- Thanks to a 2015 Supreme Court decision, married same-sex couples can qualify for Medicare in the same ways married opposite-sex couples can.
- You can use your spouse’s work history to qualify for premium-free Medicare Part A if you haven’t worked long enough to be eligible on your own.
- If you’re covered under your spouse’s job-based health plan, you can delay your enrollment in Medicare Part B without incurring a penalty.
On June 26, 2015, the U.S. Supreme Court decided that same-sex couples have a constitutional right to marry in all 50 states and that all states must recognize their marriages.
The decision means, among many other things, that married same-sex couples have access to the same federal benefits as opposite sex couples do. This includes Medicare spouse benefits.
So, what does that mean for you?
You may now be eligible for premium-free Medicare Part A (hospital coverage), even if you haven’t worked long enough to qualify on your own.
To get Part A premium-free, an individual needs to have worked a minimum of 40 quarters (roughly 10 years). You can use your spouse’s work history to qualify for premium-free Part A.
Married people may use their spouse’s work history to qualify under certain circumstances. If you’re 65 years old and your spouse has worked the required number of quarters, you can use their work history to get Part A premium-free if:
- You’re still married to that spouse.
- Your spouse qualifies for Social Security disability or retirement benefits.
- You’ve been married to that spouse at least a year.
- You’re divorced.
- Your former spouse qualifies for Social Security disability or retirement benefits.
- You were married to that spouse for at least 10 years.
- Your spouse has died.
- You were married at least 9 months before your spouse died.
- You are now single.
You can also use your spouse’s work history to access premium-free Medicare Part A if:
The Supreme Court’s 2015 decision means you can enroll in a health insurance plan offered by your spouse’s employer. This means you can now delay your enrollment in Medicare Part B if you’re covered under your spouse’s employer-sponsored health insurance plan.
If you’re 65 years old or over, you can also enroll in Medicare Part B. Medicare Part B covers medical services, which can include doctors’ visits, lab tests, outpatient care, some home health care, durable medical equipment, and other services.
You don’t need a work history to qualify for Medicare Part B.
Who pays first?
When you’re deciding whether to enroll in Medicare Part B or rely on the health insurance plan available to you through your spouse’s job, you need to know whether Medicare is the primary or secondary payer.
If your spouse’s job employs 20 people or more, Medicare pays second. This means the private insurance company pays medical bills up to the policy limits before Medicare benefits apply.
If your spouse’s job employs fewer than 20 people, Medicare pays first. Some employer insurance plans may require you to enroll in Medicare Part B before they’ll offer you coverage. For that reason, it’s usually better to enroll in Medicare Part B to keep your costs as low as possible.
Special enrollment periods
You can only join Medicare Part B during specific enrollment periods.
Your first chance to enroll is during your initial enrollment period, which starts 3 months before the month of your 65th birthday. It ends 3 months after the month you turn 65 years old.
If you don’t enroll in Medicare Part B during your initial enrollment period, you may have to pay a penalty if you enroll later.
If you’re covered under your spouse’s health insurance plan, however, you qualify for a special enrollment period. This is an extra opportunity to enroll in Medicare based on certain life changing events.
If you have health insurance through your spouse’s job, your special enrollment period begins the month you become eligible for Medicare. It ends 8 months after you lose coverage through your spouse’s job.
If you don’t enroll in Medicare Part B within those 8 months, you may have gaps in your coverage. You may also have to pay a penalty for as long as your Part B coverage lasts.
Does your marriage mean your Medicare premiums will be higher?
Depending on how you filed your taxes for the previous year, the Social Security Administration may raise your Medicare monthly premiums based on a higher joint income. This adjusted premium is known as the Medicare income-related monthly adjustment amount (IRMAA).
If you’re at least 62 years old and you have worked the required number of quarters, your spouse can usually get premium-free Medicare Part A coverage when they turn 65 years old.
If you’re not 62 years old yet, your partner may be eligible for Medicare Part A at age 65. But a monthly premium will apply.
If you’re enrolled in your spouse’s job-based health insurance plan, you may be able to delay your enrollment in Medicare Part D (prescription drug coverage) without having to pay late enrollment penalties.
When your coverage under your spouse’s health insurance plan ends, you may be eligible for a special enrollment period.
If you need help paying Medicare costs, certain programs may be able to help. These programs base your eligibility on your household’s total income and resources. Plus, the limits for a married couple are generally lower than if you add together the limits for each of you as individuals.
These programs include:
- Extra Help. This federal program offers Part D prescription drug coverage at a significant cost savings.
- Medicare savings programs. These state-operated programs help you pay premiums, deductibles, copays, and coinsurance amounts.
- Medicaid. This healthcare program is funded by state and federal governments together but is run by states.
Additional resources to help you
If you need more help or have additional questions, here are some additional resources:
- The National Resource Center on LGBT Aging offers numerous guides and tools to help you access health coverage.
- The National Center for Transgender Equality answers questions about Medicare coverage for transgender people.
- The Department of Health and Human Services (HHS) provides targeted resources for LGBTQ families.
- Lambda Legal supplies legal explanations of Medicare policies and rules as they pertain to LGBTQ families.
- The Social Security Administration (SSA) explains benefits to same-sex couples.
Medicare Part A and Part B are collectively known as original Medicare or traditional Medicare. These are government-provided healthcare insurance programs.
On the other hand, Medicare Part C (Advantage), Part D, and Medigap are all offered by private insurance companies.
Here are the basics of original Medicare:
- Part A. This covers inpatient hospital stays, including services you receive and equipment you need while you’re in the hospital. Most people don’t pay any premium for Part A coverage.
- Part B. Medicare Part B covers medical services like doctors’ visits, medical equipment, lab tests, physical and occupational therapy, and other health services. You and your spouse pay a monthly premium for Part B coverage.
Medicare Advantage (Part C)
Medicare Part C (Medicare Advantage) offers the same basic coverage as original Medicare.
These plans may also offer additional benefits, like vision and dental care, depending on the plan you choose. Sometimes Medicare Advantage plans require you to get your healthcare services through specific networks of doctors and healthcare facilities.
Medicare prescription drug plans (Part D)
Medicare Part D covers prescription drug coverage through private insurance companies.
Medicare supplement (Medigap)
Medigap (supplement) plans help you pay for out-of-pocket costs like copays, deductibles, and coinsurance. These are not fully covered by original Medicare. Like Medicare Advantage and Part D plans, Medigap is a private insurance plan.
- A 2015 U.S. Supreme Court decision means that same-sex couples have the same access to Medicare spouse benefits as opposite-sex couples.
- You can use your spouse’s work history to qualify for premium-free Medicare Part A if your own work history isn’t long enough to meet the 40-quarter threshold. If you have insurance through your spouse’s employer-sponsored health insurance plan, you can delay your enrollment in Medicare Part B until 8 months after that coverage ends.
- Many government programs that help you pay Medicare expenses use your joint income to calculate your eligibility. This may benefit you, because the limit for married couples is often much lower than the sum of your two individual limits.
- If you need help navigating the enrollment process or understanding how Medicare rules apply to same-sex couples, you can turn to many online resources.
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