Medicare and your spouse: when one of you is younger

Medicare has no spouse or family coverage. Each of you qualifies on your own, usually at 65. When one spouse starts Medicare first, the younger spouse needs a plan of their own until then.

Part A through your spouse's work

You can get premium-free Part A at 65 based on your spouse's work if your spouse paid Medicare taxes for at least 10 years. One catch: if your spouse isn't yet 62 when you turn 65, you won't get premium-free Part A until your spouse's 62nd birthday. Still sign up for Part B at 65 to avoid a late penalty, unless you're covered by your spouse's plan from a current job. See free or paid Part A.

Coverage for the younger spouse

• The working spouse's job-based plan: if one of you is still working and the plan covers both of you, the older spouse can often delay Part B without a penalty while that coverage lasts. See job-based coverage and Medicare.
• Marketplace (HealthCare.gov or your state's exchange): when one spouse starts Medicare, others on the same Marketplace plan can keep their coverage. Report the Medicare start date on your Marketplace application so only that person's coverage ends. The remaining members' deductibles may reset.
• Retiree coverage: some retiree plans cover spouses. Ask before the older spouse joins a Medicare drug plan, because with some plans that can end coverage for the spouse too. See retiree coverage.
• COBRA: may let a spouse keep job-based coverage for a time after the job ends.

When the older spouse retires

If the younger spouse was on the retiring spouse's job-based plan, that coverage usually ends. Losing it generally lets the younger spouse sign up for a Marketplace plan outside Open Enrollment, within 60 days. The older spouse has 8 months after the job or coverage ends to sign up for Part B without a penalty.

Money matters for couples

• Income-related Medicare premiums (IRMAA) are based on your joint income if you file taxes jointly. See IRMAA 2026.
• Once you have Medicare, you no longer qualify for Marketplace premium help for yourself.