If Your Or Your Spouse’s Employer Has Less Than 20 Employees And Isn’t Part Of A Multi
Medicare pays first. Medicare may pay second if both of these apply:
- Your employer, which has less than 20 employees, joins with other employers or employee organizations to sponsor a group health plan , and
- At least one or more of the other employers has 20 or more employees.
However, your plan may ask for an exception and request not to be part of a multi-employer group health plan. Check with your plan first and ask whether it will pay first or second for your claims.
It’s possible that neither the plan nor Medicare will pay if you get care outside your employer plan’s network. Before you go outside the network, call your employer group health plan to find out if it will cover the service.
If youre 65 or older, Medicare pays first unless these apply:
- You have coverage through an employed spouse.
- Your spouse’s employer has at least 20 employees.
If you don’t take employer coverage when it’s first offered to you, you might not get another chance to sign up. If you take the coverage but drop it later, you may not be able to get it back. Also, you might be denied coverage if your employer or your spouse’s employer generally offers retiree coverage, but you weren’t enrolled in the plan while you or your spouse were still working.
Can I Get Medicare For My Nonworking Spouse
When you qualify for Medicare, it only covers you. Your spouse has to apply separately. You each get your own red, white, and blue Medicare card. If you decide to get a certain type of Medicare coverage for example, a Medicare Advantage plan again, it only covers you.
That means your spouse can get the type of Medicare coverage they want. For example, you might choose to get your benefits through a Medicare Advantage plan, but your spouse might decide to buy a Medicare Supplement insurance plan instead. Youd still both have Medicare. Learn about the different types of Medicare plans.
Why Does Medicare Only Cover Individuals
Medicare isnt just an insurance program its a set of health benefits that you earned by contributing income taxes over the years. Medicare only serves individuals who qualify. Subsequently, its not lawful to extend your coverage to other people.
Your spouse should apply for Medicare if he or she is eligible to do so. If your spouse is not eligible, he or she will need to seek his or her own health insurance. Beware of trying to get around a spouses ineligibility by staying on your private or employer-based insurance plan until he or she qualifies for Medicare. The rules are complicated, and failure to enroll in Medicare on time results in a large penalty.
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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.
Medicare After Death Of A Spouse
The death of a spouse can change many aspects of your life, including health policies. If you get benefits under your spouses retirement plan coverage may change after they pass away. If you lose Medicare coverage due to the death of a spouse, you become eligible for a Special Election Period but, that period doesnt last forever.
Social Security surplus helps fund the deficit to help those in need of survivor benefits or those on disability.
Its your responsibility to enroll in a new policy as soon as possible to ensure eligibility. If you recently lost a spouse and your Medicare policy, please call an agent at the number above to start discussing your options.
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Am I Eligible For Medicare
To receive Medicare, you must be eligible for Social Security benefits.
Part A Eligibility
Most people age 65 or older are eligible for Medicare Part A based on their own employment, or their spouse’s employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it.
You are eligible for Medicare Part A if you meet one of the following criteria:
- You are eligible for Social Security or Railroad Retirement benefits, even if you do not receive those benefits.
- You are entitled to Social Security benefits based on a spouse’s, or divorced spouse’s work record, and that spouse is at least 62 years old.
- You have worked long enough in a federal, state, or local government job to be eligible for Medicare.
If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria:
- You have received Social Security disability benefits for 24 months.
- You have received Social Security benefits as a disabled widow, divorced disabled widow, or a disabled child for 24 months.
- You have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program.
- You have permanent kidney failure that requires maintenance dialysis or a kidney transplant.
- You are diagnosed with ALS or Lou Gehrig’s disease.
Part B Eligibility
If you are eligible for Part A, you can enroll in Medicare Part B which has a monthly premium.
Will I Need To Prove My Age?
Automatic Enrollment
What It Means To Pay Primary/secondary
- The insurance that pays first pays up to the limits of its coverage.
- The one that pays second only pays if there are costs the primary insurer didn’t cover.
- The secondary payer may not pay all the uncovered costs.
- If your group health plan or retiree health coverage is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.
If the insurance company doesn’t pay the
promptly , your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should’ve made.
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Rate And Comment On The Answer
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I am on medicare and my husbands income is 20, 000 a year. Combined we have 90,000 annually with my pension. He works and his jobs insurance is far too high. Can he qualify for marketplace Obamacare?
Your combined household MAGI is most likely too high to get cost assistance through ObamaCare, despite the cost of the employer coverage it is most likely your best option. Having access to employer coverage also prevents you from cost assistance, so this reinforces that. You can still apply to the marketplace during open enrollment and see what your options are, anyone can get a plan, but only certainly people are eligible for cost assistance.
Answer Rating:
The question isnt fully answered. For example, I am 58, my wife is 67 and on medicare. When I go through the questions about coverage on my BCBS online renewal application it indicates that because our family receives medicare then I do not qualify for a subsidy even though our family income for 2015 will be around 40,000. This doesnt make sense, but then regulations and tax law never do so I am asking if this is correct, that I cant qualify under any circumstances for a subsidy because my wife is on medicare.
Any family member who doesnt qualify for Medicare can get a family plan and qualify for a subsidy based on income for that coverage.
As long as the person on Medicare isnt on the plan it shouldnt matter.
Health Coverage Options When Too Young For Medicare
by Patricia Barry, AARP Bulletin, Updated February 11, 2020
En español | Q. When I retire at 65, my spouse and I will lose our health insurance. I can go on Medicare, but what are the options for my spouse, who is younger?
A. The best option for your spouse, frankly, is for you to keep working, if at all possible. That way your mate can continue coverage under your employer plan until he or she becomes eligible for Medicare at age 65, or, if that day is far off, for at least a few more years.
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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.
What If The Working Spouse Is Not Yet 65 Years Old
A non-working spouse can receive premium-free Medicare part A as long as the other partner is at least 62 years old and has satisfied Medicares work requirements.
For example, John is 65 years old and has never worked or paid Medicare taxes. His wife, Cathy, is 62 years old and has worked and paid Medicare taxes for more than 10 years.
In this scenario, John is eligible for premium-free Medicare Part A based on Cathys work history. He may enroll in Medicare Part A and Part B now, at age 65, even though Cathy must wait until she turns 65 to enroll in Medicare herself.
Now lets say Cathy is only 61 years old. In this scenario, John may still enroll in Medicare Part A and Part B, but he wont be entitled to premium-free Part A until Cathy turns 62.
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Hsa Family Contribution With Medicare Enrollment
This year my wife is eligible for Medicare part A as her 65th Birthday is Dec 07. She is still employed and we are both covered under her company high deductible medical plan. I am not eligible for Medicare. My wife will sign up for Medicare part A. We are contributing to a family HSA. I know once we get in Medicare, she is no longer allowed to pay in the HSA.
Question 1: can she enroll in Medicare in January 2021 or must she do it prior her Birthday in December 2020?
Question 2: Without my wife enrolling in Medicare, we can contribute $8100 max for 2020. If she enrolls only in January 2021, can we still contribute $8100 for 2020 since she would enroll in 2021?
Question 3: Is she enrolls in December 2020 what is the max prorated family amount we can contribute? I came up with $7425 based on some formulas I found I the internet but the HSA Service dept said $5400 max.
Medicare Part B And Spouses
Medicare Part A is hospital insurance, while Medicare Part B refers to medical insurance. Part A is free for those with the qualifying number of Social Security credits. However, Part B requires a monthly premium.
If one spouse turns 65 years of age and the other still has health insurance coverage through their employer, the individual without Medicare may decide to wait for Medicare Part B enrollment. There is no late enrollment penalty for spouses if they enroll during a SEP.
They can enroll in Part B while still using an employer-sponsored health plan. They also may enroll during the 8-month period that begins the month after the original health plan or employment ends.
Medicare base the special enrollment criteria on whichever event comes first, the end of health plan coverage or employment.
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Tricare For Life And Medicare
Sometime after passing the 90-day mark before a service member or spouses 65th birthday, DEERS will automatically notify beneficiaries of impending changes to their coverage. At this time, beneficiaries will be required to enroll in Medicare Part B to be eligible for the transition to TRICARE for Life. Once enrolled, TRICARE for Life will cover health care costs above that paid by Medicare, starting on the first day of the month of the beneficiarys 65th birthday.When receiving medical treatment, TRICARE for Life members only need to show a military ID card in addition to providing their Medicare information there is no special TRICARE for Life ID card over and above a Medicare card and a military ID. The provider will bill Medicare, who will in turn bill TRICARE for Life. There is no copay associated with these visits, and there is no authorization required to see a provider that is not a part of the TRICARE network, as TRICARE will use the providers Medicare account information to process the claim.
TRICARE recognizes all providers who accept Medicare as TRICARE-authorized service providers by default, however, these providers may not accept TRICAREs maximum allowable payment as payment-i-full for treatment.
TRICARE for Life Overseas
TRICARE for Life and the VA
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.
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What Happens When One Spouse Goes On Medicare And The Other Isnt Eligible
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?
Should I Take Medicare Part B
You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B when they become eligible.
You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.
Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium.
If you are:
- a spouse of an active worker
- a disabled, active worker
- a disabled spouse of an active worker
and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first.
You will not be enrolling late, so you will not have any penalty.
If you choose coverage under the employer group health plan and are still working, Medicare will be the “secondary payer,” which means the employer plan pays first.
If the employer group health plan does not pay all the patient’s expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing.
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What Does Medicare Cover
Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A and Part B .
The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments.
If you have questions about covered services, call Medicare at 1-800-633-4227.
Medicare If You’re Married
You and your spouse’s Medicare coverage might not start at the same time. Medicare is an individual plan . However, you may be eligible for Medicare based on your spouses work history — even if you are not eligible on your own. You and your spouse’s Medicare coverage might not start at the same time. Since you each must enroll in Medicare separately, one of you may be able to sign up before the other one, depending on your age.
Your premiums may change because of your total income. There are no family plans or special rates for couples in Medicare. You will each pay the same premium amount that individuals pay. Here’s what to know about costs:
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