if my spouse is on medicare what health insurance can i still get

If the older partner is eligible for Medicare but continues to work, their coverage still comes from their employer’s health insurance. Their spouse may continue to receive coverage under that plan. If the older spouse intends to retire on reaching 65 years of age, the younger spouse has several options for health insurance coverage.

Full Answer

Do I qualify for subsidies if spouse has Medicare?

No, as long as the coverage qualifies as “ affordable ” under the Affordable Care Act. Your spouse and dependents must get individual coverage, but they aren’t eligible for the tax subsidy. According to the Affordable Care Act, coverage is affordable if it costs 9.5 percent or less of your earned wages.

Does My Medicare supplement insurance plan cover my spouse?

Your spouse or family members cannot be included in your coverage. For your spouse to have Medicare coverage, he or she must have a separate, individual policy. Your non-working spouse is eligible for premium-free Medicare Part A coverage at the age of 65 based on your work record and if you meet the necessary requirements for Medicare coverage mentioned above. Medicare automatically enrolls you (and a dependent, non-working spouse) in Original Medicare.

Is spouse covered under Medicare?

Medicare will only cover you, not your spouse or children if they are not eligible on their own. This is where problems begin, especially when a working spouse is older than a non-working spouse. Say the working spouse turns 65, retires, and claims Medicare. The other spouse is only 61.

Does my spouse have to cover my health insurance?

Yes, it is legal. The ACA requires employers with 50 or more workers to offer coverage to employees and their children (until age 26), but not spouses. But according to the Kaiser Family Foundation’s annual survey of employer-sponsored coverage, 95 percent of employers that offer health benefits extend that offer to employees’ spouses.

What happens when my husband goes on Medicare?

Although your husband now qualifies for Medicare, you will not qualify for Medicare until you turn age 65. If you do not have health insurance now, you can consider signing up for health insurance coverage through a Marketplace plan.

Can someone have Medicare and private insurance at the same time?

It is possible to have both private insurance and Medicare at the same time. When you have both, a process called “coordination of benefits” determines which insurance provider pays first. This provider is called the primary payer.

Does Medicare cover my wife?

Does Medicare cover people's spouses? Medicare offers federal health insurance coverage for those aged 65 years and over, as well as those with a permanent disability. Medicare does not cover spouses specifically.

Can a husband and wife be on the same Medicare Advantage plan?

Medicare Advantage: what about my spouse? Medicare Advantage plans don't cover both you and your spouse together under one policy. Just as Medicare Part A and Part B cover each Medicare beneficiary separately, you can't share a Medicare Advantage plan with your spouse.

How do I qualify for dual Medicare and Medicaid?

Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. To be considered dually eligible, persons must be enrolled in Medicare Part A (hospital insurance), and / or Medicare Part B (medical insurance).

Is Medicare primary or secondary insurance?

Medicare is always primary if it's your only form of coverage. When you introduce another form of coverage into the picture, there's predetermined coordination of benefits. The coordination of benefits will determine what form of coverage is primary and what form of coverage is secondary.

Why is my Medicare premium higher than my husbands?

If you file your taxes as “married, filing jointly” and your MAGI is greater than $170,000, you'll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $85,000, you'll pay higher premiums.

Can my spouse get Medicare if I am 65?

Traditional Medicare includes Part A (hospital insurance) and Part B (medical insurance). To qualify for Medicare, your spouse must be age 65 or older. If your spouse is age 62 (or any age under 65), he or she could only qualify for Medicare by disability.

How much does Medicare cost for a couple?

Medicare Part B Medicare considers you and your spouse's combined income (if you're married and file your income taxes jointly) when calculating Part B premiums. In most cases, you'll each pay the standard monthly Part B premium, which is $170.10 per month in 2022.

Should my husband and I be on the same Medicare card?

Each family member has their name on their card , it is therefore an individual card eg I cannot use a card that has my husband's or any of my sons' names on it. I went to the Medicare office and they say that having same card or different card does not matter.

Does my spouse income affect my Medicare premiums?

No. Your eligibility for premium tax credit subsidies and the amount of your premium tax credit will be based on your family income. The amount your spouse pays for his Medicare, Part D, and supplemental insurance premium costs will not be taken into account.

Is Medicare premium based on joint income?

Medicare premiums are based on your modified adjusted gross income, or MAGI. That's your total adjusted gross income plus tax-exempt interest, as gleaned from the most recent tax data Social Security has from the IRS.

When can a spouse receive Medicare?

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.

How long do you have to be married to qualify for Medicare?

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.

How to apply for Medicare Part A?

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: 1 You have been married to your spouse who qualifies for Social Security benefits for at least 1 year before applying for Social Security benefits. 2 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. 3 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.

How long does it take to get Medicare if you don't work?

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.

What is the number to call for Medicare?

If you have further questions about Medicare benefits, you can call the Social Security Administration (SSA) at 800-772-1213 or visit your local SSA office for more information. Read this article in Spanish.

What is Medicare Advantage?

One of these options is Medicare Advantage (Part C), which bundles both Part A and Part B together and offers additional coverage and benefits. If extra coverage, like dental, vision, or hearing care, is important to maintaining your individual health, give some thought to whether original Medicare or Medicare Advantage will work best for you.

Does Healthline Media offer insurance?

Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance. Last medically reviewed on December 20, 2019.

How many credits do you need to be self employed to qualify for Medicare?

Anyone born after 1929 must have a minimum of 40 work credits, or have 10 years’ worth of credits, to become eligible for Medicare . People born before this require fewer credits.

Can a spouse lose cobra?

This could lead to a period of lapsed coverage. When the younger spouse loses coverage because the older spouse transitions to Medicare, a group health insurance plan may still be possible through COBRA. This is a law that allows coverage to continue beyond the end of employment or an employer’s healthcare plan.

Does Medicare cover spouses?

Medicare does not cover spouses specifically. However, some spouses qualify based on the work record of their spouse or a former spouse. Some spouses may qualify by reaching 65 years of age and having their own eligible work and tax record. Others, however, may not have worked for the required number of quarters.

Can an older spouse retire with Medicare?

However, in most circumstances, they would not be eligible for Medicare coverage until they reach the eligible age.

Can a domestic partner enroll in Medicare without a penalty?

Unlike a spouse, a domestic partner cannot take advantage of waiting to enroll in Medicare Part B without paying a late enrollment penalty, and there are no special enrollment periods (SEP) for unmarried domestic partners.

Can a spouse be eligible for Medicare?

A person may qualify for Medicare based on the work record of their spouse. The spouse of a Medicare plan holder becomes eligible for their own plan upon turning 65 years of age, even if they never worked outside the home. The spouse qualifies based on their spouse’s work record. If a spouse has a disability, they may qualify at a younger age.

Enrolling in Medicare at 65

If you want to enroll when you are turning 65, you can enroll in Medicare Parts A & B, Part D prescription drug coverage or a Medicare Advantage (Part C) plan. You can also look at adding a Medicare supplement insurance plan to Original Medicare (Parts A & B) to help with the out-of-pocket costs of Medicare.

Enrolling in Medicare Part A at 65

Many people who are covered by a spouse’s employer plan choose to either wait to enroll until they lose their spouse’s employer coverage or choose to only enroll in Part A since Part A usually has no premium.

Delaying Medicare Enrollment

Just because you are turning 65, doesn’t necessarily mean you have to get Medicare right now. If you decide that waiting to enroll in Medicare is the best option both financially and in terms of healthcare coverage for you, just follow Medicare’s rules, and you’ll avoid enrollment penalties when you do enroll.

When Would I Enroll If I Delay or Only Take Part A?

If you are able to delay enrolling in either all or part of Medicare, you will have a Special Enrollment Period of eight months that begins when the employer coverage is lost or when your spouse retires. During this time, you’ll be able to enroll in Medicare Parts A & B. You can also enroll in a Part D prescription drug plan.

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How old do you have to be to get Medicare?

In a case such as this, you must be at least 62 years old.

How long do you have to work to qualify for Medicare?

In the United States, as soon as you turn 65 you are eligible for Medicare benefits if you are citizen or have been a legal resident for five years or more and have worked for at least 40 quarters (10 years) paying federal taxes.

Can you get Medicare at different ages?

If you and your spouse are different ages, you will likely become eligible at different times. Primary Medicare recipients and their non-insured spouses are entitled to the same benefits under Medicare if both have reached the age of 65.

Do you have to enroll in Medicare Part B or D?

If you wish to sign up for Medicare Part B (Medical Insurance), and/or Part D (prescription drug insurance), you must enroll separately during your initial enrollment period, Open Enrollment or during Special Enrollment Period to avoid paying late enrollment penalties.

How long do you have to work to qualify for Medicare?

First, it is important to know how eligibility for Medicare works. Most Medicare beneficiaries have worked and paid Medicare payroll taxes for at least 10 years to qualify for premium-free Medicare Part A as well as Part B coverage. If you have not worked for 10 years but your spouse has, you are allowed to claim benefits on their record. Medicare benefits cannot start earlier than when you turn 65, unless you are disabled, have ALS, or have end-stage renal disease. Medicare will only cover you, not your spouse or children if they are not eligible on their own.

How long does a spouse have to be on Cobra?

If a company has more than 20 employees, it is required to offer COBRA benefits. COBRA allows coverage for 18 months, sometimes longer, so if the working spouse can wait to retire until 18 months before the younger spouses 65th birthday, this would work out nicely.

Can a non-working spouse get Social Security?

If the non-working spouse is older than the working spouse, the non-working spouse can qualify on on the working spouses work record if they are at least 62, since that is when qualification for Social Security begins. In this case, if the working spouse is still working, the non-working spouse should stay on the work health insurance ...

Can a spouse get health insurance after 65?

The other option would be for the younger spouse to find a job that offers health insurance until they turn 65. While this is a long-shot, some companies will provide coverage for the younger spouse even after the working spouse retires.

Can a non-working spouse claim Medicare?

If the working spouse is no longer employed, the non-working spouse should go ahead and apply for coverage fully from Medicare. If the working spouse is younger than 62, the non-working spouse will not be able to claim on the record.

Does Medicare cover spouse?

Medicare will only cover you, not your spouse or children if they are not eligible on their own. This is where problems begin, especially when a working spouse is older than a non-working spouse. Say the working spouse turns 65, retires, and claims Medicare. The other spouse is only 61.

Can a spouse with a low income get medicaid?

Medicaid is a joint Federal and State program designed to help people with low incomes cover healthcare costs. If, by retiring, your income falls under a certain level, the younger spouse may be eligible for Medicaid coverage. Be aware, as a family, you have to have a very low income and very little assets, so many people will not qualify.

How many employees does a spouse have to have to be on Medicare?

Your spouse’s employer must have 20 or more employees, unless the employer has less than 20 employees, but is part of a multi-employer plan or multiple employer plan. If the group health plan didn’t pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.

How does Medicare work with other insurance?

When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) ...

How long does it take for Medicare to pay a claim?

If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. If Medicare makes a. conditional payment.

What is a group health plan?

If the. group health plan. In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.

What is the difference between primary and secondary insurance?

The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the uncovered costs.

When does Medicare pay for COBRA?

When you’re eligible for or entitled to Medicare due to End-Stage Renal Disease (ESRD), during a coordination period of up to 30 months, COBRA pays first. Medicare pays second, to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.

What is the phone number for Medicare?

It may include the rules about who pays first. You can also call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).