Medicare Spousal Benefitss
  • September 22, 2020
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Medicare Spousal Benefits

For most individuals, Medicare enrollment begins at 65.  However, as more seniors are choosing to work past retirement age enrolling in Medicare can become a bit confusing, especially for individuals who are covered by their spouse’s employer health plan.  Luckily there are options.  If you are currently eligible for Medicare benefits but receive healthcare coverage through a spouse’s employment,  you can choose to enroll in Medicare, enroll in only Medicare Part A, or delay enrollment altogether.  Choosing to enroll in or delay Medicare is entirely dependant on your current healthcare coverage and spouse’s employment situation.  Let’s take a closer at your Medicare spousal benefits options.

Medicare Spousal Benefits While Still Covered Under Spouse’s Insurance

One instance in which enrolling in Medicare while covered under a spouse’s health plan is necessary, is if your spouse’s employer has fewer than 20 employees.  In this case, you will want to enroll in Medicare Part A and Medicare Part B when you are first eligible.  Some employer health plans require dependents to enroll in Medicare when they first become eligible.  When an employer has fewer than 20 employees, Medicare becomes the primary payer. It is important to check your spouse’s employer’s healthcare policy prior to your Initial Enrollment Period (IEP) to avoid late enrollment penalties or gaps in coverage.

Enrolling in Medicare Part A only

Many individuals who are covered under their spouse’s employer health coverage choose to enroll in Medicare Part A only and delay enrollment in Medicare Part B.  Medicare Part A premiums are usually free if you or your spouse has paid Medicare taxes for a certain amount of time while working.  Medicare Part A, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, nursing home care, hospice care, and home health care services.  In this case, Medicare can serve as the secondary payer and may cover the rest of the cost of your health care service.

Delaying Medicare Enrollment

Delaying Medicare enrollment is also another option for individuals who are covered under their spouse’s employer health plan.  Many choose to delay enrollment because they prefer to keep their current health care coverage while they continue to work.  While most individuals qualify for “premium-free Part A”, there is still a monthly premium for Part B.  Paying the monthly premium for Medicare Part B may not make sense for those who have “creditable” coverage through their group health plan.  It is important to note, if you choose to delay Medicare enrollment you will need to make sure you have prescription drug coverage that is comparable to Medicare Part D coverage or you may be subject to a penalty when you sign up for Medicare prescription drug plan in the future.

When Should I Enroll in Medicare?

Depending on which Medicare spousal benefits option you choose there are a few enrollment periods you need to be aware of in order to avoid late enrollment penalties:

1. Initial Enrollment Period:

The Initial Enrollment Period (IEP) is for individuals who choose to enroll in Medicare when they first become eligible.  This enrollment period runs for seven months beginning three months prior to your 65th birthday, your birth month, and ends three months after.  If you choose to enroll in Medicare rather than keep your current health coverage, you will need to do so during this time period to avoid late enrollment penalties.

2. Special Enrollment Period:

The Special Enrollment Period (SPE) is available to those who have chosen to delay their Medicare enrollment because they were covered by a group health insurance plan when they first become eligible for Medicare. This enrollment period is available for eight months beginning the month after employment ends or the group health coverage ends, whichever comes first.

Help with Enrolling in Medicare

Medicare spousal benefits can be confusing, especially when you have coverage through a spouse’s employer’s health plan.  Choosing whether to enroll or delay enrollment can be stressful.  However, the good news is there is help. Working with an experienced insurance agent who is well-versed in Medicare insurance will help ease the stress of deciding whether to enroll or not. With over 40 years of insurance experience, Griset Medicare Solutions has helped countless individuals enroll in Medicare coverage that is right for them.  Schedule a free no-obligation consultation now by calling (714) 834-1322.

Learn More About your Medicare Spousal Benefits When Covered by a Spouse’s Employer Health Plan

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