What Happens If I Leave My Employer Insurance If My Spouse Is Younger And I Carry The Insurance?

Medicare is a government-subsidized healthcare program that provides medical insurance coverage for those 65 and older. The plans are also available to people younger than 65 with end-stage renal disease…

January 3, 2023

Written by Justin Sloan

Medicare is a government-subsidized healthcare program that provides medical insurance coverage for those 65 and older. The plans are also available to people younger than 65 with end-stage renal disease or a disability. Medicare includes four parts or components that cover different expenses. Those who qualify for Medicare may choose not to enroll in the program because they’re already covered by an employer’s insurance plan.

However, if you leave your job or your employee insurance plan ends, you have a special enrollment period to sign up for Medicare. If your spouse is younger than you and received insurance through your work, you may be wondering what will happen to her coverage. Here, we’ll answer that question and explain your options. Keep reading!

Understanding What Each Plan Covers

Before we dive into this topic, it’s important to understand what Medicare plans can cover. As we mentioned, the program has four parts or components:

Part A coverage provides payments for hospitals and nursing facility boarding, and hospice care in some circumstances. The plan also includes prescription medication coverage. People who have paid social security taxes for at least ten years receive this care without any premium. 

Part B pays for visits to a doctor, preventative care, and medical testing and screening. The plan also covers emergency and urgent care facility visits and medical equipment. Unlike Part A, this plan does have a premium that varies based on household income.

Part C is also known as an Advantage plan. It’s for those who don’t want A and B plans and prefer to find care through a private company. Medicare Advantage plans provide the same coverage offered through plans A and B plus other benefits like dental, vision, and prescription drug coverage.

The part C plans also allow subscribers to choose any doctor who accepts the insurance rather than using a specific network of providers like government-subsidized programs require. The premium cost depends on the package the individual chooses. People who choose this plan must remain on Part B.

Part D also includes coverage from private insurers but is specifically for prescription medication. Every plan available through this program offers a list of the medications they cover. Anyone interested in buying this plan must ensure the insurer they choose covers the prescription drugs they need. The premiums for Part D vary by insurer, personal medical needs, and income.

Deciding When To Begin Coverage

People qualify for Part A coverage even if they have insurance through an employer and wish to remain on their employer-provided plan. Staying on employer-provided insurance enables those who don’t want to retire and need to provide insurance for their spouse or children to continue without a penalty. Everyone must sign up for Medicare within seven months of turning 65 (or losing their similar coverage) to avoid future penalties.

Keeping Spouses On Employee Insurance

Medicare plans cover individuals only and don’t provide coverage for spouses or children. Only the person reaching retirement age or qualifying in another manner can use the insurance. Couples must find another insurance option if one person is too young for retirement and relies on their spouse’s employer-sponsored plan for insurance. If the employee wants to remain with their employer, the spouse can stay on the original employee insurance.

Choosing Insurance Alternatives For Spouses

Anyone who will lose their insurance if their spouse retires has options for their needs. If the soon-to-be retiree worked for an employer with more than 20 employees, their spouse could choose coverage through COBRA. The option allows the individual to continue to have the same insurance they had when their spouse worked, but at a higher premium cost. The coverage from COBRA has limits and typically only remains available for 1-3 years. Retiring workers should talk to their employer to learn the details of the plan offered by the company.

Uninsured spouses can also select plans from private insurers through the marketplace. Lower-income participants often receive credits and tax incentives on these plans. Younger spouses with low income or who have excessive health concerns may qualify for Medicaid. Medicaid is a health insurance program offered through a state and federal partnership.

Understand Your Health Insurance Options With Nesso Senior Benefits

Retirees and anyone reaching age 65 can contact Nesso Senior Benefits to learn more about their health insurance options and their costs. At the Nesso Group in Connecticut, we offer comprehensive Medicare Advantage and Medigap plans. Contact us today to get the information you need to make the right decision for your future.

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