In light of the Supreme Court’s rulings that invalidated the Defense of Marriage Act in 2013 and legitimized same-sex marriage in all states, there were changes to Medicare and Social Security rules for same-sex spouses. You may now qualify for the following based on your same-sex spouse’s work history:

  • Premium-free Part A
  • Social Security Retirement benefits
  • ESRD Medicare


  • You can delay Medicare Part B enrollment without penalty while you are covered by insurance based on your spouse’s current work (job-based insurance).
  • You may be able to use your spouse’s job-based insurance as primary coverage to Medicare, even after you become eligible for Medicare.
  • You may be eligible for a Part B Special Enrollment Period (SEP) if you are or were covered by your spouse’s job-based insurance.
  • There may be changes to your Part B premiums.
  • There may be changes to your Part D premiums.
  • There may be changes to your eligibility for Extra Help.

For some of the benefits listed above, the date and location of your marriage may matter. For a list of when states began approving and recognizing same-sex marriage, see this chart from the Social Security Administration. Check for general information about Medicare rules related to same-sex marriages.

Also, for more information on how same-sex marriage can affect benefits for older Americans, please visit the information and resources page on the Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) website.

Finally, if you need assistance understanding how your Medicare and/or retirement benefits are affected, please contact the Social Security Administration (800-772-1213). Remember to ask for the name of the representative you speak to and get all answers in writing before making any changes to your coverage.

Return to: Medicare In-depth

This content was created and copyrighted by the Medicare Rights Center ©2021. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from and may not be distributed, modified or edited without Medicare Rights’ consent. takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a Licensed Sales Agent.