Understanding Medicare Rights for Same-Sex Married Couples
This article explains how Medicare applies to same-sex married couples following the landmark Supreme Court ruling. It covers eligibility criteria, the impact of marriage on benefits, enrollment options, premium considerations, and assistance programs, ensuring equal access to healthcare benefits for all married couples regardless of sexual orientation.
Historically, same-sex married couples faced significant challenges due to discriminatory policies. However, after the US Supreme Court's ruling on June 26, 2015, marriage equality became a constitutional right nationwide, ensuring recognition across all states. Consequently, same-sex couples are entitled to the same government benefits as opposite-sex couples, including Medicare, Medicaid, and Social Security. This landmark decision also safeguards against discrimination by insurance providers based on marital status.
Insurance companies must treat same-sex married couples equally if their marriage was legally recognized in a jurisdiction, regardless of state or location. Both partners must meet Medicare eligibility criteria independently, as coverage isn’t automatically extended through spousal employment or coverage plans.
For same-sex couples, the marriage status can influence certain Medicare aspects. Here are key points to consider:
Eligibility through Spouse’s Work Record – When reaching age 65, you qualify for Medicare Part A if you have earned 40 work credits—about ten years of work—by paying taxes on your earnings. If not, you can still qualify without credits by paying premiums, or through your spouse’s work credits if they have enough. Medicare Part B and Part D eligibility require only US citizenship and a five-year residency, regardless of work credits.
Postponing Medicare Part B Enrollment – If your spouse’s employer provides coverage, you might delay Part B enrollment to avoid unnecessary premiums. You can sign up later during the eight-month Special Enrollment Period following employment termination or coverage end to avoid penalties. If marriage-related denial caused penalties previously, you can request Social Security to reduce them.
Premiums Based on Household Income – If you're newly married or living in a state resistant to same-sex marriage, your Part B and Part D premiums may be calculated based on your joint income, potentially resulting in higher costs.
Medicare Assistance Programs – Low-income couples may qualify for programs like Extra Help (which reduces prescription drug costs), Medicare Savings Program (which covers Part B premiums and other expenses), and Medicaid (which covers comprehensive healthcare costs for eligible individuals).
