When A Spouse is Younger Than 65, How Does Medicare Work?

When A Spouse is Younger Than 65, How Does Medicare Work?

When you turn 65, you become eligible for Medicare and have to sign up with Medicare in the three months before, month of, or three months after your 65th birthday. But what if you are turning 65 and your spouse is younger (or vice versa)?

If your spouse turned 65 this year, but you still have health insurance through their job, then Medicare will depend on the size of the employer’s group. This is considered Medicare Secondary Pay (MSP), which ensures that Medicare does not pay for items or services when other health insurance is primarily responsible for paying, like employee-sponsored coverage.

If Medicare is not your primary provider, you can waive Medicare and use your employer’s plan. If Medicare is your primary provider, then you need Medicare with your employer plan for claims to be paid correctly.

Some examples include:

  • If you are 65 or older and covered by a group health plan through your current employment (or your spouse’s current employment), but the employer has less than 20 employees, Medicare pays first and the group plan pays second. If the employer has more than 20 then the group health plan pays first.
  • If you are turning 65, but your spouse is not, depending on the size of the group your spouse can select COBRA for up to 36 months while you—as the employee—goes on Medicare and get a Medicare secondary policy.
  • If you retire at 65 and go on Medicare, but your spouse is not 65, your spouse would have to receive individual coverage through the marketplace or directly with carriers in your state.
  • Other than being considered disabled for 24 months by Social Security or have End Stage Renal Disease (ESRD), you cannot get Medicare under the age of 65.

For more information on Medicare as a Secondary Player, check out our blog posts on the subject here and here. 

Have questions about signing up for Medicare? Contact Hafetz and Associates today—we can help you!

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