En español | You may be 65 years old and ready to enroll in Medicare, but unless your spouse has a disabling medical condition, your mate won’t qualify until age 65.
That’s because Medicare doesn’t operate like health insurance that you may have through your employer. It’s not a family plan. Your spouse can qualify for premium-free Part A based on your work record if he or she hasn’t paid 40 quarters of federal payroll taxes. But you both will start your Medicare coverage separately, usually based on age.
People eligible for Medicare can sign up during their seven-month initial enrollment period, which begins three months before the month they turn 65 and lasts for three months after their birthday month. The coverage begins no earlier than the month they turn 65. For those whose birthday is on the first of the month, coverage starts at the beginning of the previous month.
Anyone with a disability may qualify for Medicare before age 65. Most people younger than 65 who receive Social Security Disability Insurance (SSDI) benefits can get Medicare 24 months after they become eligible for disability benefits.
For anyone with permanent kidney failure, known as end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease, Medicare’s 24-month waiting period is waived.
If your insurance plan at work now covers both of you, you need to consider your options carefully before you transition fully to Medicare, because your spouse won’t have medical coverage. Consider these ways to bridge the gap.
If you keep your employer coverage, too, it becomes secondary to Medicare for you. Your spouse will still receive the same benefits, but the costs may change. Ask your employer for more information about the costs and coverage for your spouse after you turn 65.
The coverage and provider network won’t change under COBRA, but the premiums will. You usually have to pay both the employee’s and the employer’s share of the premiums, plus up to 2 percent in administrative costs.
If you’re losing medical coverage because you’re retiring, your spouse who had been covered through your employee plan may qualify for a special enrollment period to get marketplace coverage within 60 days after your health coverage ends.
Your spouse may qualify for a subsidy to help pay the premiums based on your household income for the year. After you retire, that income may be lower than when you were bringing home a paycheck.
The subsidy can reduce the premiums significantly, and 2021 COVID-relief legislation expanded them for 2021 and 2022. For example, a married 63-year-old in Baltimore whose household income is $40,000 in 2022 could qualify for a premium subsidy of $647 a month, lowering the monthly cost of a mid-level plan (called a silver plan in the federal marketplace) to $106 from $753 without the subsidy. The Kaiser Family Foundation’s subsidy calculator can help you estimate your premium assistance.
So far in 2022, 38 states and the District of Columbia have expanded Medicaid coverage to adults whose modified adjusted gross income is $25,268 for a household of two in the continental United States. The income guidelines are $31,588 in Alaska and $29,063 in Hawaii.
The states that have not expanded Medicaid to low-income adults are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. But your spouse may qualify under some states’ rules, especially if your family is caring for relatives age 18 and younger who live with you.
Updated May 26, 2022
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