Will I Lose Medicare Benefits If I Get Married?

You will not lose Medicare if you get married. Eligibility for Part A and Part B is decided person by person, based on age, disability, or qualifying conditions, and a wedding changes none of that. What marriage can change is the money side: your premiums, the assistance programs you qualify for, and how Medicare fits with a spouse’s employer plan.¹

Your Coverage Itself Doesn’t Change

Medicare has never worked like a family plan at a job. Each spouse qualifies on their own and pays their own premiums, deductibles, and copays. If you already have Medicare because you turned 65, received disability benefits for 24 months, have end-stage renal disease, or were diagnosed with ALS, getting married does nothing to that eligibility.¹

Your new spouse also can’t be added to your Medicare the way they might join a workplace plan. They have to qualify in their own right. One useful exception runs the other way: a spouse who never earned enough work credits may be able to get premium-free Part A through your record.

When Marriage Helps: Premium-Free Part A Through a Spouse

Most people pay nothing for Part A because they or a spouse paid Medicare payroll taxes for at least 40 quarters. If you haven’t hit that on your own, marrying someone who has can get you premium-free Part A once you turn 65, provided the marriage has lasted at least one year.²

Without that spousal record, you’d have to buy Part A. In 2026, the buy-in premium is $311 or $565 per month, depending on how many quarters of Medicare tax you’ve paid. Marriage to a fully insured spouse can eliminate that expense entirely.²

One caution if you’re remarrying: if you had been drawing Part A eligibility through a 10-year former marriage, that path closes the moment you’re legally married to someone new.

When Marriage Hurts: Higher Part B and Part D Premiums

This is where marriage most often costs people money. Medicare adds a surcharge, the Income-Related Monthly Adjustment Amount (IRMAA), to Part B and Part D premiums for higher-income beneficiaries. The standard Part B premium in 2026 is $202.90 a month, and IRMAA can more than triple it.³

Once you file a joint tax return, your combined modified adjusted gross income (MAGI) is what Social Security looks at. Two people who each cleared the threshold on their own can easily land above it after their incomes are added together. SSA uses the return from two years earlier, so your 2024 income sets your 2026 premiums.⁴

The 2026 IRMAA brackets for married couples filing jointly:

$218,000 or less: no surcharge. Standard $202.90 Part B premium and your regular Part D plan premium.
$218,001 to $274,000: extra $81.20/month for Part B and $14.50/month for Part D.
$274,001 to $342,000: extra $202.90/month for Part B and $37.50/month for Part D.
$342,001 to $410,000: extra $324.60/month for Part B and $60.40/month for Part D.
$410,001 to $749,999: extra $446.30/month for Part B and $83.30/month for Part D.
$750,000 or more: extra $487.00/month for Part B and $91.00/month for Part D.

At the top bracket, each spouse could pay $689.90 a month for Part B alone, close to $8,280 per person per year, before any Part D surcharge. If you’re in a Medicare Advantage plan that includes drug coverage, the Part D IRMAA still applies.⁴⁵

Filing “married filing separately” doesn’t rescue you. The surcharge kicks in above $109,000, the same as a single filer, and the tax deductions you lose usually cost more than the premium relief.

Asking Social Security to Recalculate IRMAA After Marriage

Marriage is on Social Security’s list of “life-changing events” that can justify redoing the IRMAA calculation. If getting married actually lowered your combined income, say because one spouse retired, you can ask SSA to use a more recent year instead of the two-year lookback. It doesn’t help if marriage raised your income, only when timing runs the other way.⁶

The request goes on Form SSA-44. Check “Marriage” as the event, give the date, provide your updated MAGI, and attach a marriage certificate (original or certified copy). Mail it in, or call 1-800-772-1213 to set up an in-person appointment. The form also lets you project an even lower income for the following year, which matters when you married mid-year and the full-year picture looks different.⁶

Risk to Medicare Savings Programs and Extra Help

If you’re on a tight budget, this is the section to read closely. Marriage combines your income and assets with your spouse’s for two important assistance programs, and the couple limits are not generous relative to the individual ones.

Medicare Savings Programs

Medicare Savings Programs are state-run programs that help pay Part A and Part B premiums, deductibles, and copays for people with limited income and resources. Once you’re married, your spouse’s income and assets count. In 2026, the federal resource limits are $9,950 for an individual and $14,910 for a married couple.⁷

The couple limit isn’t double the individual limit; it’s only about 50% higher. Two unmarried people could each hold $9,950, or $19,900 between them, but marriage drops their combined ceiling to $14,910. That gap alone disqualifies some couples who were comfortably eligible before. Income limits work the same way: the QMB program, which offers the fullest help, caps monthly income at $1,350 for an individual and $1,824 for a married couple in 2026.⁷

Some states set higher limits than the federal floors, so losing federal eligibility doesn’t automatically mean you’re out. Ask your state Medicaid agency.

Extra Help for Part D

Extra Help lowers the cost of Part D prescription drug coverage for people with limited means, and it also counts both spouses once you marry. In 2026, the full Extra Help resource limit is $33,100 for a married couple, roughly double the individual limit. The monthly income limit for couples is about $2,725.⁸

If you already receive Extra Help and your new spouse’s income or savings push you over these lines, you can lose subsidies worth hundreds of dollars a month on drugs. Run the numbers through Social Security’s Extra Help screener before you marry.

Coordinating Medicare With a Spouse’s Employer Plan

If your new spouse still works and has employer coverage, you need to know which plan pays first. Getting it wrong leads to denied claims and surprise bills.

Employer size decides it. If your spouse’s employer has 20 or more employees, the employer plan is primary and Medicare is secondary. If the employer has fewer than 20, Medicare pays first.⁹¹⁰

Delaying Part B Without a Penalty

If you’re covered under a spouse’s group health plan at a company with 20 or more employees, you can put off Part B without the late-enrollment penalty. When that coverage ends (retirement, job change, or the plan drops you), you get a Special Enrollment Period to sign up. The trigger is the loss of employer coverage, not the marriage itself.¹¹

Watch out with small-employer plans. If the company has fewer than 20 employees, Medicare is already primary. Delaying Part B in that situation leaves you exposed and can generate a permanent 10% premium penalty for each full 12-month period you should have been enrolled.

HSA Rules When Only One Spouse Has Medicare

Health Savings Accounts trip up plenty of couples. You can’t contribute to an HSA once you’re enrolled in any part of Medicare. But if only you are on Medicare and your spouse stays on a qualifying high-deductible health plan, that spouse can still contribute up to the family maximum, which is $8,750 in 2026.¹²

The money in the HSA can still pay qualified medical expenses for the Medicare-enrolled spouse, including most Medicare premiums other than Medigap. The rule is about who puts money in, not who benefits. If you’re approaching 65 and your spouse plans to keep working with an HDHP, plan your enrollment date carefully to protect remaining HSA contributions.

Medigap Household Discounts

One genuine upside on the cost side: some Medigap insurers offer a household discount when both spouses buy from the same company, often around 12% off the monthly premium. Some insurers extend it to any two policyholders at the same address, though married couples typically qualify automatically. Discounts aren’t required by law and vary widely, so compare plans through Medicare’s plan finder and filter for companies that offer one. It won’t wipe out an IRMAA hit, but it can save a few hundred dollars a year.

Reporting Your Marriage to Social Security

Tell Social Security about the marriage, since SSA runs Medicare enrollment and premium calculations. Report the change by the 10th of the month after your wedding.¹³

Call SSA at 1-800-772-1213 (Monday through Friday, 8 a.m. to 7 p.m.) or visit your local office. Keeping your Social Security record current avoids problems with premium calculations and benefit coordination.¹⁴

If the marriage changes your IRMAA picture for the better, file Form SSA-44 at the same time. Wait, and you’ll pay the higher premiums until SSA processes the adjustment, and refunds for overpayment aren’t guaranteed to be retroactive.

1
Centers for Medicare & Medicaid Services. Original Medicare (Part A and B) Eligibility and Enrollment
2
Medicare. Costs
3
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
4
Social Security Administration. Medicare Premiums: Rules for Higher-Income Beneficiaries
5
Medicare. Fact Sheet: 2026 Medicare Costs
6
Social Security Administration. Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event
7
Medicare. Medicare Savings Programs
8
Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS)
9
Centers for Medicare & Medicaid Services. Small Employer Exception
10
Medicare. Who Pays First?
11
Social Security Administration. How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period
12
Internal Revenue Service. IRS Notice 26-05 – 2026 HSA Limits
13
Social Security Administration. Communicate Changes to Personal Situation
14
Social Security Administration. Manage Your Medicare Benefits