02-06-2025
How Your Marital Status Affects Your Medicare Coverage
Your marital status can affect your Medicare coverage, eligibility, and costs. Understanding the role of marriage in Medicare can help you plan your healthcare for yourself and your spouse.
In general, you qualify for Medicare if you are over 65 or younger but living with certain disabilities. You must also have worked in the United States and paid taxes for at least 10 years.
If you meet these criteria, your legal spouse may also qualify for Medicare even if they do not meet the criteria. This article discusses the rules of eligibility for Medicare based on having a spouse who qualifies for the program, as well as considerations regarding coverage, costs, and changes in marital status.
How does marital status affect Medicare eligibility and benefits?
To be eligible for Medicare Part A benefits based on your spouse, you must have been married to a spouse eligible for Social Security benefits for at least 1 year before applying for those benefits.
Once you qualify for Medicare Part A, you are also eligible to enroll in Part B and Part D. In addition, you can choose to enroll in Medicare Advantage (Part C) instead of Original Medicare (Parts A and B). Once you enroll, both you and your spouse are eligible for all the benefits of Medicare.
How does marital status affect Medicare costs?
For Medicare Part D, you'll each need to meet a deductible of $1,676 before coverage will apply.
If you or your spouse worked and paid taxes for the required period, there's no premium for Part A. If you worked 30 to 39 quarters, you can buy Part A for $285 each, monthly, in 2025. Working less than 30 quarters results in a $518 premium for each spouse.
For Part B, each spouse pays an individual premium starting at $185 each, depending on income. The same structure applies to Part D, Part C, and Medigap plans, with private insurers setting their premiums and deductibles. Each spouse must choose their separate plan and meet their individual deductible.
How does marriage affect Medicare income limits?
Your Part B and D premiums may be higher depending on your income and whether or not you are filing taxes jointly. The following chart summarizes the income tiers and their equivalent Medicare Part B and Part D premiums.
Income (married and filing jointly) Income (married and filing separately) Part B premium Part D premium
$212,000 or under $106,000 or under $185 your plan's base premium
$212,000 to $266,000
not applicable $259 +$13.70
$266,000 to $334,000
not applicable $370 +$35.30
$334,000 to $400,000 not applicable $480.90 +$57
$400,000 to $750,000 $106,000 to $394,000 $591.90 +$78.60
$750,000 or above $394,000 or above $628.90 +$85.80
Medicare Savings Programs and Extra Help
Medicare savings programs (MSPs) can help you cover the costs of Part A and B premiums, deductibles, copays, and coinsurance. To be eligible, your monthly income and household resources must not exceed certain limits as follows:
Note that Medicare typically defines resources as funds in checking, savings, or retirement accounts, stock investments, or bond holdings. Some states may exclude certain things from counting as assets. These include:
your residence
a single vehicle
a burial plot
up to $1,500 earmarked for burial expenses from Social Security
furniture
other personal and household belongings
Like MSPs, the Extra Help program, also called the Part D Low Income Subsidy, offers financial assistance for prescription medications. Eligibility for this subsidy depends on income and economic necessity. The married income and asset thresholds to qualify for Extra Help are:
How does divorce or death affect Medicare coverage?
If you are divorced, you can still qualify for Medicare based on your former spouse's eligibility for Social Security benefits if you were married for at least 10 years.
Similarly, if you're widowed, you must have been married for at least 9 months before your spouse's death, and they must have been eligible for Social Security benefits. You must also be single now.
Whether or not you have to pay a premium for Part A with your former spouse will depend on the exact length of time they worked and paid taxes.
Can one spouse be on Medicare and the other not?
Eligibility for Original Medicare is automatic for both of you as long as your spouse is eligible. That said, Medicare enrollment is not necessarily automatic.
If you don't qualify for Medicare yourself but your spouse receives benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB), you may be eligible for premium-free Part A. However, you'll have to enroll manually.
You'll be enrolled automatically only if you are receiving these benefits yourself. After enrollment, you'll both receive your Medicare cards 3 to 4 months before the birthday of the qualifying spouse.
Note that while Medicare Part A is mandatory, Part B is not. You have the option to cancel Part B if you do not need it.
If your spouse qualifies solely by age, manual enrollment is required, and you can choose not to enroll in Part B or Part D. That said, delaying enrollment can result in a late fee if you don't qualify for a special enrollment period.
In addition, if your spouse qualifies by age and you have employer group insurance, you can usually keep your group plan, with Medicare as a secondary payer for costs not covered by your employer's insurance.
Special enrollment periods for married couples
Generally speaking, there are only specific periods during which you can enroll in Medicare or switch Medicare plans without a penalty. These are known as Medicare enrollment periods.
However, you can enroll outside of these periods in certain situations, including when you undergo a qualifying life change, such as a divorce or the death of a spouse.
Takeaway
Because the rules around Medicare in relation to marriage can be complex, it's essential to educate yourself thoroughly about your eligibility and that of your spouse.
Generally, Medicare is for those over 65 or with specific disabilities who have worked in the U.S. for at least 10 years, along with eligible spouses. That said, special rules may apply for eligibility and enrollment following a divorce or a spouse's death.
Your enrollment options include Original Medicare, Part D, Medicare Advantage (Part C), and Medigap. Spouses pay separate premiums for each Medicare part. These premiums can be affected by a couple's total income and their joint or separate tax filings.
Financial assistance programs like Medicare Savings and Extra Help can help you pay for Medicare costs, but eligibility for these can also depend on your total married income and resources.
