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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

En español

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

A: Since the Supreme Court’s historic ruling on June 26, 2015 made same-sex marriage legal throughout the United States, you now have the same rights under Medicare as any other married couple. 

This is a complete reversal of the laws that were in place only a short time ago. Until June 2013, the federal Defense of Marriage Act (DOMA) defined the word “spouse” as a man or woman who was legally married to a person of the opposite sex, thus excluding same-sex spouses from thousands of federal benefits. In that month, the Supreme Court struck down parts of DOMA as unconstitutional. The practical effect of this ruling was that same-sex spouses became entitled to federal benefits if they lived in a state that recognized same-sex marriage — but not if they lived in states that didn’t provide such recognition.

The court’s 2015 ruling, however, puts all married couples on the same legal footing in claiming benefits, anywhere in the United States and its territories. So, to be clear, if you’re in a same-sex marriage, here’s a quick primer of your rights under Medicare:

Becoming eligible for Medicare on your spouse's work record

At age 65 and older, you can get Medicare Part A benefits (mainly coverage for hospital stays) without paying monthly premiums for them if you’ve earned 40 work credits by paying payroll taxes on your earnings (usually equivalent to about 10 years of work.) If you haven’t earned 40 credits, you can qualify for premium-free Part A on the work record of your spouse, if he or she has achieved the required credits and is age 62 or older.

If neither of you has 40 credits, you can still receive Part A benefits by paying monthly premiums. No work credits are necessary to qualify for Part B (which covers doctors’ services, outpatient care and medical equipment) or for Part D (prescription drug coverage) — you just pay the required premiums, same as anybody else, provided that you’re either a U.S. citizen or a permanent legal resident (green card holder) who has lived in the United States for at least five years. (The five-year residency is waived if you’re a green card holder who has been married for at least one year to a U.S. citizen or another legal resident who is at least age 62 and has 40 work credits.)

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

Under Medicare rules, you can delay signing up for Part B beyond age 65 (and avoid paying its premiums) for as long as you’re covered under a group health plan provided by an employer for whom you or your spouse is still actively working — and provided that the employer has 20 or more employees. When that employment comes to an end, you’re entitled to a special enrollment period of up to eight months to sign up for Part B without incurring late penalties.

If you were previously denied this right on the basis that your spouse was the same sex as you, and as a result incurred late penalties that were permanently added to your Part B premiums, be aware that you can apply to Social Security (at 800-772-1213) to have the late penalties reduced.

Paying higher-income Part B and Part D premiums

If your marriage is new, or if until now you’ve lived in a state that didn’t recognize your same-sex marriage, be aware that from now on your Part B and Part D premiums will be assessed on the joint income of you and your spouse and not just you alone.

To be liable for surcharges, the modified adjusted gross income (MAGI) declared on your latest tax return must be at least $85,000 if you’re single or married but filing separately; or $170,000 if you’re a married couple filing jointly. These dollar thresholds are the same for both Part B and Part D, but the surcharges you actually pay are different for each program and vary according to your income.

Most people with Medicare don’t pay these higher premiums — which actually represent a means test designed to reduce the amount of government subsidies for wealthier people. But a relatively high salary from your work and/or your spouse’s, or a sudden income boost (for example, from the sale of a house), could easily put you into a higher-income category.

For more information, see the Social Security Administration document “Medicare Premiums: Rules for Higher-Income Beneficiaries” (pdf).

Applying for programs that lower Medicare costs

Several programs can reduce the costs for Medicare beneficiaries whose incomes and savings are under a certain level. These include:

  • Extra Help — a federal program that provides lower-cost Part D prescription drug coverage
  • Medicare Savings Programs — state-run programs under which the state pays Part B premiums and maybe other expenses (deductibles, copays and Part A premiums) according to income
  • Medicaid — the state-run safety net for health care that pays virtually all the medical costs of people who qualify

Your eligibility for these programs is based on the joint income and savings of you and your spouse — even if you’re the only one applying for assistance — just as it is for any married couple. Usually the income limits for a married couple are significantly lower than those for two single people.

Note: The information above applies to same-sex couples who have married legally in the United States or in a foreign country. It doesn’t apply to same-sex (or opposite-sex) couples who live together without being married.

Patricia Barry writes the AARP Ask Ms. Medicare column and is the author of Medicare for Dummies (Wiley/AARP, October 2013).

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