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Younger Spouse Losing Health Insurance, Now What?

Health coverage options when too young for Medicare

En español | Q. When I retire at 65, my wife and I will lose our health insurance. I can go on Medicare, but what are the options for my wife, who is younger?

A. The best option for your wife, frankly, is for you to keep working, if at all possible. That way she can continue coverage under your employer plan until she becomes eligible for Medicare at age 65, or, if that day is far off, for at least a few more years.

Many readers ask variations on your question. Some are under the impression that Medicare will automatically cover a younger spouse when they themselves qualify, but it doesn't. There is no family coverage under Medicare. Indeed, nobody can obtain Medicare benefits before age 65, unless eligible because of disability.

Some younger spouses in this situation are able to switch to health insurance provided by their own employers. Some may continue coverage under retiree health benefits provided by their older spouse's former employer. Otherwise, these are the options for a younger spouse not yet eligible for Medicare.

COBRA temporary insurance: The COBRA law allows people who have left or lost a job to continue coverage through their former employer for up to 18 months by paying the full premiums. If eligible, spouses and dependent children can receive this coverage, even if departing employees don't take it themselves. You must apply for COBRA within a certain time frame, so pay attention to deadlines. For more information, see the Department of Labor's guidance on how the COBRA program works.

Is your younger spouse not eligible for health coverage under Medicare? Consider COBRA temporary insurance. — Photo by Creasource/Corbis

Individual insurance: This is insurance you buy on your own. Even though it's called "individual" — to distinguish it from "group" employer insurance — you can purchase a family policy that will cover you, your spouse and any dependent children. This type of insurance is often costly, especially for people older than 50. And if you have a preexisting condition, you may be denied coverage or required to pay a higher premium. To find contact information for insurers that sell policies in your area, go to this government website and click on "Find Insurance Options."

HIPAA-protected insurance: If you've had group or COBRA insurance for at least 18 months — with no break in coverage longer than 63 days — you may have the right under the HIPAA law (the Health Insurance Portability and Accountability Act of 1996) to buy individual insurance that doesn't exclude or limit coverage for preexisting medical conditions. For more information, go to the Department of Labor's guidance on how the HIPAA-protected program works. For specific information on your rights and protections under state law, contact your state department of insurance.

Next: State high-risk health insurance pools. »

State high-risk pools: Thirty-five state governments currently run programs that offer health insurance to people who have difficulty buying or affording individual insurance because of preexisting medical conditions. Costs and benefits vary greatly from state to state, but, on the whole, this insurance tends to be more expensive than individually-purchased plans. Only a few states offer special rates for people with lower incomes. To see whether your state has a high-risk pool, go to the list provided by the National Association of State Comprehensive Health Insurance Plans.

Federal high-risk pool: This program, introduced in 2010 under the Affordable Care Act, the new health care law, guarantees coverage to people who are otherwise uninsurable because of health problems. Officially known as the Pre-Existing Conditions Insurance Plan (PCIP), it is available in all states. However, to qualify you must have been without any health insurance for six months before applying. For details about PCIP in your state, go to the government website that explains the program.

Medicaid: Under the current law, state medical assistance programs for people with low incomes are available to people under age 65 who have disabilities, are pregnant or are younger than age 19. Go to this list for links to state Medicaid websites. These sites include information on the state Children's Health Insurance Programs (SCHIPs), which offer coverage to otherwise uninsured children.

Free and low-cost community health clinics: You may be able to get medical treatment from a local clinic that provides health care for free or at a low cost, depending on your income. To find contact information for any clinics that might be available in your area, go to the U.S. Health Resources and Services Administration's online directory or to the NeedyMeds website.

More help starting 2014: Younger spouses facing loss of coverage will have more and better options in 2014, when the main provisions of the Affordable Care Act go into effect. If the law is implemented as written, you will then be able to go through a state insurance exchange to find private coverage that comes with federal protections. These protections include being able to buy individual insurance regardless of health or preexisting conditions, annual caps on out-of-pocket expenses, and subsidies on premiums for people with low or middle incomes. The law also greatly expands eligibility for Medicaid to adults under age 65. For more information, go to the government website that explains the law's provisions.

Also of interest: Everything you need to know about Medicare.

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