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Is Medicare a Family Plan?

Medicare has never been a family plan, in contrast to employer-sponsored health insurance.

Each spouse pays separate Medicare premiums, and married couples don’t get a discount. If both spouses are enrolled in Medicare Part B, they each pay $174.70 a month in 2024; more for couples with high incomes.

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If you’re receiving Social Security benefits, your Medicare Part B premiums are automatically deducted. Otherwise you’ll each receive a quarterly bill for your Part B premiums, which you can pay four ways:

  • Log in to your online Medicare account.
  • Mail your payment to Medicare.
  • Sign up for automatic deductions from your bank account through Medicare Easy Pay.
  • Use your bank’s online bill payment service.

Part A and Part B deductibles, copayments and other out-of-pocket costs apply separately to each spouse.

Does marriage affect Medicare costs?

Yes. Even though each spouse pays separate premiums, being married and enrolled in Medicare has benefits and drawbacks.

The good news. You can qualify for premium-free Part A based on your spouse’s work record. Most people don’t pay premiums for Medicare Part A because Medicare taxes were deducted from their paychecks for at least 40 quarters of work, the equivalent of 10 years or more.

If you haven’t worked that long but your spouse has, you can qualify for premium-free Part A based on your partner’s record. If neither of you have worked that long, you’ll have to pay Part A premiums.

In 2024, if you or your spouse paid Medicare taxes for 30 to 39 quarters, you pay $278 a month; if fewer than 30 quarters, you pay $505 a month.

The bad news. Joint income affects premiums for high earners. People with high incomes pay more for Medicare Part B and Part D prescription plan premiums, and the high-income surcharge is based on joint income for married couples filing a joint income tax return.

Married couples pay the high-income surcharge in 2024 if the adjusted gross income on their joint tax return is higher than $206,000. Each spouse must pay $244.60 to $594 a month for Medicare Part B in 2024, depending on income.

On top of that, they each must pay $12.90 to $81 plus regular premiums for Part D drug coverage. The income levels for the surcharges are different for married couples filing separately.

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The surcharge is based on the most recent income tax return on file, generally 2022 income for 2024 premiums. You may be able to reduce or eliminate it if your income has dropped because of certain life-changing events, such as marriage, divorce, the death of a spouse or retirement.

Can spouses sign up for different Medicare Advantage plans?

If you choose coverage through a private Medicare Advantage (MA) plan rather than original Medicare, you and your spouse don’t have to have the same plan. You can each pick a plan based on your medical and prescription needs and preferred providers.

Many spouses make Medicare Advantage decisions in tandem, even if that isn’t their best choice. A University of Michigan study of 1,812 couples 65 or older enrolled in Medicare Advantage plans found that 84 percent of couples began with both partners enrolled in the same MA plan. Nearly 80 percent of the individuals remained in the same Medicare Advantage plan the next year. Among those who stayed, so did more than 95 percent of their partners.

Having coverage with the same insurer may be convenient for both spouses, “but the design of these plans is to offer individual flexibility to choose the plan that best meets their care needs,” says Lianlian Lei, lead author of the study and assistant professor of psychiatry at the University of Michigan Medical School. “In most cases, partners do not have identical health care needs and should choose the plan based on their own care needs.”

Check the Medicare Plan Finder tool to find the best Medicare Advantage plan for you. You can change plans from Oct. 15 to Dec. 7 each year during open enrollment, with new coverage starting Jan. 1.

If you and your spouse choose different plans, you may have different preferred pharmacies or provider networks.

“That would be the disadvantage,” Lei says. “Now they have to deal with two plans probably for all aspects of care: providers, pharmacies, payments and cost sharing, procedures for care and claims.”

Can one of us have original Medicare but not the other?

Yes, some couples opt to have one spouse enrolled in original Medicare while the other has Medicare Advantage. You can each choose what’s best for your own situation.

“This might happen when one spouse experienced significant health shocks, and it might make more sense to stay or switch to original fee-for-service for a broader provider network and less restricted access to care,” Lei says about original Medicare. Meanwhile, the other spouse could stay in an MA plan that meets their needs and makes financial sense for other reasons, such as low premiums or additional benefits.

If you or your spouse plan to leave Medicare Advantage for original Medicare, know that one roadblock can make switching difficult: preexisting conditions.

Many people buy a Medicare supplement policy, also known as Medigap, to help cover original Medicare’s deductibles and copayments. But in most states, unless you qualify for a “guaranteed issue right,” Medigap insurers can reject you or charge more because of preexisting conditions if more than six months have passed since you signed up for Part B.

Do Medigap plans have spousal discounts?

Yes, some Medigap insurers offer discounts if both spouses buy from them. For example, you may each save 12 percent on your monthly premium, although specifics vary by company. In some cases, a discount is applied when two policyholders who live together buy coverage with the same insurer, even if they’re not married.

To find spousal discounts, go to the Medigap plan finder and click Spouse Discount in the drop-down menu, then View Policies for the letter plan you’re interested in. Click Visit Company Website to learn more about each company’s policies and spousal discounts.

Keep in mind

Medicare offers no joint eligibility — each spouse can enroll at age 65 unless a disability qualifies them to apply earlier. The initial enrollment period starts three months before the month you turn 65 and lasts for three months afterward.

If a younger spouse has health insurance through the older spouse’s employer, they may need to get coverage another way until turning 65. One way is to sign up for an individual plan through the insurance marketplace or continue employer coverage through COBRA.  

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