Medicare Coverage for Spouse: Top 5 Facts You Need to Know | GoMedigap

Medicare Coverage for Spouse: Top 5 Facts You Need to Know

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Medicare Coverage for Spouses

You and your spouse are a unit. You’ve experienced all the major ups and downs of life, and now, entering retirement, you’re experiencing new adventures together as well. Through all the aspects of life you and your spouse share together, one of those shared aspects might be insurance.

Before retirement, were you covered under your spouse’s insurance? Is your spouse covered under your insurance? As you and your spouse turn 65, it is imperative that you enroll in Medicare on time. You and your spouse may turn 65 at different times. That is okay. As long as you enroll in Medicare during your Initial Enrollment Period, you will get Medicare coverage.

These waters are tricky to navigate, but it is important that you and your spouse get coverage in the event of any medical emergency. Here are the top 5 facts you need to know when getting Medicare coverage for your spouse.

    1. Medicare Eligibility is Important

You and your spouse will become eligible for Medicare when you each turn 65. Three months before you turn 65, you will receive information in the mail about enrolling in your new Medicare plan. If you worked in the United States for 40 quarters or 10 years, you paid Medicare taxes during this time. This typically means Medicare will automatically enroll you in Medicare Part A for a $0 premium. You will have to choose if you want to enroll in additional parts of Medicare, such as your Medicare Part B outpatient coverage and Medicare Part D prescription drug coverage.

It is important that you enroll in Medicare as soon as possible. If you don’t, it is possible that you might be subject to late enrollment penalties. Depending on the part of Medicare it falls under, you might have to pay these late enrollment fees for the entire duration you have these plans.

    1. Spousal Coverage Should Be the Same

You will qualify for the same parts of Medicare as your spouse. If your spouse worked for 10 years in the United States, they will receive Part A premium-free. This means that you will also receive a premium-free Part A plan.

There are few exceptions to this rule. The main reason why you would have the same coverage as your spouse is if there is an age difference. We outline the impacts of an age difference below.

    1. Age Gaps Are Okay

While age gaps are okay when registering for Medicare, it may cause some hiccups in the process. For example, if you turn 65 before your spouse, they will have to wait until they also turn 65 to receive the same coverage benefits. On the other hand, if your spouse turns 65 before you, they will have to enroll in a premium-free Part A plan until you reach 65.

Of the mentioned scenarios, the biggest problem comes when you turn 65 before your spouse does. They might have to get additional coverage before they can enroll in Medicare.

    1. It’s Possible to Lose Coverage After Retirement

Before you retire, you might receive your health insurance coverage for you and your spouse through your employer. If you retire and turn 65 before your spouse, your spouse will be left without any health insurance coverage.

Until your spouse turns 65, it is important that they find some type of coverage, so they are protected in the event of any medical emergency. You can purchase private health insurance coverage for them, or you can enroll your spouse in a COBRA plan.

This means that until you and your spouse are both 65, you will have to pay premiums for the private health insurance coverage, and your Medicare plans, depending on the ones you choose to enroll in. This conversation around retirement and coverage is important to have with your spouse if you decide to retire before they turn 65.

    1. Getting a Medicare Supplement Plan

Once you and your spouse are both enrolled in Medicare, you might want to consider getting a Medicare supplement plan. Unfortunately, Medicare does not cover all of your medical expenses. Many people choose to fill these “gaps” in Medicare coverage with a Medicare supplement plan.

These plans often cover all of your copayments and deductibles, depending on the pan you choose. This means that for a doctor visit or hospital stay, you might not have to pay any money out-of-pocket. This type of coverage completely covers you and your spouse in the event of any medical treatment.

You’re Not Alone

In the end, it is possible and easy to enroll your spouse in Medicare. While it may seem daunting, you will not be alone during the process.

If you need help, feel free to give us as call. We can walk you through the process of enrolling you and your spouse in Medicare. We can also help you pick the right Medicare supplement plans that fits you and your family’s needs. Give us a call at (800) 310-2550 or get your free Medicare supplement quote online.

Compare Your Medicare Supplement Rates Immediately!

8 Replies to “Medicare Coverage for Spouse: Top 5 Facts You Need to Know”

  1. I am Retired Marine, my wife became eligible for SocSec and Medicare (Part A&B). We use Madigan Army MedCntr as our primary health care facility. My wife was referred to a Foot care specialist who operated on her foot by a civilian hospital. We provided our Meicare and Tricare for Life information. The hospital bill apparently was a bit more than we expected. Medicare paid for their approved payments but there was quite a bit left over for us to pay. I don’t know the procedures to make a claim to TFL to make sure the payment is made.

    1. Hi Jan,

      You can find more information on filing a claim to Tricare For Life on their website, linked here: https://tricare.mil/FormsClaims/Forms/TFL

      On this page, it will show you the different forms you might need. You can choose the one for your specific circumstance. You can also navigate to instructions that show you where to send the claim.

      I hope this helps! If you have any other questions, please feel free to contact us at (800) 310-2550. Have a great day!

  2. My husband turned 65 in August and did receive his Medicare card. I am 64 and work full-time with benefits (paid via each pay period) that also cover my husband. I understand that my benefits would be his primary coverage, medicare secondary until I retire. When I turn 65 next summer, I still plan to work full-time and understand that I will still have to apply for medicare. My health benefits would still be my primary, medicare secondary. Is this true?

    1. Hi Ms. Molloy,

      This is true. However, in most cases, if you are still working, you can choose to delay Medicare enrollment without incurring fines. As long as you are still covered under your employer, once you retire, you will enter a Special Enrollment Period. At this time, you can enroll in all parts of Medicare.

      I hope this helps! Please let us know if you have any other questions. We can be reached at (800) 310-2550. Have a great day!

  3. I will be 66 in August. I plan to retire then. My husband is 90 (currently on medicare) He is covered currently with my employer provided health plan as primary and his medicare is secondary.

    Is his age going to be factor when securing medigap insurance? Can we have different coverage? Like can he have an Advantage plan and I have a medigap plan? or can we have different medigap plans?

    1. Hi Judy,

      Congratulations on your upcoming retirement! Age may be a factor in determining the Medigap premium, but it does not affect your husband’s ability to get a plan. Spouses can have different coverage so that you can both choose what will work best for you. If you haven’t already spoken with one of our agents, we’d be happy to work with you to make sure you both have a smooth transition to Medicare. You can reach us at (800)310-2550.

  4. My wife of 45 years is 72. She has been on SS Disability since before we met, which was converted to SS Retirement a few years ago. She was on Medicare as well as my employer’s insurance plan, so we elected to stop Medicare a few years ago. I am 68, and am thinking about retirement soon. Once I no longer have employer insurance, and have used up the COBRA, I will sign up for Medicare. Will my spouse automatically be eligible when I sign up, since she previously had Medicare, or do we need to wait until the standard enrollment dates before she can get covered?

    1. Hi Bob,

      Your eligibility for Medicare depends on when you lose your coverage with your employer. Both you and your wife will be able to take your Part B to coincide with the ending of that coverage. COBRA is not considered creditable coverage for the purpose of taking your Part B, which means you could miss your enrollment period, and experience a gap in coverage. COBRA also tends to be considerably more expensive than Medicare and a Medicare Supplement. If you would like to discuss your options, one of our experts can assess both of your situations. You can reach us at (800)310-2550.

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