What Parts Of Medicare Can I Share With My Spouse
The spouses benefits apply specifically to Part A of Medicare .
You cant purchase couples coverage for any other portion of Medicare. You must pay for the other individual portions on your own policy.
However, its important to consider all of your options for Medicare coverage and what will work best for your needs. One of these options is Medicare Advantage , which bundles both Part A and Part B together and offers additional coverage and benefits.
If extra coverage, like dental, vision, or hearing care, is important to maintaining your individual health, give some thought to whether original Medicare or Medicare Advantage will work best for you.
Medicare offers its Part A coverage to eligible spouses of enrollees. Services covered under Medicare Part A include:
- inpatient hospital care
- limited stays in a skilled nursing facility
There are specific rules about the services and supplies Medicare Part A covers, as well as how long theyre covered.
Do I Have To Sign Up For Medicare If Im Covered Through My Spouses Employer
The answer depends on whether your spouse works for a small business or large company.
No matter what the size of the company, you wont have to pay a penalty if you have health coverage through your spouses current employer and you enroll in Medicare within eight months of losing that coverage. But if you get your coverage through a small business, you may face gaps that youll have to pay for yourself if you dont sign up for Medicare at age 65.
If your spouses company has 20 or more employees, it must offer the same health benefits to employees and their spouses who are 65 or older that it offers to younger workers and their pouses. This employer cannot require you or your spouse to enroll in Medicare at age 65.
The company-sponsored health insurance will continue to be what pays medical bills first, as the primary payer. Medicare will be the secondary payer.
Even though many people turning 65 have coverage from an employer, they enroll in Part A of Medicare because its free if they or their spouse has paid more than 40 quarters of Medicare taxes . If youre qualifying for Medicare through your spouse, you have to be married at least a year before applying.
But people often delay signing up for Medicare Part B so that they dont have to pay premiums for both Medicare and the employers coverage. In 2022, Part B costs $170.10 a month for most people .
Get Ready Now Talk To Your Current Employer
Before either you or your spouse turn 65, its 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 theyre eligible for Medicare. Some employers will allow Medicare-age dependents to stay on their plan, while some employers wont. Its worth it to check your employers policies so youre ready when the big day arrives.
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Divorced Know This Significant Exception To The Rule
When planning your Social Security filing strategy, its important to note that you cannot file for a spousal benefit until the higher earning spouse files for their benefit.
But this does not apply if your are filing for a spousal benefit from an ex-spouse.
If your ex-spouse has not applied for retirement benefits you can receive benefits on his or her record if you have been divorced for at least two years and your ex-spouse is at least 62.
Rules For Medicare Eligibility Based On Spouses Work History
To qualify for Medicare Part A benefits at age 65 based on your spouses work history, you must meet one of the following requirements:
- You have been married to your spouse who qualifies for Social Security benefits for at least 1 year before applying for Social Security benefits.
- You are divorced, but were married to a spouse for at least 10 years who qualifies for Social Security benefits. You must now be single to apply for Medicare benefits.
- You are widowed, but were married for at least 9 months before your spouse died, and they qualified for Social Security benefits. You must now be single.
If you arent sure you meet a certain requirement, you can contact the Social Security Administration by calling 800-772-1213. You can also visit Medicare.gov and use their eligibility calculator.
Medicare Eligibility At Age 65
- You are at least 65 years old
- You are a U.S. citizen or a legal resident for at least five years
In order to receive premium-free Part A of Medicare, you must meet both of the above requirements and qualify for full Social Security or Railroad Retirement Board benefits, which requires working and paying Social Security taxes for at least 10 full years .
Learn more about Medicare eligibility at and before age 65 by referring to this helpful chart and reading more information below.
Enroll By Phone Or In
Contact Social Security to schedule a phone or in-person appointment for this enrollment. You can call the main line at 800-772-1213 or a local Social Security office to schedule . We recommend initiating the request 4 months prior to your planned start date. These appointments are typically booked weeks, if not months, in advanceso get started early.
During a phone appointment, you and your spouse will need to be on the line together. For in-person appointments, you and your spouse will need to be present. Simply follow the SSA representatives lead. They will ask all the confirmation questions and take down your information for the application. And in some cases, you will need to provide supporting documentation, such as:
Copy of your marriage certificate This isnt always required, but be prepared for this possibility.
Form CMS-L564 This is only required when enrolling in Medicare Part B after your Initial Enrollment Period has ended and youre leaving an employer health insurance plan, based on your active employment or your spouses. This form can be accessed HERE.
If you need to send any documents, the SSA rep will ask you to either mail or fax them. After that, its usually a 3-6 week timeframe for processing. You will receive confirmation of the enrollment being complete by US mail.
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If My Spouse And I Are Enrolled On My Employers Hsa
Yes, if your spouse is otherwise HSA-eligible he or she can open an HSA at any time. You or your spouse can then make tax-deductible contributions into the HSA, up to the family maximum. This allows couples to continue to contribute to an HSA for several years even after the older spouse enrolls in Medicare.
Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
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Do I Enroll In Medicare If My Spouse Has Retiree Coverage
Yes. You can delay signing up for Medicare only if you or your spouse has coverage from a current employer. You need to enroll in Medicare no later than eight months after your spouse stops working or you may have to pay a lifetime late-enrollment penalty when you do enroll in Part B.
That is also the case if your spouse continues his or her employers coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 , a federal law that requires organizations with 20 or more employees to offer health insurance for up to 18 months after workers leave their job. COBRA doesnt count as active employment, so you must enroll in Medicare during your initial enrollment period to avoid late-enrollment penalties.
How Do You Get Medicare At Age 65
When youâre eligible for Medicare at 65, you might be automatically enrolled in traditional Medicare, also called Original Medicare, Part A and Part B. Medicare for your spouse will happen later, when she or he turns 65.
If youâre aging into Medicare at age 65, you can still help with Medicare planning for your spouse. Together, you can learn about Medicare. For example, find out when to apply for Medicare.
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Does Medicare Cover Your Spouse
Does Medicare Cover Your Spouse? Although group insurance policies through your employer typically offer options for family coverage, you may be wondering whether Medicare offers spousal coverage. While managing a policy may be easier when everyone in the family can be included in one policy, Medicare coverage is individual coverage. If you and your spouse both qualify for Medicare, you would need to enroll as an individual.
Medicare Benefits Solutions
When it comes to spousal coverage, Medicare insurance plans only cover the individual listed on the plan. This means that you are not able to share benefits with your spouse, other family members or anyone who is not on the plan. Each plan is designed for individual coverage. If your spouse would like to take part in Medicare, they will need to meet the eligibility requirements on their own and obtain an individual plan.
Before discussing Medicare and spousal coverage, however, its first important to understand the qualifications necessary to enroll in Medicare. The Medicare program was initially designed to assist seniors and retirees in obtaining insurance coverage for medical expenses. Today, the program covers these individuals, but it also includes eligibility for certain Americans with qualifying disabilities under the age of 65.
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Spousal Age Gaps And Options
Most spouses will have to determine the next steps when one partner, who is 65 years of age, is about to become eligible for Medicare but the other partner is younger.
If the older partner is eligible for Medicare but continues to work, their coverage still comes from their employers health insurance. Their spouse may continue to receive coverage under that plan.
If the older spouse intends to retire on reaching 65 years of age, the younger spouse has several options for health insurance coverage. However, in most circumstances, they would not be eligible for Medicare coverage until they reach the eligible age.
If the younger spouse has coverage under the older spouses employer healthcare plan, but the older spouse plans to retire while the younger is still working, one option is enrolling in their own employers insurance plan.
This holds true even if it is not the open enrollment period for their employers plan. Losing spousal health insurance is a circumstance allowing access to a SEP.
This timeframe is limited, however, so the younger spouse must make this decision quickly. Not enrolling during the special period means waiting until the next open enrollment period starts. This could lead to a period of lapsed coverage.
When the younger spouse loses coverage because the older spouse transitions to Medicare, a group health insurance plan may still be possible through COBRA.
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How Can My Spouse Obtain Coverage
Because Medicare benefits cant be shared between spouses, each individual in a marriage will need to obtain their own plan. If your spouse has met all of the eligibility requirements for Medicare, they will need to reach out to Medicare online or at a local office to enroll. Additionally, your spouse can work with an insurance broker to discuss their individual needs to find a plan that works.
Do Other Parts Of Medicare Cover Spouses
Can a non-working spouse also become eligible for other types of Medicare coverage?
Once your spouse enrolls in both Medicare Part A and Part B, they may be eligible to enroll in other types of Medicare coverage.
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Do I Need Part D If I Have Drug Coverage Through My Spouse
Not necessarily. The rules are different for Medicare Part D prescription drug coverage. As long as you continue to receive creditable prescription drug coverage under the employer plan whether your spouse is still working or retired you do not need to sign up for a Part D plan.
If you lose this coverage at some point, you will then be eligible for a special enrollment period of two months to purchase a Part D plan without incurring a late-enrollment penalty.
Keep in mind
Youll have different decisions to make if the spouse with employer health coverage turns 65 first. If the older spouse enrolls in Medicare instead of keeping the employers insurance, the younger spouse may lose private health insurance coverage. If that happens, a younger spouse may need to find other sources of coverage before turning 65 and becoming eligible for Medicare.
One option is to continue the employers coverage through COBRA, which can last up to 36 months if you lose employer coverage because your spouse becomes entitled to Medicare. Or you can buy a private plan through the Affordable Care Act federal insurance marketplace or through a state that has its own exchange.
Medicare Advantage Plans For A Non
If you and your spouse are eligible for Medicare Part A and Part B, then you are likely eligible for a Medicare Advantage plan.
Medicare Advantage plans offer the same benefits as Medicare Part A and Part B combined into one plan. Some Medicare Advantage plans may also offer additional benefits such as prescription drug coverage and coverage for dental, vision and hearing care.
To learn more about Medicare Advantage plans for you and your spouse, call to speak with a licensed insurance agent today.
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How To Calculate Your Own Social Security Spousal Benefits
The spousal benefit calculation is straightforward if you dont have a benefit of your own. Remember, in that case, its between 32.5% and 50% of the higher-earning spouses full retirement age benefit, depending on your filing age.
However, it can seem a little more complicated if you have Social Security benefits from your work history.
And to keep things interesting, the Social Security Administration decided that a different calculation method should be used to determine how much each benefit should increase/decrease based on your filing age.
As complicated as Social Security benefits can seem, there is a way to correctly calculate how much your spousal benefit will be if you qualify to receive it.
Check out this section of my video that goes over this calculation step-by-step. VIDEO: How To Calculate Spousal Benefits The RIGHT Way
If you understand how they break down the individual benefits, its not hard to use the table above to quickly figure out what your approximate benefit will be. Heres an example.
Joe and Julie each have a Social Security benefit from work they individually performed. Julies benefit at her full retirement age is $800 per month. Joes benefit at his full retirement age is $2,000.
Assuming they are both full retirement age when they file, Joe will be entitled to a benefit of $2,000 and Julie will be entitled to the greater of her own benefit or half of Joes benefit.
Sounds simple, right?
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 wont 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, youll 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.
The coverage and provider network wont change under COBRA, but the premiums will. You usually have to pay both the employees and the employers share of the premiums, plus up to 2 percent in administrative costs.
- Your spouse can buy private insurance through the Affordable Care Act 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.
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