What Happens When One Spouse Enrolls in Medicare and the Other Isn't Eligible?
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. Here are some important things to know as you prepare to make this change.
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.
Call: 866.939.8436 Schedule a Call
Eligibility for Medicare
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 be automatically enrolled in Medicare at the start of the 25th month you receive SSDI.
Not sure if you’re eligible for Medicare?
How can married couples benefit from Medicare?
As mentioned, your Medicare eligibility status does not affect your spouse’s and vice versa.
Unlike employer health plans, Medicare coverage is individual, which means you cannot add dependents, such as a spouse, to your plan. Each person must enroll in their own health plan based on their needs, and there are no coverage discounts for married couples when each is on a different Medicare Advantage plan.
The only potential Medicare perk for married couples is if one spouse didn’t pay Medicare taxes while working for at least 10 years (or 40 quarters), but the other spouse did, neither spouse would be required to pay a premium for Medicare Part A.
Coverage Options for a Spouse Younger than 65
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 the age requirement for Medicare.
Your younger spouse has a few options for getting coverage when you transition to Medicare. They can:
- Receive benefits through their employer (if they qualify)
- Purchase coverage through an individual health insurance policy
Our advisors are licensed insurance agents who can assist your spouse in finding the right individual health insurance policy for their needs to bridge the gap until they qualify for Medicare.
Learn more about individual health insurance and download our checklist.
Coverage Options for a Spouse 65 or Older
If you and your spouse meet the age requirement for Medicare, switching to Medicare coverage at the same time is often the most practical option.
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.
Our experienced advisors know the ins and outs of Medicare and are here to help you navigate Medicare at no cost to you. They will get to know your personal needs and preferences, consider your current doctors and prescriptions, and discuss your questions and concerns. Once you and your spouse have chosen Medicare plans, they'll even help you both enroll in your plan selections.
Need help with Medicare or individual health insurance coverage?
Whether you have questions about getting started with Medicare or your spouse needs help selecting an individual health insurance plan, we’re here to help!
Call: 866.939.8436 Schedule a Call
If you’re currently a client of RetireMed and have questions about Medicare or your plan, contact our client advisors.