medicare enrollment, spouse

Do I Need Medicare If I’m Covered By My Spouse’s Health Plan?

If you are covered under your spouse’s health insurance, you may not need Medicare. In some cases, you can delay enrolling in Medicare without paying any late enrollment penalties. The most common type of insurance that comes into play here is employer health insurance. But not all health insurance plans are created equal. It’s important to see when it does and doesn’t work.

When you can delay Medicare

In terms of employer health insurance, whether you’re able to enroll in Medicare later without paying enrollment penalties hinges on how many employees your spouse’s employer has.

If your spouse’s employer has 20 or more employees, then you can enroll in Medicare at a later time. You do not have a time limit on joining Medicare without penalty until your spouse’s health insurance ends. When that coverage ends, you have eight months to sign up for Medicare.

When you can’t delay Medicare

If your spouse’s employer has fewer than 20 employees, you still need to sign up for Medicare when you are first eligible. If you do not enroll when you first become eligible, you will have to pay a late enrollment penalty.

Medicare Part A’s late enrollment penalty will tack on an additional 10% on top of your monthly premium, which can be as high as $471 per month. You pay the late fee for twice the number of years you waited to join Part A.

Medicare Part B has a late enrollment penalty that increases an additional 10% for every year you wait before joining. This late fee is permanent.

Part D’s late enrollment penalty is permanent as well, except its added fee accrues 1% for every month you wait to sign up after being eligible.

You can have both

While you may be able to join without incurring late enrollment penalties, it’s still a good idea to sign up for Medicare as soon as you can. Your employer health insurance and Medicare plan can coexist and save you more in the end.

When you have these two policies, one will pay all that it can first, and then the other will cover what it can for the remaining costs. The two policies are designated as primary and secondary payers. 

The insurance policy that pays first is the primary payer. If your spouse is part of an employer group health plan with 20 or more employees, the group health plan pays first, and Medicare pays second. If your spouse’s employer has fewer than 20 employees, then Medicare is the primary payer, and your spouse’s insurance pays second.

You may not be required to join Medicare, but it is strongly encouraged because of how much you can reduce your out-of-pocket costs.

We’ve got you covered

Even if you have current healthcare coverage, we can still offer our guidance on what to do when you can take the next step to enroll in Medicare. At Turning 65 Solutions, we give you our honest expertise to help you get the healthcare coverage you need. To find out more, you can call us today at 830-217-6711.

Turning 65 Solutions can help you plan for the future.