Is Medicare Enrollment Automatic?

Individuals who are receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months prior to becoming eligible for Medicare and who are residing in the United States (with the exception of residents of Puerto Rico) are automatically enrolled in both premium-free Part A and Part B. Those who are not receiving Social Security benefits or RRB benefits and do have creditable health insurance coverage from other means must apply for Medicare during their initial enrollment period.

Enrollment in Medicare can be completed online at https://www.ssa.gov/medicare or by visiting a local Social Security office or by contacting the Social Security Administration at 800-325-0778 to confirm eligibility. The ideal time to enroll in Medicare is when an individual first becomes eligible, which is during their initial enrollment period, or earlier if they qualify due to a disability.

Premium Free Medicare Part A Hospital Insurance

Eligibility for Part A and Part B of Medicare depends on whether the individual is eligible for premium-free Part A or if they must pay a premium for Part A coverage. Most people become eligible for premium free Part A by paying Medicare taxes or through their spouse paying Medicare taxes.

If divorced after a marriage of at least 10-years, the non working or lower income spouse can use the Medicare and Social Security qualifications of the higher income spouse.

If widowed, the spouse can use the work history of paying Medicare taxes as long as the marriage was for at least one-year.  

Government employees who pay only the Part A portion of the FICA tax will accrue Qualifying Credits (QCs) which can only be utilized to satisfy the criteria for premium-free Part A coverage. These QCs cannot be employed to meet the requirements for monthly Social Security benefits. It is established that entitlement to Part A of Child Disability Benefits cannot be granted prior to the month in which the individual reaches the age of 20 (or 18 in the case of those suffering from Amyotrophic Lateral Sclerosis).

The CMS-43 form is employed to register for Part A and Part B of Medicare for individuals who have End-Stage Renal Disease. The CMS-4040 form is employed to enroll in Part B for those who are not eligible to receive social security or railroad retirement board benefits.

How Does Marriage Affect Medicare Coverage?

Marital status can have an impact on the premiums for both Part A and Part B of Medicare.

Medicare is individual coverage. Spouses are unable to share a single Medicare coverage as Medicare eligibility is specific to each individual and is not transferable to their spouse.

Married couples are eligible to receive premium-free Part A coverage if either of them has worked and paid taxes for a minimum of 10 years.

What Is Creditable Coverage?

Creditable coverage for Medicare is health insurance Medicare has deemed to be of similar benefit to Medicare. Our Creditable Coverage Cheat sheet can help you determine if your employer group health plan is creditable.

In brief; for employer sponsored health insurance to be deemed creditable the employer must have at least 20 employees and the Medicare beneficiary must be actively working.

Many Medicare beneficiaries with a younger spouse find it to their benefit to keep employer coverage until their spouse reaches 65. This is because individual health insurance for those under 65 can be cost prohibitive for many.

Medicare coverage is monitored on a per-beneficiary basis.

Can Non Working Spouses Get Medicare Coverage?

Non working spouses who reach the age of 65 can opt to enroll in Medicare Part B (medical insurance). Medicare Part B requires a monthly premium.

In order to be eligible for premium free Medicare Part A coverage, a non-working spouse must have a working spouse who has paid Medicare taxes for a minimum of 10 years, and the two must have been married for at least one year prior to applying. In addition, the working spouse must be Social Security eligible. In other words, they must be of an age where they can receive Social Security benefits. Currently, that is age 62.

Keep in mind, Medicare eligibility requires the non working spouse must be a U.S. Citizen or legal resident and in the United States for the most recent five consecutive years.

Non-working spouses must submit an individual application for Medicare coverage and receive their own Medicare card. They can also select the type of additional Medicare coverage that best suits their needs, such as a Medicare Supplement insurance plan and Medicare Part D prescription drug coverage.

Of course, if a Medicare supplement insurance plan does not fit into our budget, the non working spouse may also choose to trade in their Medicare for a Medicare Advantage Plan.

What Are the Enrollment Periods and When Does Coverage Begin?

Individuals do not receive Medicare coverage automatically if they are not receiving Social Security or RRB benefits. Individuals must sign up for Medicare in order to obtain this coverage.

Initial Enrollment Period

A Medicare Beneficiaries first enrollment period is the Initial Enrollment Period. This is a seven month window encompassing their birthday month, three months before and three months after. The one exception is for those whose birthday falls on the first day of a month. In that case, the entire enrollment period moves forward one month.

Special Enrollment Period

If you have creditable coverage, you may delay enrollment in Medicare indefinitely. Creditable coverage can come from participating in your Spouses Employer Group Coverage. When you are ready to cancel your creditable coverage, you will create your own Special Enrollment Period for Medicare.

General Enrollment Period

If you do not have creditable coverage, or have previously terminated Part B coverage, your next opportunity to enroll in Medicare will be the General Enrollment Period (GEP). The General Enrollment Period is from January 01 through March 31 of each year.

Late Enrollment Penalty

If you fail to enroll in Medicare during your IEP and do not have creditable coverage through your or your spouses employer, you will be subject to a late enrollment penalty. The late enrollment penalty is a permanent penalty applied to your Medicare premium each month for the rest of your life. The late enrollment penalty is 10% of your Medicare Part B premium for every 12-months you missed enrollment. For those who must pay for Part A, the penalty is similar.

Medicare Part B Start Date

Your Medicare Part B coverage will start the first day of the month after you apply, unless a different month is requested. However, you cannot start Medicare prior to the first day of your birthday month.

Medicare Part B requires a monthly premium. If you are already taking Social Security income, your Part B premium will be deducted from that payment. Otherwise, Medicare will bill you quarterly unless you set up a monthly premium payment through Medicare Easy Pay.

Medicare Part A Start Date

Those eligible for premium-free Part A are able to enroll at any time following their initial eligibility for the coverage.

If you qualify for premium free Medicare Part A hospital insurance, Part A may start retroactively to your application. It works like this; if you apply for Part A during your Initial Enrollment Period but before your Medicare start date, Medicare Part A will start on your Medicare start date (the first day of the month you turn 65). If you apply after your start date, Medicare Part A will start retroactively either on your start date or six-months prior to your application date, whichever is sooner.

Keep in mind, Medicare always starts on the first day of a month.

Individuals who were previously covered under a group health plan due to their own or a spouse’s current employment are eligible to enroll in Part B or premium Part A during the Special Enrollment Period (SEP) created by quitting or losing creditable coverage.

What Are the Premiums for Medicare Parts A and B?

Medicare Part B has a monthly premium. Everyone pays the standard premium. Those with higher incomes will pay an extra amount called the Income Related Monthly Adjustment Amount (IRMAA).

For 2023 the standard Medicare Part B monthly premium is $164.90. Those individuals with whose Modified Adjusted Gross Incomes in 2021 was $97,000 or higher ($194,000 for couples filing jointly) will owe an extra premium for their Part B and part D coverage. The table below details the numbers for 2023. This table will adjust each year for inflation. Also, please see my article on IRMAA for more details, including how to appeal IRMAA.

What Other Insurance Options Are Available for Non-Working Spouses?

COBRA coverage may be an option for non-working spouses of former employees. COBRA stands for Consolidated Omnibus Budget Reconciliation. It provides spouses with a continuation of the employer-sponsored health insurance plan for a predetermined period of time in the event of the employee’s termination or other qualifying circumstances.

Are Medicare Advantage Plans an Option?

Medicare Advantage Plans may be an option for those who must pay for Part A and have limited resources. While not ideal, the premium free Advantage plan is often a better choice than just Original Medicare because it sets a maximum out of pocket limit on medical expenses each year.

To qualify for an Advantage plan, the Medicare beneficiary must have Part A or qualify for Medicare Part A and have Medicare Part B. If they qualify for Medicare Part A it means they qualify for premium free Part A. If they don’t qualify for premium free Part A, the must purchase Part A.

Termination of Enrollment

If a Medicare beneficiary is considering becoming an expatriate and residing overseas, they can terminate their Medicare coverage. Medicare does not offer international coverage.

Individuals wishing to terminate their Premium Part A and Part B coverage should submit the CMS-1763 form. It is not possible to voluntarily cancel Part A coverage for individuals who are eligible for premium-free Part A. But it cost nothing to keep.

Summary

For non-working spouses of those eligible for Medicare, the process to receive coverage is often confusing. It is important to understand that eligibility for Medicare does not depend on marital status and that all individuals must submit an individual application for their own Medicare card.

There are specific enrollment periods for both Part A and Part B which determine when coverage begins and voluntary termination of Part A and Part B coverage is available if desired. Furthermore, there is no one size fits all when it comes to premiums and other insurance options, as they depend greatly on financial resources, such as work history and income level.

Those seeking information on Medicare coverage for non-working spouses should reach out to their local Social Security office or contact Medicare directly to ensure they understand their optimal healthcare coverage options.

Frequently Asked Questions

Is my spouse eligible for Medicare if she never worked?

In most cases your spouse is eligible for Medicare at age 65, even if he or she never worked. Your spouse may still be able to receive coverage for hospital (Part A) and medical insurance (Part B). Part B will have a monthly premium, and the non working spouse can use the working spouse’s work history for premium free Medicare Part A coverage.

Additionally, they can take advantage of the prescription drug plan (Part D). All of these benefits are available through Medicare.

Do I have to go on Medicare at 65 if my spouse is still working?

You don’t need to go on Medicare at 65 if your spouse is still working and you participate in their employer-provided health insurance. You can remain on that creditable coverage until your spouse’s employment ends or the employer’s coverage ends, whichever comes first.

Do you qualify for Medicare if you don’t work?

A person can qualify for Medicare if you do not work. U.S. citizens who are 65 or older are eligible to enroll in Medicare will pay for Medicare Part B unless they are receiving state financial assistance. If they, or their spouse, paid Medicare taxes for ten years, they may be eligible for premium free Part A.

However, if you or your spouse haven’t worked and paid taxes for at least 10 years, your Part A premiums could cost more.

Who is eligible for Medicare benefits for their spouse?

Anyone 65 years or older who has worked and paid Medicare taxes through payroll deductions for at least 10 years is eligible to receive premium-free Medicare Part A, as well as their spouse.

This is a great benefit for those who have worked hard and paid into the system for many years. It is important to note that Medicare Part A does not cover all medical expenses, so it is important to understand what is and is not covered.