Medicare does not specifically cover spouses. However, some people qualify based on their spouse’s or a former spouse’s work record.

Some people may qualify for Medicare by reaching age 65 years and having their own eligible work and tax records. Others, however, may not have worked for the required number of quarters.

In these cases, Medicare can use the work record of a married enrollee to qualify their spouse for a plan.

This article examines the eligibility criteria for the spouses, partners, and dependents of Medicare enrollees for coverage.

Glossary of Medicare terms

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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The spouse of a Medicare plan holder becomes eligible for their own plan when they turn 65 years old, even if they never worked outside the home.

This is because they qualify based on their spouse’s work record. If a Medicare enrollee’s spouse has a disability, they may qualify at a younger age.

Sometimes, even a former spouse’s work record can help a person qualify. For example, a couple may have divorced after a marriage of at least 10 years. For these people, Medicare can use the former spouse’s work record to allow a separated spouse who has not worked outside the home to qualify, as long as they meet the age or disability criteria.

However, this only applies to people who remain unmarried to a new partner. Medicare will assess the eligibility of individuals who remarry using their new spouse’s work history.

Medicare does not offer unmarried partners the same benefits as married ones. Unlike a spouse, a domestic partner cannot enroll in Medicare Part B without paying a late enrollment penalty, and Medicare has no special enrollment periods (SEPs) for unmarried domestic partners.

Learn more about Medicare enrollment.

For a person or their spouse to qualify for Medicare, they will need to have built up enough Social Security work credits throughout their employment history.

Medicare credits link to Social Security work credits. In 2024, a worker receives 1 work credit for every $1,730 they earn. They can earn up to 4 credits annually.

Self-employed individuals also receive up to 4 annual work credits per $1,730 of net earnings.

Individuals must have a minimum of 40 work credits, which is typically about 10 years’ worth of work, to become eligible for Medicare.

Younger individuals with disabilities or certain medical conditions may require fewer work credits to be eligible for Medicare.

A person who develops a disability between ages 31 and 42 years will require 20 work credits for Social Security disability benefits. On the other hand, a person who develops a disability at age 62, will require the full 40 credits to qualify for Social Security disability benefits.

Not every type of employment counts toward Social Security work credits. If the spouse works for a local or state government that does not participate in Social Security, they will not earn credits.

Those with more than 10 years of service working on the railroads do not pay into Social Security. Instead, the Railroad Retirement Board (RRB) benefits cover Medicare plans.

The RRB deducts Medicare payments from their employee’s paychecks, and railroad workers receive the same benefits as anyone else.

Although there is a connection between Social Security work credits and Medicare, a person may start collecting Social Security at age 62 years. Except in certain circumstances relating to disability, Medicare is unavailable to those under age 65 years.

A person receiving Social Security Disability Insurance (SSDI) automatically receives Medicare Part A and Part B after receiving SSDI benefits for 24 months.

Learn more about Medicare work credits.

Medicare covers individuals, not families.

While some employer-sponsored group health plans directly cover medical treatments for spouses and dependents, there are no such coverage options on Medicare plans. Each person qualifies on their own.

Read more on eligibility criteria for Medicare.

Most spouses will have to determine the next steps when one partner, who is 65 years old, 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 employer’s health insurance. Their spouse may continue to receive coverage under that plan.

If the older spouse intends to retire upon reaching 65 years old, 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 spouse’s employer healthcare plan, but the older spouse plans to retire while the younger spouse is still working, one option is enrolling in their own employer’s insurance plan.

This holds true even if it is not the open enrollment period for their employer’s plan. Losing spousal health insurance is a circumstance allowing access to an SEP.

This timeframe is limited, however, so the younger spouse must make this decision quickly. Not enrolling during the SEP 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 the Consolidated Omnibus Budget Reconciliation Act (COBRA).

This is a law that allows coverage to continue beyond the end of employment or an employer’s healthcare plan. Dependents may also stay on the group employer’s health plan through COBRA.

While this federal law usually applies only to employers with a minimum of 20 employees, this depends on the state. In some states, employers with fewer than 20 employees must still offer COBRA coverage.

Under COBRA, the healthcare plan does not change. However, the employer is no longer paying part of the premium. The younger spouse must pay the entire premium to keep coverage.

Usually, COBRA coverage comes into effect for a maximum of 18 months. However, in some situations, the younger spouse may receive coverage for a longer period. If the younger spouse becomes eligible for Medicare during this period, their COBRA benefits will end.

The employer’s group health plan or its benefits administrator will notify the younger spouse that they will no longer have coverage as of a certain date. They will then offer continued coverage via COBRA.

The Affordable Care Act (ACA) is another option for spousal health coverage. The federal government subsidizes ACA coverage for those earning less than 400% of the federal poverty level (FPL).

Those who do not qualify for the subsidy must pay the premiums in their entirety. Open enrollment for the ACA is from November 1 to January 15 each year.

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 an 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 bases the special enrollment criteria on whichever event comes first: the end of health plan coverage or employment.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

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Some people of eligible age or living with certain medical conditions or disabilities can qualify for coverage using their spouse’s Social Security work credits.

However, Medicare coverage only includes individuals and does not include spouses or dependents.

People who were listed as a dependent on their spouse’s employer-funded health insurance plan that is coming to an end have several options. These include self-funding extended cover under COBRA laws or the ACA.