Today Social Security pays benefits to nearly 54 million people. Although most people associate Social Security with retirement funds, it also includes the Medicare hospital and supplementary medical insurance programs, which cover a portion of health care expenses for beneficiaries who are over 65. It pays survivor benefits to the families of deceased workers. It also pays benefits to blind and disabled persons and their families.

Today almost everyone in the United States is paying Social Security taxes or receiving benefits. Major exceptions include:

• Most federal government employees hired before 1984.
• About 25 percent of state and local government employees. Each state and local government unit with a pension plan decides for itself whether to join Social Security/Medicare.

Railroad workers are covered under the federal Railroad Retirement system.