Fair Square Medicare Wordmark

Do I Need Medicare If My Spouse Has Insurance?

Senior couple working at a computer stock image
By Daniel Petkevich
Dec 19, 2022

If they've got creditable coverage, you can stick with your insurance plan

You already know you can depend on your spouse, but can you rely on their private healthcare plan to be there for you? If your spouse is still working, you might be confused about your needs as you become eligible for Medicare. Read on to see what rules to follow with regards to creditable coverage, including when to switch from your spouse's private health insurance to Medicare.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

First Rule of Thumb

The first rule of Medicare and private insurance is an easy one: if you’ve got creditable coverage, you don't need to sign up for Medicare. For a deep dive on creditable coverage,

check out our article here

. Your spouse's private insurance coverage is creditable if they work for a company with at least 20 employees. When weighing your options, your first question should be the size of the company providing your insurance. If your spouse works somewhere with less than 20 employees, it’s important to ask their HR representative if the insurance is creditable. If you don’t have creditable coverage, you should apply for Medicare Part A and Part B. And if you decide at any point that private insurance is not a good fit for you anymore, you can always shop for Medicare once you're eligible.

Fair Square Medicare

is the place to find your best plan. For now, all you need to know is if you have creditable coverage, stick with it.

Primary vs. Secondary

Once you’ve answered the first question, consider whether your insurance will pay primary or secondary. 
If your private insurance is paying primary to

Medicare

, Medicare pays secondary and is supplementing your employer insurance. For whatever healthcare costs pop up, your insurance takes the first swing, and if anything is leftover, Medicare comes in to cover the rest. Remember that Medicare will only pay for things covered by Medicare.
If Medicare pays primary, your health insurance pays secondary and is left to cover whatever Medicare will not. People often elect to sign up for

Part A of Medicare

even if they have creditable coverage. That's because it's free (as long you or your spouse have paid 40 quarters' worth of social security taxes) to get more secondary coverage.

Group Health Plans

When your spouse's company has 20 or more employees, that’s considered a Group Health Plan (GHP), and your insurance will pay primary. In a Small Group Health Plan (SGHP) with less than 20 employees, your insurance will pay secondary to Medicare, so you need to sign up for Parts A, B, and likely D if Medicare is meant to pay primary.
Note: If you are under 65 and eligible for Medicare due to a disability, the number used to determine primary vs. secondary coverage jumps up to 100 employees. A plan with over 100 employees is considered a Large Group Health Plan (LGHP).

Coordination of Benefits

The way your Medicare plan and your GHP might work together to share costs is called the Coordination of Benefits. There are systems in place that work to ensure your healthcare claims are being billed in the right order, but it’s still important for you to know how to apply these rules to your situation in case any claims are disputed. If you have any questions about the Coordination of Benefits for your situation, you can call us at 1-888-376-2028, and you can also call the Benefits Coordination and Recovery Center (BCRC) at 1-855-798-2627.

What about your prescription drug coverage?

The same rules apply; if you have creditable coverage through your spouse's private insurance, then you do not need to sign up for a Part D Prescription Drug plan. Other Medicare beneficiaries might incur a Late Enrollment Penalty for either Part B or

Part D

. But as long as you have creditable coverage, you have a special enrollment period of 63 days after your coverage ends to enroll without penalty.

What if you or your spouse have a retirement plan?

Medicare also pays primary to retirement plans. 
  • If you’ve got a retirement plan, your spouse’s GHP, and Medicare, it pays as follows:
    • 1. GHP
    • 2. Medicare
    • 3. Retirement Plan
If your retirement plan includes creditable drug coverage, you have a special enrollment period of 63 days after your coverage ends.

Takeaway

Suppose you have creditable coverage and your plan suits your needs. In that case, you do not need to enroll in Medicare Part B. Talk with your health insurance plan provider for more details about your specific circumstances and your coordination of benefits. For all your Medicare-related questions, we have a team of experts ready to help you get the coverage you need. Give Fair Square Medicare a call at 888-376-2028.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Recommended Articles

Union Station in Denver stock image
15 Best Ways for Seniors to Stay Active in Denver
Mar 9, 2023
Leg bones and knees, 3d rendering. stock photo
Does Medicare Cover Tymlos?
Dec 5, 2022
Doctor physician consulting with male patient in hospital exam room stock photo
Is Gainswave Covered by Medicare?
Dec 6, 2022
Kidney stone stock image
Does Medicare Cover Kidney Stone Removal?
Nov 23, 2022
senior man pondering "which medigap plan should i choose" stock photo
Comparing All Medigap Plans | Chart Updated for 2023
Aug 1, 2022
Close up top view of a woman showing a round-shaped Lipoma fatty tumor on an open palm stock photo
Does Medicare Cover Lipoma Removal?
Dec 8, 2022
Doctor demonstrating upper cervical spine anatomy stock photo
Does Medicare Cover Cervical Disc Replacement?
Jan 20, 2023
Orthopaedist at work treating a bunion, stock photo
Does Medicare Pay for Bunion Surgery?
Nov 29, 2022
The feet of a person suffering from foot pain stock photo
Does Medicare Cover Cartiva Implants?
Nov 29, 2022
Person receiving a vaccine stock photo
Is the Shingles Vaccine Covered by Medicare?
Nov 17, 2022
Medicare cost stock image
How Much Does Medicare Cost?
Jul 25, 2022
Cover image
The Fair Square Bulletin: The End of the COVID Emergency Declaration
May 30, 2023
Cover image
The Fair Square Bulletin: September 2023
Sep 19, 2023
Cover image
What Is a Medicare Supplement SELECT Plan?
Apr 25, 2023
Psoriasis on elbow stock photo
Does Medicare Cover Ilumya?
Dec 7, 2022
Diagnosis incontinence stock image
Does Medicare Cover Incontinence Supplies?
Dec 22, 2022
Medicare 2023 What you need to know in the new year stock image
How is Medicare Changing in 2023?
Dec 21, 2022
Electrocardiograph with pacemaker stock photo
How Much Does a Pacemaker Cost with Medicare?
Nov 21, 2022

More of our articles

13 Best Ways for Seniors to Stay Active in Columbus

13 Best Ways for Seniors to Stay Active in Phoenix

14 Best Ways for Seniors to Stay Active in Nashville

14 Best Ways for Seniors to Stay Active in Seattle

20 Questions to Ask Your Medicare Agent

2024 Medicare Price Changes

Building the Future of Senior Healthcare

Can Doctors Choose Not to Accept Medicare?

Can I Choose Marketplace Coverage Instead of Medicare?

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Do Medicare Supplement Plans Cover Dental and Vision?

Do You Need Books on Medicare?

Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

Does Medicare Cover Air Purifiers?

Does Medicare Cover an FMT?

Does Medicare Cover Bladder Sling Surgery?

Does Medicare Cover Cala Trio?

Does Medicare Cover Cataract Surgery?

Does Medicare Cover COVID Tests?

Does Medicare cover Deviated Septum Surgery?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover Fosamax?

Does Medicare Cover Hypnotherapy?

Does Medicare Cover Inqovi?

Does Medicare Cover Krystexxa?

Does Medicare Cover LVAD Surgery?

Does Medicare Cover Medical Marijuana?

Does Medicare Cover Mental Health?

Does Medicare Cover Mouth Guards for Sleep Apnea?

Does Medicare Cover Nuedexta?

Does Medicare Cover Qutenza?

Does Medicare Cover Robotic Surgery?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover Stair Lifts?

Does Medicare Cover TENS Units?

Does Medicare Cover the Urolift Procedure?

Does Medicare Cover the WATCHMAN Procedure?

Does Medicare Cover Wart Removal?

Does Medicare Cover Zilretta?

Does Medicare Pay for Allergy Shots?

Does Medicare Pay for Varicose Vein Treatment?

Does Medicare Require a Referral for Audiology Exams?

Explaining the Different Enrollment Periods for Medicare

Finding the Best Vision Plans for Seniors

How Can I Get a Replacement Medicare Card?

How Do I Sign up for Medicare? A Simple How-To Guide For You

How Does Medicare Pay for Emergency Room Visits?

How Medicare Costs Can Pile Up

How Much Does Medicare Part A Cost in 2023?

How Much Does Medicare Part B Cost in 2023?

How Much Does Open Heart Surgery Cost with Medicare?

How Often Can I Change Medicare Plans?

How to Become a Medicare Agent

How to Choose a Medigap Plan

How to Deduct Medicare Expenses from Your Taxes

Is Balloon Sinuplasty Covered by Medicare?

Is Emsella Covered by Medicare?

Is HIFU Covered by Medicare?

Is PAE Covered by Medicare?

Medicare Consulting Services

Medicare Explained

Medicare Guaranteed Issue Rights by State

Medicare Savings Programs in Kansas

Medicare Supplement Plans for Low-Income Seniors

What Is a Medicare Advantage POS Plan?

What is a Medicare Beneficiary Ombudsman?

What is the 8-Minute Rule on Medicare?

What's the Deal with Flex Cards?

What's the Difference Between HMO and PPO Plans?

When to Choose Medicare Advantage over Medicare Supplement

Why Is Medicare So Confusing?

Why You Should Keep Your Medigap Plan

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.
Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2023

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M