Medicare offers federal health insurance coverage for those aged 65 years and over, as well as those with a permanent disability. Medicare does not cover spouses specifically. However, some spouses qualify based on the work record of their spouse or a former spouse.
Some spouses may qualify by reaching 65 years of age and having their own eligible work and tax record. 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.
In this article, we examine the eligibility criteria for the spouses, dependents, and partners of Medicare enrollees for coverage.
The spouse of a Medicare plan holder becomes eligible for their own plan upon turning 65 years of age, even if they never worked outside the home.
The spouse qualifies based on their spouse’s work record. If a spouse has a disability, they may qualify at a younger age.
A couple may have divorced after a marriage that has lasted at least 10 years. For these people, Medicare can use a former spouse’s work record to qualify a separated spouse who has not worked outside the home, as long as they meet the age or disability criteria.
However, this only applies to those who remain unmarried to a new partner. Medicare will assess the eligibility of those 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 take advantage of waiting to enroll in Medicare Part B without paying a late enrollment penalty, and there are no special enrollment periods (SEP) for unmarried domestic partners.
For a person or their spouse to qualify for Medicare, they will need to have built up enough Social Security credits throughout their employment history.
Medicare credits link to Social Security work credits. In 2020, a worker receives one work credit per $1,410 they earn. They can earn up to four credits annually.
Self-employed individuals also receive up to four annual work credits per $1,410 of net earnings.
Anyone born after 1929 must have a minimum of 40 work credits, or have 10 years’ worth of credits, to become eligible for Medicare. People born before this require fewer credits.
The number of qualifying credits for people who have a disability varies according to the age at which they developed the disability.
A person who develops a disability between 31–42 years of age will require 20 work credits for Social Security disability benefits.
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 RBB deducts Medicare payments from their employees’ 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 the age of 62 years. Except in certain circumstances relating to disability, Medicare is unavailable to those under 65 years of age.
A person receiving Social Security Disability Insurance (SSDI) automatically receives Medicare Part A and Part B after receiving SSDI benefits for 24 months.
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.
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 employer’s 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 spouse’s employer healthcare plan, but the older spouse plans to retire while the younger 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 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.
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 cover. The premium is often substantial.
Usually, COBRA coverage comes into effect for a maximum of 18 months, but in some situations, the younger spouse may receive such 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 of the Federal Poverty Level.
Those who do not qualify for the subsidy must pay the premiums in their entirety. Open enrollment for the ACA has closed for the current year at the time of writing, but special enrollment is available for those losing health care coverage.
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.
Some people of eligible age or medical background can qualify for coverage using their spouse’s Social Security credits.
However, Medicare only covers individuals and would not include spouses or dependents.
People who were 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.