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Do I Need to Enroll in Medicare if I’m Still on My Spouse’s Insurance?

Knowing when to enroll in Medicare is key to avoiding lapses in coverage and late penalties. Most people are eligible to enroll starting 3 months before their 65th birthday. If you’re nearing 65 and have coverage through your spouse, you might consider delaying Medicare enrollment. In most cases, this is ok; however, you’ll want to ensure you’re following Medicare’s rules.

In this article:

The Importance of Creditable Coverage Jump to
Why You Still May Want to Enroll in Part AJump to
What Happens if One Spouse goes on Medicare Jump to
How to Enroll in Medicare Jump to

The Importance of Creditable Coverage

Whether it’s ok to delay enrolling in Medicare will depend on what type of coverage your spouse has. If their health insurance plan is considered creditable coverage by Medicare’s standards, then you shouldn’t have any concerns.

If your spouse’s plan isn’t considered creditable coverage, when the policy ends you might not be able to enroll in Medicare right away. This delay in coverage can lead to Part B late enrollment penalties that increase the longer you go without enrolling.

If your spouse’s plan is considered creditable coverage, when the policy ends, you should have a Special Enrollment Period (SEP) that gives you 8 months to enroll in Medicare – protecting you from late enrollment penalties.

Your spouse’s plan is considered creditable coverage if they have:

  • An employer-provided health plan from a company with 20 or more employees
  • A union-sponsored health plan that covers more than 20 people
  • Federal Employee Health Benefits

Your spouse’s plan is not considered creditable coverage if they have:

  • A TRICARE, CHAMPA or VA plan
  • A Health Insurance Marketplace Plan (Affordable Care Act/Obamacare)
  • Another private health insurance plan (not provided by an employer)

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Why You May Still Want to Enroll in Part A

When referencing Medicare enrollment, most people are talking about enrolling into Original Medicare Part A and Part B. You become eligible for both these parts when you turn 65 (or earlier if you live with a qualifying disability).

If you’re considering delaying Medicare because you’re still covered by your spouse’s insurance, you may want to still enroll in Part A.

This is because Medicare Part A is free for most people. If you qualify for premium-free Part A, then you can receive extra hospital and skilled nursing coverage in addition to your spouse’s insurance at no extra cost. Who doesn’t want more insurance without extra monthly premiums?

What Happens When Only One Spouse Goes on Medicare?

So, what happens if you decide to enroll in Medicare even if you’re already covered by your spouse’s insurance? You may be wondering if your Medicare will provide any coverage benefits to your spouse. The answer is simply, no. Your Medicare plan will only pay for your medical and hospital needs.

How to Enroll in Medicare

If you’ve decided that you’re ready for Medicare, then the next step is the same regardless of your spouse’s insurance. It’s time to prepare for enrollment into Medicare Part A and B. This process shouldn’t be too difficult as long as you follow the proper steps. You can learn more about how to enroll in Medicare here.

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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.

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Denise Austin, 65, Ensurem Ambassador

Best-Selling Author, Creator of Fit Over 50 Magazine

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