Crucial Medicare Insights Every Stay-at-Home Woman Should Know

March 11, 2024

After a lifetime of managing a household and raising children, you’re looking forward to the golden years of “you” time—an empty nest and a retired spouse who can (finally) be home with you. But as the stay-at-home spouse, you have some things to keep in mind for your Medicare coverage. What if you have a short (or no) outside work history? What if your spouse retires and becomes eligible for Medicare before you turn 65?

All of these are things to think about, but you don’t have to worry about because we’re giving you the crucial insights into Medicare eligibility and coverage every stay-at-home woman should know.

Medicare Eligibility as a Non-Working Spouse

First, it’s important to remember that your employment history is not what makes you eligible for Medicare coverage.

Medicare eligibility is based on age or medical conditions/disability:
· Individuals aged 65 and older
· Individuals under the age of 65 who are receiving disability benefits, either from Social Security Disability Insurance or Railroad Retirement Board for a minimum of 24 months.
· Individuals of any age with End-Stage Renal Disease (permanent kidney failure) or ALS (Lou Gehrig’s Disease) who are receiving disability benefits, or if they are the spouse or dependent child of an individual eligible for disability benefits.

Your years of work service does factor into the cost of your Medicare Part A hospitalization coverage. Anyone aged 65 or older who worked and paid Medicare tax for ten or more years qualifies for premium-free Part A coverage, as they’ve already paid for it through Medicare payroll taxes during their working years.

If you’ve never worked outside the home, or you did but it was shorter than the required 10 years for your work credits, does this mean you’ll be paying out of pocket for your Medicare Part A coverage? Not necessarily. You can still qualify for premium-free Part A coverage through your spouse if he worked and paid Medicare taxes through payroll deductions for at least 10 years. Keep in mind that age and eligibility of your working spouse can impact when you qualify for premium-free Part A coverage. Your working spouse must be at least 62 years old and eligible for Social Security benefits before you can enroll.

While you can qualify for premium-free Part A coverage through your spouse, the other important factor to remember about Medicare eligibility is that it is on an individual basis. Medicare doesn’t have “plans” covering couples or families. Your eligibility and coverage are not determined by your spouse, or vice versa.

So, what happens when one of you becomes eligible for Medicare before the other, especially if you already have an insurance plan together? Let’s look at both scenarios:

The Non-Working Spouse Becomes Eligible for Medicare First

If you’re the first to turn 65 and your spouse is still working, you may still have coverage under your spouse’s work plan. However, some employer plans may only cover spouses through age 65, requiring eligible spouses to get Medicare. You and your spouse will want to read the plan details and check with the employer’s benefits administrator to understand how Medicare eligibility impacts the employer plan coverage.
Regardless of your current coverage, you still want to complete your enrollment for Medicare during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday month, includes your birthday month, and continues for three months after your birthday month. You’ll complete your initial enrollment for Medicare through the Social Security Administration (SSA) to verify your eligibility.
If you are able to stay on your spouse’s plan, you can defer your Medicare coverage and be eligible for a Special Enrollment Period (SEP) later when that plan coverage ends. The SEP typically gives you eight months from the time your other coverage ends to enroll in Medicare without facing late enrollment penalties.

If you are eligible for Medicare and do not have other acceptable coverage, but fail to enroll for Medicare coverage within the appropriate enrollment periods, you could be facing a late enrollment premium penalty for the life of your Medicare coverage. That’s why it’s so important to complete your initial enrollment during your IEP, even if you think you’ll have other coverage.

The Working Spouse Becomes Eligible for Medicare First

If your working spouse turns 65 and becomes eligible for Medicare first, this may impact your healthcare coverage, especially if he also retires before you become eligible for Medicare. If that is the case, here are some options for your healthcare coverage:

Employer Plan Coverage: If your spouse keeps working after age 65, you both should continue to be covered by his employer plan. However, check with the employer benefits administrator to ensure his becoming eligible for Medicare doesn’t impact the plan coverage offered. Generally, Medicare coverage works with employer coverage until the working spouse retires. But if the employer only offers coverage to age 65 or your spouse is retiring, you’ll need to find other healthcare coverage.

COBRA: You can continue to be covered by the employer insurance plan by going COBRA. However, as the employer will no longer be paying a portion of the premium, this can be an expensive option.

Individual Health Insurance: You can buy insurance plan coverage through the Health Insurance Marketplace until you become eligible for Medicare coverage.

Regardless of which of you will be turning 65 and reaching Medicare eligibility first, it’s important to start having these conversations now. Be sure you and your spouse are on the same page with when he plans to retire. Connect with his employer benefits administrator to be sure you understand the employer plan coverage and how it may change with retirement and Medicare eligibility. If you’re unsure about your coverage options, a Medicare Advisor can help you understand all the choices available and guide you through Medicare eligibility and the enrollment process.

The Wandacare Team’s licensed Florida agents are here to help you through every step of your Medicare journey.

Contact us to get started today!

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