What happens when one spouse goes on Medicare and the other isn’t eligible? That’s what we’re going to talk about in today’s video. This is a complex subject, and so I’m going to do my best to cover most of this in one video, but be aware there are a lot of complexities to this topic, and so each situation can vary greatly. So let’s dive into it.
Enrolling in Medicare: Options and Considerations for the Eligible Spouse
Let’s say that one spouse is eligible for Medicare. What could or should they do? So the spouse who becomes eligible for Medicare can enroll in Medicare Part A and or B, depending on their eligibility criteria, and they can also opt for additional coverage such as a Medicare Advantage plan, Medicare Supplement Plan, also known as Medigap, and a prescription drug coverage depending on how you choose to receive your benefits.
Retaining Coverage: Employer-Sponsored Health Insurance for the Non-Eligible Spouse
So I know what you’re thinking and you’re probably thinking, well, what about the spouse who isn’t eligible? Well, the best scenario would be is if the spouse who isn’t eligible for Medicare continues to work and has access to employer-sponsored health insurance, they can remain covered under that plan. This can be a preferable option if employer coverage offers better benefits or is more cost-effective than Medicare.
Bridge Coverage: Understanding COBRA Continuation Options for the Non-Eligible Spouse
Now, I know what you’re thinking, what if my spouse doesn’t work? What if they don’t have access to employer-sponsored health insurance? Well, that’s what we’re going to talk about next. So if your spouse is not eligible for employer coverage, maybe they’re not working, then one of the options that you have is COBRA. If the non-Medicare eligible spouse loses access to employer sponsored health insurance due to retirement or other reasons, they may be eligible for COBRA continuation coverage for a limited time.
This allows them to stay on the employer’s health plan, but they’ll have to pay the full premium themselves plus an administrative fee. This is a scenario that I personally have seen in my work with Medicare beneficiaries. The timing worked out that the spouse who is going to be eligible for Medicare could go on Medicare, then their spouse could take the COBRA benefits that would carry them to their own Medicare eligibility. Keep in mind, I understand this is not everyone’s situation and I’m going to try to cover that in the video. That’s why I really need you to stay tuned because next we’re going to talk about an additional option that you have. So let’s say that the spouse who is eligible for Medicare decides to go on Medicare. The spouse who isn’t eligible for Medicare doesn’t have access to Cobra or their own employer sponsored health insurance. What should they do?
Exploring Options: Healthcare Coverage Through the Health Insurance Marketplace
So a lot of times this happens because Cobra isn’t an option or it’s too expensive. This provides you an opportunity for the non-eligible Medicare spouse to look to the health insurance marketplace in your state. This is what most people turn to if they don’t have employer coverage and they are not Medicare eligible. In fact, you may or your spouse may qualify for premium tax credits or other subsidies to help make the coverage more affordable. So again, just to recap, if one spouse is eligible for Medicare and the other spouse isn’t and they don’t have access to Cobra or it’s too expensive and they don’t have their own employer sponsored health insurance, then what they can do is go to the Health Insurance Marketplace and explore coverage options there, and they can hopefully find something that is comparable to what they have had under the Medicare eligible spouse’s coverage.
Coordinating Coverage: Strategies for Ensuring Comprehensive Healthcare for Both Spouses
Next, you want to make sure that Medicare and spouse coordination is happening. What does that mean? It’s important to coordinate coverage between the spouses to ensure they have comprehensive healthcare coverage that meets their needs. What this means is if you’re going to make the transition to Medicare, and let’s say your spouse who’s not eligible for Medicare is going to look to the health insurance marketplace, you want to make sure that you don’t go backward in the coverage that you had. This might involve the Medicare beneficiary including supplemental coverage. This might involve the non-Medicare eligible spouse making sure that the coverage that they get from the health insurance marketplace is comparable to what they currently have.
And one of the things that I will tell you is that sometimes there are cost savings to be had if you go through the process of this transition. I know a lot of people who get frustrated with the transition and they think, well, it would just be easier to stay put. I would caution you on doing that because there may be money to be saved and better coverage if you transition this way. Now, it doesn’t happen for everybody because, again, everybody’s scenario is different.
Shared Decision-Making: Involving Both Spouses in Healthcare Choices and Planning
Ultimately, healthcare decision-making must be decided between both spouses. And so you want to talk this over together and decide what is the right situation for you and your spouse. Even if only one person is enrolled in Medicare, they should discuss their coverage options, understand each other’s healthcare needs, and make informed decisions together.
Timing Matters: Navigating Open Enrollment Periods for Medicare and Other Health Insurance Plans
As I said at the beginning of this video, this is a complex subject and one of the things that you want to be aware of is the different open enrollment periods. This is crucial to be aware of with Medicare as well as the health insurance marketplace. This might be a great opportunity to compare your options and coverage before making that final decision because this allows both spouses to understand the coverage options that are available and make changes that may be needed for what’s best for both of you. Because this is a complex issue and there are a lot of moving parts to it, I’ll close by saying this. In essence, while navigating healthcare coverage when one spouse is on Medicare and the other isn’t can be complex, there are various options available to ensure both individuals have adequate coverage for their healthcare needs.
This is why it’s so important to consult with a Medicare advisor or a healthcare insurance specialist like myself who can be helpful in understanding and selecting the most suitable option for your specific situation. So if you have questions or would like to get in touch with me and have a completely free, no-obligation chat, this is how you can get a hold of me, on my website, meetjamie.com, or toll-free 1-800-974-0552. I hope you found this video helpful. If you did, be sure to hit the like button, and subscribe to the channel, and if you have additional questions, again, feel free to leave them in the comments below. Thanks so much for watching. Have a great day.