Understanding what happens when one spouse goes on Medicare and the other isn’t eligible is complex. Exploring all options is essential, so I will do my best to cover most of that in this article. However, this topic is very complex, and each situation can vary greatly. If you have any questions, feel free to reach out.
What if one spouse is eligible for Medicare and the other isn’t?
So, let’s dive into it. Let’s say that one spouse is eligible for Medicare. What could or should they do? The spouse who becomes eligible for Medicare can enroll in Medicare Part A and or B, depending on their eligibility criteria. Depending on how they receive their benefits, they can also opt for additional coverage, such as a Medicare Advantage plan, Medicare Supplement Plan (Medigap), and/or prescription drug coverage.
What happens when one spouse goes on Medicare and the other isn’t eligible for coverage simultaneously?
The best scenario would be if the spouse who isn’t eligible for Medicare has the option to continue to work and has access to employer-sponsored health insurance; they can remain covered under that plan.
I know what you’re thinking: what if my spouse doesn’t work? What if they don’t have access to employer-sponsored health insurance?
Cobra as an Option
If your spouse is not eligible for Medicare and doesn’t have access to employer coverage, then one of the options that you may have is COBRA. In some situations, the non-Medicare eligible spouse loses access to employer-sponsored health insurance due to their spouse’s retirement or other reasons. In that case, they may be eligible for COBRA continuation coverage for a limited time. This allows them to stay on the employer’s health plan, but they may have to pay the entire premium themselves plus an administrative fee. This is a scenario that I have personally seen in my work with Medicare beneficiaries. The timing worked out, and the spouse eligible for Medicare could go on Medicare and their spouse could take the COBRA benefits that would carry them to their own Medicare eligibility. Remember, this is not everyone’s situation, and your situation may look different.
Health Insurance Marketplace as an Alternative
Here is another option. Let’s say the spouse eligible for Medicare decides to go on Medicare. The spouse who isn’t eligible for Medicare doesn’t have access to Cobra or employer-sponsored health insurance.
What could they do?
A lot of times, this happens because Cobra isn’t an option or it’s too expensive. This provides you with an opportunity for the non-eligible Medicare spouse to look to the health insurance marketplace in your state. Most people turn to this if they don’t have employer coverage and are not Medicare-eligible. You or your spouse may qualify for premium tax credits or other subsidies to help make the coverage more affordable.
To recap, if one spouse is eligible for Medicare and the other isn’t and lacks access to COBRA or employer-sponsored health insurance, they can explore the Health Insurance Marketplace for coverage. This may help them find a plan comparable to what they had under the Medicare-eligible spouse’s coverage.
Next, you want to ensure Medicare and spouse coordination is happening.
Coordinating Coverage Between Spouses
When considering what happens when one spouse goes on Medicare and the other isn’t eligible, ensuring both have comprehensive coverage is essential.
What this means is if you’re going to transition to Medicare, and let’s say your spouse who’s not eligible for Medicare will look to the health insurance marketplace, you want to make sure that you don’t go backward in the coverage you had. This might involve Medicare beneficiaries, including those who need supplemental coverage. This might involve the non-Medicare eligible spouse making sure that their coverage from the health insurance marketplace is comparable to what they currently have.
One thing that I will tell you is that sometimes, there are cost savings to be had if you go through this transition process.
I know a lot of people who get frustrated with the transition and think it would be easier to stay put. I would caution you against doing that because there may be money to be saved and better coverage if you transition this way.
It doesn’t happen for everybody because everybody’s scenario is different. Ultimately, both spouses must make healthcare decisions. And so you want to talk this over together and decide the right situation for you and your spouse. Even if only one person is enrolled in Medicare, they should discuss their coverage options, understand each other’s healthcare needs, and make informed decisions.
As I said at the beginning of this article, this is a complex subject. One thing that you want to be aware of is the different open enrollment periods. This is crucial to being aware of with Medicare and the health insurance marketplace.
This might be a great opportunity to compare your options and coverage before making that final decision because it allows both spouses to understand the available coverage options and make changes that may be needed to best suit both of you.
Because this is a complex issue with many moving parts, I’ll close by saying this: In essence, while navigating healthcare coverage when one spouse is on Medicare and the other isn’t can be complex, various options are available to ensure both individuals have adequate coverage for their healthcare needs.
This is why it’s so important to consult with a Medicare insurance agent or a healthcare insurance specialist who can help understand and select the most suitable option for your specific situation.
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Jamie is a licensed insurance agent specializing in Medicare plans, life insurance, and dental insurance. |