Health Plus Life: Can I Get Obamacare If My Husband Is On Medicare?

Navigating health insurance can confuse anyone, especially when one spouse is on Medicare and the other isn’t yet eligible. To qualify for Medicare insurance coverage, you must be a U.S. citizen and at least 65 years old, regardless of your work history, although that can influence your costs. It’s common for spouses to reach 65 at different times, which can complicate enrolling in Medicare for the younger partner. You might be asking yourself, “Can I get Obamacare if my spouse is on Medicare?” The good news is that there are several options for those married to Medicare recipients.

If you’re married to someone on Medicare and haven’t reached eligibility yet, you can indeed get Obamacare. A practical choice for spouses of Medicare recipients is to obtain coverage through the Marketplace until they turn 65. Plans available through the Affordable Care Act are comprehensive, and insurers cannot deny coverage due to pre-existing conditions. This is particularly beneficial for individuals no longer employed and lacking workplace insurance.

The Marketplace provides a range of insurance plans tailored to fit various budgets and coverage needs. Moreover, individuals with incomes below 400% of the federal poverty level may qualify for reduced premiums through subsidies. It’s essential to remember that these subsidies are typically based on joint income, which can include retirement income like Social Security and 401(k) withdrawals. If a husband retires and their combined income drops below a certain threshold, the younger spouse might also qualify for Medicaid, although this usually requires having very low income and minimal assets.

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How Does Marriage Affect Medicare Benefits?

Medicare coverage is unique to each person and is not affected by marriage, meaning you do not gain or lose coverage because you get married or divorced. Although Medicare operates as an individual plan, your joint income and work history with your spouse may influence the costs associated with each plan. While spouses cannot share coverage, if either partner has worked and contributed to Social Security for a minimum of 10 years, both can access Medicare Part A at age 65 without incurring premiums. These benefits continue for both individuals even after a divorce or the death of one spouse, provided they were married for a specified duration. As noted by WebMD, for divorced individuals to qualify, the marriage must have lasted at least 10 years, and the ex-spouse must be at least 62 years old for the non-working spouse to be eligible. For widowed spouses, a minimum marriage duration of one year is required to qualify for Medicare benefits.

how does marriage affect medicare benefits

Is a Wife Covered By Their Husband’s Medicare?

Medicare is not just for those who retire after years of employment; non-working spouses can also qualify for Medicare once they meet certain criteria. It’s important to note that Medicare is individual insurance, meaning a wife cannot simply be added to her husband’s Medicare plan; she will need to secure her separate coverage. However, a non-working spouse may enjoy additional benefits based on their partner’s work history. If the working spouse has contributed to Medicare through payroll taxes for at least 10 years, both partners can access premium-free Medicare Part A when they turn 65.

Medicare Part A differs from Medicare Part B, as Part A primarily pays for hospital coverage, including meals, lab tests, medical supplies, and operating room, which has no premium in the previously mentioned cases. On the other hand, Medicare Part B covers doctor visits, necessary medical treatments, certain mental health services, emergency care, and some outpatient services like physical therapy. It’s worth noting that Original Medicare Parts A and B do not cover everything, such as prescriptions, dental coverage, or vision care, so adding Medicare Part C and D may be beneficial for a Medicare Advantage plan.

Can You Have Medicare and Spouse Insurance at the Same Time?

Employer-sponsored health insurance plans typically extend coverage to family members and dependents, including spouses. According to HealthLine, individuals covered under their spouse’s workplace insurance and qualifying for Medicare can have both insurances. Some employers may require spouses in their group plan who are eligible to get Medicare to do so after age 65 to remain on the plan. It’s important to note that not all parts of Medicare provide comprehensive coverage, so it is beneficial to have additional private insurance.

When an individual holds both insurances, specific guidelines dictate which insurance provider is responsible for paying for healthcare services first, a process known as coordination of benefits. Once the order of payment is established, the primary insurer covers the costs of any eligible services until the coverage limit is met, after which the secondary insurer steps in to cover any remaining expenses. The rules for coordination of benefits can vary; for instance, in companies with 20 or more employees, the group health plan is the primary payer, while in smaller companies with fewer than 20 employees, Medicare takes precedence.

what happens when one spouse goes on medicare and the other isnt eligible

What Happens When One Spouse Goes on Medicare and the Other Isn’t Eligible?

If a non-working spouse is older than the working spouse, they can qualify for benefits based on the working spouse’s employment history, provided they are at least 62 years old. If the non-working spouse hasn’t reached 62, they can still enroll in Part A and Part B by paying the full premiums until the working spouse turns 62. If the working spouse is still employed, the non-working spouse should opt for Part A while remaining on the work health insurance. However, if the working spouse is retired, the non-working spouse should apply for full Medicare coverage.

For individuals who are younger than their Medicare-eligible spouse, there are several options available until they reach 65:

Continue working: The working spouse can keep their job until the non-working spouse turns 65, or the younger spouse can remain employed to retain their work insurance.
COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows workers and their families who lose employer-sponsored coverage to maintain their insurance by paying the full premiums, which may be higher than they previously paid.
Use the Marketplace: Obtaining coverage through the Affordable Care Act (Obamacare) is often a practical choice until the younger spouse turns 65, and those with lower incomes might qualify for tax credits that reduce their premiums.

HealthPlusLife Can Help You Get Obamacare If Your Husband is On Medicare

As you or your spouse approaches age 65 and becomes eligible for Medicare, it’s essential to explore your health insurance options to learn can I get Obamacare if my spouse is on Medicare. Recent reports indicate that Medicare Part B premiums will increase in 2025, making it crucial to evaluate your choices before the Obamacare enrollment period closes in January. HealthPlusLife can help you get Obamacare if your husband is on Medicare and you do not yet qualify. Our knowledgeable insurance agents can assess your situation and recommend the best coverage options for you and your partner. Navigating Medicare can be challenging, but understanding your choices is key to securing optimal coverage at the most affordable rates.

If you’d like to discuss your Medicare and non-Medicare options with one of our licensed agents, call HealthPlusLife today at 888-828-5064.