Medicare and Your Spouse

The first thing to understand is that, unlike employer health plans, Medicare coverage is individual. This means you cannot add dependents, such as a spouse, to your plan. You must enroll in separate plans once Medicare eligible. Each person will enroll in their own health plan based on their needs and will have an individual premium (if applicable), deductible, and copays.

The short answer: No. Your spouse is eligible for Medicare when he or she turns 65. However, if your spouse has a qualifying disability such as End-Stage Renal Disease or Lou Gehrig’s Disease, he or she may be able to enroll in Medicare sooner. Your eligibility for Medicare has no impact on the date that your spouse is eligible for Medicare.

The shift from employer health insurance coverage to Medicare is significant, especially for couples where one spouse’s employer benefits insure both individuals. If you’re transitioning to Medicare soon and your spouse is not yet eligible for Medicare, you may be wondering how to make sure he or she has the health coverage they need. 

Whether you and/or your spouse are considering Medicare now or in the near future, you don’t have to spend countless hours researching plans or figuring this out on your own. Call our team today.

Your eligibility for Medicare has no impact on the date that your spouse is eligible for Medicare. To qualify for Medicare, you must be a U.S. citizen or permanent legal resident for at least five consecutive years, and you reach Medicare eligibility when at least one of the following applies: 

• You are age 65 or older 
• You are permanently disabled and have received disability benefits for at least two years 
• You have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) 

It’s important to know that there are no income limitations for Medicare eligibility. If you have a disability and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months, you will automatically be enrolled in Medicare at the start of the 25th month you receive SSDI. 

Not sure if you’re eligible for Medicare? Check My Eligibility

Medicare Part A, which covers hospital-related services, is premium-free for most people. If you or your spouse paid Medicare taxes while working at least 10 years (or 40 quarters), you won’t have to pay a premium for Part A. This is called “premium-free Part A.” Therefore, if either spouse paid Medicare taxes for at least 10 years (or 40 quarters), both spouses qualify for premium-free Part A. If you didn't pay Medicare taxes for long enough, you can still get Part A but you may have to pay a monthly premium.

Your marital status does not affect your eligibility for Medicare but it could affect the cost of your Part A monthly premium. If you do not qualify for premium-free Medicare Part A based on your own work history, you can use your ex-spouse’s work record if: 

• You were married for at least 10 years 
• You are currently unmarried 
• You are 62 years old or older

If you are widowed and do not qualify for premium-free Medicare Part A based on your own work history, you may qualify by for premium-free Part A using your deceased spouse’s work record if: 

• You are 65 or older 
• You were married for at least nine months before your spouse passed away, with some exceptions, such as an accidental death

If your ex-spouse or deceased spouse didn't pay Medicare taxes for long enough, you can still get Part A but you may have to pay a monthly premium.

If you are enrolling in Medicare coverage and your spouse is younger than 65 and does not meet one of the Medicare eligibility exceptions (such as a disability or chronic condition), they will need to secure their own insurance coverage until they reach age 65 and become eligible for Medicare. 

Your younger spouse has a couple options for getting coverage when you transition to Medicare. They can: 

• Receive health care coverage through their employer (if they qualify) 
• Purchase an individual health insurance policy 

Our advisors are licensed insurance agents who can assist your spouse in finding the right individual health insurance policy to bridge the gap until they qualify for Medicare. Call us today; we’re ready to help. 

If you and your spouse are both at least 65, switching to Medicare coverage at the same time is often a practical option. However, you will both need your own Medicare plan. You and your husband or wife may have different prescriptions, doctors, or health concerns, which is why each of you should select a Medicare plan based on your own individual health considerations as opposed to automatically selecting the same plan. 

Retirement is not a requirement for Medicare. If your spouse is still working, we can compare their employer health plan to Medicare to see which one makes the most sense.

Your eligibility to contribute to an HSA (health savings account attached to a high-deductible health plan) is determined individually depending on the employee’s Medicare enrollment status. You cannot contribute to an HSA and be on Medicare. Your spouse being on Medicare has no bearing on your ability to contribute to an HSA and visa-versa. Therefore, a spouse on Medicare can no longer make contributions to an HSA, however, they still have access to those funds for all the appropriate medical expenses.

Our experienced advisors know the ins and outs of Medicare and individual health plans. We’re here to help you navigate your options at no cost or obligation to you. Our health insurance experts get to know your personal needs and preferences, consider your current doctors and prescriptions, and discuss your questions and concerns. Once you and/or your spouse have chosen a health plan, they’ll help you enroll in your plan selections. Plus, you’ll receive lifelong client support.