In the United States, as soon as you turn 65 you are eligible for Medicare benefits if you are citizen or have been a legal resident for five years or more and have worked for at least 40 quarters (10 years) paying federal taxes. You may also be eligible for Medicare coverage if you are younger than 65 but have a qualifying disability or end-stage renal disease.
Your personal Medicare insurance policy does not cover anyone but you. Your spouse or family members cannot be included in your coverage. For your spouse to have Medicare coverage, he or she must have a separate, individual policy.
Your non-working spouse is eligible for premium-free Medicare Part A coverage at the age of 65 based on your work record and if you meet the necessary requirements for Medicare coverage mentioned above.
Medicare automatically enrolls you (and a dependent, non-working spouse) in Original Medicare. Most people get Part A (Hospital Insurance) premium-free at the age of 65 based on taxes paid while working. If you wish to sign up for Medicare Part B (Medical Insurance), and/or Part D (prescription drug insurance), you must enroll separately during your initial enrollment period, Open Enrollment or during Special Enrollment Period to avoid paying late enrollment penalties. If you and your spouse are different ages, you will likely become eligible at different times.
Primary Medicare recipients and their non-insured spouses are entitled to the same benefits under Medicare if both have reached the age of 65. So, what happens if your spouse is not 65 years old when you become eligible? Let’s look at what happens in these situations.
What Happens if Your Spouse is Younger Than You?
If your spouse is younger than you when you turn 65 and become Medicare eligible, he or she must wait until turning 65 to be automatically enrolled in premium-free Medicare Part A.
If you are eligible for Medicare benefits, but your spouse is younger and left without coverage when you leave your group health insurance, there are several options that your spouse can consider to avoid this coverage gap. Before you leave your employment, you can look into a COBRA policy for your spouse if your employer’s health insurer offers one. Otherwise you may have to insure your spouse through other private health insurance companies. In some cases, people in this situation choose to continue working until their spouse reaches the age of 65.
If your spouse is younger than 65 and receives disability benefits from Social Security for a period of 24 months, they automatically become eligible for Medicare on the 25th month.
What Happens if Your Spouse is Older Than You?
If your spouse is older than you and not working when they turn 65, they may be eligible to receive Medicare benefits based on your work record even if you are not retired or receiving Medicare coverage yourself. In a case such as this, you must be at least 62 years old. If you are not 62, your spouse must wait until your 62nd birthday to enroll in premium-free Medicare Part A.
If your spouse is not working and is 65 years old, he or she also has the option to remain on your employer health insurance policy while at the same time enrolling in Medicare Part A (with no premium) if you have reached 62 years of age.
You and your spouse can enroll in Original Medicare Part B when you reach the age of 65 without being penalized for late enrollment if your employer health insurance coverage is comparable to what Medicare recipients receive.
If you plan on enrolling in a Part D prescription drug plan and you and your spouse have different ages, you must enroll during each of your individual initial enrollment periods. You may avoid a premium penalty if you have comparable coverage through your employee insurance. Medicare restrictions allow you to enroll within 63 days of the date that your current coverage terminates without penalty.