What to Do When Your Spouse Gets Medicare?

 If your health insurance coverage comes through your spouse’s job, you may lose that coverage when he or she retires and goes on Medicare. You have several options for health insurance if you’re losing your health insurance because your spouse is transitioning to Medicare.

It’s important to understand that if your spouse is enrolling in Medicare but continuing to work past the age of 65, he or she can continue to have employer-sponsored coverage, and you can continue to be covered as a spouse on that plan. Many people who continue to work past age 65 have simultaneous coverage under Medicare and employer-sponsored insurance. But what if your spouse is retiring and will not continue to have access to employer-sponsored coverage? Your spouse will be covered by Medicare, but you’re not 65 yet… where will you get coverage? Rest assured, there are several options, and your medical history isn’t a factor.


Your Own Job-Based Health Insurance

If you have a job that provides health insurance but you’ve chosen to waive that health insurance, you’ll be eligible for a special enrollment period at your workplace when you lose access to the insurance plan your spouse had pre-Medicare. Special enrollment periods are time-limited, usually 30 days, so don’t wait too long. If you miss it, you’ll have to wait until the next open enrollment period to sign up.



If your spouse’s health plan is subject to the COBRA law, you’ll be eligible to continue your current health plan, for a limited time, through COBRA continuation coverage (private sector plans with at least 20 employees have to offer COBRA continuation if they offer group health insurance). 


In most cases, COBRA allows you to continue coverage for 18 months. But if your spouse became eligible for Medicare and then left his or her employment (and thus lost access to employer-sponsored coverage) within 18 months of becoming eligible for Medicare, you can continue your spousal coverage with COBRA for up to 36 months from the date your spouse became eligible for COBRA. So, for example, if your spouse became eligible for Medicare five months before retiring, you’d be able to keep your spousal coverage via COBRA for another 31 months after your spouse retires, since that would be 36 months from when your spouse became eligible for Medicare.


If you choose COBRA continuation coverage, you’ll have to pay the full monthly premiums for your coverage, plus a 2 percent administrative fee. The total premium will likely be larger than the premium that used to come out of your spouse’s paycheck for your health insurance, since your spouse’s employer will no longer be paying part of your health insurance premium each month (some employers don’t pay anything towards spousal coverage, but most do pay at least a portion of the total cost). You’ll pay the part you’ve always paid as well as the part your spouse’s employer used to pay. 


Not only is COBRA kind of expensive, it’s also temporary. If you’re not going to be eligible for Medicare yourself within 18 months (or up to 36 months, depending on the circumstances), you’ll have to come up with another plan for coverage when your COBRA continuation coverage runs out.


Buy Health Insurance Privately

You can also buy a health insurance policy directly from a health insurance company. But you won’t be able to get subsidized health insurance unless you get a plan from your state’s health insurance exchange.


So if there’s any chance that your income will make you eligible for a subsidy, you’ll want to buy coverage in the exchange (subsidy eligibility extends up to 400 percent of the poverty level; you can use a chart showing federal poverty guidelines to see how much that is for various family sizes; note that the previous year’s guidelines are used, so for coverage effective in 2018, you’d be looking at 2017 poverty level guidelines).


You can use an independent insurance agent to advise you and help you buy health insurance. Many, but not all, insurance agents are able to help you buy a plan listed on your state’s health insurance exchange, or one purchased directly from a health insurance company. Ask the broker to make sure that he or she will be able to advise you about both on- and off-exchange options, depending on your circumstances.


We at Cosmo Insurance can help you find a plan that’s best for your needs! Don’t hesitate give us a call at 732-363-388. Cosmo offers a universe of solutions for you!


Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.