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New Medicare Fact Sheets for LGBTQ People

Ever since the Supreme Court first overturned the federal Defense of Marriage Act in 2013 and then, in 2015, making same-sex marriage legal in every state, there has been a flood of changes in how government programs address the needs of LGBT individuals. For people who qualify for Medicare, there are many important changes:

  • Married same sex couples now have coverage for Medicare and Medicaid under the same rules as opposite-sex married couples.
  • Transgender individuals have protection from discriminatory treatment in health care.

What are the practical implications of these changes for LGBT people with Medicare?  Three new fact sheets—produced in partnership with SAGE (Services & Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders), the SHIP National Network (State Health Insurance Assistance Programs), and Administration for Community Living (ACL)—can help consumers learn how these changes may affect them.

The first fact sheet looks at marriage in terms of Medicare and Medicaid health benefits. It explains that marriage can bring significant savings for individuals who do not themselves have a long enough work history to qualify for premium-free Medicare hospital coverage. The right to rely on a spouse’s work history can save individuals more than $400/month.

For programs designed to help people with low incomes, such as the Medicare Part D Low-Income Subsidy, the Medicare Savings Programs and state Medicaid programs, the impact of marriage varies depending on how income and assets are divided between the couple. In most—but not all—cases, marriage may make it harder to qualify for benefits. One reason is that, for most programs, the combined limits for income for a couple tend to be only about one-and-a-half times the limit for an individual. Low income individuals need to do the math. It takes a careful review of their own situation for couples to understand what they will gain or lose by deciding to take a walk down the aisle.

The second fact sheet looks at recent changes affecting transgender individuals. In 2013, the Medicare program lifted a decades-long absolute prohibition on coverage of any gender reassignment surgery. Though an important first step, this move alone did not make it easy for individuals to get coverage for needed procedures. Because Medicare Advantage plans and the Medicare agency itself have limited experience with transgender surgeries, there have been a lot of bumps in the road for those seeking coverage. More clarity and smoother implementation are expected as the Medicare program develops experience in this new coverage area. Another important milestone for transgender individuals comes with new health care regulations that explicitly state that sex discrimination prohibitions include discrimination based on gender identity.

The third fact sheet provides a list of resources to use to track ongoing developments in Medicare programs affecting LGBT individuals.

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