If you’re planning ahead for Medicare for yourself and your spouse, it’s helpful to know some of the basics about Medicare eligibility. You might qualify for Medicare when you turn 65, but your younger spouse might have to wait.
Will I get Medicare coverage at age 65?
Most Americans qualify for Medicare at age 65. You need to be American citizen or legal permanent resident of at least five years in a row. If you meet these requirements, you’re generally eligible for Original Medicare, Part A (hospital insurance) and Part B (medical insurance). You may also qualify for other types of Medicare coverage, which are listed later in this article.
Can my spouse get Medicare coverage when I do?
Usually, you have to be at least 65 years old to qualify for Medicare. Your spouse may qualify before age 65 if he or she:
- Has been receiving disability benefits from Social Security or the Railroad Retirement Board (RRB) for at least 24 months in a row. Generally, you’re automatically enrolled in Medicare Part A and Part B at this point.
- Has end-stage renal disease (ESRD). This is permanent kidney failure where you need regular dialysis or a kidney transplant. You won’t typically be enrolled automatically if you have ESRD; you’ll need to contact Social Security (contact information below).
- Has amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). You’re generally enrolled in Medicare Part A and Part B automatically the same month that your Social Security or RRB benefits start.
You can call Social Security at 1-800-772-1213 (TTY users, call 1-800-325-0778). Representatives are available Monday through Friday, from 7AM to 7PM, all U.S. time zones.
Can I get premium-free Medicare Part A if my younger spouse worked and I didn’t?
Even though a spouse younger than 65 might not qualify for Medicare, she or he might affect whether you pay a premium for Medicare Part A (hospital insurance).
In general, you don’t need to pay a monthly premium for Medicare Part A if you’ve worked at least 10 years (40 quarters) while paying Medicare taxes. If you haven’t worked while paying taxes for 10 years, you generally have to pay a Part A premium. Learn more about Medicare premiums.
Suppose you’re 65 and qualify for Medicare, but you don’t qualify for premium-free Part A. Let’s say your wife is at least 62 (and doesn’t have Medicare yet). You can generally get Part A with no monthly premium if your spouse is age 62 or older, and has worked at least 10 years while paying Medicare taxes – even if your spouse isn’t enrolled in Medicare.
What kind of Medicare coverage can I sign up for?
As noted above, you generally qualify for Medicare Part A and Part B (Original Medicare) when you turn 65 or qualify by disability. You may have other options, such as:
- Medicare Supplement insurance to work alongside your Part A and Part B coverage. A Medicare Supplement plan may help with Medicare’s out-of-pocket costs, such as deductibles and coinsurance.
- A stand-alone Medicare Part D Prescription Drug Plan to help cover your medication costs. This type of plan would work alongside your Part A and/or Part B coverage.
- A Medicare Advantage plan to provide an alternative way to receive your Original Medicare coverage. A Medicare Advantage plan covers your Part A and Part B benefits (except hospice care, which Part A covers). Most Medicare Advantage plans include prescription drug coverage, and many plans offer extra benefits, like routine vision care. Please note that you’ll continue to pay your Part B monthly premium (besides any premium your plan may charge).
If you’d like to learn more about the different Medicare plan options, I’ll be glad to walk you through them. To arrange a phone call with me or have me send you customized information by email, follow the links below. Or just click the Find Plans or Compare Plans buttons on this page and enter your zip code anytime of the day or night to see a list of plans in your area.
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Benefits may change on January 1 of each year.