You may be 65 years old and ready to enroll in Medicare, but unless your spouse has a disabling medical condition, your mate won’t qualify until age 65.
That’s because Medicare doesn’t operate like health insurance that you may have through your employer. It’s not a family plan. Your spouse can qualify for premium-free Part A based on your work record if he or she hasn’t paid 40 quarters of federal payroll taxes. But you both will start your Medicare coverage separately, usually based on age.
People eligible for Medicare can sign up during their seven-month initial enrollment period, which begins three months before the month they turn 65 and lasts for three months after their birthday month. The coverage begins no earlier than the month they turn 65. For those whose birthday is on the first of the month, coverage starts at the beginning of the previous month.
Some ways to get Medicare before age 65
Anyone with a disability may qualify for Medicare before age 65. Most people younger than 65 who receive Social Security Disability Insurance (SSDI) benefits can get Medicare 24 months after they become eligible for disability benefits.
For anyone with permanent kidney failure, known as end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease, Medicare’s 24-month waiting period is waived.
What can I do to get medical insurance for my spouse?
If your insurance plan at work now covers both of you, you need to consider your options carefully before you transition fully to Medicare, because your spouse won’t have medical coverage. Consider these ways to bridge the gap.
- You can continue to work, keep your family health plan so your spouse will have full coverage, and enroll in premium-free Part A for yourself. If your company has 20 or more employees, your group plan will continue to be the primary coverage for you and your spouse, and Medicare will become secondary coverage for you. If your company has fewer than 20 employees, you’ll need to sign up for Medicare parts A and B when you turn 65.
If you keep your employer coverage, too, it becomes secondary to Medicare for you. Your spouse will still receive the same benefits, but the costs may change. Ask your employer for more information about the costs and coverage for your spouse after you turn 65.
- Your spouse can switch to health insurance from his or her employer until reaching Medicare age or beyond. Your spouse can qualify for a special enrollment period to switch to this coverage within 30 days of losing coverage under your plan or can enroll during the company’s annual open enrollment period.
- You can buy COBRA coverage up to 60 days after your employer-sponsored health insurance ends. It won’t substitute for your own Medicare coverage once you turn 65, but for your younger spouse, COBRA can last up to 36 months after you are eligible for Medicare. That means you can buy the benefits you had previously for a spouse who may not hit Medicare age for three years after you do.
The coverage and provider network won’t change under COBRA, but the premiums will. You usually have to pay both the employee’s and the employer’s share of the premiums, plus up to 2 percent in administrative costs.
- Your spouse can buy private insurance through the Affordable Care Act (ACA) federal marketplace or through a state that has its own exchange. Open enrollment generally runs Nov. 1 to Dec. 15 for new coverage starting Jan. 1 although some states have longer time frames. You can find links to the federal or state marketplace in your area at healthcare.gov.
If you’re losing medical coverage because you’re retiring, your spouse who had been covered through your employee plan may qualify for a special enrollment period to get marketplace coverage within 60 days after your health coverage ends.
Your spouse may qualify for a subsidy to help pay the premiums based on your household income for the year. After you retire, that income may be lower than when you were bringing home a paycheck.
The subsidy can reduce the premiums significantly, and 2021 COVID-relief legislation expanded them for 2021 and 2022. For example, a married 63-year-old in Baltimore whose household income is $40,000 in 2022 could qualify for a premium subsidy of $647 a month, lowering the monthly cost of a mid-level plan (called a silver plan in the federal marketplace) to $106 from $753 without the subsidy. The Kaiser Family Foundation’s subsidy calculator can help you estimate your premium assistance.
- Your spouse may qualify for Medicaid, a joint federal-state insurance program, if your household income is below a certain threshold, which varies by state. The ACA allowed for expansion of Medicaid coverage to adults with incomes of 138 percent of the federal poverty level, but not all states have expanded coverage. You can do a quick screening to see if you are eligible, at healthcare.gov or via your state marketplace.
So far in 2022, 38 states and the District of Columbia have expanded Medicaid coverage to adults whose modified adjusted gross income is $25,268 for a household of two in the continental United States. The income guidelines are $31,588 in Alaska and $29,063 in Hawaii.
The states that have not expanded Medicaid to low-income adults are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. But your spouse may qualify under some states’ rules, especially if your family is caring for relatives age 18 and younger who live with you.
Keep in mind
- If none of the options above works for you, you can search for a community health center near you. The ACA increased federal money for these public and nonprofit clinics that provide care to keep people healthy along with treating diseases — no matter what their income or age.
The health centers generally are located in areas with few doctors’ offices and hospitals, and also in areas with high rates of uninsured patients. Payment is on a sliding scale based on income.
- The Benefits CheckUp website from the National Council on Aging can lead you to benefit programs in your area that are tailored for you and your partner. You’ll be asked a series of questions to determine areas you want to learn more about, and you can remain anonymous.