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Original Medicare Enrollment

Same-sex marriage and Medicare

Legal changes impact Medicare and Social Security benefits for same-sex spouses. Learn what rules apply.

Last Updated: marzo 31, 2025

In light of the Supreme Court’s rulings that invalidated the Defense of Marriage Act in 2013 and legitimized same-sex marriage in all states, there were changes to Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage).  and Social Security rules for same-sex spouses. You may now qualify for the following based on your same-sex spouse’s work history:

  • Premium-free Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care.
  • Social Security Retirement benefits
  • ESRD Medicare

Additionally:

  • You can delay Medicare Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. enrollment without penalty while you are covered by insurance based on your spouse’s current work (job-based insurance).
  • You may be able to use your spouse’s job-based insurance as primary coverage to Medicare, even after you become eligible for Medicare.
  • You may be eligible for a Part B Special Enrollment Period (SEP) if you are or were covered by your spouse’s job-based insurance.
  • There may be changes to your Part B premiums.
  • There may be changes to your Part D premiums.
  • There may be changes to your eligibility for Extra Help.

For some of the benefits listed above, the date and location of your marriage may matter. For a list of when states began approving and recognizing same-sex marriage, see this chart from the Social Security Administration. Check www.ssa.gov/people/same-sexcouples for general information about Medicare rules related to same-sex marriages.

For more information on how same-sex marriage can affect benefits for older Americans, please visit the information and resources page on the Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) website.

Finally, if you need assistance understanding how your Medicare and/or retirement benefits are affected, please contact the Social Security Administration (800-772-1213). Remember to ask for the name of the representative you speak to and get all answers in writing before making any changes to your coverage.

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