Before You Continue: This article is for married couples in which one or both spouses are approaching Medicare eligibility, typically at age 65, and are already retired. It explains how Original Medicare, Medicare Advantage, Medigap, and prescription drug coverage work when spouses have different eligibility dates and healthcare needs.
Stop Here If You Are Not Yet Retired
This article focuses on retired couples. If either spouse is still covered through active employer-sponsored insurance, different Medicare enrollment rules may apply.
I’m Turning 65 and My Spouse and I Are Already Retired. Now What?
Medicare covers individuals only. Each spouse enrolls when eligible, and a
younger spouse bridges the gap with a Marketplace plan, COBRA, or Medicaid. Spouses can pick different plans and often should.
You can first sign up for Medicare three months before the month you turn 65, whether or not you or your spouse is already retired. Here is how Medicare planning works for married couples when one or both partners are newly eligible.
Can my spouse receive Medicare coverage through me?
Unlike other plans that offer family or spousal coverage, Medicare only provides
individual coverage. Beneficiaries can’t add dependents to their Medicare plan or to their Medigap or Medicare Advantage plans.
As a result, your spouse isn’t covered under your Medicare plan and will need to enroll
on their own when they become eligible. People are eligible for Medicare if they reach any of the following criteria:
• Are 65+
• Have a qualifying disability
• Have End-Stage Renal Disease (ESRD)
• Have ALS (aka Lou Gehrig’s disease)
Note that one spouse’s eligibility doesn’t impact the other’s. Like coverage, eligibility is individual. For example, if your partner turns 65 before you do, they become eligible, but, unless you meet the other criteria, you don’t.
While you can’t share coverage with your spouse, you can get Medicare spousal benefits through your or your spouse’s work history. That is, if your partner has no work history, they can still qualify for a premium-free Part A if you’ve paid Medicare taxes for at least 40 quarters (10 years).
Not Applicable: Your Spouse Is 65 or Older
If your spouse is already Medicare-eligible, they generally do not need Marketplace or COBRA coverage unless delaying enrollment under a valid special enrollment situation.
For adults still working after 65, employer-sponsored insurance (at a company with more than 20 employees) is a common way to keep younger spouses covered. However, if you and your younger spouse are already retired when you turn 65, their options for getting insurance are:
Marketplace insurance offers some income-based subsidies (like premium tax credits) that can lower plan premiums for qualifying enrollees.
COBRA insurance may be available to younger spouses if they are a qualified
beneficiary on the older spouse’s employer-sponsored group health plan, and the
atter left or retired (or experienced some other qualifying life event) within the
last 60 days.
Medicaid is a potential option, in states that have expanded Medicaid, for
households below 138% of the poverty level. That’s $29,187 for a couple under
the 2025 guidelines.
Not Applicable: Both Spouses Are Already on MedicareIf both you and your spouse are already enrolled in Medicare, you can skip the section about Marketplace, COBRA, and Medicaid options.
Should I have the same Medicare plan as my spouse?
Since Medicare coverage is individual, getting the same plan as your spouse isn’t
necessary. In fact, it may be unwise, especially if you have different care needs.
For example, when considering prescription drug coverage, if John needs an expensive brand name drug for a condition throughout the year, then a low-deductible plan will serve him (and his wallet) better. But if John’s wife Mary only needs generic prescriptions, then a plan with a very low premium may be better for her. In this case, it’s better for both John and Mary to choose different plans, since choosing the same plan would likely lead to higher out-of-pocket costs in the long run.
Likewise, enrolling in different Medicare Advantage plans may ultimately be the best
choice for you and your spouse. When evaluating plans, consider factors like:
Whether your preferred doctors, specialists, and hospital are in network
Total out-of-pocket costs for you and your spouse
Extra or additional benefits offered
How well it covers the services you need and use most
When choosing a Medigap plan, think about things like:
Your comfort level for cost fluctuation
Your lifestyle needs (e.g., how frequently you travel)
Current medical conditions and potential future needs
Notably, while Medigap is also an individual plan, some providers offer a household
discount for enrollees who live together and have a policy with the same company. This discount can be anywhere from 5%-15%, but it isn’t guaranteed, and providers offer it at their discretion.
Can I change my plan if my spouse doesn’t change theirs?
If you want to change your plan during open enrollment but your spouse doesn’t (or vice versa), you can change your plan with no penalty to either of you. Each person has the individual right to change their plan each year (except Medigap, which has more restrictive criteria for changing plans).
Though you and your spouse have different plans, both need to be considered when
planning for the future. For instance, in the unfortunate event of a spouse’s passing,
your Medigap household discount might end. You’ll need a plan in place for notifying
Social Security and individual insurance providers for Medigap and Medicare Advantage plans.