Yes, you can have a Marketplace plan while your husband is on Medicare
Your husband's Medicare enrollment does not prevent you from buying a health plan through the Affordable Care Act Marketplace. You and your husband can be on completely different insurance — he on Medicare, you on a Marketplace plan — and there is no rule against it. The two systems run separately, and your household income counts toward both his Medicare costs and your Marketplace plan costs, but each of you chooses your own coverage.
The main thing to understand is that once your husband turned 65 and enrolled in Medicare, his coverage became his responsibility. Your coverage is separate. If you are not yet 65, you will need your own plan, and the Marketplace is one place to look for it.
Key Takeaways
- You can enroll in a Marketplace plan even though your husband has Medicare; the two types of insurance work independently.
- Your household income (including your husband's) is used to calculate any Marketplace subsidies you may receive, but his Medicare enrollment does not affect your may be able to access.
- If you are under 65, you cannot join Medicare yourself, so a Marketplace plan, employer coverage, or private insurance are your main options.
- You must enroll during the annual Open Enrollment Period (usually November 1 to January 15) unless you have a may have access to life event such as marriage, divorce, or loss of coverage.
- Your husband's Medicare does not count as health coverage for you, so going without your own plan can result in a coverage gap and higher costs later.
How your household income affects both of your plans
When you explore for a Marketplace plan, you report your household income. That income includes your husband's Social Security, any pensions, wages, and other earnings — even though he is on Medicare. The Marketplace uses this total household income to figure out whether you may have access to for a subsidy (a tax credit that lowers your monthly premium).
Your husband's Medicare premiums are also based on household income. If your combined income is above a certain threshold, he may pay higher premiums for Medicare Part B and Part D. So the same income figure affects both of your plans, but in different ways. You are not competing for the same money — you are each getting coverage based on the same financial picture.
If your income is low enough, you may receive a substantial subsidy on your Marketplace plan. Your husband's Medicare premiums are set by federal rules and do not change based on subsidies you receive.
When you can enroll in a Marketplace plan
The annual Open Enrollment Period runs from November 1 to January 15 each year. During this window, you can enroll in any Marketplace plan in your state without needing a reason. If you miss this important date, you can still enroll if you have a may have access to life event — a major change in your circumstances.
may have access to events include losing employer coverage, getting married, getting divorced, having a baby, moving to a new state, or experiencing a significant drop in income. If any of these explore to you, you have 60 days from the date of the event to enroll. You will need to provide proof — a termination letter from your employer, a divorce decree, a birth certificate, or a tax return showing the income change.
If you do not enroll during Open Enrollment and do not have a may have access to event, you will have to wait until the next Open Enrollment Period. Going without coverage in the meantime can be costly if you need medical care.
What to expect when you compare Marketplace plans
When you shop on Healthcare.gov (or your state's Marketplace if it runs its own), you will see plans at four metal levels: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premiums but higher deductibles. Platinum plans have higher premiums but lower out-of-pocket costs when you use care. Silver plans often offer the best value if you may have access to for a subsidy.
Each plan shows you the monthly premium, the deductible (the amount you pay before the plan starts sharing costs), and the out-of-pocket maximum (the most you will pay in a year). You can filter by doctor, hospital, or prescription drug to see which plans include the providers and medications you use.
If you are under 30, you can also choose a Catastrophic plan, which has an even lower premium but covers almost nothing until you hit a very high deductible. Catastrophic plans are meant for people who rarely use medical care and want protection against a major illness or injury.
How your subsidy works when your husband is on Medicare
If your household income is between 100% and 400% of the federal poverty level, you may receive a subsidy that reduces your monthly premium. The subsidy is based on your household size and income — and your household includes your husband, even though he is on Medicare and not buying a Marketplace plan.
The subsidy is paid directly to your insurance company each month, so your actual premium is lower than the listed price. If your income changes during the year — for example, if your husband's Social Security increases or one of you loses a job — you can update your information on the Marketplace and your subsidy will adjust.
Be honest about your expected income for the coming year. If you overestimate and receive too much subsidy, you will have to pay some of it back when you file your taxes. If you underestimate, you may miss out on money you are may have access to to.
What happens if you do not have coverage
If you are under 65 and not enrolled in any health plan, you are uninsured. Your husband's Medicare does not cover you. If you need medical care without insurance, you will pay the full cost out of pocket — which can be thousands of dollars for a hospital stay, surgery, or ongoing treatment.
Some people assume that being married to someone on Medicare means they are covered. That is not true. Medicare is individual coverage; it covers only the person whose name is on the card. You need your own plan.
If you go without coverage for more than a few months, you may also face a gap in your coverage history. When you do enroll later, you may have a waiting period before certain benefits kick in, or you may pay higher premiums if you move to private insurance outside the Marketplace.
Other coverage options besides the Marketplace
The Marketplace is not your only choice. If you have access to employer health insurance through your own job, that is usually a good option — especially if your employer contributes to the premium. Employer plans often have lower out-of-pocket costs than Marketplace plans.
If you are not working and do not have employer coverage, you can also buy a private health insurance plan directly from an insurance company, though these plans are usually more expensive than Marketplace plans and do not include subsidies. Some people in this situation choose a Marketplace plan because the subsidy makes it more affordable.
If your income is very low, you may also be may be able to access for Medicaid in your state. Medicaid rules vary widely by state, but some states cover adults under 65 with little or no income. You can check your state's Medicaid program through Healthcare.gov or your state health department.
Frequently Asked Questions
Can I stay on my husband's Medicare if we get married?
No. Medicare is individual coverage and does not extend to spouses. When you marry someone on Medicare, you do not automatically gain coverage. You need to enroll in your own plan through the Marketplace, your employer, or another source. Getting married is a may have access to life event, so you have 60 days to enroll.
What if my husband's Medicare costs go up because of our household income?
Your household income can increase your husband's Medicare Part B and Part D premiums if it exceeds certain thresholds. This is separate from your Marketplace subsidy. You cannot avoid this by not enrolling in a Marketplace plan — the income counts either way. Enrolling in a subsidized Marketplace plan does not make his premiums higher.
Do I need to enroll in Medicare when I turn 65?
Yes. When you turn 65, you become may be able to access for Medicare. You should enroll during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after. If you delay, you may pay higher premiums for the rest of your life. At that point, your Marketplace plan will end and Medicare becomes your primary coverage.
What if I lose my job and my employer coverage ends?
Losing employer coverage is a may have access to life event. You have 60 days from the date your coverage ends to enroll in a Marketplace plan. You will need a letter from your employer showing the date your coverage ended. If you enroll within 60 days, there is no gap in coverage.
Can my husband and I be on the same Marketplace plan?
No. Once your husband enrolled in Medicare, he cannot enroll in a Marketplace plan. Marketplace plans are for people under 65 who are not on Medicare. Your husband must stay on Medicare, and you must have your own separate plan.