Medicare and Divorce: Knowing Your Rights

Your marital status doesn’t affect your right to receive health insurance through Medicare. However, your spouse’s earnings can affect how much you pay for your benefits. Specifically, even married seniors who’ve never worked may qualify for premium-free Medicare Part A based on their spouse’s work history.

Furthermore, this coverage rule may also apply to divorced individuals who meet certain criteria. If you think you may qualify for premium-free Part A benefits based on a former spouse’s wages, here’s what you should know about Medicare and divorce.

Who Qualifies for Medicare?

U.S. seniors typically qualify for healthcare benefits through Medicare when they turn 65. However, younger individuals, including children, may be eligible for coverage if they’ve been diagnosed with amyotrophic lateral sclerosis, end-stage renal disease or a qualifying disability.

Can My Spouse Qualify for Medicare When I Turn 65?

No. For an individual to qualify for healthcare coverage through Medicare, they must be 65 or be diagnosed with certain qualifying conditions. The age of their spouse is irrelevant.

Who Qualifies for Premium-Free Part A Benefits?

Although all U.S. seniors qualify for Medicare at the age of 65, some individuals may be eligible to receive Part A benefits at no cost. Part A plans, which are considered Medicare's hospitalization component, provide coverage for hospital stays and other inpatient services. You may qualify for premium-free Part A coverage if you’re 65 or older and meet one or more of the following conditions:

• You paid Medicare taxes for 10 years or more.
• You currently receive Social Security or Railroad Retirement benefits.
• You’re eligible to receive benefits through the SSA or Railroad Retirement Board but haven’t filed yet.
• You worked in a Medicare-qualified government position.

If you’re under the age of 65, you may be eligible for premium-free Part A benefits if you’ve been diagnosed with end-stage renal disease or if you’ve been receiving disability benefits through Social Security or the Railroad Retirement Board for at least 24 months. Individuals who’ve been diagnosed with Lou Gehrig's disease may be entitled to premium-free Medicare Part A coverage the first month they receive disability benefits.

Can You Qualify for Premium-Free Part A Through a Spouse?

Yes. To receive premium-free benefits through marriage, you must have been married for at least 1 year and your spouse must be at least 62 years old. Your spouse must also meet one or more of the following conditions:

• Paid Medicare taxes for 10 years or more
• Worked in a Medicare-covered government position
• Qualifies for Social Security retirement or disability benefits.

If you don’t meet eligibility requirements for premium-free Part A through your own work history and your spouse hasn’t yet reached the age of 62, you must continue to pay the full Part A premium until your spouse turns 62. 

Can You Qualify for Premium-Free Medicare After Divorce?

You may qualify for premium-free Part A benefits through an ex-spouse if they’re eligible for Social Security disability or retirement benefits and/or if they paid Medicare taxes for at least 40 quarters (10 years). To be eligible for Medicare after divorce, the marriage must have lasted at least 10 years and you must be currently unmarried. 

If your spouse paid Medicare taxes for fewer than 40 quarters, you may be eligible for a reduced Part A premium.

Can You Qualify for Medicare If You Lose Private Healthcare Coverage During a Divorce?

Yes. If you're 65 or over and lose your private healthcare coverage due to a divorce, you'll qualify for a special enrollment period through Medicare. During this time period, you may sign up for Medicare Parts A, B and/or D, or opt for a Medicare Advantage plan, which offers Medicare coverage that's administered through a private insurance company. 

If your former spouse was eligible for premium-free Part A benefits, you may qualify to enroll in the plan at no cost if you were married for at least 10 years prior to the official date of divorce. 

Can You Qualify for Premium-Free Medicare Part A If Your Spouse Dies?

Yes. If you’re currently single and were married for at least 9 months prior to the death of your spouse, you may qualify for premium-free Medicare Part A based on their wages.

Do Multiple Marriages and Divorces Affect Eligibility for Premium-Free Part A?

Medicare eligibility can only be based on criteria relating to one ex-spouse. However, your current marriage status, the length of prior marriages and whether your former spouse is still alive may affect your eligibility. Because situations involving multiple marriages and divorces may be complicated, it's often helpful to contact the Social Security Administration for information and guidance.  

What Out-of-Pocket Costs Will I Incur If I Qualify for Premium-Free Medicare Part A?

Beneficiaries who qualify for a premium-free Part A policy must still pay Part B and/or Part D premiums if they opt to enroll in Medicare’s general medical coverage and/or prescription drug plans. Participants are also responsible for meeting the program’s annual deductibles. After this deductible has been met, copays and/or coinsurance may apply when receiving covered services.

Where Can You Learn More About the Rules Governing Medicare and Divorce?

The rules governing Medicare and divorce can be complex and difficult to navigate. To better understand how a spouse's or former spouse’s eligibility affects your Medicare costs, you can call or visit the Social Security Administration. Railroad workers and their former spouses should reach out to the Railroad Retirement Board for relevant information. Local offices may be found by searching the organization’s field office locator tool.