Married couples’ joint incomes and work histories help determine how much they pay for Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. 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, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility, or other inpatient services. Medicare Part A is part of Original Medicare. is provided at no cost for eligible enrollees.
Same-sex marriages are viewed as legal unions by the federal government, which means Medicare recognizes them.
Married couples also may qualify for Special Enrollment PeriodsA Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs. Some Special Enrollment Periods can be up to 90 days. based on Qualifying Life Events like losing employer/spouse coverage or moving.
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 for your Part A premium. For 2021, 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: $259 per mo.
- Fewer than 7.5 years: $471 per mo.
Your Part B premiums
All part B premiums start at the same amount for every individual. In 2021, it’s $148.50 per month. 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 2021 are:
Annual income: Individual (up to $88,000) & Joint (up to $176,000)
- IRMAA: $0
- Part B premium: $148.50
Annual income: Individual ($88,000 to $111,000) & Joint ($176,000 to $222,000)
- IRMAA: $59.40
- Part B premium: $207.90
Annual income: Individual ($111,000 to $138,000) & Joint ($222,000 to $276,000)
- IRMAA: $148.50
- Part B premium: $297.00
Annual income: Individual ($138,000 to $165,000) & Joint ($276,000 to $330,000)
- IRMAA: $237.60
- Part B premium: $386.10
Annual income: Individual ($165,000 to $500,000) & Joint ($330,000 to $750,000)
- IRMAA: $326.70
- Part B premium: $475.20
Annual income: Individual ($500,000 and above) & Joint ($750,000 and above)
- IRMAA: $356.40
- Part B premium: $504.90
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 if:
- You or your spouse lose your job-based coverage
- You lose coverage because your spouse dies
- You move to a different area
- And more
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. The landmark ruling granted marriage equality to same-sex couples. This meant they were recognized as legal by the federal government, giving them Medicaid coverage, 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. That means you and your spouse can’t enroll in a family plan together. But marriage impacts each of your plans when it comes to cost and timing.
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 QLE.
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 down 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
- 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?
If you were married to your spouse for at least 10 years and they qualify for Medicare, you may be able to receive a $0 Part A premium. You must be unmarried and have a shorter work history than your former spouse to qualify.