Coverage Under Spouse’s Employer

Q. I’m nearly 65 and retired but have excellent health care coverage under my wife’s employer plan. We hope to use this until she retires in 10 years. But if I don’t enroll in Medicare now, will I be penalized when I sign up after her retirement?

A. No, as long as you follow Medicare’s rules. Almost anybody who is retired but has group health coverage from the employer of a spouse who is still working does not need to sign up for Medicare Part B on reaching 65. When your spouse retires—or gets laid off or otherwise loses employer health coverage—you will then be entitled to a special enrollment period to sign up. This period lasts for eight months after employer coverage comes to an end. As long as you enroll in Part B (which covers doctors’ and other outpatient services) during this time frame, you won’t incur a late penalty. You’ll also get a guaranteed right to buy medigap supplemental insurance within six months of enrolling in Part B.

You can enroll in Part A (hospital insurance) during your seven-month initial enrollment period around your 65th birthday. It won’t cost you anything—there are no premiums for Part A if you’re entitled to Medicare—but it provides an opportunity to tell Social Security that you’re delaying Part B because you have health coverage under your spouse’s employer plan, and this fact will be recorded in its computer system.

However, there are some exceptions to these general rules that you need to pay attention to:

• Check whether your spouse’s employer plan requires you, as a covered dependent, to enroll in Medicare when you turn 65. A few plans—notably the military’s TriCare-for-Life coverage—automatically become secondary to Medicare when an enrollee becomes entitled to Medicare—which means that Medicare pays claims first. In this case, if you’re not enrolled in Medicare, you would receive almost no coverage from the employer plan. See “Ask Ms. Medicare: TriCare and Medicare."
  

• If you are in a same-sex marriage or relationship, and are covered by your partner's health insurance at work, you should enroll in Part A and Part B during your initial enrollment period at age 65 to avoid late penalties. Under the Defense of Marriage Act (DOMA), you are not entitled to a special enrollment period to sign up for Part B when your partner stops work -- even if you are legally married under the laws of your state or country -- because DOMA defines "spouse" as a man or woman married to a person of the opposite sex.  This rule also applies to heterosexual couples who are not legally married to each other, unless they live in one of the few states that recognize common-law marriages.

Also, remember that the key phrase in the general rules is “a spouse who receives health insurance under current employment.” In other words, she or he is still working for the employer that provides the health coverage. So, even if your spouse receives terrific retiree health benefits after ceasing to work, both of you should consider signing up for Medicare (Parts A and B) at that time. You’re not obligated to enroll, of course. But if you don’t, and some years down the line those retiree benefits come to an end for some reason, you would not then be entitled to a special enrollment period.

And what about Medicare prescription drug coverage, Part D? Here the rules are different. As long as you continue to receive “creditable” drug coverage under the employer plan—whether your spouse is still working or retired—you do not need to sign up for a Part D plan.

Creditable coverage means that Medicare considers it as good as Part D. The benefits administrator of the employer plan can tell you whether it is or not. If you lose this coverage at some stage, you will then receive a special enrollment period of two months to sign up with a Part D drug plan without incurring a late penalty.

Patricia Barry is a senior editor at the AARP Bulletin.