Health insurance options for pre-Medicare spouses
Dear Savvy Senior,
My wife, who’s 60, is on my health insurance plan through my employer. When I retire in a few months at 65, and go on Medicare, what happens to her? Do we have to purchase private insurance, or is there some kind of Medicare coverage for dependent spouses?
Unfortunately for you and millions of other couples in your position, Medicare does not provide family coverage to younger spouses or dependent children when you qualify for Medicare.
Nobody can obtain Medicare benefits before age 65, unless eligible at a younger age because of disability. With that said, here are some options for your wife depending on your situation.
Work longer: If possible, you should consider working past age 65 so your wife can continue coverage under your employer health insurance until she becomes eligible for Medicare, or, if that’s too long, at least for a few more years.
Check employer options: If your employer provides retiree health benefits, check with the benefits administrator to find out if they offer any options that would allow your wife to continue coverage under their plan.
Or, if your wife works, see if she can she switch to health insurance provided by her own employer.
Use COBRA: If you work for a company that has 20 or more employees, once you make the switch to Medicare, your wife could stay with your company insurance plan for at least 18 months (but could last up to 36 months) under a federal law called COBRA.
You’ll need to sign her up within 60 days after her last day of coverage. You also need to know that COBRA is not cheap. You’ll pay the full monthly premium yourself, plus a 2 percent administrative fee.
The other benefit of using COBRA is that once it expires, your wife will then become eligible for HIPAA (Health Insurance Portability and Accountability Act), which gives her right to buy an individual health insurance policy from a private insurer that can’t exclude or limit coverage for pre-existing medical conditions.
To learn more about COBRA, visit askebsa.dol.gov or call 866-444-3272.
If, however, the company you worked for had fewer than 20 employees, you may still be able to get continued coverage through your company if your state has “Mini-COBRA” (39 states offer it).
Contact your state insurance department (see www.naic.org) to see if this is available where you live.
Buy an individual policy: This is health insurance you buy on your own, but it too can be expensive depending on your wife’s health history. Any pre-existing condition such as heart disease, diabetes, cancer, etc., can drastically increase her premiums or can nix her chances of being accepted at all.
To search for policy options and costs go to healthcare.gov. If you need help, contact a licensed independent insurance agent. See www.nahu.org/consumer/findagent.cfm to locate one near you.
Or, if you only need health coverage for a short period of time – less than 12 months – a short-term policy is another lower-cost option to consider. You can get quotes and coverage details at ehealthinsurance.com.
Get high-risk coverage: If you can’t purchase an individual health policy for your wife because of a pre-existing medical condition, you can still get coverage through a state or federal high-risk pool.
State pools, which are offered in 35 states (see naschip.org), provide health insurance to any resident who is uninsurable because of health problems. While costs vary by state, premiums run about 150 percent of what an individual policy costs.
Or, consider the federal Pre-Existing Conditions Insurance Plan (see www.pcip.gov) which is available nationwide.
Created in 2010 under the health care reform law, this program is intended to bridge the gap until better options become available in 2014 when the main provisions of the law go into effect.
To qualify, your wife must be uninsured for six months before applying.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.