How Going to Medicare Affects Your Spouse’s Health Insurance

What Happens to My Spouse’s Health Insurance When I Go on Medicare?

If your spouse is currently covered under your employer-provided health insurance and you decide to switch to Medicare, they may need to look for alternative insurance options such as the following: 

• Through their own employer 
• Individual insurance through the Health Insurance Marketplace
• Medicaid 
• Through COBRA
• Medicare, if they’re also eligible

Remember that Medicare is individual insurance, so your spouse cannot be on the same Medicare plan as you. In other words, Medicare will only cover you and not your spouse if they’re not eligible.

When Do You Traditionally Enroll in Medicare?

Generally, you can sign up for Medicare during the Initial Enrollment Period (IEP). It starts three months before you turn 65 and ends three months after you turn 65. 

If you miss this first chance to enroll in Medicare, you typically have to wait for the General Enrollment Period (GEP), January 1 to March 31 each year, to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage.

How Medicare Works When Spouses Are Different Ages 

Medicare coordination for spouses with an age gap can be tricky. Here’s what could happen when one spouse turns 65 before the other. 

When Your Employed Spouse Turns 65 Before You…

Medicare is not a family plan and only covers the enrolled individual. This means if your employed spouse turns 65 and enrolls in Medicare before you, you may need to seek alternative health coverage through Medicaid, individual insurance through the Health Insurance Marketplace, or if eligible, coverage through your own employer. 

You may also want to check with your spouse’s employer to see if they offer COBRA, which extends employer-sponsored health coverage temporarily even after your spouse retires.

When You Turn 65 Before Your Spouse… 

If you age into Medicare before your spouse and are still on their employer insurance, you may want to enroll only in premium-free Medicare Part A until your spouse retires or their employer coverage ends. Generally, you can add Part B later without penalty during a Special Enrollment Period if your spouse’s employer provides creditable coverage.

However, to be eligible for premium-free Medicare Part A, your working spouse must be eligible for Social Security benefits, meaning they must be at least 62 years old. This is because your qualification is based on your spouse’s work record. 

If your spouse is younger than 62, you may have to pay the premium for Medicare Part A until the premium-free benefit kicks in to avoid penalties

Can You Defer Medicare Enrollment?

While you can wait to enroll in Medicare after the Initial Enrollment Period, you may face a lifetime late enrollment penalty if you’re not eligible for a Special Enrollment Period (SEP). 

A SEP lets you enroll in Medicare or outside of the annual open enrollment period without penalties, and you’re generally eligible for it if you’re still covered by your or your spouse’s employer-sponsored health insurance when you turn 65. The 8-month SEP starts the month you or your spouse become unemployed or the month after the group health plan ends, whichever happens first.

Always contact your employer before delaying Original Medicare to find out how your group health insurance works with Medicare. Companies with fewer than 20 people may require you to enroll in Part A and B once you turn 65. In this case, Medicare will settle your medical bills first, and your group health insurance only covers the services Medicare does not. So, if you defer Medicare enrollment when your employer requires it, you could be left without coverage.  

Can You Enroll In Only One Medicare Part? 

Yes, you can. Everyone pays a premium for Medicare Part B, $164.90 in 2023, whereas Part A is generally free if you or your spouse has paid Medicare taxes for at least 40 quarters. If you’re enrolled in an employer-sponsored health plan and are eligible for a SEP, it could make financial sense to only enroll in Medicare Part A. 

If you are not eligible for premium-free Part A and are not covered by a group health insurance plan, you can also buy Part B without purchasing Part A. 

Will There Be a Penalty for Deferment? 

It depends. In most cases, if you do not sign up for Part B during the IEP, you’ll pay a late enrollment penalty for as long as you have coverage. However, you may be able to defer enrollment in Medicare Part B and only sign up for premium-free Part A as long as you or your spouse have paid Medicare taxes for at least ten years and an employer’s insurance still covers you. 

Note that if you have health insurance coverage from a small company with fewer than 20 employees, you’ll most likely need to enroll in Medicare Parts A & B once you turn 65 since smaller employers are not required to continue your healthcare coverage once you’re eligible for Medicare.

If you’re not eligible for a SEP, delaying enrollment in Medicare Part B could incur a 10% penalty that lasts as long as you have coverage. The longer you wait to enroll, the higher the penalty. Waiting to sign up for Medicare Part A could also result in a 10% penalty. 

If you’re concerned about the costs associated with signing up late, call Medicare at 1-800-MEDICARE to ask if you could defer Original Medicare without penalties.

Your Options If You Lose Your Spouse’s Health Insurance 

If your spouse loses your employer-sponsored health insurance and is not eligible for Medicare, they can consider getting health insurance coverage through the following options:

• Medicaid: Medicaid is a joint federal and state program that provides health coverage to low-income families and individuals in the United States. Eligibility requirements vary by state, but you generally need to make below a certain income. You can apply for Medicaid directly with your state or through the Health Insurance Marketplace. 
• ACA marketplace plans: The Health Insurance Marketplace is a service run by the federal government where individuals and families can purchase ACA-compliant health insurance plans. These plans can include medical, dental, vision, and more. To be eligible to enroll in health coverage through the Marketplace, you must live in the United States, be a U.S. citizen or national, and not be incarcerated. 
• COBRA: COBRA, Consolidated Omnibus Reconciliation Act, is a federal law that allows you and your immediate family members to stay on an employer-sponsored health plan for a limited time (up to 36 months), even after you leave the job. Your employer may offer COBRA coverage for your spouse if you retire.

Are You Still Eligible For Premium-Free Medicare If You Do Not Work? 

Generally, Medicare Part A is only free if you have at least 40 quarters, ten years, of work in any job where you paid Social Security taxes in the United States. However, you may still be eligible for premium-free Medicare Part A in one of two ways if you’ve never worked: Your spouse has enough work history to qualify or if you have certain medical conditions or disabilities. 

If you’re not eligible for premium-free Medicare Part A, expect to shell out anywhere from $278 to $506 a month for coverage, depending on the taxes you’ve paid.

All in All

Whether you or your spouse turn 65 first, it’s worth chatting with your current employer’s benefits administrator in the HR department to fully understand your options. For example, some employers allow Medicare-age dependents to stay on their plan, while some will not. To avoid any healthcare coverage gaps and confusion down the line, work with your employer to navigate this transition.