The American social security system 2023

 The American social security system 2023

I - Social security in the broad sense: "Social Insurance"

A. General
1) Structure
American social security consists of 6 components:

• the old age and death branch (survivors),
• invalidity guarantee,
• Medicare (health care for the elderly or disabled),
• unemployment,
• accidents at work and occupational diseases,
• health insurance called the Affordable Care Act (ACA) or Obama Care.

These risks, except work accidents, health insurance, and unemployment, are managed by the Social Security Administration (French pages of the website).

The pension scheme was set up in 1935. Subsequently, survivors' pensions and invalidity pensions were integrated into the social insurance scheme in 1956 (old age survivors and disability insurance, or OASDI).

The federal Medicare system was created in 1965 to allow retirees to benefit from health insurance. Old age, survivorship, and disability risks, as well as Medicare, are covered by a federal program. The amounts of contributions and benefits are set at the federal level.

Workers' compensation and unemployment insurance are managed at the level of each state under the control of the Department of Labor (DOL). Contribution rates and benefit amounts vary from state to state.

There are no family allowances in the United States.

Self-employed workers benefit from the same rights as salaried workers with regard to old-age, invalidity, and survivors risks (OASDI) and Part A Hospitalization of Medicare HI (Hospital Insurance), for which they must contribute. They are not covered against the risks of unemployment and accidents at work.

2) The Affordable Care Act (ACA) or "Obama Care" reform
Proclaimed March 23 and 30, 2010 and effective October 1, 2013, the Patient Protection and Affordable Care Act (ACA) and the Health Care and Education Affordability Reconciliation Act (Health Care and Education Act), grouped under the name Obama Care, which reformed the American social security system, were modified at the end of 2018. These modifications take effect on January 1, 2019.

These provisions have been adopted and implemented by the companies (details in point B).

3) Funding

Contribution sheet

• Health Insurance

The Affordable Care Act (ACA), which came into force in October 2013, has been amended.

Since January 1, 2019, the Obama Care reform, which required anyone not covered by the employer (via private insurance companies) to take out private individual health insurance under penalty of law, has been abolished at the federal level.

Some states, such as California, the District of Columbia, Massachusetts, New Jersey, Nevada, Rhode Island, and Vermont, have passed laws restoring the requirement for ACA-approved health insurance. Other states, such as Connecticut, Hawaii, Maryland, Minnesota, and Washington State, are considering implementing a mandate.

The amount of health insurance premiums varies according to the annual taxable resources (between 2.07 and 9.83% in 2021). State aid is allocated to families whose income is, for 2021, between 100 and 400% of the poverty line (i.e., $12,760 and $51,040 annually for a person and $26,200 and $104,800 for a family of 4 people).

• Medicare Part B (Supplementary Medical Insurance, or SMI)

Medicare Part B premiums are also set by the federal government. This is a fixed premium that amounts, for a single person, in 2021, to:

MeMedicare part B premiums based on annual income N - 2 for one persondicare part B premiums based on annual income N - 2 for one person

  au 1er janvier 2021

Revenu annuel de 2019	Montant de la prime
Inférieur à 88 000 $	148,50 $
Entre 88 000 et 111 000 $	207,90 $
Entre 111 000 et 138 000 $	297,00 $
Entre 138 000 et 165 000 $	386,10 $
Entre 165 000 et 500 000 $	475,30 $
Supérieur à 500 000 $	504,90 $

Anyone with Medicare Part A hospitalization (retirees or disabled) can enroll in medical insurance upon payment of the premium.

Salaried workers and the self-employed can contribute to and benefit from Medicare Part B insurance (see C. Medicare).

• FUTA (unemployment)

Under the supervision of the Ministry of Labor, Department of Labor, and Unemployment Insurance Service, each state applies its own provisions within the framework of federal standards. The Federal Unemployment Trust Fund is most often funded by employers' contributions alone, under the terms of the Federal Unemployment Tax Act (FUTA).

The contribution due to the federal state is 0.6% of the taxable salary (the basic rate is equal to 6% minus 5.4%). For the financing of the programs of each state, the employer pays an average of 5.4% (variable according to the "experience" of the employer, that is to say the seniority of the company). The annual ceiling serving as the basis for calculating contributions ("taxable wage base") varies according to the States.

The contribution is due when the employer has hired during the year (past or present) an employee for 20 weeks and has paid him $1,500 in remuneration for one quarter.

The funds are used to pay administrative costs (federal or local) and to make cash loans to states that fail to pay unemployment benefits.

Only salaried workers, for whom the employer pays an unemployment insurance contribution, are covered for this risk.

• Work accident

In most states, employers bear all the variable insurance premiums according to the risks and the payroll (approximately 1.9% of remuneration). In some states, a nominal employee contribution is paid for medical benefits and hospitalization.

Self-employed persons can voluntarily contribute to insurance covering accidents at work. Their contributions are, in this case, deductible from taxable income as professional expenses.

B. The Affordable Care Act (ACA) or "Obama Care" reform
The reform is based on:

• the creation of a mandate (individual or employer) giving access to minimum medical coverage,
• the establishment of private insurance comparators approved by the ACA,
• the extension of "Medicaid" to people with incomes up to 138% of the American poverty line (medical insurance for the most deprived, cf. II.B) adopted by 37 states

Since January 2019, the obligation to join and contribute to private insurance on an individual basis for permanent residents who do not benefit from either health insurance provided by their employer or health coverage managed by the government ( Medicaid or Medicare), is no longer mandatory except for certain States (see I -A - 3 - Health insurance).

A repeal process has begun but no formal replacement plan has been put in place. As a result, the Affordable Care Act (ACA) is still in effect.

Coverage of the Affordable Care Act (ACA)

Each insurance has 4 different levels of cover: Bronze, Silver, Gold and Platinum. These levels correspond to the average percentage of health costs that are covered by the insurer. Thus, with Bronze coverage, 60% of the insured's health expenses are covered, compared to 90% with Platinum coverage.

All ACA health insurance must guarantee at least 10 essential care services:

1. outpatient services,
2. emergency services,
3. hospitalization,
4. childbirth and newborn care,
5. mental health,
6. medical prescriptions,
7. rehabilitation services,
8. laboratory analysis,
9. prevention and management of chronic diseases,
10. pediatric services (including eye and hearing care).

For all of these services, no reimbursement ceiling can be set.

1- Individual or employer mandate
Since January 2019, the obligation put in place in October 2013 to subscribe each person individually to private health insurance (via an internet portal), under penalty of law, has been abolished at the federal level.

Since 2015, any employer with more than 50 employees performing more than 30 hours of work per week has the obligation to take out private insurance for the latter (with the exception of those providing proof of individual insurance), or pay a penalty.

Since 2014, the conditions for proof of good health in the event of membership have been abolished. The waiting period cannot exceed 90 days.

• Companies can no longer:
• refuse to insure an individual,
• cap spending on the 10 essential guarantees,
• impose higher tariffs on people with medical conditions,
• cancel sick people's policies.

These private insurances offer 3 types of coverage:

• individual,
• family (children can remain covered by their parents' insurance until they are 26),
• supplementary to the Medicare program.

2- Private insurance comparator

The Affordable Care Act (ACA) does not create a public health insurance fund. This risk is insured by private insurance companies.

Private health insurance providers in the United States basically fall into 3 categories:

Health Maintenance Organizations (HMOs)
HMOs are insurance plans that provide access to a network of healthcare professionals as well as hospitals. In order to benefit from health coverage, beneficiaries will only be insured if they receive medical services from providers belonging to this network.

Preferred Provider Organizations (PPOs)
PPOs are more flexible than HMOs in terms of the choice of healthcare professional, although they also rely on a network of practitioners and structures. The beneficiary can use the services of a supplier that does not belong to his network and still obtain a refund (less substantial than by calling on a member of his network).

Insurances Co-op
These companies do not depend on any company or organization. Their principle is very simple: insured members contribute according to the risks they wish to cover. The greater these risks are, the greater the contribution will be. In 2021, only 3 health cooperatives out of the 23 created in 2013 will remain operational in the states of Idaho, Maine, Montana, New Mexico, and Wisconsin.

The HealthCare.gov website allows:

• assess whether a natural person or a small business can benefit from insurance,
• enrollment or change of insurance by state.

3- Extension of "Medicaid"

The reform provides that the "Medicaid" insurance once reserved for the poorest will be extended to people with incomes up to 138% of the poverty line

($17,609 annually for a single person, $36,156 for a family of 4 in 2021).

The reimbursement of consultations with a general practitioner is aligned with that of Medicare (80% of the approved tariff).

C. Medicare
Medicare is health insurance for the elderly and disabled. It has 2 branches: hospitalization and additional benefits.

Unlike Medicaid, an assistance program managed at the level of each state, Medicare is a federal insurance program. It is possible to benefit from both; in this case, Medicaid covers the contributions due to Medicare and intervenes to cover medical expenses that would not be covered by Medicare but are targeted by the local Medicaid program.

1) Parts A and B
The program aims to guarantee medical protection to people aged 65 and over or disabled in the event of illness. It has 2 parts:

the first section "A" concerns hospitalization and care provided in a hospital or in a nursing, palliative, or home care establishment ("Hospital Insurance" - HI). It is open free of charge, without insurance conditions, to retirees, railroad workers, those who have received disability benefits for at least 2 years, or those who suffer from chronic kidney disease. Under certain conditions, beneficiaries (spouse, divorced spouse, widow or widower, ascendants, children under 18) can benefit from this program.
the second part "B" concerns various medical benefits, such as medically necessary but also preventive services ("Supplementary Medical Insurance," or SMI). You must have reached the age of 65, be disabled, or be entitled to Section "A". On the other hand, it is not necessary to justify social security contributions or federal employment. Those who receive a social security benefit or are railroad workers are admitted automatically unless they refuse. You also have to pay a monthly fee. Beneficiaries over the age of 65 who fulfill the required conditions or suffer from kidney disease are also targeted.

Part B covers the following benefits:

• outpatient care,
• hospitalization,
• clinical research,
• durable medical equipment (DME),
• mental health,
• the possibility of obtaining a second opinion before surgery,
• the ambulance service.

2) Benefits

• Hospitalization (Hospitalization Insurance - HI)

Hospital services are provided for up to 90 days in an approved hospital. Coverage only kicks in after the individual has paid a deductible of $1,484 for the first 60 days of hospitalization. From the 61st to the 90th day of hospitalization, the insured is responsible for $371 per day. Beyond 90 days of hospitalization, the insured can be hospitalized for up to 60 additional days and pays $742 per day.

There is no deductible in a specialized nursing home during the first 20 days, then a deductible equal to $185.50 is applicable from the 21st day to the 100th day.

The HI also makes it possible to cover certain specialized nursing care following hospitalization and the cost of home visits by nurses or other health professionals (for 4 days a week, up to a maximum of 21 days per year).

3) Supplementary benefits (Supplementary Medical Insurance - SMI)

The SMI covers 80% of licensed physicians' and surgeons' fees after the insured has paid a deductible of $203 in a year. However, medication, glasses, hearing aids, child care costs and, with a few exceptions, all preventive health services are not covered by either HI or SMI.

D. Old Age and Survivors Insurance (OASI)
1) Scope
This insurance covers approximately 96% of the active population.

This applies to employees and the self-employed with a minimum of $1,470 in net quarterly income in 2021.

Social Security benefits are paid monthly and in the month following the month for which they are due.

2) Old age
a) Age requirements
The retirement age is determined according to the year of birth of the insured; it has increased gradually by 2 months per year since 2003 to reach 67 years for people born in 1960. People born between 1943 and 1954 can retire at age 66 to obtain the full rate.

Full retirement age

Full retirement age

Année de naissance	Âge
1943-1954	66 ans
1955	66 ans et 2 mois
1956	66 ans et 4 mois
1957	66 ans et 6 mois
1958	66 ans et 8 mois
1959	66 ans et 10 mois
1960 ou plus	67

It is possible to obtain early retirement at the age of 62, subject to a gradual reduction in the pension rate. The insured can, however, work until the age of 70, in which case the rate is increased.

A calculator is available on the SSA website.

Insurance career
To apply for an old-age pension, you must provide proof of 40 quarters of insurance ("quarter of coverage,"  QC), i.e., 10 years of work. In 2021, to validate a quarter of insurance, you must have contributed to a salary (income for the self-employed) at least equal to $1,470, i.e., for four quarters, $5,880. See the history of the amount of wages required to validate a quarter of insurance at the link: https://www.ssa.gov/oact/cola/QC.html#qcseries

The insured person who has not reached the legal age for payment of the pension without application of the anticipation coefficient can continue to work, so that his pension is not reduced if he does not have an income greater than $18,960 per year. When the required age is reached to obtain a full pension, the pensioner can continue to work without limitation on his earnings or reduction of the pension.

An insured who begins to receive benefits before reaching full retirement age and who has an annual income exceeding $18,960 will have $1 deducted for each $2 of income received beyond the annual limit.

During the year during which the insured person reaches the age to obtain a pension at the full rate, his benefits are reduced by $1 for each $3 of income acquired above an annual ceiling set at 50,520.

b) Amount
The wages or income received by the insured during each year is taken into account within the limit of the contribution ceiling; these amounts are reassessed annually.

All of the income received by the insured during his career is indexed to a reference year (N-2 before the date of the request for payment of the pension). Only a maximum of 35 years of career will be retained for the calculation of the indexation of professional income.

The amount of the average monthly income (AIME: Average Indexed Monthly Earnings) is equal to the sum of the highest indexed incomes divided by the number of months of these incomes taken into account.

The benefit calculation formula is applied to this average monthly income, which consists of allocating a first part of the average monthly income by a coefficient:

• 90% of the first $996 of the AIME;
• +32% of the AIME between $996 and $6,002;
• + 15% of the AIME above $6,002.

The different monthly income brackets are increased each year in the same proportion as the national average salary.

In 2021, at age 66 and 2 months, the insured person born in 1955 receives 100% of the amount of the pension liquidated above (Primary Insurance Amount: PIA).

Supplements for dependent spouse and/or dependent child may be added to this amount:

• the spouse of at least 66 years of age who does not personally receive a pension equal to at least half of the PIA of the person concerned, is entitled to an increase equal to half of this amount (50% of the PIA of the insured) , so that a total of 150% of the PIA can be paid to a married insured person;
• anyone raising a child under 16 or with a disability is entitled to 50% of the PIA regardless of their age;
• children under the age of 18, 19 if they go to school, if they are disabled before the age of 22, are entitled to 50% of the PIA.

The maximum benefit that a family can receive corresponds to:

• 150% of the first $1,272 of the PIA plus,
• 272% of the PIA between $1,272 and $1,837,
• 134% of the PIA between $1,837 and $2,395,
• 175% over $2,395.

The benefits paid to the insured and his dependents vary between 100% and 150% of the PIA.

In the event of early departure, the PIA is reduced by 0.5% per month of anticipation for a pension paid from age 62 (benefits are permanently reduced by 0.5% per month of anticipation); on the contrary, in the event of deferment, from 67 to 70 years of age, the rate is increased by 3% to 8% per year, depending on the year of birth.

3) Deaths (survivors)

• with conditions

Survivors (dependent spouse and children) can claim a pension if the deceased insured has contributed for at least 10 years and if he has worked for at least 1 1/2 years during the 3 years preceding his death (https:/ /www.ssa.gov/multilanguage/French/10084-FR.pdf).

The following may benefit from a survivor's pension:

the spouse :
- married and childless: from retirement age or 60 for reduced benefits or 50 in the event of disability,
- divorced: from retirement age or at least 60 years old, or 50 years old in the event of disability if the marriage lasted at least 10 years,
- regardless of their age and status (married or divorced), if they are caring for one or more children under the age of 16 and/or with a disability;
children under the age of 18 who are single (or 19 in the case of schooling) or without an age limit if the child became disabled before the age of 22;
in certain circumstances, the children and grandchildren of the spouse;
parents aged 62 or over if they were dependents of the deceased.

b) Amount
The amount of benefits paid to survivors is calculated according to a percentage of the PIA [cf. B. 2) b) amount] that the deceased insured received or should have received:

• The surviving spouse who has reached full retirement age receives 100% of the PIA.
• The surviving spouse aged 60 or over receives 71 to 99% of the PIA.
• The surviving spouse who is responsible for one or more children under the age of 16 receives 75% of the PIA;
• The children of the deceased insured receive 75% of the PIA.

The cumulative amount of survivors' benefits cannot exceed 180% of the amount of the benefits of the deceased insured. Upon death, the surviving spouse or, failing that, a child, receives $255 for funeral expenses. The other survivors cannot claim it.

The Old Age Survivors Insurance (OASI) pension scheme guarantees the replacement of only a small proportion of the salary (56% of the federal minimum wage, 42% of an average salary, and 28% of a maximum salary), and 50% of insured persons are entitled to a supplementary pension from private or public insurance companies. The situation of the persons concerned differs considerably from one branch to another, but these pensions are generally financed entirely by the employer according to seniority in the company.

4) Private pensions
It is a funded pension system consisting of retirement savings plans governed by the Internal Revenue Code (Tax Code) and pension funds.

Set up collectively in large companies, membership can also be individual.

• 1- Private reserve funds of a "collective" nature

Defined benefit plans ("defined benefit plans," sometimes called "pensions")
The benefits payable under these plans are generally linked to previous earnings and working time, or working time alone, while directly or indirectly taking into account the amount of social security benefits.

Private pension plans are guaranteed by employers or by employers and unions. They are consolidated through trust arrangements or by private insurance companies.

Subject to minimum standards set under the 1974 Employee Retirement Income Security Act (ERISA), pension plans set rules and conditions governing participation, investment, accrual of benefits, retirement age (normal or early), as well as incapacity benefits.

Finally, companies encourage their employees to build up small capital (shareholding, investments, etc.), which is also encouraged by the federal government (tax deferral of amounts saved, tax credit under the "Tax Reduction Act Employee Stock Ownership Plan" (TRASOP)).

Defined contribution plans
In this type of plan, it is the employee who bears the associated risk associated with the investments he chooses. The performance of investments will influence the level of retirement income. They can be taxed at the time of contributions [401(k) "pretax" plans] or withdrawals [Roth 401(k) "after tax" plans].

These plans consist of employee savings offered by the employer and financed by a salary contribution, which can be increased by 50% by the employer (not compulsory).

In the event of early withdrawal of savings before age 60, a penalty of 10% is deducted. It is advisable to make withdrawals after the age of 70.

2- Individual private reserve funds

The other form of funded retirement is based on individual initiative in the absence of a plan offered by a company. It is a system for opening an individual retirement account (IRA plans - Individual Retirement Arrangements) with a wide range of providers.

Employees and managers of small businesses, the self-employed, people with atypical jobs can use this type of contract to build up retirement savings by capitalization [funds managed by commercial banks (Commercial banking), savings banks (saving institutions), Credit Unions and life insurance companies].

Contributions made to these accounts may be fully or partially deductible from income.

E. Disability Insurance (DI)
1) Conditions

• a) Duration of insurance is variable according to age

To be entitled to a disability pension, you must have carried out a subject activity and justified a certain number of quarters of insurance (QC) in particular in recent years, which varies according to age.

To be considered "fully insured" and to be able to benefit from an invalidity pension, one must meet the required conditions, namely, justifying 20 quarters of insurance during the 40 quarters preceding the beginning of the incapacity.

The conditions of insurance can be reduced in certain cases (young people or people who are blind from birth, surviving spouses who have become disabled during the 7 years following the death of the insured),

• b) Incapacity

Applicants must be unable to obtain normal earnings (less than $1,310 per month in 2021) for at least one year or be suffering from an incurable disease. The assessment of the state of incapacity is carried out by state agencies. Generally, the pension does not begin to be paid until after 5 months of incapacity.

2) Amount
The amount of the pension is determined under old-age insurance; it is equal to 100% of the PIA on the date of onset of incapacity.

A disability pension supplement may also be granted in cases where:

• the spouse (married or divorced) is aged 62 or over,
• the spouse is raising a child under the age of 16 or disabled,
• the children are under the age of 18 unmarried (or 19 if attending school) or without age limit if the child became disabled before the age of 22.

In total, the pension and supplements for the spouse and dependent children cannot exceed 150% of the PIA of the insured.

The accumulation of this pension (including supplements for spouse and dependent children) with other benefits paid out of public funds at the local level (for example, worker's compensation benefits) cannot exceed 80% of the average income of activity.

As in the context of old-age insurance, employers generally provide a supplement from private insurance companies. The objective is to guarantee the payment of a percentage of salary between 50% and 67%. Self-employed workers can also take out additional coverage on an individual basis with private insurance companies.

F. Unemployment Insurance (UI)
Unemployment insurance was instituted on a national basis under the Social Security Act of 1935. It is a mixed (federal and state) program. Each state manages its own program in accordance with the framework laws set at the federal level (relating to unemployment in a state).

Unemployment insurance only concerns salaried workers and exceptionally self-employed workers in the event of job loss following a major disaster decreed by the President of the United States (Disaster Unemployment Assistance, or DUA).

Unemployment insurance can pay benefits to a person eligible for unemployment benefits who starts his own business (Self-Employment Assistance).

1) Conditions

To claim benefits, the worker must:

• becomes involuntarily unemployed;
• is registered with a public unemployment office;
• proves a certain length of previous activity as well as certain income during the reference period;
• be fit for work;
• takes active steps to find a job.

2) Amount

The amount of weekly benefits paid varies according to the formula used in each State and the salary received prior to the occurrence of the risk. This amount varies between minimum and maximum limits.

The reference period for taking into account wages as well as the formulas for calculating benefits based on these wages vary greatly between the States.

3) Duration

The duration of benefit payments is generally 26 weeks. However, benefits can be paid for an additional 13 weeks when the unemployment rate in the region is very high. The financing of these additional benefits is provided half from state reserves and half from the Federation.

4) Extension of health coverage (COBRA)

The worker in a situation of involuntary unemployment, can benefit from the health insurance benefits to which he was entitled with his former employer for 18 months.

This extension also benefits its beneficiaries.

The insured must then continue to contribute to the group health insurance contracted by his former employer under the same conditions.

G. Accident at work - occupational diseases

Regulation of workers' compensation and occupational disease was the first form of social insurance to develop in the United States.

Currently, there are compensation programs for accidents at work and occupational diseases in each of the States. Their purpose is to grant benefits in kind and in cash to workers suffering from illness or having suffered an accident in the course of their work.

The self-employed are not covered against the risk of accidents at work but they can contribute to it voluntarily. Their contributions are in this case deductible from taxable income as professional expenses.

The number of weeks for which benefits can be paid as well as the amount of these benefits vary by state. Payments relating to total disability are generally established on the basis of the worker's income at the time of the accident (generally 66.66% of the last income within the limit of a ceiling).

1) Benefits
No internship condition is required for the various services.

The workers' compensation benefits granted include:

• medical care without limit of amount or time (depending on the state, the choice of doctor belongs to the insured or to the employer);
• Cash benefits are granted in the event of a reduction in capacity or incapacity. The former are paid on the assumption of certain losses of physical capacity; the latter are paid when there is also a loss of income;
• rehabilitation benefits.

For the allocation of cash benefits, 4 categories of incapacity are used: total temporary, total permanent, partial temporary and partial permanent.

Partial permanent incapacities are themselves subdivided between those which are without scale ("unscheduled") and those which are ("scheduled") according to the States (scale: average weekly salary or minimum quarterly income - quarter of coverage "QC" ). Most of the time, these are cases of total temporary incapacity.

2) Disability Income Benefits

In the event of temporary or permanent total incapacity, in most States, victims are guaranteed 66.66% of their income up to a ceiling. Some grant up to 75-80% of income. A fifth of them grant supplements for dependents.

In this case, benefits are paid after a waiting period (usually 3 to 7 days) except for medical care and hospitalization. The amount of the benefits is the same in the event of total incapacity whether or not it is permanent, but in the latter case, they are paid longer.

If the permanent incapacity is only partial, the benefits vary according to the loss of income or are paid at full rate for a reduced number of weeks. Care is provided for as long as necessary.

Supplements can be paid for the duration of the disability in 80% of states or for 104 to 500 weeks for:

• constant need for a third person for the acts of daily living,
• dependent.

3) Specific Loss Benefits
Furthermore, in the event of the loss of certain limbs or faculties (legs, sight, etc.), the victim may receive a lump sum ("Specific Loss Benefit"); this amount varies significantly according to the States.

4) Deaths (survivors) ("Survivors Benefits")
Survivors can obtain annuities in addition to a death benefit.

These annuities represent:

• between 35 and 70% of the income of the deceased insured person for the widow(er),
• between 60 and 80% of income for a widow(er) with dependent children.

Pensions for the surviving spouse of a victim of an industrial accident cease to be paid in the event of remarriage. Children are eligible up to a variable age (25 in some states).

Benefits paid in the event of an accident at work or an occupational disease are not taxable.

5) Anthracosis ("Black Lung Benefits Program,"  B.L.)
The anthracosis benefits program was created as part of the Federal Coal Mine Health and Safety Act of 1969. It provides monthly cash and in-kind benefits to coal mine workers. coal workers who are totally unfit for work due to pneumoconiosis (anthracosis).

Under this law, benefits may also be paid to the survivors of workers who died of pneumoconiosis (Office of Workers' Compensation Programs, OWCP).

H. State short-term disability benefits
Temporary incapacity insurance provides workers with protection against salary loss due to maternity or temporary non-occupational incapacity. This type of protection does not exist in the United States in the form of a federal program. However, it is offered to workers in California (California State Disability Insurance replaces 55% of a mother's income while on maternity leave), Hawaii, New Jersey, New York, Rhode Island, and those in the railway industry.

II. Assistance programs
A. Supplemental Security Income (SSI)
The SSI provides for the granting of financial assistance to people with low incomes who are 65 or older,  disabled, visually impaired, or blind. Monthly payments can reach $794 (for a single person) and $1,191 (for a couple).

The eligibility conditions and the amount of these benefits are uniform at the federal level. States may, however, provide additional benefits.

B. Medical assistance (Medicaid)
Medicaid covers the cost of medical assistance and health care for beneficiaries:

• SSI in most states (13 states use more restrictive rules),
• as well as for some other low-income people.

Depuis 2015, l'assurance "Medicaid" réservé autrefois aux plus démunis est étendue aux personnes ayant des revenus allant jusqu'à 138 % du seuil de pauvreté (17 609 $ annuel pour une personne seule, 36 156 $ pour une famille de 4 personnes en 2021).

Pour les personnes âgées, le Medicaid peut venir compléter le programme "Medicare" en prenant en charge les frais de franchise hospitalière et certains frais médicaux.

C. Tickets pour l'achat de nourrriture (Food Stamps)
It involves reloadable coupons for food purchases. Le montant mensuel des coupons qu'un foyer peut recevoir est déterminé en fonction de la taille de la famille et du montant de ses revenus.

D. Assistance générale
Cette assistance dispense une aide aux individus et aux familles nécessiteuses qui ne remplissent pas les conditions requises pour bénéficier du SSI.