UnitedHealthcare is the largest health insurance company in the country – – and its “customer service” people are not aware of changes in Medicare rules that affect same-sex couples with employer coverage. I googled “medicare and same-sex marriage” to confirm what the Medicare rules are.
Rules for Medicare and same-sex marriage
I got a call from a woman who lives in Connecticut and works for General Dynamics, a very large company. This woman is having trouble with her employer health insurance coverage for her spouse, who is a woman. The spouse has been on the employer health insurance plan for many years and she turned 65 last year. The dependent spouse stayed on the employer health insurance and General Dynamics has been paying premiums for her coverage – – and now UnitedHealthcare is not paying her medical bills.
The customer service rep at UnitedHealthcare says the spouse who turned 65 is supposed to be enrolled in Medicare because the government does not recognize her marriage.
UPDATE: ON JUNE 26, 2015 the Supreme Court ruled that same-sex marriage must be recognized in every state, but some insurance companies may not know that federal rules had already changed vis-a-vis same-sex married couples.
I guess the folks at UnitedHealthcare have not gotten the memos about the United States v. Windsor Supreme Court Case from 2014. I found a memo on the Medicare.gov website (April 4, 2014) titled Important Information for Individuals in Same-Sex Marriages:
On June 26, 2013, in United States v. Windsor, the Supreme Court ruled that
Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional.
Medicare is no longer prevented by DOMA from recognizing same-sex marriages
for determining entitlement to, or eligibility for, Medicare. Social Security is now
processing some Medicare enrollments for same-sex spouses, including:
- Enrollments for free Medicare Part A (Hospital Insurance) for uninsured
spouses age 65 or older based on the work history of a current or former spouse
- Enrollments for people with End Stage Renal Disease (ESRD) based on the work
history of a current or former spouse
- Reductions in Part A premiums based on the work history of a current or former
- Requests for Special Enrollment Periods based on group health plan
coverage from current employment of a same-sex spouse
- Reductions in late-enrollment penalties based on group health plan coverage
from current employment of a same-sex spouse
turned 65 was required to move off of their same-sex spouse’s employer health insurance
and enroll in Medicare. Heterosexual couples were not required to move to Medicare at 65
because they could keep their spouse’s employer health insurance and delay enrollment into
Medicare Part B without penalty. This benefit did not apply to same-sex couples because
the federal government did not recognize same-sex marriages. All that changed in 2014,
when the Supreme Court ruled that the Defense of Marriage Act was unconstitutional.
I also confirmed the “new rules” at MedicareRights.org which always explains things
in very clear language:
In light of the Supreme Court’s ruling that parts of DOMA are not legal, there will be
changes to Medicare and Social Security rules for same-sex spouses. This means parts
of your Social Security and/or Medicare may change. These changes could include
- You may qualify for free Part A based on your spouse’s working history.
- You may qualify for Social Security Retirement benefits based on your spouse’s
- You may qualify for ESRD-Medicare based on your spouse’s working history.
- You may qualify to use your spouse’s group health plan coverage
as primary coverage to Medicare, even after you turn 65. This means
you may be able to delay Part B enrollment while your spouse is still
actively working and for up to 8 months after they stop working
- You may qualify for a reduction, or roll-back, of a late enrollment penalty you
already have if you were covered by insurance provided by your spouse’s current
employer at the time you delayed Part B.
- 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, you will only be eligible if you were married in
a state that performs same-sex marriages after that state legalized same-sex marriage
and you currently live in a state that performs same-sex marriages. For a list of states
that approve and recognize same-sex marriage, and the applicable dates, see this rule
from the Social Security Administration.
All legally married people, regardless of where you live, can:
- Delay Medicare Part B enrollment without penalty while you are
covered by insurance from your own or your spouse’s current
- Enroll in Medicare Part B at any time while covered by insurance from your
own or your spouse’s current work, and for 8 months after that coverage ends.
- Have premium penalties for late enrollment removed or rolled back if you
delayed enrollment into Part B because you were covered by insurance from
your spouse’s work before you enrolled in Medicare.
Updates to these rules and new instructions are still being released. Social Security
has grouped same-sex marriage related questions on SocialSecurity.gov, which
can be found here.Medicare.gov has a similar page which can be found here.