Do I Have to Get Medicare If I’m Covered by My Spouse’s Employer Plan?

Published by: Medicare Made Clear

Do I have to get Medicare if I am covered by my spouse's employer plan?

Most people are first eligible to sign up for Medicare when they turn 65, and many choose to enroll during this time. For individuals who are covered by a spouse’s employer health care plan, it may not be necessary, or ideal, to enroll in Medicare immediately upon turning 65.

If you are covered by your spouse’s employer plan and eligible for Medicare, you may have a few options when it comes to getting Medicare. You can:

Enroll in Medicare when you turn 65
Enroll in only Medicare Part A when you turn 65
Delay Medicare until you lose your coverage

Before making any decision though, you should always talk with the employer’s health care benefits department to understand how Medicare may or may not work with your current coverage. Now let’s explore each of the options above.

Enrolling in Medicare at 65

If you want to enroll when you are turning 65, you can enroll in Medicare Parts A & B, Part D prescription drug coverage or a Medicare Advantage (Part C) plan. You can also look at adding a Medicare supplement insurance plan to Original Medicare (Parts A & B) to help with the out-of-pocket costs of Medicare. You will be able to enroll as early as three months before the month in which you turn 65. This is the start of your Initial Enrollment Period, which also includes the month of your 65th birthday and the next three months after.

You can get some great information and tips for enrolling in Medicare at 65 via this resource.

Enrolling in Medicare Part A at 65

Many people who are covered by a spouse’s employer plan choose to either wait to enroll until they lose their spouse’s employer coverage or choose to only enroll in Part A since Part A usually has no premium. You can enroll in Medicare Part A only and choose to delay Part B and Part D, but you’ll need to ensure you have creditable coverage to avoid paying late premium penalties for Part B and/or Part D.

Delaying Medicare Enrollment

Just because you are turning 65, doesn’t necessarily mean you have to get Medicare right now. If you decide that waiting to enroll in Medicare is the best option both financially and in terms of healthcare coverage for you, just follow Medicare’s rules, and you’ll avoid enrollment penalties when you do enroll.

How to avoid late enrollment penalties for Part B or Part D

Make sure you have creditable coverage and can delay enrollment.

Make sure your current prescription drug coverage is considered creditable by Medicare (it’s as good as or better than Medicare Part D).

Get written proof of your creditable prescription drug coverage.

When Would I Enroll If I Delay or Only Take Part A?

If you are able to delay enrolling in either all or part of Medicare, you will have a Special Enrollment Period of eight months that begins when the employer coverage is lost or when your spouse retires. During this time, you’ll be able to enroll in Medicare Parts A & B. You can also enroll in a Part D prescription drug plan. And, after you enroll in Part B, you’ll be able to enroll in a Medicare supplement insurance plan or a Medicare Advantage (Part C) plan.

Learn more about your options for Medicare when working past 65 or when covered by a spouse’s employer coverage here.

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