Obamacare: one spouse on Medicare, one not

I have a plan with my current employer. My wife will not be covered if I go onto Medicare. Can I do ACA for Medicare?  Will my wife be eligible for ACA once I go on to Medicare?  Should I use my current plan as a primary with Medicare as my secondary, or vice versa?

Buckeye State Hubby

 Dear Buckeye State Hubby,

Since you ask about which plan will be primary or secondary, I’m guessing that you plan to keep working.  If so, there is no reason that your wife would need to change her plan.   Your employer cannot legally change her eligibility based upon your enrolling (or not) in Medicare.

If you plan to retire, then she would indeed lose access to the group-based plan (assuming she does not have a job with benefits.)  At that point, she might be eligible for subsidies to buy her health insurance.  The subsidies would be based upon your household income.

You would not use subsidies to purchase your Medicare Part B or Part D plans.  The subsidies are only for private individual health insurance plans.

As for which plan is primary or secondary when you have an employer plan and Medicare, there are complex rules for this.  You don’t make a choice on this; it’s made for you.  If your employer has fewer than 20 employees, then Medicare pays first and your group plan pays second.  For larger employers, Medicare pays second.  For all of the details, see this Fact Sheet.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.