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?
Same-Sex Couples Eligible for Premium-Free Part A
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 without paying a premium, an individual needs to have worked a minimum of 40 quarters (roughly 10 years).
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, and your spouse qualifies for Social Security disability or retirement benefit. You must be married to that spouse for at least a year.
- You’re divorced, and your former spouse qualifies for Social Security disability or retirement benefit. You must have been married to that spouse for at least 10 years.
- Your spouse has died, and you were married at least 9 months before your spouse died. You cannot have remarried for this to apply.
You can also use your spouse’s work history to access premium-free Medicare Part A if:
- Your spouse has worked 40 quarters.
- You’re under 65 years old.
- You’ve been diagnosed with end stage renal disease (ESRD), you’re receiving dialysis, or you have had or will have a kidney transplant.
Same-Sex Couples and Part B Enrollment
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 defer enrolling 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. You don’t need a work history to qualify for Medicare Part B. Medicare Part B covers medical services, which can include:
- doctors’ visits
- lab tests
- outpatient care
- durable medical equipment
- preventive care
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.
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.
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).
Delaying Part D without penalty
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.
Programs that help pay your Medicare costs
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.
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 eligibility for domestic partners
According to the SSA, civil unions and domestic partnerships do not qualify for Medicare during special enrollment periods. This is because you are not legally married and thus have never been considered “spouses” to qualify for the working age provision. This is true even if your domestic partner was offered spousal coverage by your employer-sponsored health plan.
However, a domestic partner may qualify for Medicare as a family member in certain situations. A domestic partner who is under age 65 may be entitled to Medicare coverage based on disability and coverage under a large group health plan based on the other partner’s enrollment.