Skip Navigation

Important information for individuals in same-sex marriages

On June 26, 2013, in United States v. 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, including: 

  • Enrollments for free Medicare Part A (Hospital Insurance) for uninsured spouses age 65 or older based on the work history of a current or former spouse
  • Enrollments for people with End Stage Renal Disease (ESRD) based on the work history of a current or former spouse
  • Reductions in Part A premiums based on the work history of a current or former spouse
  • Requests for Special Enrollment Periods based on group health plan coverage from current employment of a same-sex spouse
  • Reductions in late-enrollment penalties based on group health plan coverage from current employment of a same-sex spouse
Note

Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.

You usually don't pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called "premium-free Part A."

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 depend 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. If you're at least 65 and 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. If you have ESRD and qualify for Medicare based on your own employment history, your marriage isn’t relevant to your Medicare eligibility.

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 now 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 now able to process some Medicare enrollments if you aren’t eligible for Medicare on your own and you need the work history of your spouse to be eligible to enroll. This includes enrollments for people with End Stage Renal Disease (ESRD) who need to use the work history of their same-sex spouse to be eligible for Medicare based on ESRD. 

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 or treating a non-marital legal relationship (such as a civil union or domestic partnership) as a 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 and treats non-marital legal relationships (such as a civil union or domestic partnership) as a marriage.

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 plan coverage based on the current employment of a same-sex spouse. If Social Security has held your request, it can now be processed.

Some applications are on hold while we finish all the policies affected by the Windsor ruling.  We ask for your continued patience as we work with Social Security and the Department of Justice to develop policies that are consistent with the Social Security Act and the Windsor ruling. If you think you might be eligible for Medicare based on the employment history of another person, we encourage you to apply right away for benefits.


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.

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 your 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 you live 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.

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 you 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.

You may have another chance 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. Social Security can approve a second Special Enrollment Period request for these people, even if their first Special Enrollment Period ended. To be eligible for this special opportunity, you must meet all the following:

  • 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 filed a second Special Enrollment Period request with Social Security no later than May 31, 2014.

There's 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 ended on March 31, 2014.

If you were eligible for this extended General Enrollment Period, Social Security would have notified you. The notification included a special enrollment form for you to complete and return to Social Security. To take advantage of this extended General Enrollment Period, you needed to submit your special enrollment form no later than May 31, 2014, and your coverage would have started July 1, 2014. Late enrollment penalties will apply for all enrollments made during the General Enrollment Period.

Learn more about the General Enrollment Period.

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. 

Note

The ability to request a Part A and Part B late-enrollment penalty reduction doesn't apply to Part D late enrollment penalties. Learn more about Part D late enrollment penalties.

In most cases, you can qualify for a Part A premium reduction if any of these conditions apply:

  • You have 30 or more QCs based on your own work history.
  • You’ve been married for at least 1 year to someone with 30 or more QCs.
  • Your deceased spouse had 30 or more QCs, and you were married for at least 1 year before the date of death.
  • Your divorced spouse had 30 or more QCs, and you were married for at least 10 years before the date the divorce became final.

To be eligible for a reduction based on the work history of a current, former, or deceased same-sex spouse same-sex spouse, you must also have been married in a state that permits same-sex marriage while such marriages were permitted.

If this applies to you, contact Social Security to file a request for a premium reduction.

We can process certain ESRD-based applications for Medicare that are based on the employment history of a same-sex spouse now.  You must meet all eligibility factors to get Medicare based on ESRD.  To be eligible based on the work history of a current or prior same-sex spouse, you must also meet these requirements:

  • You and your spouse (living or deceased) were married in a state that permits same-sex marriage.
  • You live in a state that recognizes same-sex marriage at the time you apply, or while the claim is pending final determination.
  • If you’re divorced, you must have been married for at least 10 years (alive or deceased).

Some ESRD-based applications for Medicare that are based on the employment history of another person may be held while we work with Social Security and the Department of Justice to develop policies that are consistent with the Social Security Act and the Windsor ruling to correctly process your enrollment in Medicare.  

For more information about how your marital status affects Social Security or Medicare 

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

  • Visit your local Social Security office.