It’s a question we get from clients all of the time – “can my spouse get Medicare through me?” It’s a good question. We’ve all been trained to understand that this is how insurance typically works. However, Medicare is different. Medicare is for the individual, so spouses can’t be on a Medicare plan together. While your spouse who never worked may reap the benefits of having no Part A premium because you worked more than 40 quarters over your lifetime, he or she will not be able to get Medicare through you when you are eligible.
In this article, we’ll discuss the common question about spouses and Medicare benefits and walk through some options that may be available for your spouse who is not yet Medicare-eligible. If you have questions about your Medicare benefits or need guidance on your spouse’s insurance coverage, we can help. Call our Medicare advisors at 901-460-7220 to discuss the options available to you and your spouse as he or she awaits Medicare eligibility.
When One Spouse Is Medicare-Eligible But the Other Is Not
Unless you and your partner were born in the same year, one of you will become Medicare-eligible first. Since both of you were covered on your employer’s insurance plan for the majority of your lives together, this can cause a lot of stress and confusion. However, you will have options. Which option is best for you will depend on your specific circumstances. One option may be your employer’s coverage. However, in some circumstances, your spouse joining a separate plan may be more cost-efficient and offer better benefits. Let’s go over some scenarios below.
When Your Spouse Is Younger Than You
If your spouse is younger than you, he or she will need insurance before they are of Medicare age. Some options may include:
If you keep working, your spouse may remain covered through your employer’s plan
If you retire, your employer may provide COBRA coverage for your spouse
Your spouse may purchase a separate insurance plan until he or she is Medicare eligible
When Your Spouse Is Older Than You
Depending on your current group coverage, your partner may want to go ahead and enroll in Part A. If your employer coverage is creditable, your spouse can defer his or her Part B coverage without paying the Part B late-enrollment penalty. This helps you both avoid the Part B monthly premium until your employer coverage ends.
Note that if your spouse hasn’t worked for 40 quarters, he or she will have to pay a Part A premium unless you are 62 years old and eligible for Social Security benefits (you just need to be eligible, not begin receiving your Social Security benefits). This is because your non-working spouse’s premium-free Part A premium is based on your work history.
When Are You Eligible for Medicare?
Typically, you are eligible for Medicare at 65 years old. There is a 7-month period for initial enrollment (IEP) into Original Medicare, which depends on when your 65th birthday is. IEP begins 3 months before the month of your 65th birthday, includes your birth month, and includes the 3 months following the month of your 65th birthday. Your coverage will begin on day 1 of the month you turn 65. If your birthday falls on the first day of the month, your coverage will begin on day 1 of the previous month.
What Are My Medicare Options?
There are a couple of ways to receive your Medicare benefits. You can elect to receive your benefits through Original Medicare or enroll in a Medicare Advantage plan. If you enroll in Original Medicare, you will need to also enroll in a Supplement plan to cover the gaps within Medicare. Identifying the right route for you boils down to understanding your specific healthcare needs and budget. We walk all of our clients through a needs analysis to make a determination together on which type of plan is best for them. Some factors to consider when making this determination include:
Costs and budget - What can you afford? Where in your Medicare coverage can you save money? How can you protect yourself from future unexpected costs? There are gaps within Medicare, so we want to ensure you aren’t paying too much money by not having the right type of coverage.
Coverage - What types of coverage do you need? Some plans offer dental, vision, and other benefits that may suit your needs.
Medications - Depending on the type of medications you’re taking, your costs and plans will vary. Which plans are most affordable based on your specific prescriptions? Are your drugs covered under a specific plan? What types of coverage rules apply to your medications?
Preferred doctors and hospitals - Some doctors and hospitals don’t take certain plans. Ensuring your doctors and hospitals are covered under your plan will help you not have to go through the hassle of finding another doctor.
Travel - Will you need travel coverage based on your lifestyle? Ensure this is included in your plan.
Medicare can be confusing, but you don’t have to go through this process alone. We’re standing by to help you understand and navigate your Medicare benefits. We’ll do the heavy lifting when it comes to enrolling you into the right Medicare plan and keeping an eye on your benefits to ensure you stay in the right plan and get the most out of your coverage.
Call Our Medicare Advisors Today to Learn More
Hopefully, this blog answered your question about spouses and Medicare coverage. However, everybody’s situation is different, and it’s important to consult a knowledgeable Medicare advisor if you have questions about your coverage. If we can help you navigate your benefits and make smart, cost-efficient healthcare decisions, please don’t hesitate to schedule a free, no-obligation consultation with our Medicare advisors today by calling 901-460-7220 or filling out this convenient and secure online contact form.
We’re located in Memphis, TN, and we serve clients across the nation. Our office is located in the iBank Tower at 5050 Poplar Ave Suite 1715, Memphis, TN 38157.