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Medicare Coverage for Non-Working Spouses

Posted: 8/11/2016 12:40 PM by Interim HealthCare

Dear Savvy Senior,
Does Medicare cover spouses who have not worked? I have worked all my life, but my spouse worked only for a few years when we first got married but then quit to take care of our children fulltime. Will she be eligible for Medicare?
Inquiring Husband

Dear Inquiring,
There are plenty of couples in your situation when it comes to applying for Medicare. The answer generally is yes, your spouse can qualify for Medicare on your work record. Here’s how it works.

Eligibility Rules
Medicare, the government health insurance program for older adults, covers more than 55 million Americans age 65 and older, as well as those younger that have a qualifying disability or have End-Stage Renal Disease.

To be eligible, you must have worked and paid Medicare taxes for at least 10 years to qualify for premium-free Medicare Part A hospital coverage when you turn 65. If you qualify, then your non-working spouse will qualify too, based on your work record when she turns 65.

Divorced spouses are also eligible if they were married at least 10 years and are single, as are surviving spouses who are single and who were married for at least nine months before their spouse died.

In addition to Part A, both you and your spouse would also qualify for Medicare Part B, which covers doctor’s visits and other outpatient services, but requires a monthly premium, not a work history. The premium for most Part B beneficiaries in 2016 is $104.90 per month, while new beneficiaries pay $121.80/month and higher earning couples – those with incomes over $170,000 per year – pay even more.

There are also a number of other caveats you should know about depending on your wife’s age.

Older Spouse
If your wife is older than you, she can qualify for Medicare on your work record at age 65, even if you’re not getting Medicare yourself, but you must be at least 62 years old. You also must have been married for at least one year for your wife to apply for Medicare on your work record.

If you are still working and your wife is covered by your employer’s health insurance, she may want to enroll only in the premium-free Medicare Part A until you retire or your employer coverage ends. Part B – along with its premium – can be added later without penalty as long as your employer’s group health plan is your “primary coverage.” Check with your employers’ human resources department to find out about this.

If your wife is more than three years older than you and has no health coverage, you can buy her Medicare Part A until you turn 62 and the premium-free benefit kicks in. The Part A monthly premium is $411 in 2016.

Younger Spouse
If your wife is younger than you, she will need health insurance until she turns 65 and becomes eligible for Medicare. This may be through your employer if you are still working, through COBRA (see dol.gov/ebsa/publications/cobraemployee.html), or through the Health Insurance Marketplace (see healthcare.gov) or outside the marketplace through a private insurance company.

Other Medicare Options
In addition to Medicare Part A and B, when you and your wife become Medicare eligible, each of you will also need to enroll in a Part D prescription drug plan if you don’t have credible drug coverage from your employer or union. And, you may want to purchase a Medicare supplemental (Medigap) policy too, to help pay for things that aren’t covered by Medicare like copayments, coinsurance and deductibles. Or, you may want to consider an all-in-one Medicare Advantage plan.

For more information on Medicare choices and enrollment rules visit https://www.medicare.gov/ or call 800-633-4227. You can also get help through your State Health Insurance Assistance Program (see shiptacenter.org), which provides free Medicare counseling.