You may be eligible for premium-free Part A under your spouse’s work history. You may also be able to defer Part B and Part D without paying a penalty.

On June 26, 2015, the U.S. Supreme Court decided that same-sex couples have a constitutional right to marry in all 50 states and that all states must recognize their marriages.

The decision means, among other things, that married same-sex couples have access to the same federal benefits as different-sex couples, including Medicare spouse benefits.

If you’re 65 years old and your spouse has worked the required number of quarters, you can use their work history to qualify for premium-free Part A if:

  • You’re still married to that spouse, and your spouse qualifies for Social Security disability or retirement benefit. You must be married to that spouse for at least a year.
  • You’re divorced, and your former spouse qualifies for Social Security disability or retirement benefit. You must have been married to that spouse for at least 10 years.
  • Your spouse has died, and you were married at least 9 months before your spouse died. You cannot have remarried for this to apply.

If you’re under age 65, you can use your spouse’s work history to access premium-free Part A if:

You don’t need a work history to qualify for Part B.

You can defer enrolling in Part B if you’re covered under your spouse’s employer-sponsored health insurance plan.

Primary or secondary payer

When you’re deciding whether to enroll in Part B or rely on the health insurance plan available to you through your spouse’s job, you need to know whether Medicare is the primary or secondary payer.

If your spouse’s job employs 20 people or more, Medicare pays second. This means the private insurance company pays medical bills up to the policy limits before Medicare benefits apply.

If your spouse’s job employs fewer than 20 people, Medicare pays first. Some employer insurance plans may require you to enroll in Part B before they’ll offer you coverage.

Special enrollment period

You can only join Part B during specific enrollment periods.

Your first chance to enroll is during your initial enrollment period, which starts three months before your 65th birthday and ends three months after your 65th birthday.

If you don’t enroll in Part B during your initial enrollment period, you may have to pay a penalty if you enroll later.

If you’re covered under your spouse’s health insurance plan, however, you qualify for a special enrollment period. This is an extra opportunity to enroll in Medicare based on certain life changing events.

If you have health insurance through your spouse’s job, your special enrollment period begins the month you become eligible for Medicare. It ends 8 months after you lose coverage through your spouse’s job.

If you don’t enroll in Part B within those 8 months, you may have gaps in your coverage. You may also have to pay a penalty for as long as your Part B coverage lasts.

Are your Medicare premiums higher if you’re married?

Depending on how you filed your taxes for the previous year, the Social Security Administration may raise your Medicare monthly premiums based on a higher joint income.

This adjusted premium is known as the Medicare income-related monthly adjustment amount (IRMAA).

If you’re enrolled in your spouse’s job-based health insurance plan, you may be able to delay your enrollment in Part D (prescription drug coverage) without having to pay late enrollment penalties.

When your coverage under your spouse’s health insurance plan ends, you may be eligible for a special enrollment period.

If you need help paying Medicare costs, certain programs may be able to help. These programs base your eligibility on your household’s total income and resources.

The limits for a married couple are generally lower than if you add together the limits for each of you as an individual.

These programs include:

  • Extra Help: This federal program offers Part D prescription drug coverage at a significant cost saving.
  • Medicare savings programs: These state-operated programs help you pay premiums, deductibles, copays, and coinsurance amounts.
  • Medicaid: This healthcare program is funded by state and federal governments together but is run by states.

You can use your spouse’s work history to qualify for premium-free Part A if your own work history isn’t long enough to meet the 40-quarter threshold.

If you have insurance through your spouse’s employer-sponsored health insurance plan, you can delay your Part B enrollment until 8 months after that coverage ends.

Many government programs that help you pay Medicare expenses use your joint income to calculate your eligibility. This may benefit you, because the limit for married couples is often much lower than the sum of your two individual limits.