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Are My Benefits the Same as My Spouse?

Are you trying to figure out how to get your Medicare benefits? Many people are covered under a spouse’s health insurance plan while they’re working. But Medicare benefits don’t usually cover your spouse. Medicare is individual coverage; there is no such thing as Medicare family coverage.

Let’s examine how Medicare benefits work if you are married.

Medicare eligibility: you and your spouse might not start getting Medicare benefits at the same time

Most people are eligible for Medicare benefits when they turn age 65. Others qualify for Medicare before age 65 through disability. So, you or your spouse might start receiving Medicare benefits before the younger spouse is eligible for Medicare.

You and your spouse may choose different Medicare coverage options

There are four “parts” to the Medicare insurance program, each one providing a certain set of Medicare benefits.

  • Medicare Part A provides inpatient hospital coverage. (It’s part of Original Medicare.)

  • Medicare Part B provides medical/outpatient coverage. (It’s also part of Original Medicare.)

  • Medicare Part C is the Medicare Advantage program. If you have Medicare Part A and Part B, you may decide to enroll in a Medicare Advantage plan. These plans are offered by private insurance companies that are contracted with Medicare to provide at least the same Medicare benefits as Part A and Part B. Often Medicare Advantage plans provide additional benefits, such as Medicare Part D prescription drug coverage, or routine vision and/or dental coverage. Medicare Advantage plans can set different premiums, deductibles, copayments, and coinsurance. Some have premiums as low as $0.

  • Stand-alone Medicare Part D prescription drug plans must cover all the core classes of prescription drugs. However, they can set unique deductibles, coinsurance, and copayment amounts. They can also differ in their formularies–that is, the prescription drugs that are covered by the plan. This coverage is optional.

For example, you might decide to stay with Original Medicare, and sign up for a stand-alone Medicare Part D prescription drug plan. Your spouse might decide to get her Medicare benefits through a Medicare Advantage prescription drug plan. Your coverage will be independent from one another.

Because you and your spouse enroll in Medicare separately, you may make different choices in how you receive your Medicare benefits. As a result of these decisions, you may have differences in your Medicare benefits.

Medicare benefits: how your spouse might affect how much you pay

Even if you and your spouse decide to get identical Medicare benefits, you will still pay separate premiums, deductibles, coinsurance and copayments.

But here’s one way that having a spouse might help you. Medicare Part A (hospital insurance) might come with a monthly premium, or not. Here’s how that works.

If you or your spouse paid Medicare taxes at least 10 years (40 quarters) while working, you generally don’t have to pay a Medicare Part A premium.

You and your spouse pay separate premiums for Medicare benefits under Medicare Part B, and Medicare Part D if you sign up for it. If one or both of you choose to enroll in a Medicare Advantage plan, you will continue to pay separately the Medicare Part B premium and possibly a separate plan premium.

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