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I'm Turning 65, But My Spouse Isn't

Intro | Should I Take Medicare Now?

|How To Signup For Medicare | Medicare Secondary Options |

I'm Turning 65 But My Spouse Is Not |

Medicare Disability | Medicaid

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"Michael was excellent in walking my wife and I thru the Medicare process." 

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Key Points:

  • People often don’t turn 65 at the same time as their spouse.

  • Choosing if you should take Medicare when you have a spouse who might not be able to is a big decision

  • Medicare can be cost-effective, but sometimes it makes sense to delay it

When you turn 65, you become eligible for Medicare. If you are married, your spouse may be younger and not eligible for Medicare. Choosing what to do in this situation can be confusing. In this article, we’ll use our expertise to discuss what to expect and your options if your spouse is indeed not eligible for Medicare. Let’s dive in.

Do You Have Creditable Health Coverage?

The first thing to consider is whether either you or your spouse have creditable work insurance available. This is insurance that an actuary has determined to be as good or better than Medicare coverage for medications and is offered by an employer with over 20 full-time employees. If neither of you has this option, you will need to transition to Medicare.  Your spouse will have to get their own individual insurance, most likely through a health insurance marketplace.

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Things get a bit more interesting if you have creditable work insurance available. Let’s talk about a few different situations.

What Should I Consider?

If you have creditable work insurance, you will have to compare it to Medicare to decide what is best. Some things to consider include:

  • Network Size and Accessibility

  • Monthly Premiums

  • Prescription Costs

  • Maximum Yearly Out of Pocket Costs

  • Extra Benefits Like Dental and Vision

 

It can be overwhelming to compare credible work coverage to Medicare, especially when you have to weigh your spouse's options. We recommend talking to the brokers at NJ Life and Health. We can guide you through each of your options and give you a comparison in simple language that will allow you to make an informed decision.

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If you’d like a more in-depth discussion, read our article Medicare vs. Work Insurance and Retiree Coverage

I Have Work Insurance At 65, But My Younger Spouse Doesn’t

If you are responsible for providing health insurance to both you and your spouse, enrolling in Medicare can be a big decision. If your employer has over 20 employees, you can keep your work insurance and make Medicare A and B your secondary insurance. You can also choose to delay Medicare Part B to make it your primary later.

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Depending on the cost and coverage of their work insurance, some people voluntarily disenroll from their work coverage at age 65 to enroll in Original Medicare or a Medicare Advantage plan. If you leave your work policy, your spouse may also be disenrolled. Some companies allow your spouse to stay on the policy without you, but most do not. Many people in this situation opt to work a few more years until their spouse is also eligible for Medicare. It all depends on what options your spouse has.

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Depending on your income, your spouse may be able to get affordable health insurance from healthcare.gov or your state’s health insurance marketplace. They also could purchase an individual plan directly from an insurance carrier or broker. Policies purchased outside the marketplace are often more expensive because you are not given a subsidy from the government.

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If you plan on keeping your work insurance to cover your spouse, you may want to consider how long it will be until they are eligible for Medicare. If they are a few years younger, this strategy could work until you are ready to retire. If they are 5-10 years younger than you, you may want to have a plan in place if you don’t plan on working that long.

I Have Work Insurance at 65, And My Younger Spouse Does Too

This situation will give you the most options. You can choose your work insurance, your spouse’s work insurance or go onto Medicare while your spouse keeps their insurance. This decision carries less weight because you know your spouse will have coverage if you choose to go onto Medicare. Like any other health insurance comparison, look at each plan's coverage and networks, monthly premiums, and out-of-pocket costs to decide what is best for your health needs.

I Have No Work Insurance at 65, But My Younger Spouse Does

If your younger spouse provides health insurance for you at 65, you can keep their work insurance past 65 without any penalties. Deciding if you should stay on their insurance or Medicare comes down to what we’ve already mentioned, such as coverage and cost. One thing that makes this situation unique is that your insurance may be more expensive than your spouse's. Let us explain.

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When a married couple is placed on health insurance through work, the spouse working for the company often has a lower monthly premium. The spouse attached to the policy usually has to pay more to be on the policy. For a hypothetical example, imagine a married couple paying $800 monthly for health insurance. The spouse working for the company may only pay $250 a month, but the spouse attached to the policy may pay $550! This is not always the case, but we see it often. In this scenario, going onto Medicare could save the couple money on their monthly premiums depending on their location and secondary plan options.

I Am Going Onto Medicare Disability, And My Spouse Has Creditable Work Coverage

If you are under 65 and going onto Medicare disability, you can keep your spouse's creditable work coverage. When you enroll in Medicare Disability, you are automatically given Medicare Parts A and B. If you keep your spouse's work coverage, you send Part B back to Social Security and get a new Medicare card with just Part A. This will allow you not to pay any Part B premiums and, most importantly, give you another Initial Enrollment Period when you are ready to leave your spouse's work coverage.

What Do I Do If I Am Keeping Work Coverage?

If you keep work insurance at 65 from either your spouse’s or your employment, you will want to delay Medicare properly. Delaying Medicare means telling Social Security you don’t want Medicare Part B when you turn 65. Delaying Medicare is important if you want to have all your options available when you do leave your work coverage.

 

If you plan on delaying Medicare, read our in-depth article on the subject: How To Delay Medicare Properly

What Is Best For Me?

We have seen these common scenarios as people decide between Medicare and work insurance. The truth is everyone has a different situation. If you are having trouble deciding what to do and what your options are, contact the NJ Life and Health brokers! We have helped thousands of people with this decision and would happily help you. Visit our website at www.njlifeandhealth.com or call our Toms River, NJ office at 848-226-6897 to schedule your free Medicare education. Our time to you is always free, and we can explain all your options in simple terms that can help you make an educated decision.

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