As of June 26, 2015, a United States Supreme Court ruling meant that Medicare could update rules and policies for married same-sex couples.
On this date, same-sex couples received the constitutional right to marry throughout the U.S., and these marriages must be legally recognized.
The decision means that all married couples can access the same federal benefits, including Medicare spousal benefits.
This article explores the Supreme Court ruling and how legislation has changed for same-sex couples.
It then looks at Medicare coverage rules and how someone can add their spouse to their plan.
Finally, it explains the credit system and additional support that people can find.
The legislation changed the rules of Medicare and Social Security for same-sex spouses. It meant that those in a same-sex marriage could now qualify for:
- Medicare when diagnosed with end stage renal disease
- premium-free Medicare Part A
- Social Security retirement benefits
The legislation also meant that a person could delay enrolling in Part B without paying the penalty if their spouse’s employer insurance previously covered them.
Individual states handled the legislation differently, and a couple may find the date and location of their marriage affects their Medicare coverage options.
In June 2015, the U.S. Supreme Court voted 5 to 4 in favor of recognizing same-sex marriages.
They declared that the right to marry is fundamental and that couples of the same sex should not forego that right and liberty under the 14th Amendment.
The ruling legitimized same-sex marriages in all U.S. states.
This new ruling was further to the Supreme Court’s ruling in 2013 that struck down the federal Defense of Marriage Act and required that the government provide equal rights to both gay and heterosexual couples.
Different parts of Medicare have distinct coverage rules.
Medicare Part A
Spouses may now qualify for premium-free Medicare Part A hospital coverage, regardless of how many work credits they have and how long they have worked.
Premium-free Part A requires 40 work credits or more. Individuals in same-sex marriages may now use their spouse’s work credits to qualify. The requirements for such are listed below.
- An individual is married to their spouse and has been for at least one year. The spouse must qualify for Social Security disability or retirement benefits.
- A person is divorced from their spouse, but they were married for at least 10 years. Their former spouse must qualify for Social Security disability or retirement benefits.
- A person is widowed, is now single, and the couple was married for at least 9 months before their spouse passed away.
Individuals may also use their spouse’s work credits for premium-free Medicare Part A if:
- their spouse has worked 40 quarters
- they are under 65 years old
- they have end stage renal disease
- they are receiving kidney dialysis or have had, or will be having, a kidney transplant
Medicare Part B
Individuals must pay a premium for their Part B coverage, regardless of their spouse’s status.
For married couples, the Part B premiums depend on joint income. Most people pay the standard premium, which in 2020 is $144.60. The premium increases in line with income.
Individuals may delay their Medicare Part B enrollment if their spouse’s employee health insurance plan covers them. Alternatively, once they turn 65 years old, a person can enroll in Part B themselves.
If a person’s employment status changes and they no longer have employer insurance, a spouse could qualify for a Part B Special Enrollment Period (SEP) and avoid late enrollment penalties.
A person can only join Part B during specific enrollment periods. However, they may qualify for a SEP if their spouse’s employment coverage changes.
The SEP lasts for 8 months. If an individual does not enroll in Part B during the 8 months, they may have a gap in coverage and need to pay a permanent penalty on their Part B monthly premium.
Medicare provides healthcare plans for individuals only. There are no couple or family plans.
The benefits available for a person’s spouse apply to Medicare Part A only. An individual must be at least 62 years old and have the required work credits for their spouse to receive premium-free Part A when they turn 65 years old.
If a person is not yet 62 years old, their partner may qualify for Part A at age 65, but with a monthly premium.
People can visit Medicare.gov and use their online eligibility calculator to determine if they meet the specific requirements.
Individuals can apply for their spouses Medicare benefits by:
- applying online, providing they are within 3 months of age 62 or older
- calling the Social Security Administration at 800-772-1213
- visiting their local Social Security office
Individuals may use their spouse’s employee insurance as primary coverage, with Medicare acting as a secondary insurer and providing coverage where the primary insurer may not.
If a spouse’s employer has fewer than 20 employees, Medicare is the primary payer. If there are more than 20 employees, Medicare will be the secondary payer.
Medicare uses a credits system to determine who qualifies for zero cost Medicare premiums. People earn these credits through their work.
To qualify for premium-free Medicare Part A, and individual needs 40 credits. A person earns one credit for each quarterly period of work.
Typically, it takes ten years of employment and paying Federal Insurance Contributions Act (FICA) payroll taxes to earn enough work credits.
Any married couple may qualify for premium-free Medicare based on their spouse’s credits if they do not have enough credits of their own.
People can enroll in Medicare Part B and enroll in Medicare Part C and Part D without work credits.
There have been some recent changes to taxes due to COVID-19, and people can check for updates on the IRS website.
Resources are available for LGBTQIA families who have questions or need additional support.
- The Department of Health and Human Services (HHS) has many resources, including updated training on inclusivity.
- Lambda Legal provides help with the legalities of Medicare policies and rules.
- The National Center for Transgender Equality helps transgender people access information about Medicare.
- The National Resource Center on LGBT Aging helps people access healthcare coverage, including Medicare.
In 2015, the U.S. Supreme Court voted to permit same-sex couples across all 50 states to have the same rights as opposite-sex couples. This includes Medicare spousal benefits.
Individuals can use their spouse’s work credits to qualify for premium-free Medicare Part A if they have not earned enough credits of their own.
If a person has insurance coverage through their spouse’s employment, they can delay enrolling in Medicare Part B until 8 months after that coverage ends.
There is a range of online resources to help LGBTQIA couples navigate Medicare’s rules.