Medicare is an individual health insurance program for workers who’ve paid Medicare taxes throughout their working life and who are age 65. You’re able to qualify for premium-free Medicare Part A (hospital insurance) by paying these taxes for 40 quarters (about 10 years). You may also be eligible for Medicare coverage as a result of a disability or if you have end-stage renal disease (ESRD).
Medicare eligibility for spouses depends on a number of factors, and it’s not applicable to unmarried partners. Spouses who haven’t worked the required number of quarters may have access to Medicare coverage. If you have questions about whether or not you qualify for Medicare coverage, read on for more information.
Medicare for Married Couples: How It Works
Medicare spousal benefits eligibility can arise from a variety of circumstances. The easiest way for married couples to both be eligible for Medicare is for both spouses to meet the tax requirement by working for ten years. This typically equates to the four Social Security work credits1 that you can receive per year, up to 40 credits. Once you or your spouse qualifies, it’s fairly simple to apply for Medicare Part A on the typical timeline.
Things get more complicated if one spouse provides medical insurance through their workplace for the whole family. In some cases, workers who are eligible for Medicare may opt to wait to enroll in Medicare to preserve existing health coverage. They may also enroll in Part A coverage while continuing to pay for their existing health coverage. A working spouse who makes this decision can avoid paying delayed enrollment penalties for Medicare Part B.
If one spouse retires at 65 and enrolls in Medicare but the other spouse isn’t old enough for coverage, it could leave them in a bind with wildly expensive coverage or no insurance at all.
If the spouse without Medicare is able to switch to employer-provided health insurance, that’s usually the most affordable option. COBRA temporary insurance or an individual plan from the ACA health insurance marketplace may work, too. To reduce the risk of a gap in coverage, it’s important to find a way to pay for health insurance for the spouse of a Medicare recipient.
Once the spouse without Medicare is eligible, they’re able to enroll in their own Medicare coverage, both Parts A and B. Unmarried partners do not have the same eligibility for Medicare coverage. In addition, domestic partners don’t enjoy the privilege of the waived Part B late enrollment penalty if they choose not to enroll.
Medicare Spousal Benefits
If you’re able to receive Medicare Part A as an eligible spouse, you have access to certain specific services. Different rules apply to both the types of services and supplies covered and how long the coverage lasts. Items covered under Medicare Part A include:
- Inpatient hospital care
- Inpatient mental health services
- Inpatient rehabilitation
- Hospice care
- Limited home healthcare
- Skilled nursing facility stays
Medicare Part B requires a monthly premium and is medical insurance. Part B premiums are determined by your income, but most people pay the standard Part B premium2.
Medicare for a Nonworking Spouse
For nonworking spouses, Medicare coverage is still an option, with some added rules. If your spouse has paid their Medicare taxes for ten years or 40 working quarters, you may be eligible when you turn 65. This is true even if you’ve never worked outside the home. If you qualify for Social Security, you and your nonworking spouse are eligible.
If you’ve divorced from your spouse or are a widow/widower, you can still enroll in Medicare Part A without paying a premium, but only if you remain unmarried.
Once you and your spouse are signed up for Original Medicare—both Part A and Part B—you’ll want to consider additional coverage, such as a Medicare Supplement or Medicare Advantage plan. These plans provide additional coverage that Original Medicare doesn’t.
Do I have to sign up for Medicare if I am covered by my spouse’s insurance?
If you or your spouse are still working, you don’t have to sign up for Medicare. You can wait until either you or your spouse stop working or lose health insurance benefits (whichever happens first). You may still want to sign up for Medicare Part A if you are eligible.
Understand You and Your Spouse’s Medicare Coverage with SelectQuote
If you or your spouse are about to turn 65 and have questions about Medicare, don’t wait to get them answered. Ensuring that you have health insurance coverage can protect you if you get sick.
SelectQuote helps Medicare- eligible individuals understand their coverage options. We can help you navigate the process of how to apply for Medicare through your spouse.
1https://www.ssa.gov/pubs/EN-05-10072.pdf
2https://www.medicare.gov/your-medicare-costs/part-b-costs
