Will my Medicare Supplement (Medigap) plan cover my spouse?
Last Updated : 09/16/20184 min read
As a Medicare beneficiary, you can’t add a spouse to your Medicare benefits or Medicare Supplement plan. Medicare benefits are only for eligible individuals. Medicare Supplement (also known as Medigap) plans are offered by private insurance companies and designed to work alongside Medicare Part A (hospital insurance) and Part B (medical insurance) to help pay some of the out-of-pocket health-care costs that Medicare doesn’t pay, such as copayments, coinsurance, and deductibles.
Can I purchase a Medicare Supplement plan for my spouse when I purchase one for myself?
Medicare Supplement plans are available from private insurance companies. Each plan is for one person, and doesn’t cover a spouse. Here are some facts about Medicare Supplement insurance.
First, let’s talk about basic eligibility. To buy a Medicare Supplement plan, you must be eligible for Medicare coverage, be a U.S. citizen or a permanent legal resident of the United States for at least 5 continuous years, and be either 65 years old or (in some states) have a disability or health condition that qualifies for you to receive Medicare benefits. You also need to be enrolled in Medicare Part A and Part B.
But even if you and your spouse meet these requirements, it’s not a guarantee that you’ll be able to purchase Medicare Supplement plans. Although you can apply for a Medicare Supplement plan anytime, there are only certain situations when you have “guaranteed issue” of acceptable into a plan. You’ll typically have guaranteed issue if you apply during your Medicare Supplement Open Enrollment Period, which begins when you’re age 65 or over and enrolled in Medicare Part B, and lasts for six months. Read more about guaranteed-issue rights.
You can apply for a Medicare Supplement plan from any insurance company that is licensed in your state to sell one. Keep in mind, you must continue to pay your Medicare Part B premium along with your Medicare Supplement premium. Also, if you decide to enroll in a stand-alone Medicare Part D Prescription Drug Plan, you will probably pay a separate premium for that prescription drug coverage (unless you qualify for “Extra Help”). Enrolling in a Medicare Prescription Drug Plan is an important consideration because Medicare Part A and Part B and Medicare Supplement plans sold after January 1, 2006 do not cover prescription drugs in most situations.
What happens if I have Medicare coverage and my spouse is not eligible for Medicare?
Eligibility for Medicare is determined on an individual basis and is not affected by marital status. Therefore, even though you may be eligible for Medicare coverage, your spouse must also meet the requirements for Medicare to receive Medicare benefits. Your spouse’s health insurance opportunities depend upon personal circumstances, such as those listed below.
- If your family income is modest, your spouse may qualify for state assistance to help pay for health care. To learn more about this option, you can contact your State Health Insurance Assistance Program (SHIP). Visit http://www.shiptacenter.org/ or call 1-877-839-2675.
- If your spouse is working, he or she may be able to get health insurance coverage at work through a group health plan sponsored by the employer or union. Alternatively, career military people typically have Tricare health benefits available to them, and federal government personnel often have the option of receiving health benefits through the Federal Employee Health Benefits (FEHB) program.
- If your spouse retires before attaining age 65, he or she may be able to get continuation of current benefits through the former employer (also known as COBRA). It’s a good idea to learn how much COBRA will cost because it can be expensive.
- If your spouse is not working, or health insurance coverage is not offered through his or her place of employment, your spouse may be able to purchase an individual insurance policy from an insurance agent.
If you want to learn more about your Medicare coverage and options, I would be happy to help you.
- You can use one of the links below to set up a phone call with me or request personalized information from me by email.
- You can also do some research on your own to get familiar with Medicare plan options in your area by clicking on the “Compare Plans” button on this page.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.