Savvy Senior: What you need to know about Medicare spouse coverage

Dear Savvy Senior,

Are spouses who have not worked outside the home eligible for Medicare benefits? I have worked most of my adult life, but my wife has been a mother and homemaker since we got married and hasn't held an income-producing job since she was in college. Will she be eligible for Medicare?

Searching Spouse

Dear Searching,

There are many couples in your situation when it comes to applying for Medicare. The answer generally is yes, your spouse can qualify for Medicare on your work record. Here's how it works.

Medicare Requirements

Medicare, the government health insurance program for older adults, covers around 60 million Americans age 65 and older, as well as those younger that have a qualifying disability or have End-Stage Renal Disease.

To be eligible, you must have worked and paid Medicare taxes for at least 10 years to qualify for premium-free Medicare Part A hospital coverage when you turn 65. If you qualify, then your non-working spouse will qualify too, based on your work record when she turns 65.

Divorced spouses are also eligible if they were married at least 10 years and are single, as are surviving spouses who are single and who were married for at least nine months before their spouse died.

In addition to Part A, both you and your spouse would also qualify for Medicare Part B, which covers doctor's visits and other outpatient services, but requires a monthly premium. The premium for Part B beneficiaries in 2024 is $174.70 per month per person. Couples filing jointly with incomes over $206,000 per year pay even more.

There are also a number of other caveats you should know about depending on your wife's age.

Older Spouses

If your wife is older than you, she can qualify for Medicare on your work record at age 65, even if you're not getting Medicare yourself, but you must be at least 62 years old. You also must have been married for at least one year for your wife to apply for Medicare on your work record.

If you are still working and your wife is covered by your employer's health insurance, she may want to enroll only in the premium-free Medicare Part A until you retire, or your employer coverage ends. Part B – along with its premium – can be added later without penalty as long as your employer's group health plan is your "primary coverage." Check with your employers' human resources department to find out about this. (Note: If your wife is funding a health savings account, she may not want to take Part A because she can't make contributions after she enrolls).

Younger Spouses

If your wife is younger than you, she will need health insurance until she turns 65 and becomes eligible for Medicare. This may be through the Health Insurance Marketplace (see healthcare.gov), or if you're still working, through COBRA (see dol.gov/general/topic/health-plans/cobra).

Other Medicare Choices

In addition to Medicare Part A and B, when you and your wife become Medicare eligible, each of you will also need to enroll in a Part D prescription drug plan if you don't have credible drug coverage from your employer or union. And, you may want to purchase a Medicare supplemental (Medigap) policy too, to help pay for things that aren't covered by Medicare like copayments, coinsurance and deductibles. Or, you may want to consider an all-in-one Medicare Advantage plan.

For more information on Medicare choices and enrollment rules visit Medicare.gov or call 800-633-4227. You can also get help through your State Health Insurance Assistance Program (see shiphelp.org), which provides free Medicare counseling.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of "The Savvy Senior" book.