As of June 26, 2015, a U.S. Supreme Court ruling meant that Medicare could update rules and policies for married same-sex couples.
On this date, same-sex couples received the constitutional right to marry throughout the United States, and these marriages must be legally recognized.
The decision means that all married couples can access the same federal benefits, including Medicare spousal benefits.
This article explores the Supreme Court ruling and how legislation has changed for same-sex couples. It then looks at Medicare coverage rules and how someone can add their spouse to their plan. Finally, it explains the credit system and additional support that people can find.
The legislation changed the rules of Medicare and Social Security for same-sex spouses. It meant that those in a same-sex marriage could now qualify for:
- Medicare when they received a diagnosis of end stage renal disease
- premium-free Medicare Part A
- Social Security retirement benefits
The legislation also meant that a person could delay enrolling in Part B without paying the penalty if their spouse’s employer insurance previously covered them.
Individual states handled the legislation differently. A couple may find the date and location of their marriage affects their Medicare coverage options.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
In June 2015, the U.S. Supreme Court voted 5 to 4 in favor of recognizing same-sex marriages.
They declared that the right to marry is fundamental and that couples of the same sex should not forego that right and liberty under the 14th Amendment.
The ruling legitimized same-sex marriages in all U.S. states.
This new ruling added to the Supreme Court’s 2013 ruling that struck down the federal Defense of Marriage Act and required the government provide equal rights to both same-sex and opposite-sex couples.
Different parts of Medicare have distinct coverage rules.
Medicare Part A
Spouses may now qualify for premium-free Medicare Part A hospital coverage, regardless of how many work credits they have and how long they have worked.
Premium-free Part A requires 40 work credits or more. Individuals in same-sex marriages can use their spouse’s work credits to qualify. The requirements for qualification are listed below:
- An individual is married to their spouse and has been for at least 1 year. The spouse must qualify for Social Security disability or retirement benefits.
- A person is divorced from their spouse, but they were married for at least 10 years. Their former spouse must qualify for Social Security disability or retirement benefits.
- A person is widowed, is now single, and the couple was married for at least 9 months before their spouse died.
Individuals may also use their spouse’s work credits for premium-free Medicare Part A if:
- their spouse has worked 40 quarters
- they are under 65 years old
- they have end stage renal disease and they are receiving kidney dialysis or have had, or will be having, a kidney transplant
Medicare Part B
Individuals must pay a premium for their Part B coverage, regardless of their spouse’s status.
For married couples, the Part B premiums depend on joint income. Most people pay the standard premium, which in 2025 is $185 each month. The premium increases in line with income.
Individuals may delay their Medicare Part B enrollment if their spouse’s employee health insurance plan covers them. Alternatively, once they turn 65 years old, a person can enroll in Part B themselves.
If a person’s employment status changes and they no longer have employer insurance, a spouse could qualify for a Part B Special Enrollment Period (SEP) and avoid late enrollment penalties.
A person can only join Part B during specific enrollment periods. However, they may qualify for a SEP if their spouse’s employment coverage changes.
The SEP lasts for 8 months. If a person does not enroll in Part B during the 8 months, they may have a gap in coverage and need to pay a permanent penalty on their Part B monthly premium.
Medicare provides healthcare plans for individuals only. There are no couple or family plans.
The benefits available for a person’s spouse apply to Medicare Part A only. An individual must be at least 62 years old when they receive SSA retirement benefits and have the required work credits for their spouse to receive premium-free Part A when they turn 65 years old.
If a person is not yet 62 years old, their partner may qualify for Part A at age 65 but with a monthly premium.
People can use the Medicare online eligibility calculator to determine if they meet the specific requirements.
Individuals can apply for their spouses Medicare benefits by:
- applying online, providing they are within 3 months of turning 62 years or older
- calling the Social Security Administration at 800-772-1213
- visiting their local Social Security office
Individuals may use their spouse’s employee insurance as primary coverage, with Medicare acting as a secondary insurer and providing coverage where the primary insurer may not.
If a spouse’s employer has fewer than 20 employees, Medicare is the primary payer. If there are more than 20 employees, Medicare will be the secondary payer.
Medicare uses a credits system to determine who qualifies for zero cost Medicare premiums. People earn these credits through their work.
To qualify for premium-free Medicare Part A, a person needs 40 credits. A person earns one credit for each quarterly period of work.
Typically, it takes 10 years of employment and paying Federal Insurance Contributions Act (FICA) payroll taxes to earn enough work credits.
Any married couple may qualify for premium-free Medicare based on their spouse’s credits if they do not have enough credits of their own.
There have been some recent changes to taxes due to the COVID-19 pandemic. People can check for updates on the IRS website.
Resources are available for LGBTQIA+ families who have questions or need additional support:
- The Department of Health and Human Services (HHS) has many resources, including updated training on inclusivity.
- Lambda Legal provides help with the legalities of Medicare policies and rules.
- The National Center for Transgender Equality helps transgender people access information about Medicare.
- The National Resource Center on LGBTQ+ Aging helps people access healthcare coverage, including Medicare.
LGBTQIA+ resources
To discover more evidence-based health information and resources for LGBTQIA+ individuals, visit our dedicated hub.
In 2015, the U.S. Supreme Court voted to permit same-sex couples across all 50 states to have the same rights as opposite-sex couples. This includes Medicare spousal benefits.
Individuals can use their spouse’s work credits to qualify for premium-free Medicare Part A if they have not earned enough credits of their own.
If a person has insurance coverage through their spouse’s employment, they can delay enrolling in Medicare Part B until 8 months after that coverage ends.
Many resources are available to help LGBTQIA+ couples navigate Medicare’s rules.