Medicare is an individual insurance system, but there are times when one spouse’s eligibility may help the other receive certain benefits.
Also, the amount of money you and your spouse make combined may affect your Medicare Part B insurance premiums.
Keep reading to find out how you or your spouse may be able to qualify for Medicare based on work history and age.
Medicare is a benefit for individuals who worked and paid Social Security taxes for at least 40 quarters of work, which is roughly about 10 years.
If a person’s spouse didn’t work, they may still qualify for Medicare Part A based on their spouse’s work history when they turn age 65.
rules for Medicare ELigibility based on spouse’s work history
To qualify for Medicare Part A benefits at age 65 based on your spouse’s work history, you must meet one of the following requirements:
- You have been married to your spouse who qualifies for Social Security benefits for at least 1 year before applying for Social Security benefits.
- You are divorced, but were married to a spouse for at least 10 years who qualifies for Social Security benefits. You must now be single to apply for Medicare benefits.
- You are widowed, but were married for at least 9 months before your spouse died, and they qualified for Social Security benefits. You must now be single.
If you aren’t sure you meet a certain requirement, you can contact the Social Security Administration by calling 1-800-772-1213. You can also visit Medicare.gov and use their eligibility calculator.
What if my spouse is older than me, and they meet the 40 quarters requirement?
If your spouse is older than you, they’ll qualify for Medicare benefits at age 65.
You may be able to receive Medicare benefits slightly earlier if you’re at least 62 years old, married to someone who is age 65, and also worked for 40 quarters and you paid Medicare taxes.
If you don’t meet these requirements, you may be able to qualify for Medicare Part A, but you’ll have to pay the Part A premium until you’re age 62.
If you didn’t work or meet the 40 quarters requirement, you may have to wait until age 65 to receive coverage under your spouse’s benefits.
What if my spouse is older than me, and I meet the 40 quarters requirement?
Now let’s look at when your spouse is older than you and your spouse didn’t meet the 40 quarters requirement, but you do.
When you turn age 62 and your spouse is age 65, your spouse can usually receive premium-free Medicare benefits.
Until you’re age 62, your spouse can receive Medicare Part A, but will have to pay the premiums if they don’t meet the 40 quarters of work requirement.
The spouse’s benefits apply specifically to Part A of Medicare (keep reading for an explanation of all the parts).
You can’t purchase couple’s coverage for any other portion of Medicare. You must pay for the other individual portions on your own policy.
It’s important to know that if your spouse loses their private or employee-based insurance and you aren’t yet age 65, there are still insurance programs that can help you.
You can contact your State Health Insurance Assistance Program (SHIP) to receive free health coverage counseling.
You can find out if your income level or health qualifies you for other federal assistance programs like Medicaid.
The federal government designed Medicare to be like an “a la carte” menu where you can choose different coverage types.
These coverage types include:
- Part A. Part A provides coverage for an inpatient hospital stay and related services while in the hospital, such as meals, medications, and physical therapy.
- Part B. Part B provides outpatient medical coverage for doctor’s visits and related outpatient medical services. You must pay a monthly premium for this service, and it’s based on how much you and your spouse make on a yearly basis.
- Part C. Part C is also known as Medicare Advantage. These plan types combine services from Part A and Part B, but they may have different rules and requirements about what healthcare providers and facilities you can receive care from. These benefits may also cover additional services, such as vision and dental.
- Part D. Part D provides prescription drug coverage in varying amounts. You purchase these policies through private insurers.
- Medigap. Medigap, also known as Medicare Supplement Plans, can cover some of the common out-of-pocket costs with Medicare and is offered through private insurance. Examples include covering insurance co-payments.
You can only qualify to receive the spouse benefit for Medicare Part A (you can learn more about it below).
The other parts of Medicare don’t require a work history, and they have premiums associated with their coverage.
In most instances, an individual qualifies for Medicare when they are 65.
There are some exceptions, including for individuals younger than age 65 who a doctor has deemed disabled, has end stage renal disease, or has Lou Gehrig’s Disease (ALS).
People who meet these requirements may qualify for Medicare Part A before age 65.
As discussed above, you may also qualify for Medicare Part A before age 65, if your spouse is 65 and qualifies.
Important Medicare Deadlines
- Around your 65th birthday. You technically have seven months to enroll in Medicare — 3 months before your birth month and 3 months after. You can visit Medicare’s eligibility calculator for the specific dates given where your birthday falls on the calendar.
- January 1 through March 31. Those who didn’t enroll in Medicare during their window around their 65th birthday can sign up during this “General Enrollment Period.” They may have to pay a penalty that’s added to their Part B premium for enrolling later.
- April 1 through June 30. The time of year when you can add a Medicare Advantage or Medicare Part D plan if you so choose.
- October 15 through December 7. This is the annual open enrollment period for Medicare Advantage and Medicare Part D. New plans will typically go into effect on January 1.
Most considerations for Medicare and spouses are surrounding Medicare Part A, which is the insurance portion that covers hospital visits.
The other portions are available when an individual turns age 65 and agrees to pay the insurance premium.
If you have further questions about Medicare benefits, you can call the Social Security Administration (SSA) at 1-800-772-1213 or visit your local SSA office for more information.