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For more information on a case,
contact Carisa Cunningham at 617-426-1350, or contact by .(JavaScript must be enabled to view this email address)

Medicare Spousal Protections


Medicare claims for surviving same-sex spouses who live in marriage equality states are now being processed.

If a same-sex spouse has a Medicare Advantage plan, then that spouse must have access to equal coverage when it comes to care in a nursing home where the other spouse lives.

Medicare has issued guidance for same-sex couples including:

  • the ability to obtain Medicare Part A premium free based on your spouse's work history
  • no Medicare Part B penalty if you are enrolled on your spouse's employer's health plan after 6/26/13--if you have been charged a penalty you should request that it be eliminated
  • if you think that you are eligible for a special enrollment period apply as soon as possible
  • if your application is on hold, you may be able to get reimbursed for some costs incurred while you should have been covered

SSA is now able to process Special Enrollment Period (SEP) requests for individuals with Group Health Plan (GHP) or Large Group Health Plan (LGHP)coverage based on the current employment of a same-sex spouse. The policy establishes eligibility for the SEP and the effective date of filing.  This applies to same-sex married couples reagardless of where the couple resides 

As a result of the Windsor decision, SSA is now able to process premium surcharge rollback request actions for individuals who enrolled in the General Enrollment Period, but had Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage based on current employment of a same-sex spouse. "The gender of the married individuals, domicile and date of marriage are not factors in determining eligibility for the premium surcharge rollback."