| Thu, May 01, 2014 @ 09:00 AM

Medicare Coverage for Married Same-Sex Couples

Posted by Medicare Made Clear

medicare eligibilityIn April of this year, the rules about who’s eligible for Medicare went through an historic change. Let’s take a look at what happened.


The Defense of Marriage Act, or “DOMA” for short, was passed in September of 1996. Working with other laws, it barred same-sex married couples from being recognized as legal spouses for purposes of federal laws. While individual states could recognize same-sex marriages, at the national (federal) level, same-sex marriages couldn’t be considered valid. This meant that same-sex married couples could not receive federal marriage benefits, including the ability to qualify for Medicare through one’s spouse.

Recent Developments

However, in the United States v. Windsor trial in June of 2013, the Supreme Court ruled that Section 3 of DOMA is unconstitutional. The effects of this ruling have been widespread, and in April, they reached Medicare.

The Social Security Administration (SSA) is the federal agency that determines eligibility for Medicare. The SSA recently announced that it is now processing Medicare enrollments for same-sex spouses. (It’s also updating its policies to allow members of same-sex marriages to automatically collect social security benefits through their spouses.)

The Centers for Medicare & Medicaid Services, or CMS, followed up soon afterwards to encourage same-sex married couples to apply for Medicare benefits for which they may qualify through their spouse. Kathleen Sebelius, Secretary of Health and Human Services at that time, said, “Today’s announcement helps to clarify the effects of the Supreme Court’s decision and to ensure that all married couples are treated equally under the law. We are working together with SSA to process these requests in a timely manner to ensure all beneficiaries, regardless of sexual orientation, are treated fairly under the law.”

Why It’s Important

The significance of this change in Medicare eligibility guidelines can be widespread for same-sex couples.

  • U.S. same-sex couples are now protected with regards to their Medicare benefits (among other federal marriage benefits), regardless of the laws of the state in which they choose to live. For example, a same-sex couple married in New York but living in Florida is eligible to seek benefits as a couple, even though Florida does not recognize their marriage (as of today’s date).
  • There are some federal marriage benefits that could be extended to the surviving same-sex spouse of a partner who has died. This would include not only the possibility of qualifying for Medicare Part A without a premium, but also benefits such as Social Security death benefits granted to surviving spouses.
  • It appears that couples in domestic partnerships and civil unions will gain access to some, but not all of these benefits as well.
  • CMS is actively encouraging same-sex couples to apply for Medicare benefits, especially those people whose previous applications may have been denied because of DOMA. Certain people may be eligible for a Special Enrollment Period that extends the time during which they can enroll in a Medicare plan. Some Medicare beneficiaries may also be eligible for reductions of late-enrollment penalties for Medicare Part A and Part B, if that penalty was incurred due to the employment of a same-sex spouse.

How this policy change affects individual in same-sex marriages (or who are the surviving spouse of a same-sex marriage) may depend on individual circumstances. If you’d like to learn more about your specific situation, the best thing is to contact Social Security. You can do so online, or by calling 1-800-772-1213 (TTY: 1-800-325-0778).

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


Medicare.gov: “Important information for individuals in same-sex marriages,” on the U.S. government’s official website for Medicare.

Social Security: “Important Information for Same-Sex Couples” on the U.S. government’s official website for Social Security.

Medicare & You: The U.S. government’s official Medicare handbook, available online.

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