Your Spouse Isn’t Eligible for Medicare Yet—Now What?

It’s a surprisingly common dilemma: one spouse turns 65 and becomes eligible for Medicare, while the other is still too young to enroll. This age gap can throw a wrench into carefully planned retirement budgets, especially when the younger spouse has been covered by the older spouse’s employer-sponsored health plan.

According to the U.S. Census Bureau, more than 3 million American couples have at least one partner aged 65 or older and another under 65. And with the average annual cost of private health insurance for a 60-year-old exceeding $7,000 per year, figuring out coverage for the ineligible spouse is more than a minor detail; it’s a financial decision that can impact the entire household.

So, what can you do when you find yourselves in this situation?

Step 1: Review COBRA Coverage

If the older spouse is retiring and losing employer coverage, COBRA can offer the younger spouse continued health insurance for up to 36 months. While it often comes at a higher cost, COBRA ensures uninterrupted coverage and time to evaluate long-term options.

Step 2: Explore Marketplace Plans

HealthCare.gov and state exchanges offer Affordable Care Act (ACA) plans. Premium tax credits may be available based on household income, especially if the working spouse retires. This route often provides more affordable coverage than COBRA and access to essential health benefits.

Step 3: Check for Employer Coverage

If the younger spouse is still working, their employer may offer health insurance. If not already enrolled, this may be the time to switch coverage to the younger spouse’s employer plan and delay Medicare enrollment for the older spouse (with proper coordination).

Step 4: Consider a Short-Term Plan (Cautiously)

Short-term medical plans can fill gaps, but they don’t meet ACA standards and often exclude pre-existing conditions. They may work for healthy individuals but should be reviewed carefully before enrollment.

Step 5: Plan for the Transition

Work with an experienced agent to create a coverage roadmap. Consider the timing of retirement, Social Security benefits, and when the younger spouse will become Medicare eligible. This coordination can save thousands and reduce the risk of coverage gaps.

Final Thought

Navigating mixed Medicare eligibility isn’t just about who qualifies; it’s about finding the best strategy to cover both spouses without breaking the bank. If you're approaching this transition, let's talk. We’ll help you evaluate your options and make informed decisions that fit your household’s needs.