Does My Medicare Plan Provide Coverage for My Spouse?
When people say “my Medicare Plan” it is often hard to tell if they mean Original Medicare, a Medicare Advantage Plan, or a Medigap plan. In what follows, we are referred to Part A, hospital insurance, only.
Who Gets Covered on Whose Plan?
The answer to “does my Medicare cover my spouse” is always “no” because Medicare was designed from the very beginning as coverage for each individual, not couples. The real question is, “can my spouse be covered based on my Social Security earning record?”, and the answer there, as with so much else in Medicare, is “it depends.”
The Role of Work
To be eligible for Social Security, and therefore for Medicare, one normally must have worked in covered employment for 40 quarters, or ten years. The variations come in when one spouse meets the 40-quarter requirement and the other doesn’t.
If one spouse meets the 40-quarter requirement and the other doesn’t, the nonworking spouse is covered based on the earnings record of the working spouse when both turn 65. No premium is charged. Part A is free.
If the working spouse is at least 62 and the non-working spouse is over 65, the non-working spouse is eligible for Medicare as soon as the working spouse turns 62. No premium is charged. If the working spouse is younger than 62, the spouse over 65 can get Medicare Part A by paying a premium until the working spouse attains 62. The premium for Part A is $471 per month in 2021 if you spouse worked less than 30 quarters and $259 if your spouse worked between 20 and 39 quarters.
The Effects of Divorce and Marriage
A divorced spouse may be eligible for Medicare at 65 based on a spouse’s earnings record if they were married to the former spouse for at least ten years. To qualify based on your spouse’s earnings record, you must have been married at least a year.
If you’re widowed or a widower and were married for at least nine months, you can qualify on your deceased spouse’s earnings record.
If there were multiple marriages and divorces, you can qualify for Medicare based on the earnings record of only one spouse.
The Effect of Disability
Those who receive Social Security disability are eligible for premium-free Medicare after two years from the date they were found disabled. Because of the way Social Security treats disability earnings, you may qualify based on your own earnings record even if you do not have 40 quarters (ten years) of covered employment.
If all the foregoing is less than clear to you, you’re not alone. If you have questions, contact your local Social Security office, which also handles Medicare issues. You can also call 1-800-MEDICARE to contact Medicare directly.