Does Medicare Insurance Cover Spouses or Dependents?

Many spouses share health insurance through their employer, but what if the policyholder retires and switches to the Medicare program? Can Medicare insurance cover a spouse? Would it cover adult dependents, like a student who isn’t in the workforce yet, an adult child with special needs, or a grandchild whom you’re the primary caregiver for?  We answer these questions and more to help you and your family better understand your Medicare insurance coverage options.

Does Medicare Insurance Cover Spouses?

Unfortunately, if your spouse isn’t eligible for the Medicare program on their own, they won’t be able to receive Medicare insurance coverage through your own plan as Medicare policies provide only individual coverage. If your spouse is eligible for the Medicare program, they’ll be able to enroll independently.  This may include premium-free Medicare Part A, since the required credits (40 quarters paying Medicare taxes) for this coverage can come from you or your spouse (in order to allow stay-at home partners to qualify).  What Other Health Insurance Options Might Your Spouse Have?  If you enroll in the Medicare program and your spouse isn’t eligible for coverage, you both have some options. One option would be for your spouse to receive health insurance through their employer. If this isn’t an option, you could continue  working until your spouse is eligible for the Medicare program, since you can work and have Medicare at the same time. If you work for a company with 20 or more employees, you’d keep your company’s insurance as the primary plan that covers both you and your spouse. If your employer has fewer than 20 employees, Medicare insurance will become your primary coverage, but your spouse should still be covered by your employee coverage.

If those solutions won’t work, you potentially have three more options. First, you can try turning to the Consolidated Omnibus Budget Reconciliation Act (COBRA). This federal program allows former employees and their families to continue employer-offered health insurance coverage at full price, meaning without the employer contribution, in certain situations. If the covered employee becomes entitled to Medicare, COBRA coverage would last for three years (or 36 months) for their spouse and dependents. Similarly, your spouse can shop for an individual health insurance plan through a private company. The costs associated with this type of plan, as well as the coverage, will vary, so it’s worth shopping around if you want to go this route. Finally, your spouse can try finding a plan through the Healthcare.gov marketplace or a state health exchange. Not only can you qualify for discounts through the Healthcare.gov marketplace, you can also learn if you qualify for financial aid through programs like Medicaid.

Medicare Insurance and Adult Dependents

Simply put, if you enroll in the Medicare program, your plan will not cover any adult dependents. Your family will have to help them secure coverage another way.

What Other Health Insurance Options Might Your Adult Dependents Have?

Similarly to if your spouse doesn’t qualify for Medicare insurance yet, you could keep working to provide health coverage until your adult dependents are able to find coverage, if they’re a student or currently unemployed for example. They may be able to receive coverage through the COBRA program, private health insurance plans, Healthcare.gov, or a state health insurance exchange.

If your adult child is considered a dependent and reliant on you for health insurance because they’re disabled and cannot work, your family may have additional options. If they worked before becoming disabled, they may be eligible for Social Security Disability Insurance (SSDI).  Even if they didn’t work, they may qualify for SSDI if the disability occurred before they turned 22 and they meet other requirements. Depending on their financial circumstances, your adult dependents may also qualify for Medicaid coverage. We suggest talking to a licensed insurance agent or individuals from the Social Security Administration (SSA), the Centers for Medicare & Medicaid Services (CMS), Healthcare.gov, or your State Health Insurance Assistance Program (SHIP) for more personalized guidance.

Is There Medicare Insurance Coverage for Children?

If you’re Medicare-aged and have children who are under 18 years old as dependents, health insurance will be a major consideration. However, Medicare insurance will not cover those dependents.

What Other Health Insurance Options Might Your Children Have?

To ensure they have coverage, you can try going with COBRA, private health insurance, Healthcare.gov, or state exchanges for coverage (though this coverage may come in the form of a family plan). If the child is disabled, you may receive assistance from Social Security through SSDI and Social Security Income (SSI) payments, which can assist in payments for health care. The child could also qualify for coverage under Medicaid. If your family earns too much to qualify for Medicaid, the Children’s Health Insurance Program (CHIP) is a state program that could help your children get coverage. Each state CHIP program is a little different, so it’s important to connect with your local CHIP program to learn the specifics. You can apply for CHIP by calling 1-800-318-2596 (TTY: 1-855-889-4325) or by filling out an application on the Healthcare.gov marketplace.

How Can You Ensure Your Family Is Covered?

One way you can ensure that everyone in your family is covered when you switch over to the Medicare program is to work with a licensed insurance agent. If you’re working with an insurance agent you trust, they can help you find a Medicare insurance plan that fits your needs and other health insurance coverage that works for your spouse or dependents. While Medicare insurance covers a wide range of health care services, it only covers individuals eligible for it. There are no Medicare family insurance plans. Fortunately, your loved ones may have other health insurance options available to them.

Read More: https://www.cms.gov/cciio/resources/files/adult_child_faq

Not affiliated or endorsed by Medicare or any government agency.