If I Have Health Insurance Coverage Through My Spouse, Do I Need to Enroll In Medicare?

Posted in Medicare

If you’ve recently become eligible for Medicare, but you’re already covered through your spouse’s health insurance, do you need to sign up? Medicare Part A is free for most people, and it doesn’t hurt to enroll even with other coverage. But what about Part B, do you really need it? And if you delay enrollment, will you have to pay a penalty? Here are a few things to consider that can help you decide the right time to enroll in Medicare. 

Who is the Primary Insurer, Your Group Plan or Medicare?

When health insurance claims are filed, there is typically a primary insurer (who pays first) and a secondary insurer (who pays second). Whether or not you should enroll in Part B depends on who is the primary insurer, Medicare or your group plan. How do you know? The number of people employed at your company is the deciding factor.

In companies with less than 20 employees: Medicare automatically becomes the primary insurer, with group insurance second. In this case, you should take Part A and Part B when you are first eligible. Why? If your employer is a secondary insurer, they pay after Medicare pays. By delaying Medicare benefits, you won’t have a primary insurer, and what you pay out-of-pocket will be high.

In companies with more than 20 employees: Your employer becomes the primary insurer, with Medicare coverage second. In this case, you can delay enrolling in Part B as your group coverage will pay your medical claims.

Sometimes Group Insurance Changes When You Become Eligible for Medicare

Even if you know that your employer will be the primary insurer, take a look at your benefits. Sometimes they change when you become eligible for Medicare. Read over your group coverage benefits to see how they work once you or your spouse turn 65. Then decide if it’s better for you to enroll in Part B now or delay enrollment. Remember, Part B carries a monthly premium that you will be responsible for paying. 

What About Penalties, Will You Qualify for a Special Enrollment Period to Enroll in Medicare Later?

With group coverage, you qualify for a Special Enrollment Period. That means you can enroll in Part B after the Medicare Initial Enrollment Period. You have 8 months after group coverage ends to enroll in Medicare without paying a penalty. If you’re interested in Medicare Supplement Insurance, you will also have a guaranteed issue right to buy for six months after you enroll in Medicare Part B.



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