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Does Medicare Cover My Spouse if I Get a Medicare Advantage Plan?

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If you’ve chosen Medicare Advantage for your Medicare coverage, you may be wondering if your spouse can enroll in the same plan when he or she becomes eligible.

Or, maybe your spouse became eligible for Medicare first, and signed up for a Medicare Advantage plan. Should you get the same plan as your spouse? Will that save you money?

First, be aware that under traditional Medicare, Part A and Part B, you and your spouse might be enrolled automatically. It’s also possible one or both of you has to sign up for Medicare, but you have to do so separately. Under Part A and Part B, you and your spouse won’t share the same coverage – your Medicare coverage is yours alone.

Medicare Advantage: a quick overview

Medicare Advantage, as you may know, is also called Medicare Part C. Through this program, you can get your traditional Medicare (Part A and Part B) benefits from a private, Medicare-approved insurance company. There are several different types of Medicare Advantage plans, although they might not all be available in your area.

Many Medicare Advantage plans offer benefits beyond those of traditional Medicare. For example, most Medicare Advantage plans include prescription drug coverage. Some plans include routine vision and/or dental care, or other benefits that traditional Medicare doesn’t generally cover.

You must be enrolled in Medicare Part A and Part B to sign up for a Medicare Advantage plan. You must keep paying your Part B premium. You’re still in the Medicare program when you have a Medicare Advantage plan.

Medicare Advantage: what about my spouse?

Medicare Advantage plans don’t cover both you and your spouse together under one policy. Just as Medicare Part A and Part B cover each Medicare beneficiary separately, you can’t share a Medicare Advantage plan with your spouse.

Certainly, there’s nothing to prevent you from signing up for the same Medicare Advantage plan as your spouse, in the sense of enrolling in a plan of the same type from the same insurance company.

For example, suppose your wife qualifies for Medicare before you do. Let’s say she enrolls in Medicare Advantage Plan X from XYZ Health Insurance Company. If your wife is happy with this plan, you might be interested in signing up for Plan X when you’re eligible for Medicare. But you won’t have the same policy. When your wife signs up, for example, her plan can’t include you. In this way, it’s different from the way group health insurance often works.

Should I get the same Medicare Advantage plan as my spouse?

Although it may be tempting to sign up for the same Medicare Advantage plan as your spouse, you’re two different people. You might have different health needs or preferences. For example, say your spouse signed up for a Medicare Advantage Health Maintenance Organization (HMO) plan. Perhaps your spouse is fairly healthy, and the plan might have a low premium – even a $0 premium.

But suppose you have a couple of health problems, and you need to see specialists. Maybe you have specialists you’ve seen for some time, and you want to continue seeing them. In that case, you might want to consider getting a Medicare Advantage Preferred Provider Organization (PPO) plan, which may let you continue to see your specialists even if they’re not in the plan network.

Your plan might charge you more to see out-of-network specialists and other providers – and these doctors must accept Medicare assignment if you want coverage for your doctor visits. Compare Medicare Advantage plans, and what each one offers, to see what works best for you. To get started with no obligations, you can type your zip code in the box on this page.

Should I sign up for Medicare Advantage just because my spouse has it?

Again, you and your spouse are two different people, and there’s no one type of Medicare coverage that suits everyone’s needs perfectly.

In fact, if you have health problems and need to see your doctor frequently, you might want to consider buying a Medicare Supplement plan instead of Medicare Advantage. A Medicare Supplement plan may cover your copayments, deductibles, and coinsurance. Read more about Medicare Supplement insurance plans.

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