Important information for individuals in same-sex marriages

On June 26, 2013, in United States vs. Windsor, the Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional. Medicare is no longer prevented by DOMA from recognizing same-sex marriages for determining entitlement to, or eligibility for, Medicare. Social Security is now processing some Medicare enrollments for same-sex spouses, as well as requests for Special Enrollment Periods and requests for reductions in late-enrollment penalties. If you’re in, or are a surviving spouse of, a same-sex marriage, we encourage you to apply for Medicare if you think you might be eligible.

In most cases, eligibility for Medicare is dependent on eligibility for a benefit from Social Security, including retirement and Social Security Disability Insurance (SSDI) benefits. Learn more about Medicare eligibility.

Medicare Part B (Medical Insurance) is available for a premium if you’re eligible. For both Part A and Part B, your enrollment rights, including whether you have a Special Enrollment Period or must use the General Enrollment Period, may be dependent on whether you’re covered through the employer-sponsored coverage of a spouse (or other family member if you’re disabled). Whether you have or had coverage through your spouse’s employment can also determine whether you pay a late-enrollment penalty.

As of June 26, 2013, you can apply for Medicare based on the Medicare taxes paid by your same-sex spouse to get premium-free Part A, as explained below. If you worked at least 10 years in Medicare-covered employment, you’re eligible for premium-free Part A based on your own work history, and you don’t have to apply based on your spouse’s work history to get Medicare.

Learn more about when and how you can enroll in Medicare.

Which Medicare enrollments are being processed now?

If you’re in an eligible enrollment period, Social Security can process any enrollment request where you meet the eligibility for premium-free Part A based on your own employment history and contributions to Social Security, regardless of your marital status.

Also, if you’re in an eligible enrollment period, Social Security is able to process some Medicare enrollments if you aren’t eligible for Medicare on your own and need the work history of your spouse to be eligible to enroll.

When the work history of your same-sex spouse is needed for you to be eligible for premium-free Part A, Social Security will use the same rules for recognizing your marriage when determining eligibility for Medicare as it uses for determining eligibility for Social Security benefits. Learn more about when and under what circumstances Social Security recognizes same-sex marriages.

The rules for recognizing a marriage for purposes of Medicare Special Enrollment Periods aren’t the same as the rules for determining eligibility for Social Security benefits and premium-free Part A. The date of the marriage and where you and your same-sex spouse live aren’t considered for Special Enrollment Period eligibility. For this reason, Social Security is now able to process Special Enrollment Period requests for people with group health plan or large group health plancoverage based on the current employment of a same-sex spouse. If Social Security has held your request, it can now be processed.

I applied for Medicare and was told that my enrollment request is on hold. When will my request be processed?

If you think you may be eligible for Medicare, we encourage you to apply now to protect against the loss of any potential benefits. Your enrollment will be processed as soon as additional policies are finalized.

My Medicare enrollment request has been placed on hold, and my private coverage has ended, so I now don’t have any coverage. What can I do?

While your request is on hold, you’ll need to pay your medical bills out-of-pocket or have other coverage to lower your costs. Once additional policies are finalized, your request will be processed. If your request for Medicare enrollment is approved, you or your health care provider can submit Medicare claims for payment to help cover any costs after the date your Medicare coverage starts. Be sure to keep your receipts.

Will my same-sex marriage be relevant for any Special Enrollment Period or a reduction in my late-enrollment penalty?

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period. If you’re covered under a group health plan based on current employment or covered under a large group health plan based on you or a family member’s current employment, you may have a Special Enrollment Period to sign up for Part A and/or Part B. You’re eligible for the Special Enrollment Period any time as long as you or your spouse (or other family member if you’re disabled) is working, and you’re covered by the employer or union based group health plan from that work. You also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan coverage based on current employment ends, whichever happens first.

The rules for recognizing a marriage for purposes of these Special Enrollment Periods aren’t the same as the rules for determining eligibility for Social Security benefits. The date of the marriage and where the person lives aren’t considered for Special Enrollment Periods.  For this reason, Social Security is now able to process Special Enrollment Period requests that were submitted any time after May 31, 2013 for people with group health plan or large group health plan coverage based on current employment. Also, there may be other relief available for people who had a Special Enrollment Period request denied in the past because of their same-sex marriage, as explained below.

Because you have to enroll in Medicare during this 8-month period to use the Special Enrollment Period and not get a late-enrollment penalty, we encourage you to apply during your Special Enrollment Period to protect against the loss of any potential benefits. Once your request is processed, if approved, your coverage will start based on the date Social Security got your request. If you already requested a Special Enrollment Period and Social Security is holding your request, it can now be processed. Your coverage will start on the date Social Security got the Special Enrollment Period request.

If you don’t enroll in Part A or Part B during your Initial Enrollment Period or during a Special Enrollment Period, you may be able to enroll in Medicare during the General Enrollment Period, and you may have to pay a late-enrollment penalty for as long as you have Part A or Part B. 

Learn more about the Part A and Part B late-enrollment penalties.    

I requested a Special Enrollment Period based on my domestic partner’s group health plan coverage. Am I eligible to enroll without a penalty?

If you’re 65 or older, you may be eligible for a Special Enrollment Period if you’re covered under a group health plan based on your or your spouse’s current employment. Individuals in civil unions or domestic (or life) partnerships aren’t considered spouses for these purposes.

If you’re under 65 and disabled, you may be eligible for a Special Enrollment Period if you’re covered under a large group health plan based on your, your spouse’s, or your family member’s current employment.  A family member includes domestic partner, so a Special Enrollment Period is available if you’re under 65 and disabled as long as you have large group health plan coverage through your partner’s current employer.

I previously requested a Special Enrollment Period that was denied because of my same-sex marriage. Can I try to apply again?

CMS is providing another opportunity to request a Special Enrollment Period. This opportunity is only for people whose previous Special Enrollment Period requests were denied before the Windsor decision solely because their same-sex marriage couldn’t be recognized by the federal government. This opportunity will permit Social Security to approve a second Special Enrollment Period request for these people, even if their first Special Enrollment Period is over. To be eligible for this special opportunity, you must meet all the following criteria:

• Your 8-month Special Enrollment Period had to start after October 2012.
• Your 8-month Special Enrollment Period had to end before May 2014.
• You’ve met all eligibility criteria for the Special Enrollment Period.
• Your first Special Enrollment Period request was denied solely because of the previous prohibition on same-sex marriages required by the Defense of Marriage Act (DOMA).
• You file a second Special Enrollment Period request with Social Security no later than May 31, 2014.

I requested a Special Enrollment Period and it was held by Social Security. Now, it was denied for a reason not related to my same-sex marriage. Can I still enroll?

CMS is also providing an extended General Enrollment Period for some people whose Special Enrollment Period requests were filed and held while the policy and procedures were being developed, and then denied for a reason not related to a same-sex marriage. For example, if the denial is because you didn’t have group health plan coverage for the required months, or you have a domestic partnership and not a marriage. This extended General Enrollment Period will permit Social Security to accept a late application for the General Enrollment Period that otherwise ended on March 31, 2014.

If you’re eligible for this extended General Enrollment Period, Social Security will notify you. The notification will include a special enrollment form for you to complete and return to Social Security. To take advantage of this extended General Enrollment Period, you must submit your special enrollment form no later than May 31, 2014, and your coverage will start July 1, 2014. Late-enrollment penalties will apply for all enrollments made during the General Enrollment Period.

Learn more about the General Enrollment Period.

I enrolled during the General Enrollment Period even though I had coverage through my same-sex spouse’s active employment, and now I’m paying a late-enrollment penalty. Can I ask for a reduction in my penalty amount?

Yes. We’re now able to process requests for reductions in Part A and Part B late-enrollment penalties for people who enrolled during the General Enrollment Period, but had group health plan coverage (or large group health plan coverage if you’re disabled) based on the current employment of a same-sex spouse (or other family member if you’re disabled). These requests can be processed regardless of when the marriage occurred or where you and your same-sex spouse live. If this applies to you, we encourage you to file a request for a premium reduction by contacting Social Security. See below for some different ways to contact Social Security.