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Medicare Eligibility

This is not a question now, but is about a point that likely affects a substantial number of your audience. Note that I have no idea if you've used this before. I expect you'll want to edit out much of my exposition below to get to the main point.

My personal income was above average. However, my wife, who is eight years older, has not worked for the duration of our marriage, having had three kids by a prior relationship and poor health for most of the marriage.

She also didn't qualify for Medicare or social security based on her earnings history. For the same reason, she didn't qualify for SSD, and the family income was too high for her to qualify for SSI.

I found it remarkably difficult to find information on the SSA web site about when an older, non-wage earning spouse would be eligible for Medicare or Social Security benefits. I eventually was obliged to make an appointment at the social security office, where I was told, incorrectly, that she would need to wait until I turned 65, if she lived that long - which would not be until she was almost 74.

In 2011, after a health setback we got her on Elderly Waiver, a federal program to provide assistance to allow people who might otherwise be forced to live in a nursing home to stay in their own home with the help of services such as personal care attendants. (This was possible only because she had never worked during our marriage - so my income didn't disqualify her - and my liquid assets were also below the limit at the time of $36,000, as all of my savings were in 401k and defined-benefit pension funds not available lo me in 2011).

A few years later, elderly waiver threatened to drop her for not being on Medicare. I told them she wasn't eligible until I turned 65. They told me I was wrong and had a short grace period to get her on it before they kicked her off Elderly Waiver.

After another unsuccessful search of the SSA web site, I scheduled another appointment at the SSA office. This time I got a more knowledgable staffer who informed me that she became Medicare eligible when I turned 62.

Bottom line here:
1. Social security law was written assuming that one of the couple would likely be a non-wage earner - but that the little lady would be the age of, or younger than, the wage-earning husband.

This policy - which originated in the 1930s - penalizes couples with an older, non-wage earning spouse. While not the norm, there are millions of couples in this situation with an older spouse who, for want of a ten year work history, may be cut off from Medicare and social security benefits until the younger spouse reaches 62 (for Medicare) or 65, for social security benefits. In the case of health problems, this is often not until after they are dead.

2. Social Security is little help in assisting even a moderately sophisticated applicant from finding this information - or even getting it directly from their staff, since, based on my admittedly small sample size, they may get the wrong answer 50% of the time.

My opinion is that the the underlying policy is unfair to older non-wage earning spouses and should be fixed. Until then, though, perhaps you can do your bit to educate your audience about this issue - and maybe prod the SSA to put this information where people can find it on the web site.

Hi. Your points are well taken, and I agree that the information available on Social Security's website and from many of their employees leaves much to be desired. Just to clarify, though, all U.S. citizens and some resident aliens are allowed to enroll in Medicare when they reach age 65. That's true regardless of their marital status, and even if they've never worked in Social Security covered employment. This is an important thing for other readers of this post to understand, because enrolling late in Medicare can result in higher premiums and a delay in coverage.

Assuming that your wife is a U.S. citizen, she could have enrolled in all parts of Medicare when she turned age 65. But, since she didn't pay Social Security or Medicare taxes long enough to be insured for benefits, she would then have been required to pay a monthly premium if she chose to enroll in Part A of Medicare (https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance). Everyone must pay a monthly premium if they enroll in Part B of Medicare, though, and the premium rates for that coverage are no higher for uninsured individuals than they are for insured people.

The only real difference that your reaching age 62 made with regard to your wife's Medicare options is that she could then qualify for premium free Part A of Medicare. Uninsured spouses can enroll in premium free Part A of Medicare if their spouse is a) at least age 62 and insured for Social Security or Medicare, or b) drawing Social Security retirement or disability benefits.

Best, Jerry

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Posted: 
Jan 28 2022 - 2:18pm
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