Medicare Choices for Couples: When One Spouse Is Eligible First

As you approach the milestone of turning 65, thoughts naturally turn towards Medicare and the complex choices it presents. However, what happens when one spouse goes on Medicare and the other isn't eligible?

In this guide, we'll explore common scenarios and practical solutions for couples in this situation.

Assessing Your Current Situation

Consider this scenario: you, the wife, are on the brink of turning 65, while your husband is only 59. 

The first step in making an informed decision is to evaluate your current group insurance. 

• Are you still employed and covered by a group plan? 
• Is your husband covered under your insurance? 

This is a common dilemma faced by many couples today, as people are working longer than ever before.

Weighing Your Options

When one spouse is eligible for Medicare and the other isn't, it becomes a matter of crunching the numbers. 

Compare the costs and benefits of staying on your group plan versus transitioning to Medicare. 

Factor in deductibles, copays, and other expenses. In most cases, we find that our clients can save a significant amount of money by switching to Medicare.

Considerations for the Younger Spouse

If your spouse is under age 65, obtaining health insurance through the Affordable Care Act (ACA) marketplace can be prohibitively expensive unless they qualify for a subsidy. 

The older spouse may choose to continue working so their younger spouse can stay on their group plan until they turn age 65. 

That said, if the younger spouse is also working and has an insurance option at their job, your switching to Medicare would be considered a life changing event. That means they could enroll in their employer’s group plan using this special enrollment period.

For spouses under the age of 65, alternative coverage options like MediShare may provide a viable solution. These alternatives can help bridge the gap until they become eligible for Medicare.

Special Enrollment Periods and Life Events

If circumstances change, such as a qualifying life event or reaching the age of eligibility for Medicare, you have the opportunity to reassess your insurance options. 

Utilize special enrollment periods to explore different coverage avenues, including your employer's insurance plan.

Conclusion

Navigating Medicare when one spouse isn't eligible requires careful consideration and evaluation of your unique circumstances. 

By weighing the costs, benefits, and available alternatives, you can make informed decisions that best suit your healthcare needs and financial situation.

Remember: you don't have to navigate this journey alone. Our team of licensed insurance agents can show you your options and find the best solution for you and your spouse.