TN 8 (05-14)
GN 00210.706 Same-Sex Marriage – HI Premium Reduction for Aged and Disabled Individuals
Some aged and disabled individuals who are not fully insured for monthly title II benefits and/or premium-free Hospital Insurance (HI) but have at least 30 quarters of coverage (QCs) are eligible for a reduction of the amount of their HI premium. In certain cases, individuals can be eligible for the premium reduction based on the QCs of a current or former spouse.
As a result of the Windsor decision, we are now able to approve some HI premium reduction requests for aged and disabled individuals based on the earnings record of a current or former same-sex spouse.
IMPORTANT: Review spouse claims and appeals that have been on hold for possible processing now.
B. HI premium reduction policy
An individual must meet all other factors of general eligibility not addressed in this instruction before we approve a HI premium reduction claim, see HI 00801.134B. HI premium reduction also applies to Premium-HI for the Working Disabled. For discussion of how the reduction applies to the disabled, see HI 00801.170E.
An individual in a same-sex marriage is eligible for HI premium reduction when he or she meets all the other requirements in HI 00801.134B or HI 00801.170E (as applicable) and the NH:
was legally married in a jurisdiction that permits same-sex marriage while such marriages were permitted, and
meets the duration of marriage requirements.
For states that permit same-sex marriage, see list in GN 00210.003.
Domicile is not a factor in determining eligibility for a reduction in HI premium under this policy.
The duration of marriage requirement for premium reductions for widow(er)s differs from the duration-of-marriage requirement for title II widow(er)s benefits. For duration of marriage requirements see HI 00801.134B.
IMPORTANT: Current Title II development rules apply in determining relationship, divorce and death of the NH for all cases not addressed by this instruction, as outlined in HI 00801.134B. If the aged or disabled individual has a legal same-sex relationship other than marriage, such as a civil union or domestic partnership, follow instructions outlined in GN 00210.004B.
C. Procedure for verifying eligibility for reduction
In order to approve an individual for HI premium reduction, verify eligibility following HI 00801.134D and take the following steps:
1. Confirm the validity of the same-sex marriage
Determine marital status as set out in GN 00210.002. Only consider the “Date Same-Sex Marriages Were Permitted in the State” column of the chart found in GN 00210.003.
If the claimant alleges a non-ceremonial (common-law) marriage as outlined in GN 00305.060, or a deemed marriage as outlined in GN 00305.055, refer the case for legal opinion following GN 01010.815.
If the claimant has another legal same-sex relationship, such as a civil union or domestic partnership, follow instructions outlined in GN 00210.004.
2. Confirm the duration requirement
The duration of marriage requirement as outlined in HI 00801.134B must be met prior to adjudication of the claim.
NOTE: Do not consider the date of the Windsor decision in determining the duration of marriage. Rather, rely on the date the couple was married.
If the marriage between the claimant and the NH does not meet the duration requirement, deny the claim.
D. Processing the current enrollee
Approve all HI premium reduction claims if all other eligibility criteria are met. If approved, process the claim following instructions in HI 00801.134E.
GN 00210.005 Holding Claims, Appeals, and Post-Entitlement Actions Involving Same-Sex Marriages or Legal Same-Sex Relationships other than Marriage
GN 00210.002 Same-Sex Marriage – Determining Marital Status for Title II and Medicare Benefits
GN 00210.003 Same-Sex Marriage – Dates States and U.S. Territories Permitted or Recognized Same-Sex Marriage
GN 00210.004 Non-Marital Legal Relationships (Such as Civil Unions and Domestic Partnerships
GN 00210.400 Same-Sex Marriage – Benefits for Surviving Spouses
GN 00305.055 Deemed Marriages
GN 00305.060 Common-Law Marriage – General
GN 01010.815 Request for Legal Opinion
HI 00801.134 HI Premium Reduction for Aged Individuals With At Least 30 Quarter of Coverage
HI 00801.170 Premium HI for the Working Disabled