Medicare’s secondary payer rules generally let someone maintain employer-sponsored coverage after they’ve obtained Medicare eligibility. They don’t have to join Medicare Part B (covering certain doctors’ services, outpatient care, medical supplies and preventive services) and pay its monthly premium as long as they maintain that workplace insurance as their primary coverage and Medicare Part A (covering inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care) as their secondary coverage.
The law also protects people in this situation who later transition to Medicare Part B when they lose that employer-sponsored coverage: They don’t have to pay a late enrollment penalty, as would someone who simply waited to obtain Part B coverage until they got sick.
But Stark, D-Fremont, said constituent Joseph Goleman of Newark was told he would have to pay that late-enrollment penalty because he disclosed that he was in a same-sex marriage.
“The practical effect of my legislation is to provide people over age 65 in same-sex marriages the choice to remain on their spouse’s employer health coverage as their primary insurance, without facing significant financial penalties from Medicare in the future,” he said. “Regardless of one’s position on same-sex marriage, this small change in law makes financial sense for Medicare and will ensure consistent treatment of people regardless of their age.”
Current law has different definitions for family depending on whether one becoming eligible for Medicare through disability or through age. The definition is “family member” for people with disabilities includes legally-recognized same-sex marriages, but for those turning 65, the term is “spouse” – and the federal Defense of Marriage Act prohibits that term from including state-recognized same-sex marriages.
“Joseph knew what happened to him when he visited the local Social Security office didn’t feel right. Thankfully, he immediately reached out to my office and we were able get him the benefits he was due,” Stark said in a news release. “The confusion in current law is likely denying eligible beneficiaries the benefits they are due today – as it would have Mr. Goleman if he’d not reached out to me.”
Stark is the ranking Democrat on the Ways and Means Health Subcommittee that oversees Medicare.