Health Insurance Navigator

By Lisa Zamosky

Married couples are rarely the exact same age. A few years between you and your spouse may not make much of a difference in your day-to-day life, but it can matter plenty when the older spouse becomes eligible for Medicare (you need to be 65), is ready to retire, and happens to be the one whose job provides health insurance for the couple.

This scenario is quite common. So, what’s the younger spouse – who may be years away from being Medicare eligible – to do? Here are four options for continuing health insurance coverage when your spouse is eligible for Medicare but you’re not:

Go to work – It’s common for two spouses who both work for employers that offer insurance to be covered by just one of the plans. As your wife or husband retires, think about taking on your own employer’s insurance. Although you may be between open enrollment periods, the loss of coverage will count as a qualifying event and allow you to enroll in your employer’s plan at any point during the year. This is likely your safest and least expensive option, if it’s available to you.

COBRA coverage – As long as the employer with which you have health insurance has at least 20 employees you can continue with the same health plan you’ve had for another 18 months after your working spouse leaves his or her job with COBRA continuation coverage. Just be aware that you’re likely to face sticker shock: You’ll be on the hook for the full cost of the plan (the part you pay in addition to what your employer pays) plus a 2% administrative fee.

HIPAA policies – If once the 18 months of COBRA runs out you’re still not old enough for Medicare, the Health Insurance Portability and Accountability Act (HIPAA) guarantees you an insurance policy on the individual market. The rules about the type of coverage that must be made available to people who exhaust their COBRA benefits vary by state. You can check with your department of insurance to learn the details where you live.

Insurance exchanges – The health reform law put in place the requirement that all states have an insurance exchange – a marketplace where people can shop for, compare, and buy health insurance starting in 2014. Anyone who applies for coverage after January 1, 2014 cannot be denied a health plan. It’s also possible that you’ll be eligible for financial assistance from the federal government depending on your income. This option is largely dependent on the outcome of the Supreme Court’s decision later this month about the fate of the health reform law.

Tell your story: What health insurance issues have you and your spouse faced? Sound off in the comments section, or ask a question and check back for a response.