Turning 65 brings a pivotal decision about healthcare coverage, especially for those still employed. If you’re eligible for Medicare but still working, you might be unsure whether to switch from your employer’s group health plan. The situation becomes more complex when considering if you have family members currently on your group coverage – whether they’re also working and have their own coverage or rely on your employer’s plan. Let’s explore the scenarios and key considerations to help you make an informed choice and answer the question, “What happens to my spouse when I go on Medicare?”
Scenario 1: Your Spouse/Family Member is Also Working and Has Their Own Employer Coverage
This is the simplest scenario. You have two main options:
- Enroll in Medicare and Drop Employer Coverage: If your employer’s plan is expensive or doesn’t meet your needs, enrolling in Medicare (Parts A and B) could be a good option. You can then choose a Medicare Supplement (Medigap) plan to help with out-of-pocket costs or a Medicare Advantage plan (Part C) for comprehensive coverage. Your spouse can continue on their own employer’s plan.
- Delay Medicare and Keep Employer Coverage: If your employer’s plan is affordable and provides good coverage for both of you, you can delay enrolling in Medicare Part B (and potentially Part A, if you have to pay a premium). This allows you to maintain your current coverage until you or your spouse stop working.
Scenario 2: Your Spouse/Family Member is Not Working and is on Your Employer Coverage
This situation requires more careful consideration. Here are your options:
- Enroll in Medicare and Drop Employer Coverage: If you enroll in Medicare, your spouse will lose their coverage under your employer’s plan. They would need to find alternative coverage through the Affordable Care Act (ACA) marketplace or COBRA (if eligible). You might want to compare the cost and coverage of individual plans for your spouse with the benefits of switching to Medicare for yourself.
- Delay Medicare and Keep Employer Coverage: You can delay Medicare enrollment to keep your spouse covered under your employer’s plan. However, be aware of potential late enrollment penalties for Medicare Part B if you delay past your Initial Enrollment Period.
- Enroll in Medicare Part A Only: If Medicare Part A (hospital insurance) is premium-free for you, and if you’re not contributing to an HSA, consider enrolling. This won’t affect your or your spouse’s coverage under your employer plan but can provide extra protection for hospital stays.
IMPORTANT NOTE: If your employer partners with SmartConnect, our licensed insurance agents can also provide guidance and enrollment support for your spouse or family member on other health coverage, such as ACA plans. Even better — if your spouse or family member is eligible for Medicare, and not yet enrolled, we can also assist them with the process.
Making the Decision
The right choice for you and your spouse depends on various factors:
- Cost: Compare the costs of all options, including premiums, deductibles, out-of-pocket maximums, and potential penalties.
- Coverage: Evaluate the benefits and limitations of each plan for both you and your spouse.
- Doctor and Hospital Networks: Consider if your preferred providers are in-network for your current plan and any Medicare plans you’re considering.
- Prescription Drug Coverage: If you or your spouse take prescription medications, compare drug coverage options.
Next Steps
Talk to your employer’s benefits administrator to understand how your current plan interacts with Medicare and the impact of enrolling or delaying. You can also connect with a licensed insurance agent at SmartConnect to get guidance and compare Medicare plans. We can help you weigh the pros and cons of each option and choose the best path for your family’s healthcare needs.
Remember, making informed decisions is key to ensuring you and your spouse have the right coverage, regardless of your work status.
