Navigating the Medicare rules can be a frustrating experience when it’s time to plan for your future during retirement. Missing essential details about how you and your spouse can qualify could mean missing out on critical coverage that you need as you stop working and rely on Medicare to cover ongoing medical costs.
Medicare can be a wonderful benefit when you understand the rules and how to make sure your spouse receives critical coverage. Qualifying for Medicare can be straightforward for those employed full-time, but how do benefits apply to a spouse? Keep reading to learn seven key things about medicare spousal benefits.
1. Medicare Is For Individuals
Unlike most employer insurance policies, Medicare policies are for individuals. There are no “family plans” that allow the primary insured to add family members to a policy.
You and your spouse will need to sign up for Medicare coverage as individuals. Because Medicare is available on an individual basis, your coverage might begin at a different time than your spouse’s coverage.
It’s important to know that if your spouse didn’t work enough to qualify on their own, the benefits they can receive might depend on your work history. Before you reach the age of 65, make sure you understand how both you and your spouse will qualify for Medicare coverage based on your combined work history.
2. Your Spouse Must Be 65 Years of Age
You and your spouse must be 65 years of age for either of you to qualify for Medicare coverage. Even if they never worked outside the home, your spouse can be eligible at age 65 based on your work history. However, if your spouse has a disability, they might qualify at a younger age.
In many cases, retirees’ primary focus is qualifying for Medicare Part A Benefits. Part A coverage includes hospital stays, labs, skilled nursing, and other long-term care.
It’s also common for retirees to enroll for Medicare Part B benefits to receive coverage for medically necessary services and preventive care. Signing up for Parts A and B provides coverage for you and your spouse for routine medical exams, vaccinations, and inpatient hospital services if needed. However, delaying Part B enrollment for your spouse can be a good option if they are not yet 65 years old and can receive coverage through another option.
Also read: What is the Medicare Flex Card for Seniors?
3. You Must Have Enough Work History
To qualify for Medicare, you must have a work history that translates into enough Social Security work credits. As of 2020:
- Workers (including self-employed) who participate in Social Security receive one work credit per $1,410 they earn (up to four credits per year)
- Medicare qualification requires 40 work credits (or about ten years’ worth of credits)
If you or your spouse have a disability, different work credit rules apply.
When you have worked enough to retire with plenty of work credits, you and your spouse should be able to qualify for Medicare coverage.
4. You Must Be Married For At Least One Year
Medicare coverage for your spouse (at age 65 or older) can begin after you’ve been married for at least one year. Before a year of marriage, your spouse will need to maintain coverage through their employer or another insurance option like COBRA.
Again, because Medicare coverage is offered through individual enrollment, it’s critical to plan your spouse’s coverage to protect them during the first year of marriage before they can enroll.
5. Your Ex Can Qualify After Divorce
Your former spouse could qualify for Medicare if your marriage lasted at least ten years. In this scenario, if your ex-husband or ex-wife doesn’t have enough work credits—and they are still single—they can receive the free Part A benefits based on your work history and participation in Social Security.
Your ex’s eligibility under your Social Security work credits doesn’t impact your current spouse’s ability to receive Medicare coverage. If your former spouse re-marries, they will no longer receive Medicare coverage based on your work history. They’ll need to re-apply based on their new spouse’s benefits or seek insurance coverage another way.
6. Your Widowed Spouse Can Qualify
What happens to your spouse’s coverage if you pass away? As long as they are at least 60 years old, they will continue to receive Medicare coverage based on their Social Security work history.
Once enrolled, Medicare coverage does not stop for your spouse in the event of your death—unless they remarry. If your spouse gets married again, they will stop receiving Medicare benefits based on your work history. However, they can re-enroll using their new spouse’s work credits.
As you plan your Medicare benefits and retirement, make sure your spouse understands that their coverage continues in the event of your death, as long as they pay the premiums for Part B. Part A coverage does not require a premium.
7. Your Spouse’s Enrollment Is Not Automatic
In most cases, if you are the primary worker, you will be automatically enrolled in Medicare when you turn age 65. However, your spouse will not be automatically enrolled if they are not employed.
If your spouse plans to use your Social Security work credits to qualify for Medicare, they can enroll during the three months prior to or immediately following their 65th birthday. Do your research and plan for this timeframe when choosing Medicare coverage for your spouse.
However, if they miss the enrollment period around their birthday, there are other opportunities:
- Open enrollment for Parts A and B takes place from January 1 through March 31 every year.
- Add Medicare Advantage or Part D coverage between April 1 and June 30.
Don’t panic if understanding your options or enrolling your spouse seems overwhelming! Help is available to help explain the benefits and how to enroll. Check out https://medicareonvideo.com/ to learn more about the options for you and your spouse!
Know Your Options For Medicare Spousal Benefits
Make sure your husband or wife receives the Medicare spousal benefits they need! Keep these seven critical things in mind when it’s time to think about enrollment for you and your spouse.
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