Medicare offers federal health insurance coverage for those turning 65 years and over, as well as those with a permanent disability. Medicare does not cover spouses specifically. However, some spouses qualify based on the work record of their spouse or a former spouse.

Some spouses may qualify by reaching 65 years of age and having their own eligible work and tax record. Others, however, may not have worked for the required number of quarters.

In these cases, Medicare can use the work record of a married enrollee to qualify their spouse for a plan. In this article, we examine the eligibility criteria for the spouses, dependents, and partners of Medicare enrollees for coverage.

Medicare spouse coverage

The spouse of an individual holding a Medicare plan becomes eligible for their own plan once they reach the age of 65, regardless of whether they have previously worked outside the home. The eligibility for the spouse is determined based on their spouse’s employment history. If the spouse has a disability, they may become eligible at a younger age.

In cases where a couple has divorced after a marriage lasting at least 10 years, Medicare can consider the work record of the former spouse to qualify the separated spouse, provided they meet the age or disability requirements. However, this eligibility applies only to those who remain unmarried to new partners. 

For those who remarry, Medicare assesses their eligibility using their new spouse’s work history.

It’s important to note that Medicare does not extend the same benefits to unmarried partners as it does to married ones. 

Unlike a spouse, a domestic partner cannot delay enrollment in Medicare Part B without incurring a late enrollment penalty, and there are no special enrollment periods (SEPs) available for unmarried domestic partners.

Read more about Medicare enrollment periods here.

Spousal Coverage and the Role of Social Security Work Credits

To be eligible for Medicare, an individual or their spouse must have accumulated a sufficient number of Social Security credits over their work history.

Medicare eligibility is closely tied to Social Security work credits. In 2020, workers earned one work credit for every $1,410 they earned, with a maximum of four credits attainable per year.

Self-employed individuals also have the opportunity to earn up to four work credits per $1,410 of net earnings.

For individuals born after 1929, a minimum of 40 work credits, equivalent to ten years’ worth of credits, is required to become eligible for Medicare. Those born before this date require fewer credits.

The number of qualifying credits for individuals with disabilities varies depending on the age at which the disability developed.

• Individuals who become disabled between the ages of 31 and 42 will need 20 work credits to qualify for Social Security disability benefits.
• Those who become disabled at age 62 or later will require the full 40 credits to qualify for Social Security disability benefits.

It’s important to note that not all types of employment contribute to Social Security work credits. Spouses who work for local or state governments that do not participate in Social Security will not accrue these credits.

Additionally, individuals with over ten years of service in the railroad industry do not contribute to Social Security. Instead, their Medicare plans are covered by the Railroad Retirement Board (RRB). Medicare payments are deducted from railroad workers’ paychecks, and they receive the same benefits as other Medicare recipients.

While there is a connection between Social Security work credits and Medicare, individuals may begin receiving Social Security benefits at age 62. However, except in specific disability-related situations, Medicare is typically unavailable to those under the age of 65.

Individuals receiving Social Security Disability Insurance (SSDI) automatically qualify for Medicare Part A and Part B after receiving SSDI benefits for 24 months.

Does My Policy Cover My Spouse?

It’s essential to understand that Medicare covers individuals, not families.

While some employer-sponsored group health plans offer direct coverage for medical treatments for spouses and dependents, such coverage options do not exist within Medicare plans. Each person must qualify for Medicare on an individual basis.

Age Gaps in Spousal Health Coverage: Exploring Options

Many couples face decisions regarding health coverage when one partner is on the brink of turning 65 and becoming eligible for Medicare while the other spouse is younger.

Older Partner Still Working:

If the older spouse is eligible for Medicare but continues to work, they typically maintain health coverage through their employer’s insurance. Their younger spouse can often remain covered under the same plan.

Older Spouse’s Retirement Plans:

In cases where the older spouse plans to retire upon turning 65, the younger spouse must explore health insurance options. However, in most instances, they won’t qualify for Medicare until they reach the eligible age.

Younger Spouse’s Options:

If the younger spouse currently has coverage through the older spouse’s employer healthcare plan but anticipates that the older spouse will retire while they’re still employed, one viable option is enrolling in their own employer’s insurance plan. This can be done even outside the typical open enrollment period because losing spousal health insurance qualifies as a special circumstance that triggers a Special Enrollment Period (SEP).

• Consideration of COBRA:

When the older spouse’s transition to Medicare leads to the loss of coverage for the younger spouse, COBRA (Consolidated Omnibus Budget Reconciliation Act) can come into play. COBRA allows for the continuation of coverage beyond the termination of employment or an employer’s health plan. Dependents can also remain on the group employer’s health plan through COBRA. 

Note that while this federal law generally applies to employers with at least 20 employees, state regulations may require smaller employers to offer COBRA coverage. Under COBRA, the healthcare plan itself remains unchanged, but the employer no longer contributes to the premium. The entire premium, which can be substantial, becomes the responsibility of the younger spouse.

• Duration of COBRA Coverage:

Typically, COBRA coverage extends for a maximum of 18 months, but certain circumstances may allow for longer coverage. If the younger spouse becomes eligible for Medicare during this COBRA coverage period, their COBRA benefits will terminate. The employer’s group health plan or its benefits administrator will notify the younger spouse of the coverage’s end date and offer continued coverage through COBRA.

• Consider the Affordable Care Act (ACA):

Another option for spousal health coverage is the Affordable Care Act (ACA). The Federal Government provides subsidies for ACA coverage to those with incomes below the Federal Poverty Level. Those who don’t qualify for subsidies must cover the full premiums. 

While the open enrollment period for the ACA may have concluded at the time of this writing, special enrollment options are available for individuals experiencing a loss of healthcare coverage. To learn more about Special Enrollment Periods, refer to our dedicated section.

Medicare Part B and Spouses:

Medicare Part A covers hospital expenses, whereas Medicare Part B encompasses medical insurance. Part A is generally free for individuals with the required number of Social Security credits, while Part B involves a monthly premium. If one spouse reaches the age of 65 while the other still holds health insurance through their employer, the non-Medicare-eligible spouse may opt to delay enrollment in Medicare Part B.

 There is no late enrollment penalty for spouses who enroll during a Special Enrollment Period (SEP). They can enroll in Part B while maintaining their employer-sponsored health plan or within the 8-month period beginning the month after the original health plan or employment ends. Medicare bases special enrollment criteria on the event that occurs first, either the termination of health plan coverage or employment.

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