Can I enroll in Medicare at any time when my wife loses her employer group health insurance?

1 answer | Last updated: Oct 13, 2016
A fellow caregiver asked...

I have multiple sclerosis and am on long-term disability and well under retirement age. My wife is still working, but within six years of retirement. We have good insurance through her employer with United Healthcare. I do not want Medicare as long as my health insurance is intact. I will be eligible for it in April. If I don't enroll then, can I at any time after that should my wife lose our insurance?

Expert Answers

Since you're well under retirement age, it sounds like you're describing a situation in which you'll become eligible for Medicare not because you turn 65 but because of your disability status. Anyone who's been receiving Social Security disability benefits for 24 consecutive months becomes eligible for Medicare.

But just because you become eligible for Medicare does not mean that you are required to enroll. When you become eligible for Medicare, you probably should enroll in Medicare Part A hospital insurance because will not cost you anything -- there are no monthly premiums to pay for Medicare Part A. To get coverage from Medicare Part B medical insurance, however, you'd have to pay a monthly premium of at least $96.40 (in 2010). If you've already got good medical coverage through your wife's employer-sponsored health insurance, Medicare Part B may not be worth enrolling in.

Whether it's a good idea for you to enroll in Medicare Part B depends on how much she has to pay for your coverage and on how much you regularly wind up paying out of pocket for your medical bills.
-- If you stay on your wife's employer-sponsored insurance, Medicare Part B would only become a secondary payer, covering only a portion of the bills the employer-sponsored insurance does not pay. It may not be worth paying the monthly Medicare Part B premium just for such secondary coverage. (If your wife's employer has fewer than 20 employees, Medicare would become the primary payer with the insurance becoming secondary, but the situation would remain the same -- you'd be paying an extra $96.40 per month just to add secondary coverage.)

-- However, it might be worth it for you to pay the $96.40 a month for Medicare Part B if you often have hundreds of dollars of medical bills that are left over, and that you now have to pay out of pocket, after your wife's insurance pays its share.
-- Or, it might be worth enrolling in Medicare Part B and dropping your wife's insurance entirely -- in which case Medicare Part B would become your primary medical coverage -- if she has to pay considerably more for your coverage than the $96.40 per month that Medicare Part B charges. To figure this out, check with the benefits office at her work to see how much is being taken out of her paycheck to pay for your health insurance coverage.