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Ask Ms. Medicare

Marital Status and Medicare Eligibility

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

Medicare Benefits for Same-Sex Couples

Where do same-sex couples stand in relation to Medicare? — Corbis

Q: I’m in a same-sex marriage and will soon be 65. How does my marital status affect my eligibility for Medicare?

A: Until quite recently, same-sex couples who had been legally married under the laws of their state or country were excluded from many federal benefits granted to married couples of the opposite sex. That was because the 1996 Defense of Marriage Act (DOMA) specifically defined a "spouse" as a man or woman legally married to a person of the opposite sex.

But in June 2013, the U.S. Supreme Court struck down parts of DOMA as unconstitutional, and since then federal officials have been working to clarify the ruling's practical effect on thousands of federal benefits, including Medicare.

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Not all issues have yet been resolved. But so far, here's what is known about where married same-sex spouses stand in relation to Medicare.

Becoming eligible for Medicare

Anybody who has earned enough credits from paying payroll taxes at work — 40 credits, equivalent to about 10 years' work — is entitled to full Medicare benefits in their own right at age 65. This means not having to pay monthly premiums for Part A (hospital insurance). The rule applies to anyone who is 65 or older and a U.S. citizen or a legal resident (green card holder), regardless of marital status.

If you haven't earned the required credits, you can qualify for premium-free Part A on your spouse's work record, if she or he is at least age 62 and has at least 40 credits. In the case of same-sex couples, however, this right has not yet been fully clarified and currently depends on where you live.

As of this writing, it's clear that you can qualify for premium-free Part A benefits on your spouse's work record if you live:

  • In the same state as the one where you married.

  • In another state (or the District of Columbia) that permits same-sex marriage or recognizes the marriage laws of another state or foreign country. (Same-sex couples married abroad automatically come under the rules of the District of Columbia.)

  • Anywhere in the United States if you or your spouse works for the federal government or for the Department of Defense in a military or civilian job. (The federal government announced equality of benefits for all employees immediately after the Supreme Court decision.)

But if you live in a state that does not recognize same-sex marriage or the marriage laws of the state where you wed, the situation is far less clear. The Supreme Court ruling allows states to refuse to recognize same-sex marriages legally performed in other states. Also, the Social Security Administration (the federal agency that administers Medicare eligibility and enrollment) has always looked to the laws of the state where people live when they apply for benefits — not for where they were when they married. Officials from SSA and the Department of Justice are still working on these issues. Meanwhile, if you’re in this situation and in your initial enrollment period for Medicare, go ahead and apply to Social Security for premium-free Part A benefits based on your spouse’s work record—so that if the rules change, your application is already in the system and can be processed faster.  For up-to-date information, call Social Security at 800-772-1213 (TTY:  1-800-325-0778) or go to its website and type "DOMA" into its search engine.

Note: If you cannot qualify for premium-free Part A benefits on your own or your spouse's work record, you can choose to buy these benefits by paying monthly premiums for them (in 2014, $426 a month for people with fewer than 30 credits; $234 a month for those with 30 to 39 credits). You qualify for Part B benefits (doctor visits, outpatient care, medical equipment) and Part D (prescription drug coverage) by paying the same premiums as anybody else. These benefits don't depend on work credits.

Next page: Delaying Part B enrollment. »

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