Medicare eligibility begins three months before you turn 65 — whether or not you or your spouse is already retired. In this third installment of our “I’m Turning 65, Now What?” series, we’ll dive into Medicare planning for married couples when one or both partners are newly eligible.

Can my spouse receive Medicare coverage through me?

Unlike other plans that offer family or spousal coverage, Medicare only provides individual coverage. Beneficiaries can’t add dependents to their Medicare plan or to their Medigap or Medicare Advantage plans. 

As a result, your spouse isn’t covered under your Medicare plan and will need to enroll on their own when they become eligible. People are eligible for Medicare if they reach any of the following criteria:

• Are 65+
• Have a qualifying disability 
• Have End-Stage Renal Disease (ESRD)
• Have ALS (aka Lou Gehrig’s disease)

Note that one spouse’s eligibility doesn’t impact the other’s. Like coverage, eligibility is individual. For example, if your partner turns 65 before you do, they become eligible, but — unless you meet the other criteria — you don’t.

While you can’t share coverage with your spouse, you can get Medicare spousal benefits through your or your spouse’s work history. That is, if your partner has no work history, they can still qualify for a premium-free Part A if you’ve paid Medicare taxes for at least 40 quarters (10 years).

For adults still working after 65, employer-sponsored insurance (at a company with more than 20 employees) is a common way to keep younger spouses covered. However, if you and your younger spouse are already retired when you turn 65, their options for getting insurance are:

• Marketplace insurance offers some income-based subsidies (like premium tax credits) that can lower plan premiums for qualifying enrollees.
• COBRA insurance may be available to younger spouses if they are a qualified beneficiary on the older spouse’s employer-sponsored group health plan, and the latter left or retired (or experienced some other qualifying life event) within the last 60 days.
• Medicaid is a potential option for households below 138% of the poverty level — that’s $29,197 for a couple in 2025.

Should I have the same Medicare plan as my spouse?

Since Medicare coverage is individual, getting the same plan as your spouse isn’t necessary. In fact, it may be unwise, especially if you have different care needs. 

For example, when considering prescription drug coverage, if John needs an expensive brand name drug for a condition throughout the year, then a low-deductible plan will serve him (and his wallet) better. But if John’s wife Mary only needs generic prescriptions, then a plan with a very low premium may be better for her. In this case, it’s better for both John and Mary to choose different plans, since choosing the same plan would likely lead to higher out-of-pocket costs in the long run.

Likewise, enrolling in different Medicare Advantage plans may ultimately be the best choice for you and your spouse. When evaluating plans, consider factors like:

• Whether your preferred doctors, specialists, and hospital are in network
• Total out-of-pocket costs for you and your spouse
• Extra or additional benefits offered
• How well it covers the services you need/use most

When choosing a Medigap plan, think about things like:

• Your comfort level for cost fluctuation
• Your lifestyle needs (e.g., how frequently you travel)
• Current medical conditions and potential future needs

Notably, while Medigap is also an individual plan, some providers offer a household discount for enrollees who live together and have a policy with the same company. This discount can be anywhere from 5%-15%, but it isn’t guaranteed, and providers offer it at their discretion.

Can I change my plan if my spouse doesn’t change theirs?

If you want to change your plan during open enrollment but your spouse doesn’t (or vice versa), you can change your plan with no penalty to either of you. Each person has the individual right to change their plan each year (except Medigap, which has more restrictive criteria for changing plans).

Though you and your spouse have different plans, both need to be considered when planning for the future. For instance, in the unfortunate event of a spouse’s passing, your Medigap household discount might end. You’ll need a plan in place for notifying Social Security and individual insurance providers for Medigap and Medicare Advantage plans.

Still have questions about Medicare planning for married couples? Our agents can help you evaluate and choose the plan that best suits your needs.