Sharing health insurance coverage between spouses is a common practice among couples. However, with Medicare, the rules are different, and couples should research options once they enter their 60s. With the proper knowledge and information, you can prepare to make the best choices for you and your family.
Individuals are generally eligible for Medicare once they turn 65. You may qualify if you are younger than 65 or have a qualifying disability or condition.
Many married couples believe they can share a Medicare plan as they've shared health coverage under an employer plan. However, this is not the case.
Medicare coverage is on an individual basis, and there are other options for those who may lose health coverage once their spouse obtains Medicare.
Medicare has four parts, and you may choose one or multiple. The most common parts of Medicare are:
- Part A, hospital insurance.
- Part B, medical insurance.
- Part C, or a Medicare Advantage plan.
Part C differs from Original Medicare and includes Parts A and B combined and additional benefits. Prescription drug coverage is called Part D and is usually included in a Medicare Advantage plan, but one can obtain Part D separately if you have Original Medicare.
Most Medicare beneficiaries have at least Part A. Generally, you will not have to pay a premium for Part A, but Part B will almost always require a premium payment based on your income. You may choose to reject Part B due to the premium cost. Signing up for Medicare is not required if you already receive Social Security benefits, as you will be automatically enrolled. If not automatically enrolled, you can apply for Medicare at the same time as Social Security benefits.
Eligibility for Medicare
You become eligible for Medicare once you turn 65. The initial enrollment period begins three months before turning 65 until three months after. It is in your best interest to sign up during this time frame to avoid a late penalty charge and a lapse in coverage. However, if you still have qualifying insurance such as through an employer, you can wait to sign up and still avoid the penalty. If you have been diagnosed with Lou Gehrig's or are on long-term dialysis as a result of kidney failure, you may be eligible for Medicare enrollment before age 65.
How can I check my eligibility for Medicare?
To check your eligibility, visit the eligibility calculator on the Medicare.gov website. You will be asked to enter your date of birth and verify if you have worked for at least 10 years. It may also ask you if you have a disability, live in the United States, and if you currently receive group health benefits through an employer. If you are not currently eligible, it will provide an estimated time for when you will become eligible.
Can I get Medicare at age 62?
If younger than 65, you must have a qualified disability and have received 24 months of Social Security Disability to obtain Medicare benefits. If your spouse has obtained Medicare, you won’t be able to obtain Medicare yourself until you are 65 or become disabled. There are other options if you have lost health care coverage due to a spouse obtaining Medicare.
Can my spouse get Medicare at 62?
Your wife or spouse cannot be on the same Medicare plan as their married partner. Medicare is individually based, and everyone must have a separate plan. If you are of age to receive Medicare, generally 65, and your spouse is younger than 65, they would need to investigate other options for health coverage.
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Can I share Medicare coverage with my spouse?
Unfortunately, a married couple cannot share health benefits under one Medicare plan. Medicare is an individual-based system, and everyone must have their own plan. Many couples sharing health benefits under an employer-based plan are surprised when the one working spouse retires. When the older spouse retires, obtains Medicare, and loses the employer health plan, this causes the younger, non-working spouse to lose health benefits.
Health coverage options for spouses
If you haven't retired yet but are 65 and still working, some employers may allow you to keep your employer-based health plan in addition to Medicare until you retire. If this happens, your primary payer will become the employer-based plan, and Medicare will become the secondary payer. Your spouse will keep insurance coverage under the employer plan in this situation.
If your employer has less than 20 employees, they can stop providing healthcare coverage for you once you turn 65. Other options are available if you lose your employer's healthcare plan and your spouse is not yet eligible for Medicare.
One alternative is to continue an employer-based health plan through the Consolidated Omnibus Budget Reconciliation Act (COBRA). With COBRA, your spouse could continue their healthcare coverage under the employer-based plan for a 36-month limit if you pay the entire premium amount. However, it's not a standard option as the premiums are more expensive with COBRA.
The Affordable Care Act (ACA) allows one to purchase an individual plan through the marketplace, known as the exchange. There are also options to buy plans through non-employer groups as well. As a last resort, you could check to see if you are eligible for Medicaid.
What happens when I turn 65?
At 65, you will become eligible for Medicare and have the option to enroll during the initial enrollment period. This period begins three months before turning 65 and continues three months after. You can apply for Medicare Parts A, B, or C if you prefer a Medicare Advantage Plan to Original Medicare. You can also choose a Part D plan unless your Medicare Advantage includes prescription drug coverage. For some people, you may be automatically enrolled in Medicare at age 65, and Social Security benefits have already started.
Can I stay on my spouse's health insurance when I turn 65?
If your spouse still has an employer-based plan as they are still working, you can likely stay on their health insurance and apply for your own Medicare plan. If you apply for Medicare, the employer group plan will likely become the primary payer, and Medicare will be the secondary payer.
Will I lose my Medicare benefits if I get married?
Once you marry, this will not affect your eligibility for Medicare or change your coverage if you are already receiving Medicare. However, your premiums may increase if you are now in a higher tax bracket. Also, if you get married and your spouse is still working, you may receive additional health coverage through your new spouse's employer plan.
Many couples are used to sharing healthcare coverage, and entering retirement age can present barriers and frustrations to understanding Medicare benefits. A spouse can remain on your health insurance plan in their 60s if you still have an employer-based plan. If you only have a Medicare plan and no longer have employer group insurance, you must find other options for your spouse until they turn 65. However, It is possible to have both employer insurance and Medicare in certain situations.
Can a husband and wife share a Medicare plan?
Medicare benefits are individually based, so each partner must have their own Medicare plan. You and your spouse cannot share Medicare.
Who is the best person to talk to about Medicare?
You can call Medicare at 1-800-Medicare and speak with a representative. You can also contact your State Health Insurance Assistance Program (SHIP) and talk to a local, licensed insurance broker.
When can a spouse claim spousal Medicare benefits?
One can be covered for Medicare under their current or former spouse's work record at age 65. To receive Medicare benefits under your spouse's record, your spouse must be of age to qualify for Social Security, which is 62, and have paid Medicare taxes for a minimum of 10 years while working.
- Medicare.gov. Estimate When I'm Eligible for Meidcare.
- HHS.gov. Who's Eligible for Medicare?
- HHS.gov. When Should I Sign-up for Medicare?
- Medicare.gov. How Medicare works with other Insurance.
- Health Economics. The Effect of Medicare Eligibility on Spousal Insurance.