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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 spouse and I will lose our health insurance. I can go on Medicare, but what are the options for my spouse, who is younger?

A. The best option for your spouse, frankly, is for you to keep working, if at all possible. That way your mate can continue coverage under your employer plan until he or 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 they are disabled or have end-state kidney disease.

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, here are some 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.

Close up of aged couple .

Photo by Creasource/Corbis

Is your younger spouse not eligible for Medicare? He or she might able to get subsized health coverage via your state's insurance marketplace.

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.

One way to shop for individual and family insurance is through the Health Insurance Marketplace established under the Affordable Care Act (ACA). To find contact information for insurers that sell policies in your area, go to the government's Health Care.gov site and click on "Get Coverage." You'll be directed to the marketplace for your state.

Open enrollment for ACA plans only runs from November 1 to December 15 in most states, but people who are losing their current health coverage may qualify for a special enrollment period. Depending on your income and the plan you choose, you may be eligible for subsidies (in the form of tax credits) to reduce your premiums.

Not all insurers offer health plans through the government-run marketplaces. To shop for coverage outside the marketplace, contact insurance companies directly to get information on the individual plans they offer, or consult a health insurance agent in your area.

Medicaid

Jointly funded by the federal and state governments, Medicaid is the nation's public health insurance program for people with limited income and financial resources, serving nearly 65 million people as of late 2019. Eligibility is based primarily on income and family size, but as each state operates its own Medicaid program, the specific criteria vary widely from state to state.

The ACA gives states the option to expand Medicaid eligibility to people with incomes of up to 138 percent of the federal poverty level ($17,236 in 2020). As of January 2020, 36 states and the District of Columbia had done so. Some 13 million Americans have gained health coverage as a result of the expansion, according to "What Consumers Need to Know About Medicaid," a February 2019 report by the AARP Public Policy Institute.

To learn more about your Medicaid options, contact your state's Medicaid agency.

Community health clinics

You may be able to get medical treatment from a local clinic that provides primary health care services for free, at a low cost or on a sliding scale, depending on your income. Some offer access to prescription drug discounts and dental, mental health and substance abuse services..

The U.S. Health Resources and Services Administration has an online directory of community health centers that receive federal funding. The nonprofit organization NeedyMeds maintains a searchable database of clinics that offer free or low-cost care or financial assistance to uninsured and underinsured patients.

Editor's note: This article, originally published in September 2010 and previously updated in June 2012, was revised again in February 2020 to eliminate outdated information and reflect implementation of the Affordable Care Act.

Also of interest: Everything you need to know about Medicare

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