Even though Medicare is an individual insurance system, one spouse’s eligibility can help the other to get certain benefits. Also, the amount of money your spouse and you make together can affect your Medicare Part B insurance premiums. 

Unlike Medicaid, Medicare doesn’t cover everyone in your family. Instead, each person must meet the Medicare eligibility criteria themselves. Those criteria not only include U.S. citizenship or legal residency but also demand proof of medical need.

While you may not have Medicare covered by your family, your family life plays a role in how much you pay for Medicare.

Defining Marriage According to Medicare

Before June 2013, marriage was defined as a legal union between a man and a woman for Medicare — established by the Defense of Marriage Act 1996 (DOMA). When part of the DOMA was abolished in 2013, the federal government offered Medicare benefits to same-sex couples, but only if they lived in states.

Later, the U.S. Supreme Court removed the DOMA. As a result, since June 2015, all marriages (same-sex or opposite-sex) recognized for Medicare coverage regardless of their location in the country.

Medicare if You’re Married

You and your spouse cannot start Medicare coverage at the same time. Medicare is an individual plan, and there is no family plan. However, you can be eligible for Medicare based on your spouse’s work history — even if you’re not eligible on your own. 

The Medicare coverage of your spouse and you might not start at the same time. However, since each of you must register separately for Medicare, one of you may be able to sign up for Medicare before the other one depending on your age.

Your premium may change due to your total income. There are no special rates or family plans for couples in Medicare. You will all pay the same premium that individuals pay. Here are things to know about the costs:

Medicare Part A – Hospital coverage has no monthly fee for most people working or having a working spouse and is eligible for Social Security. However, there are premiums in other parts of Medicare.

For Medicare Part B – Outpatient medical coverage – your premiums are based on how much your spouse and you earn together. The standard premium is $148 a month in 2021, which most people pay. However, the more you earn each year, the more you will pay each month for Medicare.

In Medicare Part C, Medicare Advantage, your spouse and you will have your own premiums, deductible, and copays. The case remains the same even if you have the same plan. Part C is a type of Medicare plan offered by a private insurance company to provide you Medicare Part B and Part A services.

The insurance company may charge you a separate premium in addition to your Part B premiums, and then you may be eligible for additional benefits, including prescription drugs. In addition, you may be required to use the plan’s network of healthcare providers once you become eligible for Medicare for the first time. 

Part C has a 7-month enrollment period that starts three months before you turn 65, including the month of your birthday, and three months after you turn 65. You can also enroll during the annual open enrollment period from 15 October to 7 December each year.

For Medicare Part D, prescription drugs, plans vary in scope, and so do premiums. Even if you and your spouse choose the same plan, you still need to make a deductible before Medicare pays anything for your health care. The enrollment period remains the same as we discussed in Part C.

The loss of a spouse can affect the individual’s ability to qualify for Original Medicare (Parts A and B).

Note that your marital status doesn’t affect your eligibility for Medicare. You are eligible for Medicare if:

• You have been in the U.S. for at least five consecutive years, are citizens or legal residents; and

You are:

• Age 65 or older or
• Under 65 with a qualifying disability or
• If you’ve end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) at any age.

Impact on Part B Enrollment If You Lose Coverage Through Your Spouse

In most cases, individuals who do not sign up for Part B the first time they become eligible may incur late registration penalties. However, if you were covered within a spouse’s employer or retiree coverage, you may be eligible for a Part B special enrollment period.

Medicare for Divorced Spouse

The Social Security Administration requires that you meet specific criteria to qualify for Medicare benefits from a divorce. Eligibility for Medicare is different from Social Security benefits. For example, you can qualify for your spouse’s/ex-spouse’s Social Security benefits at the age of 62, and you won’t qualify for Medicare until age 65. 

Of course, you may qualify for Medicare sooner if you have end-stage renal disease or disability for at least two years.

If you are 62 and your spouse or former spouse is 65, you cannot use their Medicare benefits for being eligible. To be eligible, you must wait until age 65 unless you’re eligible through disability.

You may be eligible for Medicare after a divorce if the following conditions apply:

• Your ex-spouse is at least sixty-two years old and eligible for Social Security.
• You must be unmarried at this time.
• You are at least 65 years old.
• You have been married for 10+ years.

Part A benefits are free when you, a current or former spouse, have at least 40 calendar quarters or ten years of work history paying into Social Security.

If there’s anything that you didn’t understand or have more questions regarding Medicare, feel free to get in touch with our licensed insurance agents specializing in Medicare.