What same-sex couples should know about Medicare

same-sex graphic

More gay couples than ever will have access to Medicare benefits, but certain rules apply




InvestmentNews.com, Jun 29, 2015 @ 1:16 pm

By Katy Votava

The Supreme Court decision last Friday that makes same-sex marriage legal throughout the United States comes two years to the day of another historic decision regarding same-sex marriage. On June 26, 2013, the Supreme Court ruled that the Defense of Marriage Act was unconstitutional in United States v. Windsor.

As a result of the DOMA decision, Medicare could no longer be denied to married same-sex couples with respect to entitlement to or eligibility. With the new decision from the high court, more same–sex couples will marry and more people will be eligible in different ways for Medicare benefits.

It is important to note that these benefits do not extend to domestic partners or civil unions, whether same-sex or not. In fact, the following summary of Medicare entitlement and benefits actually pertains to all married couples. Some may never have considered the possibility of being able to access Medicare through their spouse or being able to rely on their spouses’ employer-based coverage to defer their enrollment in certain parts of Medicare. Let’s review the basics.

Married couples can:

• Enroll in premium-free Medicare Part A, also known as hospital insurance, based on a current or former spouse’s work history and accumulation of Social Security credits.

• Enroll in Medicare Part B, also known as medical insurance, based on a current or former spouse’s work history.

• Enroll in Medicare A and B based on the work history of a current or former spouse for people with end stage renal disease or amyotrophic lateral sclerosis. A poignant note: The spouse of James Obergefell, the lead plaintiff in the newest Supreme Court case, succumbed to ALS.

• Request special enrollment periods to coincide with current employer-based group health care coverage of a spouse.

If the person is 65 or older, they may be able to decline Medicare Part B coverage if their spouse is covered under a group health plan based on their spouse’s current employment and be eligible to enroll during a SEP in the future. The result is that the person saves a great deal of money in the near term as Medicare Part B premiums range from $1,260 to $4,030 annually. In the longer term, they preserve their eligibility to enroll in Medicare Part B in the future during a SEP, meaning that they can start coverage without costly delays and lifelong penalties.

• If an individual already has Medicare Part B and marries a person with a qualifying employer health plan, they can disenroll or decline Medicare Part B. That process is completed by the beneficiary signing off to that effect on the back of the Medicare card and submitting it to Medicare. They will receive a new Medicare card indicating that the Medicare Part A is still in effect.

As the saying goes, “In sickness or in health.” Whether your clients are newlyweds or long-term spouses approaching their Medicare decisions for the first time, more of them than ever will have access to Medicare benefits and be able to manage sickness if it comes, as well as maintain their health along the way.

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