If you’re enrolling in Medicare for the first time, you’ve probably found out that it works a bit differently than the individual or employer-based insurance you’re used to. Medicare has its own structure and types of plans. It also has its own rules about who’s eligible and when – which makes it a little tricky for couples who are used to having the same health insurance together.
This brings us to a big question that gets asked often and early in enrollment: can a couple share the same Medicare coverage? The answer is no – Medicare plans are issued to individuals only – each person has their own separate plan, even if married or in a domestic partnership.
However, this answer usually brings up many more questions:
- What happens when I’m enrolled in Medicare but my husband, wife or domestic partner isn’t?
- What if my spouse is on Medicare but I’m not?
- What if my spouse isn’t working or isn’t eligible right now?
- Am I eligible if I get a divorce or become widowed?
Fortunately, we can help give you some answers. We’ll show you why Medicare was built for individual enrollment. Then, we’ll go over different scenarios that can happen as you and your spouse transition to Medicare.
The reasons you can’t share Medicare coverage with a spouse
Why can’t two people share the same Medicare coverage? The biggest reason is because everyone’s eligibility for Medicare is unique. Your qualifications for Medicare, as well as how much you will pay for Medicare, depend on things like your birthday and work history. For example, your Initial Enrollment Period is directly linked to your 65th birthday.
Plus, the way Medicare works, each beneficiary’s coverage is tracked to the individual. Your number of office visits, how much you spend on premiums and deductibles, your dollar limits on services – all of this is linked to you and only you.
This is different from how private health insurance works. The plans that you’ve likely had in the past had a policyholder (you, the person who is insured directly) and dependents (like your spouse and children). However, for Medicare it all comes down to the individual – one member per plan, one person receiving care under their plan.
So, even though you and your spouse might be eligible for Medicare at the same time and even have similar Medicare plans, things like your eligibility and what you pay are tied directly to you, not you and your spouse together.
Marriage and Medicare
The good news is that because your coverage is your own, it isn’t affected by things like marriage. Your marital status doesn’t affect your coverage, so you don’t gain or lose coverage by getting married or divorced, or if you’re widowed.
Medicare eligibility if you’re divorced or widowed
While your Medicare eligibility isn’t based on your marital status, how much you’ll pay in premiums is. Most people qualify for premium-free Medicare Part A because they’ve worked and paid Medicare taxes for at least 10 years. And if you’re not working but are married, you’ll likely qualify due to your spouse’s work history.
But can you still receive premium-free Medicare coverage if you didn’t work, and you get a divorce or become widowed? The short answer is yes – if you meet certain conditions.
If you’re divorced, you may qualify to receive coverage for premium-free Part A if:
- You were married for at least 10 years before the date your divorce was finalized
- Your ex-spouse worked and paid Medicare taxes for at least 10 years (40 quarters)
- You’re currently unmarried
- Your former spouse is at least 62 years old
If you’re widowed, you may qualify for premium-free Part A if:
- You were married for at least nine months before the date of your spouse’s death
- Your late spouse paid Medicare taxes for at least 10 years
- You’re currently unmarried, or you remarried after age 60
- You’re at least 65 years old
If you don’t meet all qualifications for premium-free Part A after a divorce or the death of your spouse, you still qualify for Part A coverage. However, you could be required to pay a premium, and what you pay will be based on how long your spouse worked and paid Medicare taxes.
Divorce and the death of a spouse don’t typically impact your eligibility for Medicare Part B, but they can affect how much you’ll pay. Part B premiums are based on income, so a change in income due to divorce may mean your payments change, too.
Medicare, Social Security and the differences in how spouses are covered
Medicare and Social Security are different programs in that Medicare is considered health coverage for retirees, and Social Security is considered income for retirees. But just like with Medicare, you can qualify for spousal Social Security benefits after divorce or death of a spouse, even if you didn’t work, provided your spouse meets certain criteria.
If you’re divorced, you may receive Social Security spousal benefits if:
- You’re at least 62 years old and currently unmarried
- You were married to your spouse for at least 10 years before you divorced
- You care for your and your spouse’s child who is younger than 16, or who has a disability
You can also receive benefits even if your ex-spouse hasn’t started to receive their benefits, as long as you’re both 62 and have been divorced for at least two continuous years.
If you’re widowed, you may receive Social Security spousal benefits:
- When you reach retirement age (this varies depending on the year you were born)
- At any age if you take care of your and your spouse’s child who is younger than 16, or has a disability
Benefits can also be paid to your unmarried children, dependent parents, stepchildren, grandchildren, step-grandchildren and adopted children, but it depends on the situation.
When you can enroll – the basics
Before we dive into the different situations that can happen when you and your spouse enroll in Medicare, it might help to revisit some of the basics – especially when it comes to when you’re eligible to enroll.
To be eligible for Medicare you must be a United States citizen or lawfully present in the United States. You must also:
- Be age 65 or over, OR
- Be under age 65 with certain disabilities, OR
- Have end-stage renal disease
So, the key to eligibility for many is age – namely, when those 65 candles show up on your birthday cake. The work history of you or your wife, husband or domestic partner doesn’t matter when it comes to being eligible to enroll. But what happens if you or your spouse retire early?
Premium-free Part A – the one spousal benefit you can share
Even though you may not be able to share coverage, there is one benefit that spouses can share. If either you or your husband, wife or domestic partner worked and paid taxes for at least 10 years, both of you can get Medicare Part A at age 65 without having to pay premiums.
There are some exceptions that will allow you to get premium-free Part A coverage earlier, particularly if you’ve received disability benefits for 24 months or if you’re a kidney dialysis or kidney transplant patient. The benefit also stays with you if you divorce your spouse or if they pass away after you’ve been married for a certain period of time. (Also, this only affects your Part A premium. While most people do not pay a Part A premium, you’ll most likely need to pay a Part B premium.)
For more information, and to see if you’re eligible, check out the eligibility calculator at Medicare.gov.
Medicare coverage for non-working spouses
Let’s say that, between you and your spouse, one of you is finally ready to enroll in Medicare. Unless you have initial enrollment dates around the same month and year, you’re going to have a period where one of you is on Medicare and the other isn’t. Here’s how most of those situations play out:
Your non-working spouse is younger (reaching age 65 later)
This situation is the trickiest, so let’s talk about this one first. If you reach the age of 65 before your spouse, they won’t be able to sign up for Medicare until they turn 65 themselves. In order for your spouse to maintain health insurance coverage in the meantime, you can:
- Continue to work and receive health insurance benefits through your current employer – This way, you can keep your spouse on as a dependent. Your employer may require you to enroll in Medicare Part A and possibly Part B too when you’re eligible. Your Medicare coverage can work together with your employer’s coverage until you’re ready to retire. For more information about what to do and to better understand your options, contact your employer benefits administrator.
- Take advantage of COBRA when you retire – Your spouse can continue to be covered by your previous employer’s insurance. However, once you retire, your employer will no longer pay a portion of your monthly premium. Since employers usually pay a significant portion of premiums, continuing coverage through COBRA can be extremely expensive.
- Have your spouse buy individual health insurance through the state or federal marketplace or directly with an insurer – This is an excellent solution to help bridge the gap between you and your spouse’s eligibility for Medicare. We can take you through the steps of shopping for individual health insurance, and see if there’s financial help available.
Your non-working spouse is older (reaching age 65 sooner)
This situation is easier, but also comes with a few things to keep in mind. By now, it goes without saying that you should sign up for Medicare as soon as you’re eligible, whether you’re working or not.
Same goes here – your spouse can sign up for Parts A and B and stay on your current employer’s health insurance as a dependent. (Like we mentioned before, employer-sponsored insurance can work hand-in-hand with Medicare.)
Even better, if either you or your spouse has the 10 years of previous employment that we mentioned earlier, your spouse will get premium-free Medicare Part A coverage, regardless of your spouse’s employment status when they sign up. If your spouse is depending on your work history for premium-free coverage, it will only come into play when you reach age 62. Until then, your spouse will have to pay their Part A premium until you become eligible.
As far as signing up for Part B goes, your spouse could sign up as soon as they’re eligible. Most often, however, your spouse’s Part B enrollment can be delayed until you’re on Medicare. As long as your spouse was covered by your insurance, there’s no penalty for this delay in signing up for Part B.
All of this said, the best thing to do first is to contact your employer benefits administrator. They can help you better understand the options you have and to create a game plan to put into action.
Get ready now – talk to your current employer
Before either you or your spouse turn 65, it’s a good idea to talk with your current employer benefits administrator in the human resources department. They can help guide you through the rules and expectations about the kind of coverage you and your spouse can keep as you both transition to Medicare.
For example: some employers have certain rules about coverage for dependents when they’re eligible for Medicare. Some employers will allow Medicare-age dependents to stay on their plan, while some employers won’t. It’s worth it to check your employer’s policies so you’re ready when the big day arrives.