Going on Medicare when your spouse is younger than 65

Medicare is one person at a time

This surprises a lot of couples. For years you've had one health plan that covered both of you. Medicare doesn't work that way. You'll have your own Medicare card, and your spouse will get their own when they qualify, usually at 65.

So the question isn't really about your Medicare. It's about what your spouse does for coverage in the gap between your 65th birthday and theirs.

If you're still working

If you have health coverage through your current job, you may not need to change anything yet. When the employer has 20 or more employees, you can generally keep the employer plan, keep your spouse on it, and delay Part B without a penalty. When you do stop working, you get a Special Enrollment Period to sign up.

If the employer has fewer than 20 employees, Medicare usually pays first at 65, so you'd want Part A and Part B. Your spouse may still be able to stay on the employer plan. Ask your benefits office how it works for both of you. There's more detail in my guide to Part B and employer coverage.

If you're retiring and your spouse needs coverage

This is where planning matters. When your employer coverage ends, your spouse loses it too. Here are the usual options.

• Their own employer plan. If your spouse works and their job offers health insurance, losing your coverage generally lets them enroll outside the normal sign-up window. They should ask their HR office about the deadline.
• COBRA from your employer. COBRA lets your spouse keep the same plan for a limited time by paying the full premium. It's usually the most expensive choice, but it keeps the same doctors and can bridge a short gap.
• A Marketplace plan. Losing your employer coverage opens a Special Enrollment Period on HealthCare.gov. Your spouse generally has 60 days to pick a plan. Depending on your household income, they may qualify for help with the premium.
• Retiree coverage. Some employers offer retiree health benefits that include a spouse. If yours does, read the terms before you turn it down, because you often can't get it back.

Which one fits depends on your spouse's age, health, doctors, and how long the gap is. A two-year gap and a seven-year gap are very different decisions.

Things couples often miss

• Part A on your spouse's work record. If you didn't work long enough to get Part A without a premium, you may qualify through your spouse's work record once they're at least 62.
• Health savings accounts. Once you're enrolled in any part of Medicare, you can't add money to your own HSA. Your spouse's HSA follows their own coverage, not yours. See Medicare and HSA contributions.
• Income-related premiums. If you file taxes jointly, your combined income from two years ago decides whether you pay more for Part B and Part D. A spouse who's still earning can push that up.
• Dropping coverage too soon. Don't cancel the employer plan until your Medicare is active and your spouse's new coverage has a start date.

A simple order to work through

• First, ask your benefits office what happens to your spouse's coverage when you enroll in Medicare, and when you retire. Get it in writing if you can.
• Second, write down your spouse's doctors and prescriptions. Any new plan needs to work for those.
• Third, compare the options above on total cost, not just the premium.
• Fourth, line up the dates so nobody has a month without coverage.

When your spouse reaches 65, they'll go through their own enrollment. Your choices don't lock in theirs. One of you can have a Medicare Supplement and the other a Medicare Advantage plan if that's what fits. And once you're both on Medicare, each of you can review your coverage every fall. I explain that window on the Annual Enrollment page.

I'm a licensed insurance agent, so I can help with the Medicare side and point you to the right place for the rest. If you'd like to map out the dates for both of you, book a free consultation. Your spouse is welcome to join.