Does Medicare Cover Your Spouse?

Medicare is a federal health insurance program that provides health coverage for millions of Americans aged 65 or older, and for younger people with specific disabilities or medical conditions. The program helps manage healthcare costs for its beneficiaries. This article clarifies how Medicare coverage applies to spouses, addressing common questions regarding eligibility and benefits for the general public.

Spousal Eligibility Conditions

Individuals typically qualify for Medicare Part A based on their own work record, requiring at least 10 years (40 quarters) of Medicare-covered employment for premium-free coverage. However, a spouse may also qualify for premium-free Part A through their current or deceased spouse’s work record. To qualify, the claimant spouse must be at least 65 years old, and the working spouse must be at least 62 and receiving Social Security or Railroad Retirement benefits, or have worked long enough to qualify. A marriage duration of at least nine consecutive months before applying is required for spousal benefits. Spousal work records can also be relevant for Part A eligibility for individuals with certain disabilities or medical conditions, or after receiving Social Security Disability benefits for 24 months; however, while Part A may be premium-free based on a spousal work history, other parts of Medicare, such as Part B, C, and D, involve premiums for all beneficiaries.

Understanding Medicare Parts for Spouses

Medicare has different parts, each covering specific health services.
Part A, Hospital Insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. A spouse may qualify for premium-free Part A if they or their spouse paid Medicare taxes for 10 years (40 quarters).

Part B, Medical Insurance, is optional and covers medically necessary services and preventive care, including doctor visits, outpatient care, and some medical equipment. All beneficiaries, including spouses, pay a monthly premium for Part B.

Part C, Medicare Advantage, offers an alternative to Original Medicare (Parts A and B) through private companies. Spouses eligible for both Parts A and B can enroll in a Medicare Advantage plan, which often includes prescription drug coverage and additional benefits.

Part D provides optional prescription drug coverage through private companies. Spouses can enroll in a standalone Part D plan or obtain this coverage as part of a Medicare Advantage plan.

Enrolling a Spouse in Medicare

Enrolling an eligible spouse in Medicare involves specific timeframes.
The Initial Enrollment Period (IEP) is a seven-month window: three months before, the month of, and three months after an individual’s 65th birthday. Enrollment during this period helps avoid penalties and ensures timely coverage.

Special Enrollment Periods (SEPs) allow individuals to sign up for Medicare Part B and premium-free Part A outside their IEP if they delayed enrollment due to active employment or group health plan coverage. These periods last eight months after employment or coverage ends.

For those who miss their IEP and do not qualify for an SEP, the General Enrollment Period (GEP) runs from January 1 to March 31 each year, with coverage beginning July 1. Late enrollment penalties may apply.

The application can be completed online through the Social Security Administration (SSA) website, by phone, or in person at a local SSA office. Necessary documents include the applicant’s Social Security number, birth certificate, and proof of marriage. If enrolling based on current employment, employer health coverage details may be required. Once submitted, the SSA processes the application and mails the Medicare card to the eligible spouse.

Spousal Medicare Costs

Medicare coverage involves various costs for spouses.
Part A is premium-free for most eligible individuals because they or their spouse paid Medicare taxes through employment for at least 10 years. However, if neither spouse has sufficient work credits, a monthly premium for Part A may apply, up to $518 in 2025 for those with fewer than 30 quarters of coverage, or $285 for those with 30-39 quarters.

Part B has a standard monthly premium that all beneficiaries, including spouses, pay. In 2025, the standard Part B premium is $185.00. Higher-income individuals may pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to the standard premium, based on their modified adjusted gross income from two years prior. For example, in 2025, if a single individual’s 2023 income exceeded $106,000 or a married couple’s joint income exceeded $212,000, they would pay a higher Part B premium, with surcharges ranging from $74 to $443.90.

Beyond premiums, spouses will encounter out-of-pocket costs like deductibles, copayments, and coinsurance. The Part B annual deductible is $257 in 2025, after which Medicare generally pays 80% of approved services, leaving the beneficiary responsible for the remaining 20% coinsurance.

Medicare Advantage (Part C) and Prescription Drug (Part D) plans have varying premiums, deductibles, and cost-sharing structures, including different copayments for prescription drugs and varying maximum out-of-pocket limits. The average estimated monthly Part D plan premium in 2025 is around $46.50, but can range from about $3 to $128 depending on the specific plan.