Understanding Spouse Coverage Under Medicare Fundamentals

Medicare and Coverage for Married Couples
Medicare, a federal health insurance program, often raises questions about coverage for married couples, as it differs from typical shared health benefits. This guide will clarify how Medicare works for those who are married.

What is Medicare?
Medicare provides health insurance for Americans 65 and older, younger people with disabilities, or those with end-stage renal disease. It includes:

• Medicare Part A (Hospital Insurance): Covers inpatient care like hospital stays and nursing home care.
• Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, and preventive services.
• Medicare Part D (Prescription Drugs): This separate plan covers prescription drugs, with each plan having its own list of covered medications.

Medicare Advantage Plans (Part C) are an alternative, often including extra benefits like dental and vision.

Understanding Medicare Eligibility
Eligibility for Medicare hinges on age, disability status, or having end-stage renal disease. Most people 65 and older qualify for premium-free Part A if they’ve worked and paid Medicare taxes for at least ten years. Those who haven’t met this requirement can still enroll but may have to pay premiums. Part B coverage requires paying a premium based on income.

Medicare Coverage and Social Security Credits
Qualifying for Medicare typically requires earning enough Social Security credits through employment. In 2023, one credit is earned for every $1,640 of earnings, up to four credits a year. However, some jobs, like certain government roles, don’t earn Social Security credits.

Spouse Coverage in Medicare
Medicare doesn’t offer shared plans for spouses. However, a non-working spouse might qualify for premium-free Part A at 65 based on their working spouse’s history. Conditions include being married, or divorced after at least 10 years of marriage, or being widowed after a minimum of nine months of marriage. Spouses with disabilities might qualify earlier.

For Part B, a spouse with employer health insurance might delay enrollment to avoid paying both premiums. It’s important to check for creditable coverage to avoid late penalties.

Insurance Options for Non-Medicare Eligible Spouses
When one spouse is Medicare-eligible and the other isn’t, the younger spouse needs alternative health insurance. Options include:

• COBRA Coverage: Extends employer coverage for a limited time but can be expensive.
• Affordable Care Act (ACA) Marketplace: Subsidized plans are available for those under the Federal Poverty Level.

FAQ: Navigating Medicare with a Spouse
When one spouse is on Medicare and the other isn’t, options vary. The non-covered spouse might need to seek insurance outside Medicare. If one spouse has worked and paid Medicare taxes for ten years, both can get premium-free Part A at 65.