| Thu, May 16, 2013 @ 09:00 AM

Medicare is Not a Family Health Plan

Posted by Medicare Made Clear

medicare spouse coverage borthdayThe transition to Medicare might be smoother for many couples if every married person were the same age as their spouse. Why? Many couples get their health insurance through one spouse’s employer. If that spouse retires at age 65 and enrolls in Medicare, a younger spouse—and any dependents—may be left without coverage. This is also true for domestic partners covered under one partner’s health plan.

You can only get Medicare if you yourself are 65, unless you are eligible due to disability. You are not eligible for Medicare when your spouse or partner turns 65. (The use of “spouse” in the rest of this article also means “domestic partner.”)

Health Insurance for a Younger Spouse

It’s important to plan ahead when a younger spouse relies on health coverage through an older working spouse’s employer. There are a number of considerations, including:

  • How many years will it be before the younger spouse turns 65 and becomes eligible for Medicare?
  • Does the younger spouse work and have access to a health plan through their employer?
  • Does the retiring spouse have retiree health benefits from their former employer that will cover the younger spouse?
  • Does the younger spouse have a pre-existing condition that may be an obstacle to getting other coverage? (Note that starting in 2014, as part of the Affordable Care Act, insurers can no longer discriminate on the basis of a person’s pre-existing condition.)

Buying health insurance for a younger spouse until they are eligible for Medicare can become costly. If eligibility is several years away, the retiring spouse may want to continue working—at least for a few years. That way, the younger spouse can continue to receive benefits through the working spouse’s employer plan until he or she turns 65.

Alternative health insurance options for younger spouses do exist. You’ll need to do some homework to find the one that may work for you. Here’s a run-down of the types of coverage available.

COBRA Temporary Insurance

Spouses and dependent children may be eligible for COBRA insurance through the retiring spouse’s former employer. The COBRA law allows you to continue receiving benefits for up to 18 months. You must pay the full premium; the employer no longer pays its share. You may only have a short time to apply for COBRA after the older spouse retires. Talk to the plan benefit manager ahead of time so you can be ready to act if you choose to go with COBRA.

Individual Insurance

Most private insurance companies offer individual plans. An “individual” plan may cover one person, spouses/partners or families with dependent children. Historically, people with preexisting conditions could be denied coverage or charged a high premium. This will no longer be the case in 2014 when the Affordable Care Act goes into effect. Healthcare.gov is a good place to start when looking for insurers in your area. You may also want to contact your current insurer to see what individual plans are available.

Group Health Plans

Some organizations offer group health plans to their members. These might include professional, alumni and social organizations. Premiums may be lower for this type of coverage than for individual insurance. Check with the organizations you belong to and see if they offer this member benefit.

HIPPA-Protected Insurance

HIPAA, or the Health Insurance Portability and Accountability Act of 1996, allows individuals to buy insurance that doesn’t exclude or limit coverage for preexisting medical conditions. (Note that the Affordable Care Act provides additional protections.) You are protected by HIPPA if you’ve had group or COBRA insurance for at least 18 months with no break in coverage longer than 63 days. You can learn more about your protections from your state department of insurance.

Spouses facing Medicare decisions have many things to consider and choices to make. Take the time to understand your specific situation and learn your options.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Retirement and Medicare Basics: Watch this video to learn what you need to know before you retire.

Understand Your Enrollment Periods: Use this online tool to learn when you can enroll in Medicare.

Medicare.gov: Visit the official U.S. government site for Medicare.

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