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Social Security and SSI

What is Social Security?
Social Security is a system of social insurances financed by equal contributions from workers and employers. It is this nation’s basic method of providing a continuing source of income when family earnings are reduced due to retirement, death or disability.

How is coverage earned?
To qualify for Social Security benefits, a worker must have credit for a certain amount of work covered by the Social Security system. The work covered under Social Security is measured in "quarters of coverage." The calendar year is divided into four equal parts with one quarter equal to three months. The number of quarters a worker needs to be eligible for Social Security depends on the type of benefit, retirement, disability or survivors benefits and the age of the worker.

What will the amount of benefits be?
The amount of your monthly benefits check will depend on several factors, including:

1. Average monthly wage in past years, which is determined by a set formula.
2. When benefits begin. If the recipient chooses to receive benefits at age 62, rather than waiting until age 65, there will be a specified reduction in benefits.
3. Current earned income. If the recipient has a job or is self-employed, benefits may be reduced or stopped, depending upon the amount of earnings and the age of the recipient.

The Social Security office will figure the exact amount of your benefits after you apply.

What kinds of benefits are there? Who receives them?
There are three basic types of benefits available:

1. Retirement benefits: Workers can retire as early as age 62, but workers who retire before 65 will take a permanent reduction in the amount of benefits. Workers receive more money if they wait until retirement age. The amount of the benefits check you will receive depends on what your earnings were as a worker and the age at which you choose to retire.

2. Disability benefits: Social Security Disability Insurance is designed to supplement a family’s income when one of its working members becomes disabled. Disability benefits are possibly the most complicated of all benefits available under the Social Security system. This pamphlet will only attempt to discuss some very general rules concerning disability

To be considered disabled under Social Security law, you must have a severe physical or mental condition which prevents you from doing any substantial, gainful work, and which is expected to last at least 12 months, or to result in death. Your spouse and dependent children can be eligible for benefits, too.
If you think you are disabled, you should see an advocate or lawyer who has training or experience in representing claimants before the Social Security Administration.

3. Survivor’s benefits: Social Security survivor’s insurance benefits are designed to ease the financial burden of the family after a wage earner has died. This insurance provides financial benefits to the minor, unmarried children of a worker who dies and, in some cases, the widow, widower, divorced spouse, grandchildren, or parents. Unmarried children under 18 are eligible for benefits. Unmarried children between 18 and 22 can also receive benefits if they are attending school full-time. Disabled children of a deceased worker can receive benefits if their disability occurred before age 22. Widows and widowers over 60 can also receive survivor’s benefits. A divorced spouse who is at least 60 years of age and who was married to the deceased worker for at least 10 years can also receive benefits.
A widow, widower, or divorced wife under 60 can also receive benefits if they are providing care for a child of a deceased worker, if the child is under 18 or disabled and if the child is getting benefits based on the worker’s record.

Other benefits: In addition to the monthly cash payments under retirement, disability and survivor’s benefits, there is a hospital and medical insurance program under Social Security called Medicare. It helps persons 65 and older and severely disabled persons under age 65 who have been receiving Social Security disability benefits for 24 consecutive months pay the high costs of health care.

In some instances, a monthly premium must be paid for Medicare benefits. In other cases, you may receive it without paying the premium. If you are 65 or older, or under 65 and severely disabled and do not have Medicare coverage, you should contact your Social Security office for

In addition to the eligibility requirements for retirement, disability or survivor’s benefits, there are special situations which may apply to you:

Common law marriages: In some situations, common law spouses, widows and widowers may be eligible for benefits just as if there had been a traditional ceremonial marriage. New Mexico does not recognize common law marriage.

Children born out of wedlock: Children born out of wedlock are eligible for benefits just as children born within a marriage are, although there may be the problem of proving the relationship to the retired, disabled or deceased parent.

Grandchildren: Unmarried grandchildren may be able to receive benefits if three requirements are met: (1) the child actually lives or lived with the grandparent, (2) the child receives or received at least half of his or her support from the grandparent; and (3) both parents are dead or totally disabled.

What is SSI?
There is another major program operated by the Social Security Administration. It is called Supplemental Security Income (SSI). Basically, both programs have the same disability (i.e. medical) standard but have different financial and work history criteria. It seems similar to the Social Security insurance program, because it covers those who are 65 or above or disabled. SSI is for those who are aged, disabled or blind, and who have not had a work history. Or, if they have worked, it was only for short periods, and they have made only small employee contributions to the Social Security insurance program. To qualify, a person must also be without present income and must meet certain resource tests.

Some people can receive both SSI and Social Security, if their Social Security payments are less than the maximum SSI payment that can be paid the recipient. For example, in 2003 a person living alone could receive maximum SSI payment of $552 a month. If that person received $300 in Social Security, they would receive $272 in SSI ($552 SSI maximum, minus $300 Social Security income, plus $20 income disregard = $272 SSI). A married couple can only receive a maximum payment of $829 under SSI. Anyone who has a history of low paying jobs should ask Social Security about applying for both SSI and Social Security.

Applying for both programs can be very important because those receiving any SSI also receive Medicaid, which is a much broader medical coverage program than Medicare. Some people, depending upon their work history, may be eligible for both the Social Security insurance program and SSI.

How can I begin receiving benefits?
Receipt of Social Security benefits is not automatic. If you believe you are eligible, you should file an application by mail or in person at the nearest Social Security Administration district office. Specific times when you should contact the office include:

1. When someone in your family dies.
2. When you are unable to work because of injury or illness expected to last a year or more.
3. When you are 62 or older and plan to retire.
4. When you are within three months of age of 65, even if you do not plan to retire.

What if my application is denied?
If your application is denied, and you think the decision is wrong, you should appeal. Some people make the mistake of just starting over again with a new application. This is a mistake. Your date of application is important as it sets the date of your eligibility for benefits. You have 60 days from the date of a denial to file an appeal. There are three levels of appeal at the administrative level and two further levels of appeal within the federal court system. This means that if your initial application has been denied, you may ask for a reconsideration. If the reconsideration is denied, you may request a hearing by an administrative law judge at the Office of Hearings and Appeals.

At any point, but especially before you try to present your case to an administrative law judge, it is advisable to consult with a private attorney, an advocate or a legal services program which provides services to low-income people.

At a hearing before an administrative law judge, it may be necessary to present complicated medical evidence. It is also important that this first hearing be properly handled in the event a later appeal to federal court is necessary.

An attorney or advocate familiar with Social Security law and practice will be able to assist you in making sure your case is presented and handled as it should be to best benefit you. If the administrative law judge’s decision is unsatisfactory, you may request review by the appeals council. And, if you are still not satisfied, you may then take your case to federal court.

The Social Security office can explain how you may appeal and will assist you in getting your claim reconsidered or in requesting a hearing. There is no charge for any of the appeals before the Social Security Administration. However, if you choose to have a private attorney represent you, the private attorney will charge a fee which is limited and subject to approval by the Social Security Administration. However, if a Legal Services Program accepts your case, under their eligibility guidelines, no fee is charged for their services.

How can I find the nearest Social Security office?
Look in your telephone directory under Social Security Administration or ask at your post office. In addition to handling applications for benefits, your Social Security office will be able to provide you with additional information about benefits and requirements.

How can I locate a lawyer to assist me?
If you do wish to consult with a lawyer about a problem with Social Security, and you do not know a lawyer or know how to locate one to assist you, you may contact the State Bar’s Legal Resources for the Elderly Program toll free: (800) 876-6657 or in Albuquerque: 797-6005 for residents age 55 and older. For residents below age 55 you may contact the State Bar’s general referral program toll free: (800) 876-6227 or in Albuquerque 797-6066.

Special Note - This information has been issued to inform and not to advise. It is based on New Mexico law in effect at the time of writing. The statements are general and individual facts in any given situation may alter their application or involve other laws not referred to here. You should always seek advice from an attorney if any questions arise. This document is intended as a public service and is not an endorsement of any attorney or law firm.