Let's say you're nearing retirement age, jumping into Medicare and ready to enjoy the benefits that this government-funded policy can offer you and your spouse.
Now, let's add a twist. Your spouse, who's historically gotten their health benefits from your work policy, hasn't hit the landmark age of 65 quite yet.
Will Medicare cover the both of you? In short, no.
Many retirees are thrown off by this lesser-known fact, as many expect coverage will continue as it did during their working years. But Medicare is a senior-focused program and, aside from some unique exceptions, uses age as a hard rule in terms of eligibility.
Covering a spouse under the age of 65
The principle behind Medicare eligibility is simple: You need to have paid into the Social Security System, and you need to be of retirement age. As long as you have at least 40 calendar quarters of work during which you paid taxes, a non-working spouse can benefit from your plan - as long as they are also of retirement age.
If a spouse is not yet 65, you have three options to ensure they still receive benefits:
1. You can keep working.
It's not uncommon for those of retirement age to keep working until their spouse reaches retirement age too. Independent plans can be costly, and depending on how many years the spouse has to catch up, this is often the best option.
2. They can keep working.
If your spouse is currently working, and covered by your company plan, they will have to switch to a plan offered by their own company. Once they turn 65, they will be eligible for their own Medicare coverage. If they have not paid into Social Security for the full 40 calendar quarters, turning 65 still makes them eligible to join your plan.
3. They can purchase an independent plan.
Depending on the age gap, many couples choose to purchase an independent health plan for the "gap years" until the spouse reaches 65. There is a range of coverage options that offer important benefits until Medicare is accessible to both of you.
Covering a spouse over the age of 65
If your spouse is over 65, they will roll into their own Medicare plan based on their work history or yours. If they don't have their own work history, they are eligible to receive benefits from yours if:
- You are currently married, and have been for at least one year.
- You are divorced and currently single, but had been married for at least 10 years.
- They are your widow, but were married to you for at least nine months.
It's important to note that if your employer is covering your spouse, they aren't guaranteed to stay on the plan once they turn 65. If your spouse is older than you, they may need to move to Medicare before you do.
Like any government program, Medicare has rules and exceptions that require learning and understanding. To learn more about Medicare health insurance accepted by Sharp HealthCare for you or your spouse, call 1-800-82-SHARP ( 1-800-827-4277), Monday through Friday, 7 am to 7 pm.
Still have questions about Medicare?
Sharp hosts free online seminars, where you'll learn more about enrollment periods and how Medicare works. Sign up for the "Understanding How Medicare Works" seminar or the "Understanding Your Medicare Open Enrollment Options" seminar.
These classes are also available in Spanish. Please visit Entienda Cómo Funciona Medicare and Entienda Sus Opciones de Medicare Durante la Inscripción Abierta for more information.
This story was updated February 4, 2021, to reflect the most up-to-date Medicare information.