10 Group Health Insurance Terms You Should Know
July 12, 2021
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August 11, 2021
Anyone born after 1929 will need at least 40 work credits to be eligible for Medicare benefits. Since you can earn up to four credits per year, this adds up to at least 10 years in the workforce. As of 2020, you’ll receive one work credit per $1,410 you earn.
In general, most people earn enough credits on their own to qualify for Medicare once they turn 65. But if your spouse has little to no work history outside of the home, they may depend on your credits to qualify for Medicare.
Here’s what you need to know.
When Will My Spouse Qualify for Medicare?
Medicare does NOT offer a family plan. Instead, each person qualifies for an individual plan based on either their own work history or the work history of a spouse. Regardless, your spouse will qualify for Medicare once they turn 65 years old. If they meet Medicare’s disability criteria, they may qualify earlier.
What If My Spouse is Younger Than Me?
You’ll be eligible for Medicare once you reach the age of 65. But since Medicare offers individual coverage, this eligibility does NOT extend to your spouse. Instead, your spouse will need to wait until they're 65 or older before they become eligible for Medicare.
If you plan on working past age 65, you can keep your employer-sponsored health insurance until you're ready to retire.
If you retire at age 65, your spouse will need to explore their options for health insurance so they don’t experience a lapse in coverage.
Here are their options:
Option #1: Employer-Sponsored Health Insurance
If your spouse works, they may be able to enroll in their own employer-sponsored health insurance. Losing coverage from a spouse qualifies them for a special enrollment period. But they’ll need to act fast to avoid missing the deadline.
If your spouse misses the deadline for the special enrollment period, they may experience a lapse in health insurance coverage until the next enrollment period.
Option #2: COBRA
Your spouse may be eligible for if you worked at a company with 20 or more employees. Through COBRA, your spouse will be able to stay enrolled in your old group health insurance plan. The only difference is that your old employer will no longer be paying part of the premium.
This means that you and your spouse will be responsible for paying the entire premium to maintain coverage. Just a warning though, this option can get expensive fast.
Option #3: Affordable Care Act
Your spouse may through the Affordable Care Act. Since they’ll lose the coverage they had with you, they’ll be eligible for a special enrollment period. If they miss this period, they’ll have to wait until the next open enrollment period to get their health insurance.
What If My Spouse and I Get Divorced?
If you get a divorce, your spouse may still be eligible for Medicare benefits based on your work record. But this is only if your marriage lasts at least 10 years and your ex-wife or ex-husband doesn’t remarry.
If the ex-spouse does remarry, then they’ll qualify for Medicare based on their new spouse’s work record.
What If I Die Before My Spouse?
The surviving spouse may qualify for Medicare based on the decedent’s work record. But only if they were married for at least a year up to the date of death.
Learn More About Your Medicare Benefits
MI E-Benefits is a group health insurance broker. But we’re also proud to help our customers better understand their Medicare benefits.
To learn more about Medicare, please call MI E-Benefits at (833) 921-2888. You may also fill out our online contact form and someone from our team will reach out to you soon.
