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Spouse Medicare 101

Anastasia Iliou Medicare

Spouse Medicare 101

Medicare does not work like individual health care plans – there are no family plans. Every individual Medicare beneficiary will have his or her own plan. However, even though you can’t be on the same plan or share spouse benefits, you’re still in it together. You can meet with an agent together, you can pool your income, and you can mail in one check to pay your premiums. Let’s look at how precisely spouse Medicare works.

Medicare Eligibility Requirements

In some cases, both spouses may not meet Medicare eligibility requirements. Usually, one spouse will turn 65 before the other, or one will become disabled while the other is not. This means one person may hold onto their individual marketplace plan while the other person enrolls in Medicare. Eligibility is different for every person. That’s why Medicare beneficiaries cannot be on the same plan.

Medicare Premium Payments

Every single person will have his or her own premium payment each month. However, if you and your spouse have the same plan, you can mail in just one check to pay for both plans.

Make sure that when you are paying your premiums, you send in money for the correct account. If you only want to send in one check, make sure you write clearly on the check which account the payment is for (or write both if it is for both).

Spouse Social Security Benefits

While Social Security and Medicare are regulated by the same government agency, and in most cases pertain to the same age demographic, they are vastly different programs. In fact, spouse Social Security benefits and spouse Medicare benefits are one of the many areas in which they differ.  

For example, with spouse Social Security benefits, if your spouse dies, his or her benefits may become available to you. However, this is not the case with Medicare. Since Medicare is an individual healthcare plan, one spouse’s Medicare plan does not provide any benefit to the other. Thus, it is imperative that if both spouses are in need of Medicare, they each have their own plan.

Medicare for Non-Working Spouse

People often wonder if Medicare for their non-working spouse is available. In short: yes, as long as they are eligible. However, your spouse’s costs may be different from yours.

Any individual who has been employed for more than 10 years and has paid taxes qualifies for premium-free Medicare Part A coverage, (hospital insurance), upon turning 65. If you have not worked and paid Medicare taxes, you’ll have to pay a premium for Part A Medicare regardless of your spouse’ employment history.

In many cases, if you qualify for Medicare, when your non-working spouse turns 65, they may qualify based on your work record. However, the same basic eligibility requirements still apply to the non-working spouse. For example, if you are 65 and receiving Medicare, and your non-working spouse is 62, he or she will have to wait until they are 65 to start receiving benefits. Conversely, if your spouse is older, Medicare for your non-working spouse will be available to purchase Medicare will have to pay a premium for Part A until your premium-free benefit kicks in at age 65.

Medicare Family Coverage

In general, Medicare is not applicable 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. It is important to note that there is often a two-year waiting period for Medicare coverage for people with disabilities, including children. For example, if your child was born with a disability, he or she might have to wait until their second birthday to get Medicare. (Though, if your child has End-Stage Renal Disease or Lou Gehrig’s disease there is generally no waiting period for Medicare coverage.)

Medicare Plan Spousal Discounts

While Medicare does not provide spouse benefits, there are some plans that offer household discounts.  

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, and are also covered during the Coverage Gap.

Single and married beneficiaries have different requirements for what constitutes a low income level. For example, to qualify for LIS (a prescription drug savings program), single beneficiaries must make less than approximately $18,000 per year, but married couples must make less than approximately $24,000 per year.

Meet with one of our agents to find out if you qualify for savings.

Joint Meeting with a Licensed Agent

Even if you and your spouse have different Medicare plans, you can still share a medicare agent! Sharing an agent will make your enrollment process easier and help you build a relationship with someone who knows everything about Medicare and can help you find savings.

Do you have a licesned agent? Have more questions about spouse Medicare? Give us a call today to set up a free meeting. Our agents are licensed to sell several different plans, so they can offer you an unbiased opinion and help you find the plan that truly works best for your needs. Call us at 1-844-431-1832.

This post was originally published on 3/8/18 and updated on 9/25/18