Medicare is a system that offers individual insurance, not family plans or group benefits. However, there are some instances when a wife’s eligibility can extend certain benefits to the husband and vice versa. Additionally, your Medicare Part B premiums could be impacted by the amount of combined income earned by you and your spouse, rather than your income alone. There are several aspects you need to consider.

Medicare coverage is available to anyone who has worked and paid into Social Security for about 10 years, or a minimum of 40 quarters. If a spouse didn’t work, they might still get Medicare Part A eligibility based on their spouse’s work and Social Security tax history. The rules are pretty straightforward, and anyone who has questions can contact the Social Security Administration, visit the Medicare.gov eligibility calculator, or HellaHealth’s Eligibility Wizard.

What happens when one spouse goes on Medicare before the other?

Unless you and your spouse were born in the same month and year, one will become eligible for Medicare before the other. Typically, when one spouse goes on Medicare, the coverage is limited to them exclusively and does not carry over to the other spouse. Unlike traditional insurance, Medicare is based on individual eligibility. 

A person must be 65 or older to qualify for Medicare; if one spouse is younger, they will have to wait until they are old enough to enroll on their own. This applies by extension to Medicare Advantage since to be able to sign up for it you first need to have enrolled in Original Medicare (both Part A and Part B).

Age eligibility is not the only way to qualify for Medicare, though. If a younger person has a disability, End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant), or Amyotrophic Lateral Sclerosis they are also eligible to enroll in Medicare.

 Can I get Medicare through my spouse?

Typically, if someone qualifies for Medicare, but their spouse doesn’t, he or she may have to continue working to keep their employer coverage (if that’s an option) so that their younger spouse continues to be covered. The other choices are to purchase a COBRA policy (again, if available) or to buy individual coverage for the younger spouse until he or she is old enough to qualify for Medicare.

When can a spouse claim spousal Medicare benefits?

If a spouse didn’t work, they may be able to claim Medicare spouse benefits based on their spouse’s work history. This only applies to Part A benefits, and all other coverages must be paid for individually. 

When your non-working spouse is younger and you go on Medicare, your non-working spouse will need health insurance until he or she is also eligible for Medicare. 

When your non-working spouse is older (meaning they turned 65 before you), your age as the working spouse will affect when your spouse qualifies for premium-free Medicare Part A. The qualification is based on your work record; if you paid taxes long enough to qualify for premium-free Part A then your spouse is eligible too. You don’t have to actually start getting Social Security benefits; you just need to be old enough to file for them if you wanted to. 

If you, as the working spouse, are at least 62 years old and eligible for Social Security benefits, your spouse can enroll in premium-free Part A. 

If you, as the working spouse, are younger than 62, your non-working spouse who has turned 65 may choose to pay the premium for Medicare Part A if needed until you reach the age of 62 and the premium-free benefit kicks in.

Medicare is individual insurance, but spouses should think about the above when helping each other make Medicare decisions.

As mentioned, anyone unsure of their coverage can contact Medicare for more information or to find out if their spouse is covered.

Medicare spouse eligibility

For a spouse to be eligible for Medicare benefits from their partner, they must meet certain requirements. In addition to the details above, one of the following requirements must be met:

·       The spouses must have been married for at least a year before applying for Social Security or Medicare benefits.

·       You are divorced but were married to someone for at least 10 years and they qualify for Social Security benefits. If you are single, you may be able to apply for Medicare.

·       You are widowed and were married for 9 months (minimum) before your spouse passed away. If he or she qualified for Social Security and you’re single, you may be eligible for Medicare Part A.

Other eligibility considerations may come into play on a case-by-case basis, but these are the standard rules. Anyone with questions or who thinks they should be covered needs to make sure that they understand how to add a spouse to Medicare coverage.

How to apply for Medicare through a spouse

There are a couple of options for applying for Medicare spouse benefits.

• You can contact your local Social Security Administration, which can help you understand benefits and eligibility and walk you through the application process.
• You can also reach out to the Medicare Benefits Coordination and Recovery Center, available via phone at 855-798-2627 (TTY: 855-797-2627).

You need to be aware of Special Enrollment Periods and other timing issues related to Medicare benefits coordination to ensure that you maximize the perks of having spousal Medicare benefits. This also ensures that you and your spouse are protected and won’t have to worry about a lapse in coverage, which provides additional peace of mind.