Marriage & Medicare: What You Need to Know
Key Takeaways
- Married couples’ joint incomes and work histories help determine how much they pay for Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. . Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare. is provided at no cost for eligible enrollees.
- Married couples also may qualify for Special Enrollment PeriodsA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. based on Qualifying Life EventsQualifying Life Events (QLE) are life changes that allow you to enroll in a new health insurance plan during a Special Enrollment Period. These include having or adopting a child, losing other coverage, marriage, a change of income and moving. like losing employer/spouse coverage or moving.
How Does Being Married Affect Medicare Costs?
There are no family plans on Original Medicare or when you switch to a Medicare Advantage plan offered by a private insurance carrier. Every individual has their own coverage and is responsible for their own costs.
However, being married means you and your spouse’s joint income and work histories will be considered in some circumstances. Usually, they’re used to determine the separate cost for each plan. Here’s how it works:
Your Part A premiums
You and your spouse’s monthly Part A premiums are based on how long you paid Medicare taxes while employed. If neither of you worked at least 10 years, you might have to pay a Part A premium. For 2025, if you or your spouse paid Medicare taxes for:
- At least 10 years: $0 per mo.
- Fewer than 10 years but more than 7.5: $285 per month.
- Fewer than 7.5 years: $518 per month.
Your Part B premiums
Part B premiums start at $185 per month in 2024. That monthly payment amount can increase depending on your income. This rate increase is called an Income-Related Monthly Adjustment Amount (IRMAA). The higher your income, the greater the IRMAA you will need to pay for your Part B premium.
The IRMAA rates for 2025 are:
Annual income: Individual (up to $106,000) & Joint (up to $212,000)
- IRMAA: $0
- Part B premium: $185
Annual income: Individual ($106,000 to $133,000) & Joint ($212,000 to $266,000)
- IRMAA: $74
- Part B premium: $259
Annual income: Individual ($133,000 to $167,000) & Joint ($266,000 to $334,000)
- IRMAA: $185
- Part B premium: $370
Annual income: Individual ($167,000 to $200,000) & Joint ($334,000 to $400,000)
- IRMAA: $295.90
- Part B premium: $480.90
Annual income: Individual ($200,000 to $500,000) & Joint ($400,000 to $750,000)
- IRMAA: $406.90
- Part B premium: $591.90
Annual income: Individual ($500,000 and above) & Joint ($750,000 and above)
- IRMAA: $443.90
- Part B premium: $628.90
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How Does Being Married Affect Medicare Enrollment?
Being married also may affect how you enroll in Medicare. While each beneficiary will enroll when they turn 65, in some instances, being married may grant you additional enrollment opportunities. These are known as Special Enrollment Periods and can apply in situations like:
- You or your spouse lose your job-based coverage.
- You lose coverage because your spouse dies.
- You move to a different area.
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Does Medicare Recognize Same-Sex Married Couples?
Yes. In 2013, the Supreme Court repealed a vital portion of the Defense of Marriage Act, clearing the way for same-sex married couples to enjoy the same protections as other Americans. That includes access to federal programs such as Medicaid, Children’s Health Insurance Program (CHIP), and Medicare.
Being in a marriage of any kind won’t affect which type of Medicare you enroll in — Original Medicare (Parts A and B) and Medicare Advantage only offer individual plans.
Do domestic partners qualify for the same Special Enrollment Periods as married couples?
No. While many group health plans recognize domestic partnerships, Medicare does not. This often comes into play when one partner loses their job-based coverage. If their partner is older than 65 and covered under the group plan, they’ll be subject to the Part B late enrollment penalty. For married couples, this is considered a qualifying life event.
Does being in a same-sex marriage impact the kind of coverage we get?
No, just as with marriage rights, all Americans are afforded the same medical rights when it comes to what their plan will cover. The Affordable Care Act (ACA) states that Medicare, along with all health insurance plans sold in the Health Insurance Marketplace, must provide the following services for all beneficiaries:
- Outpatient care
- Emergency services
- Hospitalization
- Maternity, pregnancy and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative and habilitative services and equipment
- Laboratory services
- Pediatric services like oral and vision care
- Preventive care
I’m divorced and my ex-spouse worked. Can I still qualify for no-cost Part A?
Sources
- H.R. 3396 (104th): Defense of Marriage Act. Govtrack.us
- Benefits For Your Family. SSA.gov.
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