Council on Aging Answers 2015 - 96

COUNCIL ON AGING - ORANGE COUNTY

INSURANCE

Defense of Marriage Act - Increased Access to
Key Medicare Benefits 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. As a result,
Social Security is no longer prevented by DOMA from
recognizing same-sex marriages for determining entitlement to, or eligibility for Medicare.
In June 2014, regulations were released that govern the
determination of entitlement /eligibility for Medicare.
Individuals can now apply for Medicare based on the
Medicare taxes paid by their same-sex spouse to get premium-free, Medicare 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, Medicare Part A
based on your own work history. You don't have to apply
based on your spouse's work history.
Social Security is now processing Medicare enrollments for same-sex spouses, including:
Medicare Part A (hospital insurance)
n Enrollment for premium free, Medicare Part A for
uninsured spouses age 65 or older based on the
work history of a current or former spouse.
n Enrollment for people with End Stage Renal Disease (ESRD) based on the work history of a current
or former spouse
n Reductions in Part A premiums based on the work
history of a current or former spouse
n Requests for Special Enrollment Periods based on
group health plan coverage from current employment of a same-sex spouse
n Reductions in late-enrollment penalties based on
group health plan coverage from current employment of a same-sex spouse
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 if 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 are disabled). You may be assessed
a late payment enrollment penalty if you have or had
coverage through your spouse's employment.
Same-sex spouses, who are working and are covered
under an employer health plan, can delay enrollment
96

Answers Guide 2015

into Medicare Part B. Once their employment ends, they
will have a Special Enrollment Period (SEP) opportunity
to enroll in Medicare Part B without a penalty.
In the past, this SEP was not available to same-sex
couples. Since it is available now, it can lead to significant
savings. The Medicare Part B late enrollment penalty
is 10% of the premium for every 12-month period that a
beneficiary was eligible to enroll, but didn't do so.
According to Karen Fletcher of California Health Advocates, Medicare Part B enrollment statutes are covered
under the "place of celebration rule," it does not matter
where the married couple resides, as long as they were
married in a state or foreign jurisdiction that recognizes
the marriage. Couples who already have a Part A and/or
B premium penalty can now request a reduction in penalty from Social Security.
For more information, you can contact The Health
Insurance Counseling and Advocacy Program (HICAP)
of the Council on Aging - Orange County regarding
Medicare enrollment issues. Call 800-434-0222 to ask
for assistance.
HICAP is a no-cost service to help you understand
and maximize your Medicare benefits. Funded in part
by the California Department of Aging, HICAP is the
most dependable source of unbiased, accurate and up-todate Medicare-related information.

COUNCIl ON AGING - ORANGe COUNTY IS A 501 (C)3 NONpROFIT CORpORATION. TO DISTRIbUTe ANSweRS FRee OF COST, we mUST Sell ADveRTISING SpACe. wHIle we AppReCIATe THe pAID lISTINGS IN ANSweRS, THeIR
Aging and Disability Resource Connection | 800-510-2020 | www.adrcoc.org
INClUSION does not imply a recommendation or endorsement of products or services by coaoc. AlwAYS be A vIGIlANT CONSUmeR. veRIFY INFORmATION AND SeeK ReFeReNCeS wHeRe AppROpRIATe.

Council on Aging Answers 2015

Table of Contents for the Digital Edition of Council on Aging Answers 2015