1. The surviving spouse who was living in the same household with the worker at the time of death.
2. A surviving spouse not living in the same household but potentially entitled to monthly benefits on the deceased worker's account in the month of death.
3. If there are neither of the above, then the payment is made to the surviving children of the worker who are eligible for monthly benefits on the account. All the surviving children split the lump sum death benefit evenly.
Only $255 is paid, even if it is split among the surviving children.
If there are no people who fit these categories, there is no lump sum death benefit payable.
The application for this benefit must be filed within two years of the death of the worker.
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Section 209 - Being Age 62 "Throughout the Month"
Social Security has a special rule that applies to retired workers and their wives who file for benefits beginning with age 62. You can not receive a retirement benefit or an aged wife's benefit unless you are 62 throughout the entire month. Generally, this means that you cannot receive a Social Security benefit for the month of your sixty-second birthday, because you are not age 62 throughout that entire month. This rules does not apply to widows.
If your sixty-second birthday is on the first day of the month, you will be eligible because you will be age 62 throughout the month. If your birthday is on the second day of the month, then you are eligible for that month as well, because for Social Security purposes you attain your age the day before your birthday. In other words, if you were born on August 2nd, you become age 62 on August 1st for Social Security purposes. Therefore you are eligible to receive the benefit for that month. If your birthday was on August 3rd, your first month of eligibility would be September. Of course, you can be eligible for benefits for any month after the month you turn 62.
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Section 210 - The Marriage Requirement
In order to qualify for spouse's benefits or for widow(er)'s benefits, the claimant must have been married to the worker. Generally, this means that the marriage must be recognized as valid in the state where it was performed. A common law marriage will be accepted by Social Security only if entered into in a state which recognizes common law marriages. Most states do not.
A person may meet the marriage requirement even if he or she was not legally married to the worker, if the following conditions are met:
1. There was a marriage ceremony.
2. The claimant married the worker in good faith not knowing any impediment to the marriage.
3. The claimant was living with the worker at the time of his or her entitlement to benefits or at the time of death.
4. There is no other person entitled on the workers earnings record as a legal wife or widow.
5. The marriage is invalid because there was a legal impediment or there was a defect in the procedure followed in connection with the marriage ceremony. A legal impediment exists, for example, where the worker was already married at the time of this marriage.
This provision is called the "deemed valid marriage." If your benefits are based on a deemed valid marriage, they will end if another person becomes entitled on the account as the legal wife or widow. You may be re-entitled when that other persons entitlement ends.
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Section 211 - Exceptions to the One-Year
Duration of Marriage Requirements for Spouse's
Benefits
In most cases, to be eligible as the spouse of a worker, the marriage must have lasted for a least one year before eligibility begins. There are however some exceptions to this general rule. These exceptions are as follows:
1. The claimant is the natural parent of the workers child. This requirement is met if a live child was born to the worker and the claimant even though the child may not be alive at the time the claimant applies for benefits;
or,
2. The claimant was entitled or potentially entitled (under Social Security or Railroad Retirement) to spouses benefits, widows benefits, parents benefits, or childhood disability benefits in the month before the month of marriage to the worker. "Potentially entitled" means that you could have received benefits if you had applied for them. Your age is not considered when determining whether or not you are potentially entitled.
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Section 212 - Exceptions to the Nine-Month
Duration of Marriage Requirement
for Widow(er)'s Benefits
The general rule is that to be eligible for widow's benefits, you must have been married to the worker for at least nine months before the death of the worker. There are some exceptions to this rule. The exceptions which apply to spouses (see Section 211) also apply to widows, in addition to the following:
1. The worker died because of an accident.
2. The worker's death occurred in the line of duty while he or she was a member of a uniformed service on active duty.
3. The claimant was previously married to the worker and divorced from him and the previous marriage lasted at least nine months.
NOTE: For these three exceptions to apply, the worker must have been expected to live for at least nine months at the time of marriage.
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Section 213 - The "Child in Care" Requirement
If you are the wife/husband or widow(er) of a covered worker, you may be eligible for benefits at any age if you have a child of the worker in your care. To meet this requirement, the child must be entitled on the same earnings record as the one on which you are making your claim. The child must be under age 16 or disabled. If the child is disabled and over 16, you can be eligible if you are performing personal services for the disabled child.
Please note that the child may continue to receive benefits until age eighteen, but your entitlement will end when the child turns 16 unless he is disabled.
The child does not have to be physically in your custody to meet the "in care" requirement. If you are exercising parental control and responsibility over the upbringing of the child, you may still satisfy the requirement. For instance, if the child is away at boarding school, you may still be eligible if you are reviewing his work and providing parental guidance. Note however, that if you are separated from the other parent of the child you cannot meet the "child in care" requirement while the child is in the custody of the other parent.
A child is considered in your care if he is with you at least one day of the month. If, for instance, the child goes to the other parent on July 15th, and comes back to you on August 15th, you will meet the requirement for both July and August. If the child did not come back until September 15th, however, you would not meet the requirement for the month of August. For any month in which the child is not in your care, you are not entitled to benefits and they are suspended. Once the child returns to your care, the benefits may resume.
If the child is over age 16, but is disabled, you may still meet the "in care" requirement if you are performing personal services for the child. Personal services include such things as helping the child wash himself, feeding the child, dressing the child, and so forth. Personal services require that you render more services than for a non-disabled child.
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Section 214 - The Child Relationship
Requirement
In addition to a natural child, certain other kinds of children can be eligible for Social Security benefits. These are adoptive children, stepchildren, equitably adopted children, and grandchildren.
To be eligible, an adopted child must either have been adopted before the worker becomes eligible for benefits or before the child becomes 18. If the child turned 18 and was adopted after the worker becomes entitled, then the child must have received one-half support from the worker and lived with him for the 12-month period preceding the workers entitlement to benefits. The adoption must be legal.
The stepchild must be dependent on the worker (Section 215) and the marriage of his parent to the worker must have lasted one year (9 months for survivor cases). Benefits for a stepchild will be terminated if the parents divorce. Benefits end with the month the divorce becomes final. That month is the last for which benefits are paid.
A child may be equitably adopted if there was an intent by the worker to adopt the child but he was unable to complete the legal requirements. If you have a possible case involving equitable adoption, you should consult an attorney.
Grandchildren may be eligible on the grandparents account, but only if all of the requirements described in Section 205.4 above are met. Generally, this means that the parents are either deceased or totally disabled at the time the worker (the grandparent) becomes entitled to benefits, becomes disabled, or dies, whichever is earliest.
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Section 215 - Dependency Requirements:
Children and Grandchildren
The natural and adoptive children of a worker are deemed dependent upon him. This means that there is no requirement for proof of dependency. However, in all other cases, including stepchildren, there must be proof that the child was dependent on the worker for at least one half of his support in the year before the worker became eligible for benefits or died, in survivor cases.
Basically, Social Security will itemize all the reasonable and necessary expenses for the childs food, clothing, shelter and education and will total these expenses. If the worker was making contributions to the childs support which are equal to or greater than one-half of these living expenses, the dependency requirement will be met.
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§ 202 Retirement Benefits
§ 203 Disability Benefits
§ 204 Spouse's Benefits
§ 204.1 Spouse Age 62 and Over
§ 204.2 Spouse Benefits; With Child in Care
§ 204.3 Divorced Spouses Benefits
§ 204.4 Widow(er): Age 60 and Over
§ 204.5 Mothers/Fathers Benefits: With Child in Care
§ 204.6 Disabled Widow(er)s' Benefits: Age 50 through 59
§ 204.7 Divorced Widow(er)s' Benefits
§ 205 Child's Benefits
§ 205.1 Under Age 18
§ 205.2 High School Student
§ 205.3 Disabled Adult Child
§ 205.4 Grandchildren
§ 206 Parents' Benefits
§ 207.1 Medicare Generally
§ 207.2 Hospital Insurance
§ 207.3 Medical Insurance
§ 208 The Lump Sum Death Payment
§ 209 Being Age 62 "Throughout the Month"
§ 210 The Marriage Requirement
§ 211 Exceptions to the One-Year Duration of Marriage Requirement
For Spouse's Benefits
§ 212 Exceptions to the
Nine Month Duration of Marriage
Requirement for Widow(er)s' Benefits
§ 213 The "Child in Care"
Requirement
§ 214 The Child Relationship Requirement
§ 215 Dependency Requirements: Children and Grandchildren
Section 201 - In General
The Social Security Act provides for the payment of many different types of social security benefits. The benefits usually referred to as social security benefits are provided under the basic programs known as Retirement Insurance, Survivors Insurance, Disability Insurance, (RSDI) and Health Insurance, better known as Medicare. These benefits are funded by taxes on earnings, the F.I.C.A. taxes that are deducted from paychecks. There are many other social insurance and welfare programs in the United States, some administered by the Social Security Administration (SSA) and some administered by the states. This book discusses only social security benefits, although we briefly discuss the Supplemental Security Income (SSI) program in Chapter 14, Miscellaneous Provisions.
Many people confuse SSI with Social Security, because the SSI program provides payments for the aged and the disabled and both are administered by SSA. Some social security beneficiaries whose benefit amounts are low are eligible to receive additional payments under the SSI program. To really muddle it, all the double-S acronyms confuse even lawyers and accountants, so it is not surprising that most people get mixed up.
In a nutshell, social security benefits are based on the taxed earnings of workers, and paid to them, their dependents and survivors. It is called an entitlement program and pays "benefits." Supplemental Security Income (SSI) is a federally administered (by SSA) welfare program for the elderly, the disabled and the blind. The SSI program makes "payments" to supplement the income of the needy recipient. If the recipients income exceeds certain levels, which can vary by state, then SSI payments are suspended. Unlike SSI, social security benefits are entitlements, so the beneficiary is paid regardless of income. The exceptions to that are in the cases of earned income which may indicate that a disabled worker is not in fact disabled, or a retired worker is not retired. Unearned income, such as pensions, dividends, interest, annuities, etc. do not affect eligibility for social security benefits.
Each social security benefit has specific eligibility requirements which a claimant must meet in order to receive it. Even though a person becomes entitled, a benefit may not be paid, often because earnings are in excess of the applicable limits, but there may be several other reasons as well. This chapter deals only with the basic eligibility requirements. Earnings as they affect the payment of benefits will be discussed in Chapter 8, Earnings Limitations.
Additionally, almost all benefits require an application to be filed by the claimant. Application requirements are discussed in full in Chapter 4. Each type of benefit requires that the worker on whose record the benefits are based have what is called an "insured status." This means that he or she has enough work credits. There are different kinds of insured status. Some require more work than others. These different types of insured status will be discussed in detail in Chapter 6. The amount of the actual benefit the beneficiary receives is discussed in detail in Chapter 7, Benefit Amounts.
Spouses, young children and disabled adult children of disabled and retired workers are paid monthly benefits if they meet the specific eligibility requirements discussed in this chapter. Surviving widows, widowers, young children and disabled adult children of deceased workers may also be eligible for benefits.
Benefits are also payable to certain divorced wives/husbands and divorced widows/widowers and to certain parents of covered workers. There are many different kinds of monthly benefits. We have categorized fifteen different types of benefits in this chapter. Eligibility requirements for each are listed separately. In addition to monthly benefits, the Social Security Act also provides for Medicare. This is officially called Health Insurance and has two parts - Hospital Insurance and Medical Insurance. This is discussed more fully in Chapter 12 - Medicare. We list in this chapter the eligibility requirements.
We do not discuss eligibility requirements for other programs that are administered by Social Security such as Supplemental Security Income (Section 1401) or Black Lung benefits (Section 1402).
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Section 202 - Retirement Benefits
Other Names: Old Age Insurance Benefits; Retirement Insurance Benefits.
Beneficiary Identification Code (Section 1407) : A
Requirements:
1. You are at least age 62 throughout the month. Usually you are not eligible until the month after your 62nd birthday, see Section 209.
2. You have enough work covered by Social Security to be "fully insured." Generally, this means that you have worked for at least 10 years, see Section 602.
3. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.2.
Benefit Amount: 100% of the Primary Insurance Amount (PIA) at Full Retirement Age, reduced for age before Full Retirement Age. Benefits vary greatly depending on the work record. Low average earnings may yield a PIA of $721, maximum average earnings can result in a PIA of $1784, for 2004. See Chapter 7 for a full discussion.
Termination: Entitlement ends with the month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
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Section 203 - Disability Benefits
Other Names: Disability Insurance Benefits; Disabled Worker Benefits.
Beneficiary Identification Code (Section 1407) : HA
Requirements:
1. You are under Full Retirement Age (at Full Retirement Age the benefit is converted to an unreduced retirement benefit, even if you are still disabled).
2. You have enough work covered by Social Security to meet the special disability insured status (Section 604). Generally, you must have worked at least 5 years within the preceding 10 year period.
3. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.6.
4. You are totally and permanently disabled for any employment. "Permanent" means that the disability is expected to last at least a year, or result in death. See Section 502.
5. You have been totally disabled for at least five months (Section 507).
Benefit Amount: 100% of the Primary Insurance Amount.See Chapter 7 for a full discussion of computations of benefits. The disability benefit is not reduced for age but is subject to offset in some cases. See Sections 511 - 512 for the effect of workers compensation benefits or other disability benefits.
Termination: Entitlement ends with:
1. The month before you reach Full Retirement Age. (You then are switched automatically to Retirement benefits).
2. The second month after the disability ceases. See Section 513 for a discussion of the payment rules at the time of cessation of disability.
3. The month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
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Section 204 - Spouse's Benefits
§ 204.1 Spouse Age 62 and Over
§ 204.2 Spouse Benefits; With Child in Care
§ 204.3 Divorced Spouses Benefits
§ 204.4 Widow(er): Age 60 and Over
§ 204.5 Mothers/Fathers Benefits: With Child in Care
§ 204.6 Disabled Widow(er)s' Benefits: Age 50 through 59
§ 204.7 Divorced Widow(er)s' Benefits
Section 204.1 - Spouse's Benefits: Age 62 and Older
Other Names: Wife's Benefits; Husband's Benefits , Aged Spouse, Aged Wife, Aged Husband.
Beneficiary Identification Code (Section 1407): B (or HB if the worker received disability benefits)
Requirements:
1. You are the wife or husband of a worker entitled to retirement or disability benefits. Note: the marriage may be "deemed valid" by SSA even if it is not legally recognized, see Section 210.
2. Your marriage lasted for at least one year. See Section 211 for exceptions to this requirement.
3. You are at least age 62 throughout the month. Usually you are not eligible until the month after your 62nd birthday, see Section 209.
4. You file an application. See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.5.
5. You are not entitled to a higher retirement or disability benefit on your own earnings record. (You may be entitled to some spouses benefits even if you are entitled on your own record, if your benefit is lower than one-half of your spouses Primary Insurance Amount (see Section 302).
Benefit Amount: one-half of your spouses Primary Insurance Amount (Section 702.1) at Full Retirement Age reduced for age before Full Retirement Age (Section 703.1) unless you have a child in your care (Section 213); reduced by your own benefit (see Section 302); and subject to the family maximum. See Chapter 7 for a full discussion.
Termination: Entitlement ends with:
1. The month before you become entitled to a higher benefit on your own account (see Section 302).
2. The month before you become divorced (you may be able to switch over to divorced spouses benefit - Section 204.2).
3. The month before the spouse on whose earnings you receive benefits dies or is no longer disabled [in the event of death you may switch to a widow(er)s benefit (see Section 204.4 for requirements and see Section405 for automatic conversion from spouses to widow(er)s benefits].
4. If your benefits are based on a "deemed" marriage, (see Section 210), the month before you marry someone else or the legal wife of the worker becomes entitled on his account.
5. The month before the month of death. See Section 1009 for a discussion of the rules about payments at termination.
Other: Spouses benefits are now gender neutral. You may be eligible either as the husband or the wife of the worker. Whenever the term wifes benefits is used in this book, you may substitute husbands benefits if applicable.
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Section 204.2 - Spouse's Benefits: With Child in Care
Other Names: Young Wife; Young Husband; Young Spouse
Beneficiary Identification Code (Section 1407): B2 (or HB2 if the worker receives disability benefits)
Requirements: The requirements are the same as an aged spouse, (Section 204.1), with one exception. You may collect at any age as long as you have a child of the worker in your care (Section 213) who is entitled to child benefits on the workers account and who is either under age 16 or a disabled child of any age for whom you are rendering substantial personal services (Sections 205.1 - 205.4 for who qualifies as children).
Benefit Amount: 50% of the spouses Primary Insurance Amount (Section 702). There is no reduction for being under Full Retirement Age. The benefit is subject to reduction for the family maximum (see Chapter 7 for a full discussion of computations).
Termination: Occurs the same as for aged spouses benefits (see Section 204.1), and the month before the month the youngest child turns 16 (see Section 213).
Other: Spouses benefits are gender neutral. You may be entitled whether you are the wife or the husband of the covered worker.
Note: the benefits may be suspended for any month you do not have a child in your care (Section 213, "Child in Care" and Section 1008, Suspension of Benefits).
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Section 204.3 - Spouse’s Benefits: Divorced Spouse
Other Names: Divorced Wife, Divorced Husband.
Beneficiary Identification Code (§1407) : B6
Requirements:
1. Your ex-spouse (the worker) is entitled to retirement or disability benefits. A divorced spouse may be “independently entitled” if divorced at least two years. This means the divorced spouse may receive benefits even though the worker has not yet filed, or his benefits are being suspended because of excess earnings. The two year requirement is designed to avoid any incentive for divorce solely to take advantage of this provision. If the ex-spouse has not filed, he or she must be “eligible”; he or she must be “insured” (see Chapter 6) and age 62 or disabled. NOTE: The worker's earnings will have no effect on the ex-spouse's benefits under the Work Test (§801) if the worker's first month of entitlement is prior to the month the divorce becomes final. If the worker first becomes entitled in or after the month of divorce, then his or her earnings in excess of the work test may affect the ex-spouse's benefits payment, but only for two years.
2. You are the wife or husband of the worker as defined by SSA (§210).
3. You had been married to the worker for at least ten years immediately before the divorce became final. This requirement is met even if this period was interrupted by a prior divorce from the same spouse, provided the remarriage took place in the calendar year of the divorce or the calendar year immediately following. The marriage must be in existence in each of the 10 years before the divorce in order for the claimant to be entitled. You may also qualify based on a 10-year marriage immediately before a prior divorce.
4. You file an application (see Chapter 4).
5. You are age 62 throughout the month (§209). You cannot be entitled as a divorced wife if you are under age 62 even if you do have a child in your care.
6. You are not entitled to a higher retirement or disability benefit on your own account (§302).
7. You are unmarried.
Benefit Amount : same as aged spouse (§204.1), but not subject to the Family Maximum.
Termination: Entitlement ends with:
1. The same conditions for an aged wife (§204.1).
2. When you re-marry. However, you may continue to be eligible if you re-marry certain other Social Security beneficiaries (§904).
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Section 204.4 - Spouse's Benefits: Widow/Widower, Age 60 and Over
Other Names: Widow's Insurance Benefit, Widower's Insurance Benefit, Aged Widow, Aged Widower.
Beneficiary Identification Code (Section 1407): D
Requirements:
1. The worker to whom you were married died fully insured (see Chapter 6).
2. You were "married" to the worker. This may include other than legal marriages. See Section 210, The Marriage Requirement.
3. You were married for at least nine months before the worker died (see Section 212 for exceptions to this requirement).
4. You file an application., See Chapter 4 for a discussion of the filing rules, especially the limits on retroactivity. See Section 404.6. See also Section 405, for automatic conversion from spouse to widow(er).
5. You are at least age 60. The special "throughout the month" rule for retirement and spouse benefits discussed in Section 209 does not apply to widow(er)'s benefits.
6. You are not actually entitled to a higher retirement or disability benefit on your own account (Section 303).
7. You are not married (if you re-marry after age 60 then you are not married for Social Security purposes).
NOTE: Even though a widow(er) could meet all the requirements, entitlement is precluded if (1) the widow(er) was convicted of the felonious and intentional homicide of the worker, or (2) the Railroad Retirement Board has jurisdiction of the survivor's claim.
Benefit Amount: 100% of the workers Primary Insurance Amount plus delayed retirement credits. The benefit amount is reduced if you take it before Full Retirement Age, but cannot be reduced below 71%. Also subject to other reductions, see Chapter 7. The benefit amount cannot exceed the workers benefit amount paid during his/her life. See Section 703.5 . See Chapter 3 if you also worked on your own account, especially Section 303.
Termination: Entitlement ends with:
1. The month before you become entitled to a higher retirement or disability benefit on your own account (see Section 303 for a discussion of dual entitlement).
2. If you are entitled based on a deemed marriage (Section 210) benefits will end if another person becomes entitled as the legal widow or widower.
3. The month before the month of death (Section 1009).
Other: Widows benefits are gender neutral.
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Section 204.5 - Spouse's Benefits: Mother/Father with Child in Care
Other Names: Young Widow, Mother's Benefits, Father's Benefits.
Beneficiary Identification Code (Section 1407): E
Requirements:
1. The worker died fully or currently insured (see Chapter 6).
2. You were "married" to the worker (Section 210).
3. You file an application (see Chapter 4, especially Section 405).
4. You are unmarried.
5. You are not entitled to a higher widows benefits on another account or to a higher retirement or disability benefit on your own account (see Chapter 3, Dual Entitlement).
6. You have a "child in your care" (Section 213).
Benefit Amount: 75% of the workers Primary Insurance Amount (Section 702) subject to the family maximum (see Chapter 7).
Termination: Entitlement ends with the month before the month in which any of the following occur (see Section 1009 for a general discussion of termination of benefits):
1. You become entitled to a higher benefit on another account.
2. The child in your care turns 16 unless the child is disabled and you are rendering services for that child (see Section 213, The Child in Care Requirement). If you are entitled because you have a disabled adult child in your care, the benefits will end if the child is no longer disabled.
3. You re-marry (for exceptions if you re-marry another Social Security beneficiary, see Section 904).
4. If your entitlement is based on a deemed marriage (Section 210), and another person becomes entitled on the account as the legal widow.
5. The month before the month of death.
Other: If your benefits end because you have re-married they may be reinstated if the subsequent marriage is terminated (Section 904). Benefits are sex neutral.
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Section 204.6 - Spouse's Benefits: Disabled
Widow(er)'s Benefits; Age 50 to 59
Other Names: Disabled Widow's Insurance Benefit, Disabled Widower's Insurance Benefit.
Beneficiary Identification Code (Section 1407) : W
Requirements: the requirements are the same as for an aged widow (Section 204.4) except that instead of being 60 you meet the following requirements:
1. You are at least age 50.
2. You are totally disabled (Section 502).
3. The disability started not later than seven years after the workers death or seven years after you were last entitled to mothers benefits (Section 204.5) or disabled widows benefits, if you were previously entitled.
4. The disability lasts for more than five months (Section 507) and is expected to last at least one year (Section 502).
Benefit Amount: 71% of the workers Primary Insurance Amount (Section 702). See Chapter 7 for a full discussion of computations of benefits.
Termination: Entitlement ends with the same events as the Widow (Section 204.4), and when the disability ends (see Section 513). Note that for the Disabled Widow, re-marriage after age 50 is not considered for Social Security purposes.
Other: Disabled Widows benefits are sex neutral.
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Section 204.7 - Spouse's Benefits: Divorced
Widow(er)'s Benefits
Other Names: Surviving Divorced Wife, Surviving Divorced Husband, Divorced Widower, Divorced Mother, Divorced Father.
Beneficiary Identification Code (Section 1407): D6 (divorced aged widow); E1 (divorced young widow - child in care); W6 (disabled divorced widow).
Requirements:
1. The worker died fully insured, or in the case of a young widow; currently insured. See Chapter 6 for a discussion of insured status.
2. You were legally married. Note that the "deemed valid" marriage discussed in Section 210 is not sufficient.
3. The marriage lasted for at least ten years immediately before the divorce.
4. You file an application. (See Chapter 4).
5. You are age 60, or disabled (Section 502), or have a child of the worker in your care (Section 213).
6. You are not entitled to a higher retirement or disabled benefit on your own account (Section 303).
7. You are unmarried.
Benefit Amount: Same as for a non-divorced widow, but not subject to the Family Maximum (Section 703.7).
Termination: Entitlement ends under the same conditions described in Section 204.4 for an aged widow, Section 204.6 for a disabled widow, or Section 204.5 for a young widow.
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§ 205.1 Under Age 18
§ 205.2 High School Student
§ 205.3 Disabled Adult Child
§ 205.4 Grandchildren
Section 205 - Child's Benefits Introduction
Social Security benefits are payable to certain children of retired, deceased or disabled workers. The most common situation is for the child under age 18. These benefits can be extended if the child is still in high school through the end of the semester or quarter in which the child turns age 19. No benefits are payable after that even if the child continues on to college.
Benefits for children in college were eliminated many years ago. Benefits are also payable to adult children who become disabled before age 22. Benefits are also payable to the grandchildren of covered workers provided that the parents are either deceased or totally disabled at the time the worker became eligible for benefits. The requirements for these benefits are discussed in detail in the following sections.
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Section 205.1 - Child's Benefits: Under Age 18
Other Names: Surviving Child, Dependent Child.
Beneficiary Identification Code (Section 1407): C (HC if the worker receives disability benefits)
Requirements:
1. The worker is entitled to retirement or disability benefits, or, in the case of survivors, died either fully insured (Section 602) or currently insured (Section 603).
2. You are the child of the worker as defined in Section 214 below. Under certain circumstances this can include stepchildren, illegitimate children, adopted children, and grandchildren.
3. You are dependent on the worker at the time he or she becomes eligible for retirement or disability benefits or dies (Section 215). Note that if you are the natural child of the worker, you are deemed dependent.
4. You file an application (see Chapter 4).
5. You are unmarried.
6. You are under age 18 (see Section 205.2 for students and Section 205.3 for disabled adult children).
Benefit Amount: Children entitled on a living workers account receive 50% of the Primary Insurance Amount (Section 702.1). Children entitled on a deceased workers account receive 75% of the Primary Insurance Amount. In all cases it is subject to the family maximum (see Chapter 7 for a full discussion of computations).
Termination: Entitlement ends with the month before any of the following events occur (Section 1009):
1. You turn 18 (unless you are a student or disabled, see Section 205.2 and Section 205.3).
2. You marry.
3. The workers entitlement ends for a reason other than death. If the worker dies, you will be converted to a survivor benefit as a child.
4. You die.
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Section 205.2 - Child’s Benefits: High School Student
Requirements:
1. The requirements are the same as for a child under age 18, except that you do not have to be under age 18.
2. You must be no older than age 19. Benefits may continue for up to three months after age nineteen if you turn 19 during the school quarter or semester.
3. You must be a full time student in an approved elementary or secondary school, or an approved home school program. A high school level program taken in a college, community college, vocational, or technical school qualifies if the program is approved as a secondary level school program by the Board of Education or State.
4. You must not be paid by your employer to attend school.
Benefit Amount: Same as for a child under 18 (§205.1).
Termination: Same as for a child under 18 (§205.1); or if you are no longer a full time student; or you start to be paid by your employer to attend school.
Note: A school is considered approved if it is accredited by the state in which it is located and its primary purpose is to provide secondary or elementary education. “Full time” means twenty hours per week and at least a 13-week course. Home schooling qualifies if the student meets the Federal standards for full-time attendance (20 hours per week for 13 weeks, not a correspondence course); the State recognizes home school as an educational institution and the program meets all the State requirements, even after age 16 when some states no longer require compulsory education.
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Section 205.3 - Child's Benefits: Disabled
Adult Child
Other Names: Childhood Disability Beneficiary, Adult Disabled Child.
Requirements:
1. The requirements are the same as Section 205.1, except that you must be age 18 or older.
2. You become totally disabled before you reach age 22 (Section 502). Note that if your benefits stop when you turn age 18, they may be re-established if you become disabled before age 22.
Benefit Amount - same as for children under age 18 (Section 205.1).
Termination: Entitlement ends with:
1. Under the same conditions described in Section 205.1 for children under age 18, except the age requirement. In some cases, marriage to another Social Security beneficiary does not terminate disabled childs benefits (Section 1009).
2. When the disability ceases (Section 513). If you become disabled again after the disability ceases, the benefit may resume if you become disabled for the second time within seven years after the month in which your disabled child benefits ended.
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Section 205.4 - Child's Benefits:
Grandchildren
Other Names: These are referred to as Child's Benefits even though the entitlement is based on a grandchild relationship.
Requirements:
Grandchildren may be eligible for benefits if they meet the requirements for children's benefits discussed in the preceding sections and in addition meet these requirements:
1. You are the child of the covered worker's child (Section 214).
2. Your parents were both either deceased or totally disabled (Section 502) at the time the grandparent first became entitled to retirement benefits, disability benefits, or died. If the grandparent died after becoming entitled to benefits, you must have met the requirements as of the date he or she became entitled to benefits.
3. The grandchild is dependent on the grandparent (Section 215).
Benefit Amount: The benefit amount of grandchildren's benefits is the same as for regular child's benefits.
Termination: The benefits end under the same conditions as they end for other types of child's benefits.
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Section 206 - Parent's Benefits
Note that these benefits are payable only to surviving parents of deceased workers. They are not payable if the worker is alive.
Beneficiary Identification Code (Section 1407): F
Requirements:
1. The worker died fully insured (Section 602).
2. You are the natural parent of the worker according to the laws of the state where the worker had a permanent home. If you adopted the worker, you must have adopted him or her before he or she was 16. If you are a stepparent you must have married the workers natural parent before the worker became 16 years old.
3. You are at least age 62.
4. You have not married since the worker died.
5. You file an application (see Chapter 4).
6. You are not entitled to a retirement or disability greater than the parents benefit amount.
7. You received at least one half of your support from the worker at the time he died or became disabled if the disability continued up to the time of death. Note that proof of support must be filed with the Social Security Administration (SSA) within two years of the death of the worker or the date he became eligible for benefits. If this proof is not filed within two years of the workers death or disability whether or not you are eligible to start receiving benefits at that time, you cannot be eligible at a later date, unless you can establish good cause for not filing it timely. You may also be eligible for an exception provided by the Soldiers and Sailors Civil Relief Act of 1948. It would be wise to consult an attorney if the proof of support was not filed within two years of the workers death or disability.
Benefit Amount: The amount of the parents benefit depends on whether there are one of two parent entitled on the account. If there is one eligible parent, the benefit is 82% of the workers Primary Insurance Amount (Section 702.1). If there are two eligible parents, it is 75% of the workers Primary Insurance Amount, payable to each parent. It is subject to reduction for the family maximum (see Chapter 7 for a full discussion of computation of benefits).
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Section 207.1 - Medicare Generally
In this section we will discuss only the basic eligibility requirements for Medicare. Coverage provisions (what Medicare pays for) are discussed in Chapter 12 and application requirements are discussed in Chapter 4.
Medicare has three parts: Hospital Insurance (Part A), Medical Insurance (Part B), called Original Medicare, and Prescription Drug Coverage (Part D), which is optional for those who are eligible for Medicare, and is provided by private companies. Medicare Advantage Plans, referred to as Part C, are another option available in some areas of the country.
The Medicare Advantage plans provide hospital, medical and drug coverage through Health Maintenance Organizations (HMOs), Preferred Provider Plans (PPOs) and several other types of arrangements. Hospital Insurance primarily pays for in-patient care and Medical Insurance covers doctor bills. Both parts A and B also cover other charges as well (see Chapter 12). Drug coverage is available through some Medicare Advantage Plans or Part D.
There are limits for filing an application for Medicare coverage. If you do not file timely you may lose coverage and have to pay an extra premium for Medical Insurance (§407), and for Part D Prescription Drug Coverage (§1203.2). You may enroll in Part D Prescription Drug Coverage if you are eligible for either Part A or Part B. Part D enrollment is made directly to the private company you choose for this coverage. See §1203.1.
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Section 207.2 - Hospital Insurance
There are three groups of individuals eligible for Medicare Hospital Insurance. The first group are those age 65 or older who either:
a) Receive any Social Security monthly benefit or Railroad Requirement Board monthly benefit or are eligible for them. An application must be filed for Medicare even if you are still working (§404.3); or
b) Are federal employees with sufficient quarters of coverage (federal employees started having Medicare tax withheld from their paychecks effective January of 1983). There are special provisions to grant credit for those employees for work performed before 1983, if they were employed by the Federal government in January 1984; or
c) Pay a monthly premium and who are either U.S. citizens or lawfully admitted resident aliens who have resided in the United States for five continuous years or more.
The second group eligible for Hospital Insurance are those individuals who are entitled to monthly Social Security disability benefits (including disabled adult children and disabled widows) or disabled federal employees with enough work covered for Medicare purposes. The coverage for these groups begins with the twenty-fifth month of disability benefits entitlement, not counting the waiting period (§507). For those disabled with a primary or secondary diagnosis of Amyotrophic Lateral Sclerosis (ALS), also called Lou Gerhig's Disease, Medicare coverage begins with the first month of disability benefits entitlement.
The third group are those individuals who suffer from End Stage Renal Disease (kidney failure) and who undergo a regular course of dialysis or have a kidney transplant and are either fully or currently insured (§§602 and 603); or are the spouse or former spouse (married at least ten years) of someone who is fully or currently insured; or, if under age twenty-five when kidney failure occurs, the child of a worker who is fully or currently insured.
Note: the spouse or parent of the kidney patient need not be eligible for or collecting Social Security benefits. For example, a wage earner who is age 50 and working full time is not eligible for monthly Social Security benefits but his spouse, or children under 25, can still be entitled to Medicare on his record under this provision.
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Section 207.3 - Medical Insurance
There are three groups of people who are eligible for Medicare Medical Insurance.
The first group are those people age 65 or over who are U.S. citizens (or legal aliens admitted for permanent residence and who have resided in the country for five continuous years or more) and who pay the monthly premium. You do not have to be eligible for Hospital Insurance or any other Social Security benefit to be eligible for medical insurance.
The second group of people are those eligible for Hospital Insurance on the basis of disability (see above) who pay the monthly premium.
The third group are those entitled to Medicare Hospital Insurance for the End Stage Renal Disease (see above), and who pay the monthly premium.
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Section 208- The Lump Sum Death Payment
A lump sum in the amount of $255.00 is payable to certain survivors of a worker who died fully or currently insured (see Chapter 6). A benefit is paid to only one person (with the exception of children, discussed below) according to the following order of priority:
1. The surviving spouse who was living in the same household with the worker at the time of death.
2. A surviving spouse not living in the same household but potentially entitled to monthly benefits on the deceased worker's account in the month of death.
3. If there are neither of the above, then the payment is made to the surviving children of the worker who are eligible for monthly benefits on the account. All the surviving children split the lump sum death benefit evenly.
Only $255 is paid, even if it is split among the surviving children.
If there are no people who fit these categories, there is no lump sum death benefit payable.
The application for this benefit must be filed within two years of the death of the worker.
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Section 209 - Being Age 62 "Throughout the Month"
Social Security has a special rule that applies to retired workers and their wives who file for benefits beginning with age 62. You can not receive a retirement benefit or an aged wife's benefit unless you are 62 throughout the entire month. Generally, this means that you cannot receive a Social Security benefit for the month of your sixty-second birthday, because you are not age 62 throughout that entire month. This rules does not apply to widows.
If your sixty-second birthday is on the first day of the month, you will be eligible because you will be age 62 throughout the month. If your birthday is on the second day of the month, then you are eligible for that month as well, because for Social Security purposes you attain your age the day before your birthday. In other words, if you were born on August 2nd, you become age 62 on August 1st for Social Security purposes. Therefore you are eligible to receive the benefit for that month. If your birthday was on August 3rd, your first month of eligibility would be September. Of course, you can be eligible for benefits for any month after the month you turn 62.
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Section 210 - The Marriage Requirement
In order to qualify for spouse's benefits or for widow(er)'s benefits, the claimant must have been married to the worker. Generally, this means that the marriage must be recognized as valid in the state where it was performed. A common law marriage will be accepted by Social Security only if entered into in a state which recognizes common law marriages. Most states do not.
A person may meet the marriage requirement even if he or she was not legally married to the worker, if the following conditions are met:
1. There was a marriage ceremony.
2. The claimant married the worker in good faith not knowing any impediment to the marriage.
3. The claimant was living with the worker at the time of his or her entitlement to benefits or at the time of death.
4. There is no other person entitled on the workers earnings record as a legal wife or widow.
5. The marriage is invalid because there was a legal impediment or there was a defect in the procedure followed in connection with the marriage ceremony. A legal impediment exists, for example, where the worker was already married at the time of this marriage.
This provision is called the "deemed valid marriage." If your benefits are based on a deemed valid marriage, they will end if another person becomes entitled on the account as the legal wife or widow. You may be re-entitled when that other persons entitlement ends.
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Section 211 - Exceptions to the One-Year
Duration of Marriage Requirements for Spouse's
Benefits
In most cases, to be eligible as the spouse of a worker, the marriage must have lasted for a least one year before eligibility begins. There are however some exceptions to this general rule. These exceptions are as follows:
1. The claimant is the natural parent of the workers child. This requirement is met if a live child was born to the worker and the claimant even though the child may not be alive at the time the claimant applies for benefits;
or,
2. The claimant was entitled or potentially entitled (under Social Security or Railroad Retirement) to spouses benefits, widows benefits, parents benefits, or childhood disability benefits in the month before the month of marriage to the worker. "Potentially entitled" means that you could have received benefits if you had applied for them. Your age is not considered when determining whether or not you are potentially entitled.
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Section 212 - Exceptions to the Nine-Month
Duration of Marriage Requirement
for Widow(er)'s Benefits
The general rule is that to be eligible for widow's benefits, you must have been married to the worker for at least nine months before the death of the worker. There are some exceptions to this rule. The exceptions which apply to spouses (see Section 211) also apply to widows, in addition to the following:
1. The worker died because of an accident.
2. The worker's death occurred in the line of duty while he or she was a member of a uniformed service on active duty.
3. The claimant was previously married to the worker and divorced from him and the previous marriage lasted at least nine months.
NOTE: For these three exceptions to apply, the worker must have been expected to live for at least nine months at the time of marriage.
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Section 213 - The "Child in Care" Requirement
If you are the wife/husband or widow(er) of a covered worker, you may be eligible for benefits at any age if you have a child of the worker in your care. To meet this requirement, the child must be entitled on the same earnings record as the one on which you are making your claim. The child must be under age 16 or disabled. If the child is disabled and over 16, you can be eligible if you are performing personal services for the disabled child.
Please note that the child may continue to receive benefits until age eighteen, but your entitlement will end when the child turns 16 unless he is disabled.
The child does not have to be physically in your custody to meet the "in care" requirement. If you are exercising parental control and responsibility over the upbringing of the child, you may still satisfy the requirement. For instance, if the child is away at boarding school, you may still be eligible if you are reviewing his work and providing parental guidance. Note however, that if you are separated from the other parent of the child you cannot meet the "child in care" requirement while the child is in the custody of the other parent.
A child is considered in your care if he is with you at least one day of the month. If, for instance, the child goes to the other parent on July 15th, and comes back to you on August 15th, you will meet the requirement for both July and August. If the child did not come back until September 15th, however, you would not meet the requirement for the month of August. For any month in which the child is not in your care, you are not entitled to benefits and they are suspended. Once the child returns to your care, the benefits may resume.
If the child is over age 16, but is disabled, you may still meet the "in care" requirement if you are performing personal services for the child. Personal services include such things as helping the child wash himself, feeding the child, dressing the child, and so forth. Personal services require that you render more services than for a non-disabled child.
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Section 214 - The Child Relationship
Requirement
In addition to a natural child, certain other kinds of children can be eligible for Social Security benefits. These are adoptive children, stepchildren, equitably adopted children, and grandchildren.
To be eligible, an adopted child must either have been adopted before the worker becomes eligible for benefits or before the child becomes 18. If the child turned 18 and was adopted after the worker becomes entitled, then the child must have received one-half support from the worker and lived with him for the 12-month period preceding the workers entitlement to benefits. The adoption must be legal.
The stepchild must be dependent on the worker (Section 215) and the marriage of his parent to the worker must have lasted one year (9 months for survivor cases). Benefits for a stepchild will be terminated if the parents divorce. Benefits end with the month the divorce becomes final. That month is the last for which benefits are paid.
A child may be equitably adopted if there was an intent by the worker to adopt the child but he was unable to complete the legal requirements. If you have a possible case involving equitable adoption, you should consult an attorney.
Grandchildren may be eligible on the grandparents account, but only if all of the requirements described in Section 205.4 above are met. Generally, this means that the parents are either deceased or totally disabled at the time the worker (the grandparent) becomes entitled to benefits, becomes disabled, or dies, whichever is earliest.
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Section 215 - Dependency Requirements:
Children and Grandchildren
The natural and adoptive children of a worker are deemed dependent upon him. This means that there is no requirement for proof of dependency. However, in all other cases, including stepchildren, there must be proof that the child was dependent on the worker for at least one half of his support in the year before the worker became eligible for benefits or died, in survivor cases.
Basically, Social Security will itemize all the reasonable and necessary expenses for the childs food, clothing, shelter and education and will total these expenses. If the worker was making contributions to the childs support which are equal to or greater than one-half of these living expenses, the dependency requirement will be met.
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