Under the Social Security Administration (SSA) Title II program, the spouse and children of a person who is receiving Retirement Insurance Benefits (RIB) or Disability Insurance Benefits (DIB) or who is deceased may receive family benefits. However, there is limit on how much a family can receive on one Social Security earnings record, regardless of the number of beneficiaries entitled on that record. Whenever the total amount of the original monthly benefits of all the beneficiaries entitled on one record exceeds this limit, SSA adjusts the benefits.
This limit, called the Family Maximum (FMax), can reduce each family member’s benefit below what would normally be paid.
To calculate the FMax amount, SSA uses one of various methods that are related to the type and computation of the original benefit (Primary Insurance Amount or PIA) of the person on whose record benefits are being paid (wage earner.) These formulas can become somewhat complicated since they involve using numerous factors. For example, for DIB the FMax (called the DMax) is usually 85% of the average of the wage earner’s lifetime monthly earnings, but it cannot be less than the wage earner’s PIA or more than 150% of the PIA. For a RIB beneficiary or deceased wage earner, the FMax computation is different with the FMax amount being at least 150% of the PIA. POMS RS 00615.730
It is possible for the FMax for a DIB beneficiary to be the same as or less than his/her PIA, in which case no auxiliary benefits are paid. This happens when the PIA amount is 85% or less of the wage earner’s average lifetime monthly earnings which occurs when a wage earner’s average lifetime earnings are relatively low.
To apply the FMax to a family’s benefits in life cases, the RIB or DIB beneficiary’s PIA is first subtracted from the FMax amount, and then the remainder is divided proportionally among all the other beneficiaries on the record. So in situations when a DIB beneficiary’s DMax is the same as his/her PIA (as mentioned earlier), family members would not be eligible for any payments on that record. POMS RS 00615.756
When the wage earner is deceased and the total amount of original benefits for all the survivor beneficiaries exceeds the limit, the distributions of the FMax among the entitled survivors may not be equal. When all the original benefits are 75% of the PIA, the FMax is distributed in equal amounts; when the original benefits are not based on the same percentage of the PIA, the FMax is proportionately divided based on each beneficiary’s original benefit rate (for example, a widow(er) receiving 82.5% and other survivors 75% of the PIA.)
The FMax can be exceeded in certain exceptional situations, such as with the entitlement of a divorced spouse in certain cases. POMS RS 00615.801
Also, when a child is entitled to Social Security benefits on more than one parent’s record, SSA will combine the family maximums from the parents’ records if a higher benefit for the child results (there is an upper limit on a combined maximum.) The amount of the monthly payment for just the child is based on the combined family maximum. POMS RS 00615.772 (C.1)
Recalculating SSDI
You may notice that some SSDI beneficiaries see their benefit increase during the turn of the year. Let’s take a closer look at two events that cause this – The Cost of Living Adjustment (COLA) and recent quarters of coverage due to work earnings.
COLA Increase
Social Security adjusts the SSDI payment using the COLA percentage. In 2012, this amount is 3.6%. Each individual has a different dollar amount increase, as it is based on their previous benefit amount. The increased benefit amount can change eligibility for other benefits the person is accessing.
Let’s take a closer look at individuals who have concurrent benefits – SSI and SSDI. The COLA can cause someone to lose SSI eligibility, therefore lose automatic Medicaid. These individuals can apply for Medicaid at their local County and Tribal Human Services Offices or www.access.wisconsin.gov. They may be eligible for Medicaid through other programs such as Special Status 503 or MAPP. Special Status 503 is a way to get Medicaid that disregards COLA to the date it occurred. MAPP is a Medicaid program for individuals with disabilities who are working. They both have different eligibility criteria you can review using the Medicaid Eligibility Handbook.
Work Earnings and New Credits
SSDI beneficiaries who are working are contributing to their maximum benefit amount because they are earning Social Security Credits as they contribute to payroll taxes. Each year, Social Security will recalculate benefits for SSDI individuals, and sometimes the result is a higher benefit amount. This could have quite an impact on someone who has other benefits.
Individuals who have concurrent benefits could lose SSI eligibility and 1619(b) coverage with an increased SSDI payment. This means a loss of Medicaid. There is not a Special Status Medicaid group that allows someone automatic Medicaid coverage by applying for a State Medicaid program. These individuals must apply for Medicaid at their local County or Tribal Human Services agency.
Start discussion »