DOMA Increases Medicare Costs For Same-Sex Married Couples

Medicare costs more for same-sex married couples as a result of DOMA. 

In response to the Supreme Court reviewing the constitutionality of the Defense of Marriage Act (DOMA), news outlets are reporting that DOMA increases private and federal health care costs for same-sex couples. As a result of a DOMA — which prevents the federal government from recognizing same-sex marriages — these couples are not privvy to the same benefits offered to hetrosexual married couples in programs like MedicareMedicaid and Social Security. Politico recently reported, “The result is thousands of same-sex couples [are] facing more limited access to health insurance and steeper costs for coverage than their heterosexual counterparts.”

(Related: Elder Abuse Not Unique to James and Etta Jennings’ Overwhelming Story)

Fact or Fiction?

Fact. DOMA equates to limited access and higher costs when it comes to Medicare.

DOMA prohibits the federal government from acknowledging same-sex couples’ marriages. As a result, Medicare is more expensive for same-sex couples because it keeps  these couples from qualifying for spousal benefits. This impacts same-sex married couples’ Medicare eligibility and enrollment, and  can result in higher Medicare costs for these individuals.


To qualify for Medicare Part A (hospital insurance) without paying any monthly premium, a person must:

  • be 65 years or older;
  • be a legal resident of the United States for at least five years; and
  • have worked for at least ten years (40 work credits) in which Federal Insurance Contribution Act (FICA) taxes (consisting of both Social Security and Medicare taxes) were paid, or be married to someone who has met this requirement.

(Related: (Related: Medicaid Applicant Denied for Uncompensated Transfer of Assets))

Individuals who meet these criteria are exempt from paying monthly premiums for Part A because they or their spouse paid Medicare taxes while working. With that said, this provision does not apply to same-sex married couples because DOMA does not accept same-sex married couples as married. As a result, those in same-sex marriages are not eligible for Part A through their spouse and must meet all eligibility requirements individually, or pay a monthly premium. This premium was $441 in 2013 if the individual has less than 30 work credits, or $243 with 30 to 39 work credits.

Additionally, DOMA prohibits same-sex married couples who might be covered by their spouse’s health benefits from deferring enrollment in Medicare Part B (medical insurance), which helps pay for doctors, outpatient hospital care and other medical services. Currently,  Americans who turn 65 must enroll in Part B unless the individual is still working, or is married to a spouse who is still working, and is covered by their employer’s group health plan.

These individuals can defer Part B enrollment without risk of being penalized and are able to choose to keep their employer’s or spouse’s employer’s insurance instead. However, those in a same-sex marriage cannot claim exemption from Part B enrollment even if they are married to a spouse who is still working and who is covered by their employer’s insurance because the federal government does not consider them married.

(Related: Bloomfield Hills Elder Lawyer Advice: Create a Personalized Healthcare Directive)

Thus, DOMA hinders same-sex couples Medicare benefits because same-sex married couples cannot enjoy Medicare spousal benefits, which can end up costing same-sex married individuals more when it comes to both eligibility and enrollment.

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