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I’m 65 and enrolling in Medicare. Can my spouse get Medicare at age 63?

You may be 65 years old and ready to enroll in Medicare, but your spouse won't qualify until age 65 unless he or she has a disabling medical condition.

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 personal 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 ends 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.

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What are some ways to get Medicare before age 65?

People with disabilities 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.

The 24-month waiting period is waived for people with permanent kidney failure, known as end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease.

What can I do to get medical insurance for my spouse?

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.

Continue to work. You can keep your employer’s family health plan so your spouse will have full coverage, and enroll in premium-free Part A for yourself. If your company has 20 or more employees, your plan will be the primary coverage for you and your spouse; Medicare will be secondary for you. If your company has fewer than 20 employees, you’ll need to sign up for Medicare parts A and B when you turn 65.

Then, 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 about the costs and coverage for your spouse after you turn 65.


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Use spouse's employer coverage. Your spouse may qualify for a special enrollment period to switch to his or her own employer’s coverage within 30 days of losing coverage under your plan. He or she can also enroll during the company’s annual open enrollment period.

Sign up for COBRA coverage. The Consolidated Omnibus Budget Reconciliation Act of 1985, known as COBRA, is a program that allows employees and eligible family members to continue receiving employer coverage after their employer-sponsored health insurance ends. It won’t substitute for your own Medicare coverage once you turn 65, but for your younger spouse, COBRA can last up to 36 months after you’re eligible for Medicare.

The coverage and provider network won’t change under COBRA, but the premiums will. You’ll typically pay both the employee’s and the employer’s share of the premiums, plus up to 2 percent in administrative costs.

Buy private insurance. Your spouse can purchase insurance through the Affordable Care Act (ACA) federal marketplace or through a state that has its own exchange. Open enrollment generally runs Nov. 1 to Jan. 15 (or the next business day) for states that use the federal exchange. Some states have different time frames. You can find links to the federal or state marketplace in your area by typing your zip code in at

If you’re losing medical coverage because you’re retiring, your spouse may qualify for a special enrollment period to get marketplace coverage within 60 days after your health coverage ends.

He or she may also 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.

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The subsidy can reduce the premiums significantly, and the size of the subsidy and income levels for eligibility were expanded significantly from 2021 to 2025. KFF’s subsidy calculator can help you estimate your premium assistance.

See if your spouse qualifies for Medicaid. If your household income is below a certain threshold, he or she may be eligible for Medicaid, a joint federal-state insurance program. The ACA allowed for expansion of Medicaid coverage to adults with incomes of 138 percent of the federal poverty level, but not all states have expanded coverage. You can do a quick screening to see if you’re eligible at or through your state marketplace.

Keep in mind

Another option is to look for a community health center near you. These are often located in areas with few doctors’ offices and hospitals, and also in areas with high rates of uninsured patients. Payment is on a sliding scale based on income.

The Benefits CheckUp website from the National Council on Aging can lead you to a wide range of benefit programs and resources in your area and includes tools to help you determine if you’re eligible

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