Medicare for same sex couples

Published by Medicare Made Clear®

Medicare is individual insurance but your significant other can impact (1) if you qualify for premium-free Medicare Part A and (2) when you need to enroll.

A quick reminder that if you're already at least 65-years-old and you made contributions to Medicare for at least 10 years or 40 quarters while you were working, you qualify for premium-free Medicare Part A based on your own work history.

Let’s look now at how your significant other could impact enrollment premium-free Part A when you need to enroll, and then finally, an important note about spouses vs domestic partners.

Same-sex spouses do qualify for premium-free Part A

In 2015, the Supreme Court of the United States ruled in Obergefell v. Hodges 576 U.S. 644, that the fundamental right to marry is guaranteed to same-sex couples. This also translated into ensuring that same-sex spouses could get the same rights as opposite-sex spouses to qualify for premium-free Medicare Part A.

If you don’t meet the minimum work history requirements but your same-sex spouse does, you may qualify for premium-free Part A based on your current or former spouse’s employment.

You can qualify for premium-free Part A via your same-sex spouse if your spouse worked and paid Medicare taxes for at least 10 years, and one of the below are true.

  • You are 65 years old or older.

  • You have received Social Security disability benefits for at least 24 months.

Read this if you have ESRD or ALS

You may qualify for premium-free Part A, minus the 24-month wait period and 65-year-old age requirement, based on your current or former spouse’s employment if you have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), and you meet the ESRD and ALS Medicare eligibility requirements and the following conditions.

  • You and your spouse (living or deceased) were married in a state that permits same-sex marriage.

  • You live in a state that recognizes same-sex marriage at the time you apply, or while the claim is pending final determination.

  • If you’re divorced, you must have been married for at least 10 years (alive or deceased).

Medicare Part B enrollment for same-sex couples

Another thing same-sex couples will want to know is when they should enroll for Part B. The 2015 law also ensures that same-sex spouses had the right to delay Medicare Part B if qualified.

To qualify to delay Part B, the following must be true:

  1. The employer coverage you have must be considered creditable.
  2. Your spouse’s employer doesn’t have rules requiring Medicare-age dependents to get Medicare at age 65 in order to stay on the employer plan.

Medicare eligibility & enrollment are different for domestic partners

Domestic partners are not formally married, and while in many cases couples in this relationship can get a lot of the same health care benefits as married spouses, that is not so with Medicare.1

Social Security doesn't recognize a domestic partner as a spouse, so domestic partners cannot use each other’s work history to qualify for Medicare Part A if they’re not married at the time of Medicare eligibility. Domestic partners also cannot use their partner’s employment status and employer health coverage to delay Part B without financial penalty. Unlike spouses, domestic partners will not qualify for a Special Enrollment Period based on his or her partner’s work record. If a person is insured through their domestic partner’s employer plan and misses their Medicare Initial Enrollment Period, they could end up with late enrollment fees for Part B, Part D, and depending on their own work history, even Part A.

Think carefully about Medicare if you’re in a relationship

If you’re in a relationship, make sure you know all the rules and rights you have when it comes to getting Medicare for the first time. It’s always a good idea to ask questions, and your local State Health Insurance Assistance Program (SHIP) office can offer free counseling and guidance.

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