In my 12 years of experience as a broker (licensed in Missouri, Florida, Michigan, and Illinois), this is an issue that 90 percent of my new enrollees experience. They speak to an agent or broker and are ready to get their Medicare enrollment underway and … “Wait. What about my spouse?”
Most of the time people are retiring from a Group Health Insurance policy, and they may have a younger spouse who will not be Medicare eligible for a few years. In this situation, your spouse has a few options, though a lot of agents may not deal with individual or private health insurance. This is why it’s important to straightforwardly ask your agent or broker if they can assist.
What Should I Do If My Spouse Is Eligible For Medicare But I’m Not?
First things first: Ask your broker if they can help your spouse get coverage. Unfortunately, a lot of brokers only handle Medicare, in which case your spouse can be left high and dry. People start searching for help online and get inundated with calls from 100 brokers all over the country. If your broker handles private health insurance options, that is a good thing. You have a one-stop shop.
Pro Tip: If your broker does not offer assistance in private healthcare, then you have the option to find a local licensed agent to assist you at https://localhelp.healthcare.gov/.
What Are Your Options?
The good news is that there are a lot of great options in this situation. The most common is COBRA, the acronym for the Consolidated Omnibus Budget Reconciliation Act. COBRA is available to spouses of retiring individuals who are leaving group health coverage and are not yet eligible for Medicare. You are able to continue your group coverage but the employer no longer has to cover the premium at 50 percent, meaning you are responsible for the whole premium — and making this, usually, the most expensive option.
ACA Or Marketplace Coverage
The Marketplace is another option that can potentially offer a subsidy for your spouse to keep the cost down. The subsidy is based on income and age, and when moving into retirement, you’ll usually have a bit less income, which can be a benefit. However, if you are not able to get a subsidy for these plans, they can be almost as expensive as a COBRA policy.
That said, the other major benefit of ACA policies is that they pay 100 percent for preventive care and accept all pre-existing conditions. People with chronic conditions should stay with their COBRA coverage or get an ACA policy to tide the gap until they are Medicare eligible. If you are unable to get a subsidy and do not have pre-existing conditions, then the next option may be for you.
Off-Exchange Or Private Health Insurance
These are much like health insurance plans of the past. The policies are underwritten, meaning applicants can be denied for pre-existing conditions. They also do not typically cover preventive care. However, if you are healthy, here is your reward for those long walks on the beach. You will get inexpensive coverage with low deductibles and maybe some additional perks like dental and vision discounts and even free telemedicine. The cost can also be a quarter of the cost of COBRA or less, so eat your vegetables!
There are other options such as hospital indemnity plans and religious group offerings, but these are not considered health insurance. Contact your agent to see what is best for you.
The important thing to know is there are a lot of options for you or your spouse when making the transition to Medicare. Neither you nor your spouse will be left out in the cold when you make the move. I suggest finding a good broker who offers a lot of options to see what works best for you. The good news is that typically you can find an option that is less expensive than you expect so you can stretch those retirement dollars as far as possible.
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