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Do I have to sign up for Medicare if I’m covered through my spouse’s employer?

The answer depends on whether your spouse works for a small business or large company.

No matter what the size of the company, you won’t have to pay a penalty if you have health coverage through your spouse’s current employer and you enroll in Medicare within eight months of losing that coverage. But if you get your coverage through a small business, you may face gaps that you’ll have to pay for yourself if you don’t sign up for Medicare at age 65.

If your spouse’s company has 20 or more employees, it must offer the same health benefits to employees and their spouses who are 65 or older that it offers to younger workers and their pouses. This employer cannot require you or your spouse to enroll in Medicare at age 65.

The company-sponsored health insurance will continue to be what pays medical bills first, as the primary payer. Medicare will be the secondary payer. 

Even though many people turning 65 have coverage from an employer, they enroll in Part A of Medicare because it’s free if they or their spouse has paid more than 40 quarters of Medicare taxes (the equivalent of 10 years’ work over many decades). If you’re qualifying for Medicare through your spouse, you have to be married at least a year before applying.

But people often delay signing up for Medicare Part B so that they don’t have to pay premiums for both Medicare and the employer’s coverage. In 2022, Part B costs $170.10 a month for most people (it’s more for high earners).

When your spouse retires, gets laid off or otherwise stops working for this employer, you will be entitled to a special enrollment period (SEP) to sign up for Medicare. You can enroll in Part B anytime while your spouse is working or up to eight months afterward without incurring a late-enrollment penalty.

If your spouse’s company has fewer than 20 employees, then Medicare generally becomes the primary payer at age 65 and the employer’s coverage is secondary. This means that Medicare pays your bills first and the employer’s plan pays only for services it covers but Medicare doesn’t. In this case, if you’re not enrolled in Medicare, you would receive almost no coverage from the employer plan.

If Medicare becomes the primary payer, you generally need to sign up during your initial enrollment period, which begins three months before the month you turn 65 and ends three months afterward. In rare cases, some small businesses continue to provide primary coverage after age 65.

Check whether your spouse’s employer plan requires you, as a covered dependent, to enroll in Medicare when you turn 65. If the employer says that you don’t have to enroll in Medicare, get the response in writing.

Do I enroll in Medicare if my spouse has retiree coverage?

Yes. You can delay signing up for Medicare only if you or your spouse has coverage from a current employer. You need to enroll in Medicare no later than eight months after your spouse stops working or you may have to pay a lifetime late-enrollment penalty when you do enroll in Part B.

That is also the case if your spouse continues his or her employer’s coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), a federal law that requires organizations with 20 or more employees to offer health insurance for up to 18 months (36 in some cases) after workers leave their job. COBRA doesn’t count as active employment, so you must enroll in Medicare during your initial enrollment period to avoid late-enrollment penalties. 

Do I need Part D if I have drug coverage through my spouse?

Not necessarily. The rules are different for Medicare Part D prescription drug coverage. As long as you continue to receive “creditable” prescription drug coverage under the employer plan — whether your spouse is still working or retired — you do not need to sign up for a Part D plan.

Creditable coverage means that Medicare considers it to be as good as Part D. This can include coverage from a current employer, former employer or other source, such as a union or military Tricare coverage. You should receive a notice from the plan provider every September letting you know whether Medicare considers the coverage creditable.

If you lose this coverage at some point, you will then be eligible for a special enrollment period of two months to purchase a Part D plan without incurring a late-enrollment penalty.

Keep in mind

You’ll have different decisions to make if the spouse with employer health coverage turns 65 first. If the older spouse enrolls in Medicare instead of keeping the employer’s insurance, the younger spouse may lose private health insurance coverage. If that happens, a younger spouse may need to find other sources of coverage before turning 65 and becoming eligible for Medicare.

One option is to continue the employer’s coverage through COBRA, which can last up to 36 months if you lose employer coverage because your spouse becomes entitled to Medicare. Or you can buy a private plan through the Affordable Care Act federal insurance marketplace or through a state that has its own exchange.

Updated June 29, 2022

     

        


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