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Ask Ms. Medicare

Marital Status and Medicare Eligibility

How Medicare works when you're in a same-sex marriage

Delaying Part B enrollment if you're covered by your spouse's health plan at work

Under Medicare rules, people can delay signing up for Part B beyond age 65 (and avoid paying its premiums) for as long as they're covered under a group health plan provided by an employer for whom they or their spouse are still actively working. When that employment comes to an end, they're entitled to a special enrollment period of up to eight months to sign up for Part B without incurring any late penalties.

Before the Supreme Court ruling on DOMA, people in same-sex marriages with health coverage under their spouse's employer plans did not have the right to this special enrollment period. Therefore, if they didn't enroll in Medicare Part B at age 65, they were landed with late enrollment penalties — added permanently to their premiums — after they finally signed up.

That discrimination has now ended.  On April 3, 2014, the Centers for Medicare & Medicaid Services (CMS) announced that all same-sex spouses—wherever they live in the United States—would have the same right to this special enrollment period (SEP) as other married couples.  (CMS works under different rules from Social Security.)  

Therefore, if you are in this situation, you can delay Part B enrollment after age 65 based on coverage from your spouse’s current work, without risk of being penalized when this employment comes to an end.

If you’ve already applied for a SEP but Social Security has placed your request on hold, it can now be processed and your coverage will be backdated to when Social Security received your request.

If you previously asked for a SEP but were denied solely because of being in a same-sex marriage, you can now apply again.  To qualify for this second opportunity, you must meet the following conditions:

  • Your eight-month SEP (following the date when your spouse ceased employment) had to start after October 2012
  • Your eight-month SEP has to end before May 2014
  • You must file your second SEP request no later than May 31, 2014
  • You must meet all the other eligibility conditions for an SEP—namely, you’ve been covered under the group health plan provided by an employer for whom your spouse has been working, and you are legally married to that person.

If you were denied an eight-month SEP in the past on the basis of being in a same-sex marriage—and, as a result, were late enrolling in Part B and therefore have had to pay late penalties added to your premiums—you can now apply to Social Security for a reduction in the amount of the penalty. You can apply for this reduction regardless of when you and your same-sex spouse were married or where you currently live.

For more information, see CMS’s guidance on the new rules

Note:  Your spouse’s employer may require you to sign up for Part B when you turn 65 if the employer has fewer than 20 employees—or, if you have Medicare through disability, fewer than 100 employees.  In these situations, always consult the employer about how its health insurance plan fits in with Medicare.

Next page: Applying for programs that lower Medicare costs. »

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