Spouse on an employer plan and Medicare

When one spouse keeps working past 65 and the family stays on one job-based plan, the spouse who works, the spouse on Medicare and any younger spouse all face different rules. This guide walks through the most common situations.

Common situations

1. The older spouse turns 65 first; the younger spouse is still working with coverage for both.
2. The older spouse works past 65; the younger spouse is under 65 and covered as a dependent.
3. Both spouses are 65 or older; one keeps working and both stay on that plan.
4. The working spouse retires; one goes on Medicare and the other needs coverage until 65.

Older spouse turning 65, younger spouse still working

Example: Joan turns 65 in March. Her husband Mike is 62 and works for an Oregon employer with 50 employees. Joan is on Mike's plan.

• Because Mike's employer has 20 or more employees and the coverage is from his current job, the employer plan pays first for Joan.
• Joan can delay Part B without penalty while she stays on Mike's plan.
• Joan can usually take premium-free Part A at 65, unless she contributes to her own HSA.
• When Mike stops working or the coverage ends, Joan has 8 months to sign up for Part B, using Form CMS-L564 completed by Mike's employer.

Older spouse working past 65, younger spouse under 65

Example: Robert is 67 and works for an Oregon hospital. His wife Amelia is 60. Both are on Robert's plan.

For Robert: if his employer has 20 or more employees, he can delay Part B; otherwise he generally needs Part A and Part B at 65.

For Amelia:

• She isn't eligible for Medicare by age yet. She stays on Robert's plan as a dependent.
• When Robert retires, losing that coverage gives her a special enrollment period for a Marketplace plan.
• If Robert's employer offers retiree coverage for spouses, she may qualify.
• COBRA is another option. It usually lasts 18 months after a job ends. If Robert became entitled to Medicare less than 18 months before he left the job, Amelia's COBRA can last up to 36 months from the date he became entitled to Medicare.

Both spouses 65 or older, one still working

Example: Linda and Tom are both 67. Tom works for a Portland firm with 30 employees; both are on his plan.

• Both can delay Part B, because the employer has 20 or more employees and the coverage is from Tom's current job.
• Either or both can take premium-free Part A.
• If Tom contributes to an HSA, Tom must not enroll in any part of Medicare. Linda's Medicare doesn't stop Tom's contributions, and Tom's HSA can pay Linda's qualified medical costs.
• When Tom stops working, each of them has an 8-month window to sign up for Part B and needs their own Part B application and proof of coverage.

Linda can also choose to sign up for Part B at 65 even though Tom is still working. Medicare would then pay second after Tom's plan.

When a spouse's coverage lets you delay Part B

To delay Part B without penalty based on your spouse's coverage:

• The coverage must be a group health plan based on your spouse's current employment (not retiree coverage, not COBRA).
• You must be covered on that plan.
• If you are 65 or older, the employer must have 20 or more employees for that plan to pay first.

Ask the plan, in writing, whether it pays first or second for you once you're 65.

When the working spouse retires

1. Confirm the end dates. The 8-month Part B window starts the month after the job or the coverage ends, whichever is first.
2. Get proof of coverage for each person enrolling. Ask the employer to complete Form CMS-L564 before the last day.
3. Compare retiree coverage with Medicare options. Some Oregon employers offer retiree coverage for spouses; most retiree plans expect you to have Part A and Part B.
4. Treat COBRA as a bridge only. COBRA doesn't extend the Part B window, and it generally pays second to Medicare.
5. Join a drug plan within 2 months. If the job's drug coverage was creditable, each spouse on Medicare has 2 full months after it ends to join a Part D plan or a Medicare Advantage plan with drug coverage.
6. Cover the under-65 spouse. Marketplace, COBRA, retiree coverage or OHP; Medicare isn't available to them by age yet.

Coverage for an under-65 spouse in Oregon

• Marketplace: losing job-based coverage opens a special enrollment period, generally 60 days, to buy a plan through the Oregon Health Insurance Marketplace. Premium tax credits depend on household income, which often drops at retirement.
• Oregon Health Plan: depending on household income, the younger spouse may qualify for OHP. Apply at benefits.oregon.gov or call ONE Customer Service at 1-800-699-9075 (TTY 711).
• COBRA: generally 18 months after a job ends, longer in some cases (see above).
• PEBB and OEBB: under OEBB's rule (OAR 111-050-0015), dependents of an early retiree who aren't Medicare-eligible may keep OEBB coverage until they lose eligibility, even after the retiree's coverage ends at Medicare. Ask PEBB about its rules for your family. See PEBB and Medicare and OEBB and Medicare.

Where to get help

• Social Security (Part A and Part B sign-up): 1-800-772-1213, TTY 1-800-325-0778.
• Medicare (coverage questions): 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
• OHP and ONE Customer Service (OHP applications): 1-800-699-9075, TTY 711.
• Medicare plan choices: to compare plans from the companies they work with, you can request a call from a licensed insurance agent.

Quick decision guide

1. Is the coverage from a current job? If not (retiree plan, COBRA), sign up for Part B when first eligible.
2. Does the employer have 20 or more employees? If yes, the 65-or-older spouse can usually delay Part B. If no, sign up for Part A and Part B at 65.
3. Will the working spouse retire first? Mark the 8-month Part B and 2-month Part D deadlines from the date the job or coverage ends.
4. Is one spouse under 65? Plan Marketplace, COBRA, retiree coverage or OHP for them.

Related guides

• Working past 65 in Oregon
• Employer plan and Medicare coordination
• Retiring at 66, 67, 68 or 70
• HSAs and Medicare

Sources

• Medicare.gov — Working past 65
• Medicare.gov — Which insurance pays first
• CMS — Form CMS-L564, Request for Employment Information
• Medicare.gov — Creditable drug coverage
• U.S. Department of Labor — An Employee's Guide to Health Benefits Under COBRA
• IRS — Publication 969, Health Savings Accounts
• Or. Admin. Code § 111-050-0015, OEBB early retiree coverage and dependents (via Cornell LII)
• Oregon Health Authority — OHP contact information

Frequently asked questions

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