Tuesday, April 2, 2024

Do I Need Medicare If My Spouse Has Insurance

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How Will My Spouse Receive Health Care

Do I Need Medicare If I’m On My Spouse’s Employer Health Plan?

If your spouse is younger than you and isnât yet eligible for Medicare, he or she will need some different kind of health insurance when you become eligible for Medicare. Other types of health-care could be an employer-sponsored group plan, or health insurance purchased through the Health Insurance Marketplace. When your spouse turns 65, he or she will then be eligible to enroll in Medicare Part A and B and then purchase a Medicare Supplement insurance plan.

What If The Non

If the non-working spouse is older than the working spouse, the non-working spouse can qualify on on the working spouses work record if they are at least 62, since that is when qualification for Social Security begins. In this case, if the working spouse is still working, the non-working spouse should stay on the work health insurance and just take Part A, as Part A is premium free for most people. If the working spouse is no longer employed, the non-working spouse should go ahead and apply for coverage fully from Medicare. If the working spouse is younger than 62, the non-working spouse will not be able to claim on the record. In this case, when they are 65, and assuming they have lived in the US for 5 consecutive years, they can purchase Part A and Part B and pay full premiums until the working spouse turns 62. Purchasing Medicare is not cheap, Part A can be as much as $422 a month in 2018. Make sure to consult a qualified professional before making this decision.

Your Rights To Continue Health Insurance After Divorce

Continuing healthcare after divorce will depend on your situation.

You have many options when it comes to health insurance. Here are a few of the more common:

  • Employer-sponsored plans
  • Medicaid
  • Tricare

One of the things I get asked about all time is whats the difference between an HMO, PPO, and POS.

Heres a quick overview:

State laws may also come into play. For example, in some states, it is illegal for a spouse to drop the other person from healthcare coverage while a divorce is in progress.

Other states view legal separation the same as divorce, and a spouse may be dropped from coverage just as they would if they were divorced.

In all cases following a divorce, an employer will no longer cover a spouse under an employees healthcare policy.

However, a spouse does have rights under COBRA to continue coverage. A spouse will have 60 days to notify the employees health plan administrator that they would like to continue coverage. They will be able to do so as long as they pay the healthcare plan premium.

Also, during a divorce, temporary orders by the court may mandate that a spouse continue to provide health insurance until a divorce is finalized.

If a spouse violates that order and drops a spouse anyway, the spouse that loses coverage can file a petition for a violation of the court order. The spouse will be required to add the person back on to the policy and incur any additional costs to do so.

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How Does Employer Health Insurance Work With Medicare

The size of your employer will determine how your Medicare benefits will coordinate with your employer coverage. If youre aging into Medicare while working for an employer with over 20 employees, your group plan is primary and Medicare secondary.

In this scenario, most beneficiaries choose to sign up for Part A, since its premium-free for those who have paid in for sufficient quarters. If youre currently collecting Social Security Income, youll automatically be enrolled in Part A. You cant collect SSI without registering in Part A.

If you require care at a hospital, your Part A benefits will keep your costs lower. For example, if your employers group insurance has a $4,000 hospital deductible, it makes sense to enroll in Part A for a lower deductible.

For your outpatient and medication insurance, a plan from an employer with over 20 employees is creditable coverage. This safeguards you from having to pay late enrollment penalties for Part B and Part D, respectively.

Medicaid As An Option After Divorce


A spouse going through a divorce who cant afford healthcare insurance might consider applying for Medicaid.

It is a need-based federal program administered at the state level that provides health coverage for low-income families.

Contact the state Medicaid offices in your state to see if you qualify for benefits.

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What Is A Medicaid Divorce

When planning for retirement, many couples realize they may make too much each month to qualify for nursing home assistance.

To get around this, some couples resort to what is known as a Medicaid divorce. This is a planning tool that helps reduce the overall amount of assets a couple has in their name. It helps each spouse qualify for Medicaid without losing a substantial amount of their assets.

Currently, Medicare does not cover the costs of long-term care. Medicaid assistance is necessary for many families who cannot afford the staggering costs of a nursing home.

Medicaid eligibility requires that a family spend down their assets to the point of poverty before Medicaid assistance may become available.

To get around this, in a Medicaid divorce, one spouse will offer nearly all of the couples assets to the other in a divorce settlement. A spouse can then apply for Medicaid benefits without having to report assets on a Medicaid application.

There are several possible implications in doing this that can have impacts on other benefits.

It is best to consult an elder law attorney before considering a possible Medicaid divorce.

What If My Employer Does Not Have 20 Employees But I Still Want To Explore The Option Of Cobra Coverage

COBRA rules only apply to employers with 20 or more persons, but many states have similar requirements known as Mini-COBRA laws. Employees separating from service from smaller employers should check to see what options are available to them under their state law. These rules can vary widely from state to state.

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Should I Enroll In Medicare

Enrolling in Medicare when you already have health coverage is not necessary, but if you dont want to delay your enrollment, then you should familiarize yourself with the enrollment periods to avoid possible penalties.

If you have any questions regarding the Medicare Enrollment Periods, we welcome you to give us a call at 877-877-5505 or send us a message through our online form and one of our helpful licensed Medicare insurance agents will get back with you.

If You Have Or Can Get Both Medicare And Veterans’ Benefits You Can Get Treatment Under Either Program

Do I have to get Medicare at 65 if I’m covered by my spouse’s employer plan?

If you have or can get both Medicare and Veterans benefits, you can get treatment under either program. Generally, Medicare and VA cant pay for the same service or items. Medicare pays for Medicare-covered services or items. Veterans Affairs pays for VA-authorized services or items.

When you get health care, you must choose which benefits to use each time you see a doctor or get health care.


To get the U.S. Department of Veterans Affairs to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility.

If the VA authorizes services in a non-VA hospital, but didnt authorize all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered services the VA didnt authorize.

I’m covered under TRICARE

For active-duty military enrolled in Medicare, TRICARE pays for Medicare-covered services or items, and Medicare pays second

For inactive-duty military, Medicare pays first for Medicare-covered services and TRICARE may pay second.

TRICARE pays first for services or items from a military hospital or any other federal provider

Get more information on TRICARE.

I have coverage under the Federal Black Lung Program.
I have COBRA continuation coverage

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What If Im Required To Carry Insurance For An Ex

You can go to court and seek a modification in the terms that were put forth in your settlement. Be prepared to thoroughly document why you are not able to meet the original terms, or you may be found in contempt of court.

You may also be able to tap into state-sponsored health insurance for your children. It is often offered with billing on a sliding scale based on your ability to pay.

If I Qualify How Affordable Is Medicare

Extremely so due to premium sharing with the federal government. Costs are funded through Medicare taxes deducted from workers wages and self-employment income. It covers anywhere from 77% to 99% of the actual costs.

Part A covers hospital expenses, skilled nursing facilities, and so forth. It is covered 100% by the government.

Part B covers outpatient services, doctor services, and related costs. It is not free, but those who enroll pay a premium that is equal to only 25% of the cost of Part B. In 2019, that amount is $135.50 per month, per person. Higher-income individuals could pay more through IRMAA rules.

Part D is prescription drug coverage. Costs vary depending on what plan you choose, but in 2019, the average cost is about $32.50 per month.

All of these costs do not take into account some deductibles and co-pays that will need to be met.

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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.

Is Coverage Guaranteed When Buying A Health Insurance Policy Through An Obamacare Exchange

If I Have Health Insurance Coverage Through My Spouse, Do I Need to ...

Since 2014, the Affordable Care Act requires that all major medical insurance policies are issued on a guaranteed basis. A person cannot be denied coverage for a pre-existing condition.

That means people can transition from employer-provided health insurance to a private insurance plan on an insurance exchange, regardless of any health conditions.

The catch is that while a person cant be denied coverage for a pre-existing medical condition, they cannot simply purchase coverage on an exchange whenever they want. Instead, coverage can only be purchased during an enrollment period.

If coverage is not purchased during the enrollment period, it is generally necessary to wait until the next Open Enrollment Period that runs from the beginning of November to mid-December each year. Coverage takes effect at the beginning of the subsequent year.

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Medicare Options After A Divorce

If you are married, you are generally eligible for premium-free Part A Medicare through either your work history or your spouses work history. You must have paid Medicare taxes for at least 40 quarters of your working life.

When you get a divorce, you may have options for Medicare benefits depending on your situation and your ex-spouses situation.

According to the Social Security Administration, you can use your ex-spouses employment history after a divorce if you meet the following conditions:

  • Your marriage must have lasted at least ten years or longer.
  • You must be currently unmarried.
  • You have reached the age of 62.
  • Your ex-spouse is entitled to Social Security Retirement or disability benefits.
  • The benefit you would receive based on your work is less than the benefit you would receive based on your ex-spouses work

If all of those conditions apply, you may be entitled to premium-free Part A and Part B coverage. This will be with the same premium that all enrollees must pay for Part B coverage.

If you or your ex-spouse do not meet the eligibility requirements for Medicare, you may still be able to purchase Part A after paying the applicable premium.

Anyone eligible for Medicare Part A and B can enroll in Medicare Part D prescription drug coverage or Medicare Advantage Part C. The only caveat is that you as long as they live in an area serviced by the plan.

Does Medicare Advantage Cover Younger Spouses

Medicare Advantage does not cover younger spouses that are not eligible for Medicare. However, younger spouses who have a disability can enroll in a Medicare Advantage plan.

This might be a good choice for a younger spouse to limit their out of pocket costs and have extras offered like drug, hearing, vision, and dental coverage. The only real downside is they would be limited to a local, HMO network, instead of the nationwide Medicare/Medigap network.

To learn more call a Senior65 agent at 800-930-7956.

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If A Nonworking Spouse Is Older Than You And They Meet The 40 Quarters Requirement

If your spouse is older than you, theyll qualify for Medicare benefits at age 65.

You may be able to receive Medicare benefits slightly earlier if youre at least 62 years old, married to someone who is age 65, and also worked for 40 quarters and you paid Medicare taxes.

If you dont meet these requirements, you may be able to qualify for Medicare Part A, but youll have to pay the Part A premium until youre age 62.

If you didnt work or meet the 40 quarters requirement, you may have to wait until age 65 to receive coverage under your spouses benefits.

What Happens When One Spouse Goes On Medicare And The Other Isnt Eligible

Spouses and Medicare Coverage

Hans Scheil

While it would be convenient for spouses to have the exact same birthday, this is not usually the case. For many couples, their age gap becomes a problem when it comes time to sign up for Medicare. When one spouse goes on Medicare and the other spouse is not yet eligible, what options do they have?

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What Happens If One Of You Becomes Eligible For Medicare Before The Other

Unless you and your spouse were born in the same month of the same year, one of you will become eligible for Medicare before the other. If you both are covered by your employer health insurance, and one of you turns 65, youll have decisions to make about Medicare. In this case, it will depend on the employer and their rules around covered dependents of Medicare age. Some employers may require spouses who are eligible to get Medicare to do so at age 65 in order to remain on the employer plan.

You can learn more about your potential options by talking with your employer benefits administrator.

Does Medicare Work With Health Savings Accounts

When enrolled in any Medicare parts, you CANNOT contribute to a Health Savings Account . Your employer also cant contribute to your HSA once your Medicare is active. If you continue to add to your HSA, you could face tax penalties.

If your spouse has coverage on your group insurance, they can still contribute as long as their Medicare is not active. The good news is, you can use the funds in your HSA to pay for any medical expenses.

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Determine If Medicare Or Group Insurance Is The Primary Insurer

The size of your employer often decides whether or not you can delay enrollment in Part B without paying a penalty. In companies with fewer than 20 employees, Medicare automatically becomes the primary insurer, with group insurance secondary. If you learn that your current insurance will become secondary to Medicare, then you should take Part A and Part B when you are first eligible. The reason for this is because secondary insurance only pays after the primary insurer pays, and pays very little. If you choose to delay Medicare, you will not have a primary insurer, and your out-of-pocket costs will be high.

On the other hand, if your employer has more than 20 employees and you learn that your group health insurance will remain the primary insurer with Medicare coverage second, then you may not need to enroll in Part B immediately as your current coverage will cover your needs.

Enrolling In Medicare At 65

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If you want to enroll when you are turning 65, you can enroll in Medicare Parts A & B, Part D prescription drug coverage or a Medicare Advantage plan. You can also look at adding a Medicare supplement insurance plan to Original Medicare to help with the out-of-pocket costs of Medicare. You will be able to enroll as early as three months before the month in which you turn 65. This is the start of your Initial Enrollment Period, which also includes the month of your 65th birthday and the next three months after.

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