Medicare for Spouses: How Husband and Wife Coverage Works

Medicare does not offer a family plan. Unlike employer health insurance, where a working spouse can add a husband or wife to a single policy, Medicare is strictly individual coverage. Each spouse enrolls on their own, pays their own premiums, and manages their own plan choices. But that does not mean your spouse's work history is irrelevant -- far from it. One spouse's employment record can determine whether the other qualifies for premium-free Part A, potentially saving thousands of dollars every year.

This guide covers how Medicare works for married couples, what happens when spouses reach 65 at different times, how divorced spouses can qualify, and how to coordinate Medicare with employer insurance. Whether you are a stay-at-home parent approaching 65, a couple planning retirement together, or a divorced individual wondering about your options, understanding spousal Medicare rules can save you money and prevent costly enrollment mistakes. For a broader overview of who qualifies for Medicare, see our complete Medicare eligibility guide.

How Spousal Eligibility for Medicare Works

Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Whether you pay a premium for Part A depends on how many quarters of Medicare-taxed employment you -- or your spouse -- have accumulated. You need 40 quarters (10 years of work) for premium-free Part A.

The critical rule for spouses: if you do not have 40 quarters on your own work record, you can qualify for premium-free Part A based on your spouse's work record. This applies to current spouses, divorced spouses (under certain conditions), and surviving spouses. The Social Security Administration treats your spouse's work history as if it were your own for the purpose of Part A eligibility.

To qualify for premium-free Part A through a current spouse's work record, all of the following must be true:

• You are 65 or older.
• You are a U.S. citizen or lawful permanent resident who has lived continuously in the U.S. for at least five years.
• Your spouse has at least 40 quarters of Medicare-taxed employment.
• Your spouse is at least 62 years old.
• You have been married for at least one continuous year.

Your spouse does not need to be enrolled in Medicare or even retired. They just need to meet the age and work history thresholds. This rule is especially important for stay-at-home parents, caregivers, and anyone who spent significant time outside the paid workforce.

Premium-Free vs. Paid Part A for a Non-Working Spouse

If you cannot qualify for premium-free Part A through either your own work record or a spouse's record, you can still enroll in Medicare -- but you will pay a monthly premium for Part A. The amount depends on how many quarters of work you have accumulated. To understand all the costs involved, see our detailed breakdown of how much Medicare costs in 2026.

• 40 or more quarters (yours or your spouse's): $0 per month -- premium-free Part A.
• 30 to 39 quarters: $283 per month in 2026 (reduced premium).
• Fewer than 30 quarters: $518 per month in 2026 (full premium).

At the full rate, a non-working spouse without access to a partner's work record pays $6,216 per year just for Part A -- on top of Part B premiums. Before paying that amount, always check whether you qualify through a current spouse, ex-spouse, or deceased spouse. Many people overpay because they do not realize spousal eligibility exists.

Part B has no work history requirement. Both spouses pay the standard Part B monthly premium regardless of employment history. In 2025, the standard Part B premium is $185.00 per month. High-income couples may pay more due to Income-Related Monthly Adjustment Amount (IRMAA) surcharges based on their modified adjusted gross income from two years prior.

Each Spouse Must Enroll Individually

One of the most common misunderstandings about Medicare for couples is the assumption that enrollment is automatic or linked. It is not. Medicare is entirely individual. There is no dependent coverage, no family plan, and no joint enrollment form.

Each spouse must take action on their own. This means:

• Each spouse has their own Initial Enrollment Period based on their own 65th birthday.
• Each spouse receives their own Medicare number and Medicare card.
• Each spouse independently selects a Medicare Advantage plan, Medigap supplement, or Part D drug plan.
• Each spouse has separate deductibles, copays, and out-of-pocket maximums.
• Each spouse is individually responsible for meeting enrollment deadlines and avoiding late penalties.

If you are already receiving Social Security retirement benefits when you turn 65, you are enrolled in Parts A and B automatically. But if you are not collecting Social Security -- for example, because you are delaying benefits to maximize your monthly payment -- you need to actively sign up. For step-by-step instructions, see our guide on how to apply for Medicare.

When Spouses Turn 65 at Different Times

Most couples do not share the same birthday, and age gaps of several years are common. This creates a transition period where one spouse has Medicare and the other does not. Planning for this gap is one of the most important things couples can do before retirement.

When the older spouse turns 65 and enrolls in Medicare, the younger spouse cannot join Medicare until they also turn 65 (unless they qualify through disability or a condition like ESRD or ALS). Medicare has no dependent coverage provision -- a 65-year-old cannot add a 60-year-old spouse to their Medicare.

This creates a coverage gap for the younger spouse, especially if both were previously on one employer plan. Once the older spouse moves to Medicare, the younger spouse may lose access to the employer plan (if the older spouse was the employee and retires). The younger spouse will need to find their own coverage.

Coverage Options for the Younger Spouse

• Employer insurance: If the younger spouse works and has access to an employer plan, this is often the simplest and most affordable option.
• ACA Marketplace plan: The younger spouse can purchase coverage through HealthCare.gov or their state exchange. Premium tax credits are available based on household income. Losing employer coverage as a dependent qualifies you for a Special Enrollment Period outside of open enrollment.
• COBRA: If the older spouse retires and the employer plan ends, the younger spouse may be eligible for COBRA continuation coverage for up to 36 months. However, COBRA is expensive because you pay the full premium plus a 2% administrative fee with no employer subsidy.
• Medicaid: If household income drops significantly after the older spouse retires, the younger spouse may qualify for Medicaid in states that expanded coverage under the Affordable Care Act.

Couples with a large age gap should budget carefully for this transition period. A five-year gap between spouses could mean five years of paying for individual health insurance outside of Medicare, which can cost $500 to $1,500 or more per month depending on age, location, and plan type.

Medicare Eligibility for Divorced Spouses

Divorce does not necessarily end your ability to qualify for premium-free Part A based on your former spouse's work record. The Social Security Administration allows divorced individuals to use an ex-spouse's work history if specific conditions are met.

To qualify for premium-free Part A based on a divorced spouse's work record:

• The marriage lasted at least 10 years.
• You are currently unmarried.
• You are 65 or older.
• Your ex-spouse is at least 62 and eligible for Social Security benefits.
• Your ex-spouse has at least 40 quarters of Medicare-taxed employment.

Several important details make this provision more accessible than people expect. Your ex-spouse does not need to know you are claiming benefits on their record. Their own benefits are not reduced in any way by your claim. If you have been divorced for at least two years, you can claim benefits even if your ex-spouse has not yet filed for Social Security, as long as they are eligible.

If you remarried and that subsequent marriage ended (through divorce, annulment, or death of the second spouse), you may be able to use either your first or second ex-spouse's work record -- whichever provides the greater benefit. Many divorced individuals are unaware this pathway exists, and it is one of the most underutilized provisions in Medicare eligibility.

Same-Sex Marriage and Medicare Spousal Benefits

Following the Supreme Court's 2015 ruling in Obergefell v. Hodges, all legally married same-sex couples have the same access to Medicare spousal benefits as opposite-sex couples. The Social Security Administration recognizes marriages performed in any U.S. state or territory, and also recognizes some marriages performed in foreign countries where same-sex marriage is legal.

This means same-sex spouses can:

• Qualify for premium-free Part A based on their spouse's work record.
• Use divorced spouse eligibility rules if the marriage lasted at least 10 years and they are currently unmarried.
• Claim surviving spouse Medicare benefits after the death of a spouse.
• Qualify for the same Special Enrollment Period protections related to a spouse's employer coverage.

Same-sex couples who were married before the Obergefell decision but lived in states that did not recognize their marriage at the time may still be able to use the date of their original marriage to establish the one-year marriage requirement or the 10-year rule for divorced spouse benefits. The Social Security Administration evaluates these cases individually. If you believe you were denied benefits incorrectly, you can request a reconsideration or appeal.

Coordinating Medicare with Employer Insurance as a Couple

Many couples reach 65 while one or both spouses are still working and covered by an employer health plan. Coordinating Medicare with employer insurance is one of the trickiest aspects of Medicare planning for couples, and making the wrong choice can result in claim denials and permanent late enrollment penalties. For a deeper dive, see our full guide on Medicare and employer insurance.

The rules depend on the size of the employer.

Employer With 20 or More Employees

If either spouse is actively employed by a company with 20 or more employees and covered by that employer's group health plan, the employer plan is primary and Medicare is secondary. In this scenario, the spouse turning 65 should enroll in premium-free Part A (there is no cost and no downside) but can safely delay Part B enrollment without facing a late penalty.

This also applies when the younger spouse is the one still working. If the older spouse is covered as a dependent on the younger spouse's employer plan from a large employer, that employer plan remains primary. The older spouse can delay Part B without penalty while that coverage continues.

When the employer coverage ends -- whether through retirement, job change, or loss of dependent status -- the spouse who delayed Part B gets an 8-month Special Enrollment Period to sign up penalty-free. Coverage starts the month after enrollment.

Employer With Fewer Than 20 Employees

When the employer has fewer than 20 employees, Medicare becomes the primary payer at age 65. The employer plan becomes secondary. In this case, both Part A and Part B enrollment during the Initial Enrollment Period is essential. If you delay Part B, the employer plan may deny claims -- and you will owe a permanent late enrollment penalty when you eventually sign up.

This small-employer rule catches many couples off guard, particularly when one spouse works for a small business. If your spouse works for a company with 15 employees and you are turning 65, Medicare is primary for you even though you have employer coverage as a dependent. Failing to enroll in Part B on time can result in unpaid claims and a 10% permanent premium surcharge for each year you delayed.

Common Mistakes Couples Make

• Assuming COBRA counts as employer coverage: It does not. COBRA is continuation coverage, not active employer coverage. Electing COBRA instead of enrolling in Part B will trigger the late enrollment penalty.
• Confusing retiree coverage with active employer coverage: Retiree health benefits from a former employer do not qualify for the Special Enrollment Period. You must enroll in Part B during your Initial Enrollment Period or face penalties.
• Forgetting about HSA rules: Once either spouse enrolls in any part of Medicare, that spouse can no longer contribute to a Health Savings Account. Since Part A can be backdated up to six months, stop HSA contributions at least six months before Medicare enrollment to avoid tax penalties.
• Not checking employer size: The 20-employee threshold is based on the number of employees the company has for 20 or more calendar weeks in the current or previous year. Ask your HR department for a written confirmation of whether Medicare or the employer plan is primary.

Surviving Spouse Medicare Benefits

When a spouse passes away, the surviving spouse may qualify for premium-free Part A based on the deceased spouse's work record. The surviving spouse must be at least 65 and meet the standard citizenship or residency requirements. If the surviving spouse remarried after age 60, they can still use the deceased spouse's record. Remarriage before age 60 generally disqualifies the surviving spouse from using the deceased spouse's work history, unless that later marriage also ended.

Surviving spouses who are under 65 may qualify for Medicare if they are receiving Social Security survivor disability benefits. After 24 months of those benefits, Medicare enrollment is automatic. This can be a critical safety net for younger surviving spouses who depended on the deceased spouse's employer insurance.

Tips for Couples Planning Medicare Enrollment Together

Planning Medicare as a couple requires coordination even though enrollment is individual. Here are the key steps every couple should take.

1. Check both work records: Log in to ssa.gov and verify how many quarters each spouse has earned. If one spouse is short of 40 quarters, determine whether they qualify through the other spouse's record.
2. Map out your timeline: Mark each spouse's 65th birthday and the corresponding 7-month Initial Enrollment Period on a calendar. If there is a gap, plan how the younger spouse will be covered during that time.
3. Understand your employer situation: Determine whether each employer has 20 or more employees. Get written confirmation from HR about which insurance -- employer or Medicare -- is primary for each spouse.
4. Budget for the transition: Calculate the cost of Part B premiums for each spouse, any Part A premiums if applicable, supplemental coverage like Medigap or Medicare Advantage, and Part D drug plans. Two people on Medicare can easily spend $400 to $800 per month combined in premiums alone.
5. Consider IRMAA: If your combined household income exceeds certain thresholds, both spouses may pay higher Part B and Part D premiums due to Income-Related Monthly Adjustment Amounts. IRMAA is based on your tax return from two years prior, so a high-income year shortly before retirement can increase your premiums.
6. Get free counseling: Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare counseling. SHIP counselors can review both spouses' situations and help you avoid costly mistakes. Find your local SHIP at shiphelp.org or by calling 1-800-MEDICARE.

The Bottom Line

Medicare does not work like employer health insurance. There is no family plan, no dependent coverage, and no way to add a spouse to your policy. Each person enrolls individually, pays their own premiums, and manages their own coverage decisions. But the system does recognize the value of a spouse's work history. Premium-free Part A through a spouse's or ex-spouse's record can save a non-working individual more than $6,000 per year.

The biggest risks for couples are coverage gaps when spouses turn 65 at different times, missed enrollment deadlines that trigger permanent penalties, and misunderstanding how employer insurance interacts with Medicare based on company size. Divorced spouses should always check whether they qualify through an ex-spouse's work record -- the 10-year marriage rule opens the door for many people who assume they have no options.

Start planning at least 12 months before the first spouse turns 65. Check work records at ssa.gov, confirm employer size with HR, map out coverage timelines, and take advantage of free SHIP counseling. Medicare enrollment mistakes are expensive and often permanent -- but with the right preparation, every couple can navigate the transition smoothly and avoid unnecessary costs.