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What Same-Sex Couples Should Know About Medicare

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If you’re in a same-sex marriage, you may be wondering how your marital status affects government benefits like Medicare. The 2015 Supreme Court ruling, Obergefell v. Hodges, upheld the constitutional right for same-sex couples to marry and legalized same-sex marriage in every state. This means that, regardless of the state they live in or where they got married, married same-sex couples are now entitled to the same rights as married opposite-sex couples when it comes to government benefits like Medicare, Medicaid, and Social Security.

Here’s an overview of how these changes may affect same-sex couples when it comes to Medicare coverage.

Same-sex couples and Medicare eligibility

The Social Security Administration (SSA) recognizes a marriage (for both opposite-sex and same-sex couples) if it was legally entered in:

  • One of the 50 states
  • The District of Columbia
  • A U.S. territory, including the U.S. Virgin Islands, Puerto Rico, Guam, American Samoa, or the Northern Mariana Islands

Social Security also recognizes some marriages performed in foreign countries.

Medicare covers people individually, so both you and your spouse must meet Medicare eligibility requirements to get Medicare coverage. Unlike employer-based group plans, you’re not entitled to Medicare coverage just because your spouse is eligible, and you generally can’t cover a spouse or family member through your coverage.

However, if you’re a married same-sex couple, your marital status may still affect your Medicare benefits in a few important ways:

  • Part A premiums: most people get Part A without a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes. But if you haven’t worked long enough, you may still qualify for premium-free Part A based on your spouse’s work history. You can also pay for Part A, with your premium cost varying, depending on how long you worked.
  • Part B premiums: some people have an extra charge added to their Part B premium if their yearly income and assets falls above a certain threshold. If you and your spouse file jointly and make above a certain amount, you may have to pay a higher Part B premium.
  • Part D premiums: similarly, married same-sex couples whose joint income is above a certain amount may have to pay higher Part D premiums for Medicare prescription drug coverage.
  • Delaying Part B enrollment: if you’re covered under your spouse’s employer-based group coverage when you become eligible for Medicare, you have the option of delaying Part B instead of paying a premium for extra coverage you don’t need. You can sign up for it later during an eight-month Special Enrollment Period (SEP) when that coverage ends or your spouse stops working, whichever happens first. Remember, the health coverage must be based on your spouse’s current employment to qualify for an SEP; retiree benefits or COBRA don’t count.
  • Eligibility for Medicare assistance programs: Programs that help with Medicare costs, such as Extra Help and Medicare Savings Programs, are based on income and asset levels. So, for married same-sex couples, their total joint income would be considered when determining eligibility.

For more information, or to notify Social Security of a change in marital status, same-sex couples can contact the SSA at 1-800-772-1213, Monday through Friday, from 7AM to 7PM. TTY users can call 1-800-325-0778.

Same-sex couples versus domestic partners

It’s important to note that while married same-sex couples are entitled to the same Medicare benefits as opposite-sex married couples, this doesn’t apply to all types of relationships. For example, domestic partnerships (where two individuals live together in a long-term relationship, but without the legal status of marriage) don’t generally have the same Medicare rights as married couples. Some states may offer certain legal protections for registered domestic partners, but this varies by state.

If you live in a state where domestic partnership has the legal implications of marriage, you may be able delay Part B enrollment and sign up with a Special Enrollment Period if you’re covered through your domestic partner’s group coverage. However, if you’re not sure whether you qualify for a Special Enrollment Period, it’s best to contact Medicare to clarify. If you’re not eligible for an SEP, you could wind up owing a late-enrollment penalty if you don’t sign up when you’re first eligible for Medicare.

Finding the right health coverage is an important part of caring for your family’s well being. If you or your spouse need help choosing Medicare plan options, you’re in good hands. To get started, just enter your zip code on the page to view your plan options.

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