Medicare is different from other forms of insurance in a lot of ways. One of the biggest differences is that there are no family plans in Medicare. All Medicare coverage is individual-based.
However, even though Medicare and marriage are not directly related, your marital status can impact your Medicare costs in a few special ways.
Does Medicare Offer Spouse Coverage?
Medicare does not offer health coverage for spouses. You would have to be eligible on your own to qualify for Medicare – your spouse’s eligibility does not affect yours.
According to the rules set in place by the Centers for Medicare & Medicaid Services, marriage can affect your Medicare in the following ways:
Eligibility for Medicare cost savings can change due to your spouse’s income
Your Part D (prescription drug plan) premiums can be higher due to your spouse’s income
Premium-free Part A eligibility can be determined based on your spouse’s work history if they worked more than you.
So, can you get Medicare through your spouse? Not technically, no – but your marital status is not irrelevant.
Medicare if Spouse is Disabled
If one spouse is 65 and begins receiving Medicare and the other is not yet 65, there may be other ways to qualify. If you are diagnosed with ESRD or ALS or if you have been receiving SSDI (Social Security Disability Insurance) for at least two years, you can qualify for Medicare regardless of your age.
The good news is that if you do qualify for Medicare based on a disability, you may also qualify for a Medicare Special Needs Plan at a low cost.
Medicare Eligibility Requirements
The “main” Medicare program is called “Original Medicare.” You can qualify for Original Medicare by:
Unlike Medicaid, income does not impact Medicare eligibility. Additionally, unlike ACA plans, pre-existing conditions do not affect your Medicare costs or coverage. The only exception to this is in private Medigap (or Medicare Supplement) plans. If you do not enroll in a Medigap plan when you first become eligible for Medicare, you can be charged more based on your health history. Medigap plans are completely optional and are there for additional financial protection.
You can qualify for additional health and drug coverage through Medicare Advantage plans or Medicare prescription drug plans after you’ve enrolled in Original Medicare. Those plans cannot charge more based on your age or preexisting conditions.
Spouse Social Security Benefits
Even though the Social Security Administration manages Medicare enrollments, Social Security and Medicare are two vastly different things. There are a few differences in how your marital status affects your benefits.
For Social Security, your benefit is calculated based on your total household income according to your tax returns. That includes both your and your spouse’s income. Both you and your spouse can benefit from Social Security, even after one spouse has passed away.
Medicare does not work like that. Your marital status and income do not impact your eligibility, and there are no additional Medicare benefits given to a spouse after a Medicare beneficiary passes.
Health Insurance Options for Spouse of a Medicare Recipient
If one spouse is ineligible for Medicare and needs to find a different health plan, don’t panic – there are plenty of options for health insurance for the spouse of a Medicare recipient. You might want to start by checking to see if that spouse is eligible for Medicaid based on your total household income. If the answer is no, you’ll want to start looking at individual health plans in your area, which you can do through healthcare.gov/.
If the Medicare spouse has insurance through an employer when they become eligible for Medicare, the non-Medicare eligible spouse can also try getting COBRA until they are also eligible for Medicare. COBRA allows an individual, couple, or family to continue health coverage after leaving a job. However, keep in mind that even if you’re able to keep your health plan through COBRA, your costs may go up because your employer won’t be sponsoring the plan for you anymore.
Can my Wife get Medicare at 62?
To get Medicare, you have to either be 65 or have a qualifying disability.
If your husband or wife is just a few years short of Medicare eligibility, they can select an ACA plan or enroll in a short-term health plan. Short-term medical insurance can be renewed for up to 36 months, so it’s a good option if you’re within 36 months of becoming eligible for Medicare. Since these plans are designed for such short periods of time, they tend to be a bit cheaper than long-term plans, like the ones offered by your employer or the ACA.
Will non working spouse get Medicare?
People often wonder if Medicare is available for their non-working spouse. In short: yes, as long as they meet the age or disability requirements. However, your spouse’s costs may be different from yours. Your employment status does not determine your Medicare eligibility – but it can determine your Medicare costs as such:
If you or your spouse has worked and paid Medicare taxes for at least 40 quarters, you can qualify for premium-free Medicare Part A
If you and your spouse have worked and paid Medicare taxes for less than 30 quarters (or have not worked at all), your Medicare Part A premium will be $518/month in 2025.
Can my Wife get Medicare if she Never Worked?
Employment and marital status do not impact Medicare eligibility. Even someone who has never worked a day in their life can get Medicare, but their costs may be higher than someone who has been paying Medicare taxes.
Medicare vs. Medicaid
Unlike Medicare, your Medicaid coverage can be impacted by your marital status. While each state has somewhat different regulations, most of Medicaid eligibility is based on the Federal Poverty Line. Your income is calculated using your total household income, which is verified with your tax returns. Both your and your spouse’s income are included. That means that even if you qualify for Medicaid based on your income, you won’t be eligible if you and your spouse’s total income together is higher than your state’s limits.
How to Apply for Medicare Through a Spouse
You cannot apply for Medicare through your spouse. You’ll have to wait until you are eligible and then apply during your Initial Enrollment Period. If you qualify by turning 65, this period begins three months before your 65th birthday and ends three months after. If you miss that period, you can apply during the Open Enrollment Period from 1/1 through 3/31. To apply for Medicare online, visit the Social Security website, not medicare.gov.
How do I Apply for Spousal Medicare Benefits?
There are no spousal Medicare benefits – but you can apply for spousal Social Security benefits, here.
What is Not Covered Through Your Spouse’s Medicare?
Your spouse’s Medicare plan won’t provide health coverage for you. If you’re looking for Medicare for spouses, you’ll have to wait until the other spouse is eligible. Then, you can talk to an agent about finding separate plans that work for both of you and both fit into your household monthly budget.
Medicare Family Coverage
In general, Medicare is not available to non-qualifying spouses or dependants. However, if your child has a qualifying disability, they may be eligible for a Medicare plan of their own. Note that except for in the cases of ALS and ESRD, you will have to receive disability benefits for at least two years before you can enroll in Medicare.
How Does Getting Married Affect Medicare?
Getting married? Congrats! A new marriage often involves complicated discussions about finances, and you might be wondering, “will getting married affect my Medicare benefits?” The good news is that no, marriage does not affect your current Medicare benefits – but it CAN impact your eligibility for Medicare cost savings programs. For example, Medicare Savings Programs and Low-Income Subsidies for Medicare prescription coverage base eligibility on total household income. If your new spouse causes your household income to increase, you could become ineligible for these programs.
If you’re not yet 65, you might be wondering, “will I lose my disability Medicare if I get married?” No! Even if you are qualifying for Medicare based on disability and not age, your Medicare coverage won’t change based on your marital status.
Medicare Premium Payments: How Much Does Medicare cost for a Married Couple?
How much does a married couple pay for Medicare? Medicare is 100% individual, so each spouse will have to pay their own premium. There are no joint plans with joint costs.
Your Medicare Part A monthly premium will depend on your and your spouse’s work history and will range between $0 and $518 per month in 2025. Your Medicare Part B premium will be $185 in 2025 (unless you qualify for savings programs or have your premium covered by a Medigap plan). If you have Medicare Part D prescription drug coverage or either a Medicare Supplement or Medicare Advantage plan, you’ll pay a separate premium for those plans.
Do Husband and Wife pay Separate Medicare Premiums?
Yes – families and spouses cannot have joint Medicare plans. All premiums will be separate. Some people will have their premiums automatically deducted from their Social Security benefits.
How Your Spouse Might Affect how Much you Pay
Your spouse can reduce your Part A premium amount if they have worked more than you. Additionally, your spouse’s income can affect your eligibility for assistance programs such as Medicare Savings Programs, Medicaid, and Medicare Extra Help.
Medicare Plan Spousal Discounts
While Medicare does not provide spousal benefits, there are some plans that offer household discounts for plan premiums. You should always confirm with your agent whether or not a household discount exists as some companies may have specific requirements regarding spousal discounts.
Medicare Extra Help and Income Limits
The one thing that marriage will affect when it comes to Medicare is whether or not you qualify for the Extra Help Program, otherwise known as Low-Income Subsidy (LIS). LIS exists to help people with limited income pay for their prescription drugs. Those who qualify for the program pay less in drug premiums, copayments, and coinsurances.
Meet with a Licensed Agent
Even if you and your spouse have different Medicare plans, you can still share an agent!
Sharing an agent will make your enrollment process easier and help you build a relationship with someone who knows everything about Medicare plan options and can help you find savings.
Do you have a licensed agent? Have more questions about spouse Medicare? Give us a call today to set up a free meeting.
Our agents are licensed to sell many different insurance plans, so they can offer you an unbiased opinion and help you find the plan that truly works best for your needs.
Additional Benefits with Medicare Advantage Plans: What You Need to Know
When exploring Medicare options, Medicare Advantage plans stand out due to their potential to offer benefits beyond what Original Medicare covers. These additional benefits can significantly enhance your healthcare coverage, but it’s important to remember that not all Medicare Advantage plans are the same. Each plan varies in the additional benefits offered, making it crucial for beneficiaries to compare plans carefully based on their health needs and preferences.
Understanding Medicare Advantage Plans
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They provide all the benefits of Medicare Part A and Medicare Part B, often combined with other health services that Original Medicare does not cover. The inclusion of additional benefits is one of the primary reasons these plans have gained popularity among Medicare beneficiaries.
Types of Additional Benefits
Dental, Vision, and Hearing Care
Most notably, many MA plans include coverage for dental, vision, and hearing care—services not covered by Original Medicare. Dental benefits might cover routine check-ups, cleanings, x-rays, and even some types of dental surgery. Vision care often includes eye exams, glasses, or contact lenses, while hearing care might cover hearing aids and auditory exams.
Wellness Programs
Many plans incorporate wellness programs such as fitness memberships or discounts on health and wellness services. These benefits are designed to promote a healthy lifestyle among seniors, which can help prevent or manage common diseases associated with aging.
Over-the-Counter Allowances
Some MA plans offer allowances for over-the-counter (OTC) products such as vitamins, pain relievers, and first aid supplies. This benefit can be particularly helpful as it reduces out-of-pocket costs for everyday health items.
Telehealth Services
With the growing popularity of digital health services, many MA plans now include telehealth benefits, allowing beneficiaries to consult with healthcare providers from the comfort of their homes. This is especially beneficial for those with mobility challenges or those living in remote areas.
Transportation Benefits
Transportation to and from healthcare facilities can be a significant hurdle for many seniors. Some MA plans offer transportation benefits, which can be a deciding factor for those who do not have easy access to transportation or who are unable to drive.
Nutritional Support
Recognizing the importance of nutrition in health, some plans provide benefits aimed at nutritional support, including meal deliveries, especially after hospital stays, or nutritionist consultations to help manage dietary needs.
Choosing the Right Plan
When selecting a Medicare Advantage plan, consider the following steps:
Assess Your Health Needs: Understand your specific health requirements—do you need regular vision or dental services, or are you managing a chronic condition that might benefit from wellness programs?
Compare Plans in Your Area: Not all plans are available in every location, and benefits can vary widely between plans. Use the Medicare Plan Finder tool or consult with a licensed insurance advisor to compare the plans available in your area.
Read the Fine Print: Once you’ve narrowed down your choices, look closely at the plan’s summary of benefits to understand what is and isn’t covered, and at what cost. Pay attention to any specific limitations or rules regarding how you can use the benefits.
Check Provider Networks: Ensure that your preferred doctors and hospitals are included in the plan’s network. Medicare Advantage plans often have network restrictions, and going out of network can result in higher out-of-pocket costs.
Review Star Ratings: Medicare rates plans based on quality and performance. These ratings can help you understand the quality of care and customer service you can expect from different plans.
Conclusion
Medicare Advantage plans can offer a range of additional benefits that enhance your healthcare experience, but the key is to choose wisely based on your personal health needs and circumstances. By doing thorough research and understanding the specifics of each plan, you can find a Medicare Advantage plan that not only meets your health needs but also enhances your quality of life through additional benefits.
One survey about Medicare satisfaction vs. private insurance satisfaction found that people with Medicare were happier with their health plans than people with individual plans. Will you find the same to be true?
As you turn 65 or otherwise become eligible for Medicare, you probably have a lot of questions. What’s going to change? Will I lose or gain new benefits? The good news is that signing up for Medicare does not necessarily mean giving up your plan flexibility or your favorite doctors. There are plenty of Medicare options available, and we’ll explain why it’s worth it to go ahead and get signed up as soon as you can.
Employer Coverage
You can purchase health insurance through your employer, as long as it meets the coverage limits set by the federal government. If you’re retiring but aren’t eligible for Medicare yet, you can use COBRA to hold you over. COBRA allows you to continue receiving your employer coverage for a short period of time (but your employer likely won’t help you pay for it except for in some unique cases).
You can also technically have Medicare and employer coverage at the same time, if you become eligible for Medicare while you are still employed. That might make sense for some people and not others.
Private Coverage
You can purchase insurance from an exchange like Healthcare.gov, directly from your state, or directly from a health insurance company. Generally, purchasing private insurance is more expensive than employer coverage, and much more expensive than Medicare and Medicaid.
Medicaid
Medicaid is a federal health program. Each state has slightly different rules and each state has its own funding. The program can cover any person of any age with low income (according to the Federal Poverty Level and with some adjustments in each state). Most Medicaid beneficiaries will have either no or very small premiums. If you have a low monthly income AND are over 65, you may qualify for both Medicaid and Medicare! In that case, you can get what is called a “Dual-Eligible Special Needs Plan,” which is low-cost and tailored to your needs.
Medicare
Original Medicare is a federally funded health program that can cover any adult over the age of 65 as well as some adults with disabilities, such as end-stage renal disease.
Most people with Medicare will start with parts A and B. Part A provides hospital coverage, and Medicare Part B provides medical coverage. Anyone who wants more coverage can opt to enroll in either a Medicare Advantage plan or a Medicare Supplement (also called Medigap) plan. Medicare Advantage is sometimes referred to as “Part C” because you have to have Part A and Part B first to enroll in it, and it can cover a lot of services that parts A and B do not.
Unless you enroll in a Medicare Advantage plan that includes prescription drug coverage, you’ll want to enroll in a separate drug plan. These plans are referred to as “Medicare Part D,” because they are completely separate from the other “parts.” Part D plans only cover prescription costs.
Some people may qualify for no or low-cost Medicare coverage, but others will have to pay premiums. Most people will not have to pay nearly as much for Medicare as they would with an individual or private health plan.
You may think that individual plans provide more coverage due to the higher premiums, but that is not always the case. All Medicare plans include preventative services. Plus, you can choose to enroll in Medicare Advantage, which is like a private plan for Medicare. With Medicare Advantage, you can roll all your benefits – medical, dental, vision, prescription drugs, and even fitness – into one convenient plan.
How is Medicare different from other health insurance?
Medicare is vastly different from other health insurance options for a lot of reasons, ranging from the way you pay for your coverage to when you can enroll.
For starters, the Medicare enrollment period is different from the ACA enrollment periods and your employer’s enrollment periods. The Medicare Annual Enrollment Period runs from October 15 through December 7, but be sure to not confuse it with the ACA Open Enrollment Period, which runs from November 1 through December 15 of each year.
Another thing that is different is that some people can have their Medicare Part A payments automatically deducted from their Social Security check.
Employer Health Insurance vs. Medicare Plans
It’s hard to even compare Medicare plans vs. employer health plans because the only thing they have in common is that they provide health insurance. If you’re turning 65 or otherwise preparing to make the switch from your employer plan to Medicare, you should know the pros and cons of each option.
For starters, Original Medicare is the same for everybody. Technically, there are not separate plans to choose from within the government Medicare program. Once you’ve enrolled in Original Medicare, you can decide to add coverage through a private Medicare Advantage or Medicare Supplement plan. Some people may see this as a great thing because you can enroll right away without stressing about all your options. Others don’t like it, because one plan clearly cannot work for everybody. However, that’s what the private plans are for (and many of them are incredibly cheap compared to employer plans – some even have $0 premiums).
The advantage of private health insurance for Medicare (Medicare Advantage or Medicare Supplement) is that you can pick and choose which benefits are most important to you so that you aren’t paying for coverage that you don’t need. Plus, some people will qualify for Medicare Special Needs Plans which are specifically designed for people with special financial or medical needs and are usually relatively low-cost plans. Private Medicare plans can closely resemble individual marketplace plans or employer plans.
The disadvantages of private health insurance for Medicare-eligible people are that they sometimes have limited doctor networks and that some areas might have a limited number of plans to choose from. Typically, people who live in rural areas may have fewer plan options when it comes to private Medicare coverage.
Medicare vs. Medicaid
Both Medicare and Medicaid are government programs that are regulated by CMS (Centers for Medicare and Medicaid Services). They both provide health insurance for medically necessary services.
The main difference between Medicare and Medicaid is who qualifies. It is possible to qualify for both programs, but Medicaid qualifications are based on income while Medicare qualifications are based on age and disability. Another difference is that while the Medicare qualification rules are federal, Medicaid qualification rules can change slightly by state.
Medicare Versus Spouse Insurance
A lot of people who are newly qualified for Medicare wonder if it might be better to stay on their spouse’s insurance plan. The fact is, it depends on how good your spouse’s insurance is. However, if you do qualify for Medicare, Part A (the part that covers hospital costs) has a $0 premium for anyone who has worked and paid Medicare taxes for at least ten years. If you haven’t worked that long but your spouse has, you might still qualify. If that’s the case, there’s no reason not to go ahead and enroll in Medicare Part A as soon as you become eligible.
Additionally, if you wait too long to seek out further Medicare coverage, your costs may go up. You can be charged a penalty of up to 10% of your premium if you don’t enroll in Medicare Part B when you first become eligible. Plus, Medicare Supplement plans can charge more or deny coverage based on preexisting conditions if you wait too long to enroll. So if you think you might want to enroll in a Medicare Supplement plan, don’t wait too long to start looking.
Medicare vs Other Health Insurance: The Benefits
If you are eligible for Medicare coverage but considering alternative health insurance, you should start by learning what Medicare does and does not cover. Medicare Part A and Part B are the same for all who enroll. They cover preventative healthcare, like your annual wellness visits and flu shots at 100%.
Part A also covers 60 consecutive hospital days at 100%. After the 60th day, you’ll start to owe co-payments. Part B covers mental health, lab tests and X-rays, emergency transportation, and medical equipment.
Medicare A and B do not include prescription drug coverage, dental, vision, hearing, podiatry, or any service that is not deemed medically necessary either for treatment or prevention. For additional health coverage, millions of Medicare beneficiaries enroll in Medicare Advantage.
Since Medicare Advantage plans are owned by private companies, they can add in benefits like dental, vision, hearing, etc. – any of those extra benefits that you might be accustomed to from having private health insurance. Some Medicare Advantage plans also cover prescriptions. If you want prescription coverage but don’t care about all of the extra benefits, you can enroll in a stand-alone prescription drug plan instead. However, you cannot have both a Medicare Advantage plan and a Medicare prescription drug plan at the same time, so choose wisely.
The Costs of Medicare vs Other Health Insurance
The good news about Medicare is that as long as you or your spouse have worked and paid Medicare taxes for a certain number of years, your Part A Medicare costs will be low.
If you or your spouse has worked and paid Medicare taxes for at least 40 quarters, you’ll owe $0 in Part A premiums.
If you or your spouse has worked and paid Medicare taxes for less than 30 quarters, you’ll owe $518/month in 2025 in Part A premiums.
Part B premiums are standard for all Medicare beneficiaries. It can change each year, but the Part B monthly premium in 2025 is $185, and the deductible is $257. Most services that Part B covers are covered at 80%, so you may owe 20% coinsurance or doctor co-payments.
If you choose to enroll in a prescription drug plan, a Medicare Advantage plan, or a Medicare Supplement plan, you may face an additional premium.
Medicare vs. Private Insurance Costs
If you’re choosing between enrolling in Medicare Part B versus private insurance, remember that delaying your Part B enrollment can leave you with up to a 10% increase in your premium when you do decide to enroll.
If you decide to add on private Medicare insurance through a Medicare Advantage or Medigap plan, remember that you’ll still have to pay your Medicare Part A and B monthly premiums (unless you qualify for a savings program such as QMB). You cannot enroll in Medicare Advantage without enrolling in Medicare parts A and B first.
Medicare Advantage and Medicare Supplement plans are completely separate and therefore come with separate bills. You’ll owe a premium (which in some cases can be $0), and you’ll likely have a deductible as well as co-payments for certain services.
Many private health insurance plans also have out-of-pocket maximums, which means that if you have a lot of health care costs, you can reach a point where you stop having to pay out-of-pocket for services. Those out-of-pocket expenses can really start to add up even with Medicare if you’re someone who needs a lot of medical care!
Why is Medicare cheaper than private insurance?
A lot of new Medicare beneficiaries do find that their Medicare costs are cheaper than what they were paying before they qualified. The biggest reason for that is the way Medicare is funded. While you or your spouse were working hard for all those years, you were paying Medicare taxes. Your low premiums today are because of all that hard work! Plus, the Medicare office does not incur nearly the same amount of administrative costs that many healthcare companies do.
Is it better to have Medicare or private insurance?
Is Medicare a good insurance option? Is private health insurance better? It depends on who you ask. This is a great question to ask an insurance agent who knows what sort of medical expenses you have and what your budget is.
The main difference you have to remember when you’re wondering if private insurance or Medicare is better is that private insurance gives you more plan options. To get a private Medicare Advantage plan, you’ll have to enroll in Medicare A and B, first. Then, you can choose if you want to personalize your coverage and add benefits by enrolling in additional medical insurance.
If you’re stuck between Medicare and keeping your employer plan, remember that you could face penalties if you don’t enroll in Medicare when you first become eligible – and nothing says you can’t keep both!
Is Medicare or private insurance better for people with dependents?
If you have dependents, Medicare isn’t going to help you. But that doesn’t mean you shouldn’t enroll. Medicare only provides individual coverage – there are no family plans or spouse Medicare plans. However, your Medicare Part A might be free. If that’s the case, you might want to consider enrolling in Medicare for yourself first, and then taking a look at options for your dependents.
If you have access to an employer plan, do the math to figure out if it may be more cost-effective for you to have your group vs. individual Medicare Advantage coverage. In some cases, it might even make sense for you to keep both. If your Medicare Advantage premium is low enough, you can keep that for yourself but also hang onto your group coverage for as long as you can to support your family. An insurance agent can help you figure out what’s best for you.
Can I drop my employer health insurance and go on Medicare?
If you become eligible for Medicare while still receiving employer health insurance, you can and should still enroll in Medicare to avoid penalty fees.
First, find out if you’re currently in one of the Medicare enrollment periods. Medicare open enrollment is different from your employer’s open enrollment period.
If you just became eligible, you’ll have a few months for your “Initial Enrollment Period.” If you’re aging into the program, this period begins three months before your 65 birthday and ends three months after. If you’ve already missed that period, don’t panic – you can enroll for the first time from January 1 through March 31 of each year.
Once you’re enrolled, the “Annual Enrollment Period,” is when you can add or make changes to your Medicare coverage. It runs from 10/15 through 12/7 of each year. This period is not for enrolling in Medicare for the first time – it’s only for adding or making changes to your private Medicare coverage.
According to Medicare.gov, some people will be automatically enrolled in Medicare Part A upon becoming eligible. If you are not automatically enrolled, you can apply for Medicare on the Social Security website.
How Medicare Works with Other Insurance
Millions of Medicare beneficiaries opt to enroll in Medicare Advantage or Medicare Supplements on top of their Medicare coverage. In these cases, the private insurance companies act as the “secondary payers.” Health benefits that Medicare does not cover will be automatically billed to the private company, but anything else will go to Medicare first. If you have both employer insurance and Medicare, Medicare might actually be the secondary payer. Check with your employer or your employer’s health insurance plan to be sure.
Both Medicare and private insurance coverage will have limitations – so having both is a great way to keep yourself and your families financially covered in case of a medical emergency.
How Medicare Plan Finder Can Help You
We specialize in Medicare and serving the underserved senior and Medicare-eligible population. Do you or a loved one need help selecting a Medicare plan that truly helps? Set up a free appointment with one of our licensed agents in your area to get bias-free assistance.
