In this article we will take a look at some of the comparatively infrequent instances in which a mistake in how you apply for Medicare can have major financial consequences. This is especially true in the case of couples when one spouse has not regularly worked full time or when deaths or divorces are in play. We’ll be focusing mainly on Medicare Part A, the hospital insurance part, which usually has no premium cost.
Imagine a couple different scenarios. A woman who’s been divorced from her husband for a few years reaches age 65 and applies for Medicare. It happens that she was a stay-at-home mom and never worked the required 10 years (for Social Security purposes, this is technically referred to as 40 quarters) and thus never paid the associated employment taxes to make her eligible on her own for free Medicare Part A coverage. She applies and is told her Part A premium charge will be just over $500 per month.
Or imagine a different situation, this time with a woman still happily married whose husband is a veteran and receives his health coverage through the Veterans Administration, as opposed to Medicare. This woman had worked intermittently for a total of eight years in all (32 quarters). She now turns 65 and applies for Medicare. She’s informed that her Part A premium charge will be close to $300 a month. The difference in the quoted premiums reflects the difference in the number of quarters each woman worked, or didn’t work.
Could either of these women have avoided those exorbitant Medicare premiums? Can they still do anything to change them? The answer to both questions is a qualified “Yes.”
Medicare policies are for individuals only
As soon as someone turns 65 they are eligible for Medicare benefits if they are a U.S. citizen or have been a legal resident for five years or more and have worked for at least 40 quarters (10 years) paying federal taxes. (One may also be eligible for Medicare coverage if they are younger than 65 and have a qualifying disability or end-stage renal disease. But this article won’t discuss those situations.)
In circumstances where a husband and wife are still married and one of them—let’s assume it’s the husband in this instance—is duly enrolled in Medicare, the wife is automatically covered once she becomes age-eligible at 65, regardless of whether or not she had the qualifying 40 quarters of employment. If she is younger than her ex when he turns 65 and becomes Medicare eligible, she must wait until turning 65 herself to be automatically enrolled in premium-free Medicare Part A.
But what about the divorcee without a qualifying work record of her own? What about the person, also short of 40 quarters of employment, whose spouse is not already enrolled in Medicare? Continuing with the opening scenarios we presented, we’ll discuss what the women’s situations entail. But note these spousal issues do work both ways, regardless of whether the affected spouse is/was the husband or wife.
A wife’s personal Medicare insurance policy covers only her. She cannot literally be included in her husband’s coverage but must have a separate, individual Medicare policy. However, even as a “non-working” spouse, her policy can be premium-free for Medicare Part A coverage based onher husband’s work record, provided he otherwise meets the necessary requirements for Medicare coverage regarding age and qualifying work record.
Medicare for Spouses in cases of divorce and death
If a woman happens to be divorced and does not have a qualifying work record of her own, she may still be able to use her ex-spouse’s qualifying work record to obtain premium-free Part A coverage. For her to get this free Part A coverage, her marriage must have lasted at least 10 years, and she must have remained unmarried up to the time she applies for Medicare. (Medicare will assess the eligibility of those who remarry using their new spouse’s work history.) In this scenario both she and her ex-spouse must still meet the age 65 requirement to be eligible for the free Medicare coverage.
Suppose a woman is a widow without a qualifying work record. Can she get Medicare Part A with a no-cost premium? She can provided her husband had qualified for premium-free Medicare, and the two had been married at least one year before his death, and she has not remarried. If those criteria are met, she can obtain premium-free Medicare Part A once she is age eligible at 65.
Circumstances involving veterans and Medicare
In the case of the veteran who was not presently covered by Medicare, if he had fulfilled the requirement of having 40 quarters of employment that would have qualified him for Medicare, his wife could have applied for Medicare under his Social Security account. If his Medicare eligibility were confirmed, then at age 65 her Medicare Part A premium would be free of cost, just as it is for other spouses of Medicare enrollees.
It’s worth noting here that as a person approaches age 65 who is receiving Tricare benefits—the health care program for active and retired military and eligible family members— that Tricare-covered person must enroll in Medicare Part A and Part B in order to continue receiving Tricare benefits. At age 65 their original program becomes “Tricare for Life,” and is designed to supplement Medicare, much like Medigap plans do for many of those who sign up for original Medicare. If they don’t enroll in Medicare prior to turning 65, their Tricare benefits end the first day of the month they reach 65.
Bear in mind that you should sign up for Medicare at least a month before you turn 65 to allow yourself enough time to receive your Medicare card before your coverage begins. If you don’t sign up within your Medicare initial enrollment period (IEP), which begins three months before the month you turn 65 and continues for three months after the month you turn 65 (making the IEP 7 months total), you may have to pay a late enrollment penalty if you sign up later. If you wish to also sign up for Medicare Part D (prescription drug insurance), you must enroll separately for that during your initial enrollment period to avoid paying late enrollment penalties.
A retirement could create a temporary snag
Primary Medicare recipients and their spouses are entitled to the same benefits under Medicare if both have reached the age of 65. What happens if a wife is under age 65 and when her husband becomes eligible for Medicare benefits he retires and leaves the family health coverage he had with his employer, resulting in the younger spouse no longer having medical insurance? In such circumstances the couple might look into whether a COBRA policy would still be available through the husband’s employer’s health insurer. Otherwise, the option may be to insure the wife through private insurance companies until she reaches age 65.
On the flip side, suppose you are not yet age 65 and are still working but your older spouse turns 65, is not working and does not have 40 quarters of qualifying work record? That older spouse may be eligible to receive Medicare benefits based on your work record even if you are not retired or receiving Medicare coverage yourself. In a case such as this, you—the still working spouse—must be at least 62 years old. If you are not 62, your spouse must wait until you turn 62 to enroll in premium-free Medicare Part A.
Can a mistake in applying for Medicare be cured?
Getting back to our initial scenarios in which the affected female spouses were quoted high costs for their Medicare Part A premiums, what could they do about their situations after the fact? Toni King, an author and columnist who specializes in Medicare, Social Security, and long-term care planning, said in an online column that she advises such persons to contact their local Social Security office, since it is the government office that enrolls Americans in Medicare, and explain their circumstances carefully and thoroughly.
“Tell the Social Security representative that you need to appeal the Part A premium and need help to do that,” King said. Then Social Security will look over the husbands’ accounts and verify with the IRS that they have enough quarters to qualify for premium-free Medicare Part A. Be prepared to provide a certified marriage license showing you are married if that’s the case, King added. Same for divorce documents, if that applies. And these will most likely have to be certified original documents, not photocopies.
Of course, knowing how these policies and processes work, it becomes readily apparent that for spouses anticipating that unusual circumstances may affect their Medicare eligibility, the best move to make is file your initial Medicare application in a way that takes your and your spouse’s circumstances into account. A major step is to be sure you apply on the correct person’s work record. It may be well worth consulting with a professional advisor who specializes in Medicare applications. This can hopefully let you avoid the hoops you have to jump through to fix things after you get an unexpectedly steep cost quote for your Medicare premium that could—and maybe should—be free.
Specialized Colorado Medicare Savings Programs
While correctly applying for Medicare can save substantially on your Medicare premiums, there are other Medicare savings programs available to Coloradans who qualify for them based mainly on income and limits on available resources. You can find details on these programs on our AgeWise Colorado website at https://agewisecolorado.org/blog/medicare-savings-programs-help-is-available-for-paying-premiums/.
