Can I get a spousal benefit through Social Security and my spouse's quarters to qualify for Medicare?

Yes, to qualify for Medicare, you need to have paid into Social Security for 10 years or 40 quarters, or you can qualify under your spouse’s record of quarters paid to Social Security. Many times, in this scenario the spouse is/will be taking Social Security as well as Medicare through the other spouse.

The important difference between taking Social Security and taking Medicare through a spouse, is that you must be 65 to qualify for the Medicare portion of benefits through your spouse. I only note this because taking Social Security through a spouse can take place before turning 65. In this situation, the timing of the Medicare benefit for the younger spouse can be mistaken as active when one spouse is over 65 and the other is under 65, yet taking Social Security benefits through the older Medicare eligible spouse. This isn’t a common mistake, but just a reminder.

Typically, the younger spouse may start taking a portion of the older spouse’s Social Security benefit (allowing their benefit to grow to a certain point) At a later time, they may choose to elect to start their own Social Security benefit separately from their spouse. Timing the Social Security benefit and Medicare are separate enrollments, but many times this can overlap and seem complicated when enrolling in Medicare and changing Social Security benefits at the same time.

If you have been taking benefits through a spouse (delaying your own benefit) and decide to elect to start your own Social Security benefit at a later date (ie. your SS benefit has been building on the side for you as you have been delaying it), remember to update Medicare and your Medicare insurance plans because it’s likely your Medicare ID# will be updated under your own benefit (you’ll get a new Medicare card). Medicare coverage should not be affected. Rather, just a new Medicare ID# to run your own medical billing through the same product you’re currently covered under.

For more Social Security planning guidance, please refer to the Social Security 101 tab at the top of the home page or contact my office for one on one advice with John to talk through when its best for you to take your Social Security benefit.

Are you working until 65, delaying your Social Security, and plan to enroll in Medicare at 65?

This scenario is similar to the one above, but in this situation, you are currently working and covered under your employer group plan until the last day of the month you leave your group plan (or spouse’s) and retire. You are planning to retire the month prior to your 65th birthday and looking to time your Medicare start date the day after your employer health plan benefits end (last day of the month). Maybe you chose to work up to this date because you know the cost of insurance plans in your early 60’s are extremely expensive as an individual and you are timing your retirement to coincide with Medicare your 65th birthday IEP Medicare start date.

In this scenario, you are delaying your Social Security benefit. Therefore, you will need to proactively enroll into Medicare (Part A & B) for coverage to start the 1st of the month you turn 65. It is best to do this 1-3 months before your 65th birthday month (The Part B Initial Enrollment Period starts 3 months before your 65th birthday). Most clients apply in the 1-3 month window prior to their birthday (plan ahead if possible). You can enroll online or in person with the Social Security office (pending appointment availability). We are available to help you through the enrollment process if you have questions at this stage in the process. Once enrolled online or in-person, always print a receipt of your enrollment date, write down and/or print the confirmation number from the Social Security.

Since you are delaying your Social Security benefit, there is no monthly Social Security benefit check for the Part B premium to be withdrawn from, right? For this reason, you’ll be receiving a quarterly Part B bill. You will need to continue paying this bill to keep you Medicare Part B active until you elect to start your Social Security benefit and it’s automatically withdrawn. You will have the option to pay through a monthly checking account auto draft or monthly credit card. You’ll need to wait until you receive the quarterly bill to set up these other payment options. The standard Part B premium for 2022 is $170.10 (more if subject to IRMAA). Part A is again, “premium free” if you have fulfilled the minimum requirement of 10 years (40 quarters).

Once you elect to start your Social Security benefit at a later time (ie. 66-70), the Part B premium will then be withdrawn automatically each month (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security benefit draft into your checking acct.)

I chose to show this example because many times the SEP forms for Medicare enrollment for someone leaving an employer group plan AFTER the age of 65 can be mistakenly used in conjunction with IEP or in place of IEP (Initial Enrollment Period) 3 months prior to turning 65.

IEP will take precedent over the SEP forms in this situation. To be clear, you do not want to use the SEP (leaving an employer group plan) enrollment unless you are outside the IEP period surrounding your 65th birthday. With that being said, for this example, he/she is enrolling prior to turning 65, yet still leaving an employer group plan. So, use the standard IEP enrollment period and proactively enroll directly with Social Security in-person or online for your Medicare (Part A & B) to begin on the 1st of your 65th birthday month. See SEP situation in the next example if you are curious how that works when enrolling in Medicare AFTER turning 65 and leaving an employer group plan outside your IEP.

Mentor One Insight

Diane is approaching her 65th birthday –August 19th, 2022. Diane has been anticipating her retirement date since last year at 64, but after viewing the cost of medical insurance through the employer COBRA option or going on her own with an individual plan costing her approx. $1000 a month, this wasn’t an option for her. She decided to work another year with her current employer and plans to retire in July- the month before she turns 65. Since she is currently covered under her employer plan, she knows that if she retires the month prior to turning 65 (on the 10th of July and her 65th bday is August 19th), her Medicare coverage starts 08/01/2022. If she leaves the employer plan on the 10th of July, she will have coverage through the end of the month through the employer plan. She will have no lapse in coverage.

The day the employer plans ends, is the same day her Medicare activates as her primary coverage (08/01/2022). Diane is delaying her Social Security and plans to take it at a later date (ie.66-70). She is focused on Medicare timing at this time and can elect to start her Social Security at any point she sees fit in the future. Electing to start her Social Security benefit will not have an effect on her Medicare. It will only effect how her Medicare Part B premium is paid to Social Security (quarterly if delaying/monthly withdraw if taking the benefit).

Three months before Diane’s 65th birthday month of August, Diane should proactively enroll herself into Medicare during her IEP (Initial Enrollment Period). Again, she is proactively enrolling in Medicare in-person or online because she has chosen to delay her Social Security benefit at this time. Once she has met with Social Security or confirmed her effective date/start date by enrolling in Medicare online, she is set to start her Medicare coverage – effective 08/01/2022.

Now that Diane completed the first enrollment of coordinating her Medicare properly, she can comfortably continue reviewing the second enrollment process of reviewing Medicare plan paths and the insurance products to find the plan that best suits her coverage needs. After reviewing Medicare Basics 101 and the following steps of the process (5 Steps), Diane can now confidently contact John in May, June, or July to confirm her understanding of insurance products on her Medicare plan path as well as ask for quotes, pricing, and enrollment paperwork to start the enrollment process for the insurance products. Diane’s Medicare and Medicare insurance product(s) will all start 08/01/2022. Diane timed her retirement perfectly from leaving an employer group plan and transitioning to Medicare with no lapse in coverage.

Are you delaying your Social Security benefit and plan to enroll in Medicare when you turn 65?

You will need to proactively enroll into Medicare (Part A & B) for coverage to start the 1st of the month you turn 65. It is best to do this 3 months before your 65th birthday month (The Part B Initial Enrollment Period starts 3 months before your 65th birthday). Most clients apply in this 1-3 month window prior to their birthday (plan ahead if possible).You are able to enroll up to the day prior to your 65th birthday month (ie. March, 31st– for an April 1 start date when 65th birthday is in April). If you apply the month of or just weeks prior to your 65th birthday month, you may not have your card in hand, but you will be covered- effective as of the 1st of your 65th birthday month. You can enroll online or in person with the Social Security office (pending appointment availability). We are available to help you through the enrollment process if you have questions. Always print a receipt of your enrollment date, write down and/or print the confirmation number from the Social Security website if enrolling online.

Since you are delaying your Social Security benefit, there is no monthly Social Security benefit for the Part B premium to be drafted from, right? With no Social Security benefit for you to withdraw your Part B, you will be receiving a direct bill in the mail. This bill will likely be quarterly, which you’ll need to continue paying to keep you Medicare active until you elect to start taking your Social Security benefit. The Part B premium will then be automatically withdrawn.

Referring back to the quarterly Part B bill, you will have the option to pay through a monthly checking account, auto draft, or monthly credit card on the quarterly statements if you choose. You’ll need to wait until you receive the quarterly bill to set up these alternative payment options. The standard Part B premium for 2022 is 170.10 (more if subject to IRMAA). And as with all Medicare beneficiaries that worked for 10 years or 40 quarters and paid into Social Security, Part A is again, “premium free” to you.

Once you elect to start your Social Security benefit at a later time since you are delaying it at this time, the Part B premium will then be automatically withdrawn each month (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security draft into your account). Once this is set up, you should never have to update it.

Mentor One Insight

Mark is currently retired. He works part time as a consultant, but continues to be covered through his spouse’s employer group health plan until he turns 65. He turns 65 on April 7th of 2022, so he wants his Medicare to start on the 1st of his 65th birthday month- 04/01/2022. Mark has savings and other forms of income through investments as well as his spouse’s income which is allowing him to delay his Social Security benefit to a later date. He has not decided exactly when he’ll take his benefit (he’s planning on a date between 66 and 70). For now, he is focused on only starting Medicare. Let’s assume it is early January, 2022 in this example.

Mark will need to proactively enroll in Medicare for his Medicare to activate 04/01/2022. His Initial Enrollment Period for Part B (IEP) begins on January 1 of 2022 (3 months prior to his 65th birthday month). He can call Social Security to schedule an in-person appointment or can go online to SSA.gov to proactively enroll in Medicare prior to his desired April 1 start date. Mark and his wife show less income on their IRMAA than $182,000 so he will be paying the standard $170.10 per month for his Part B premium. He also fulfills the requirement for Part A after working for 45+ years. Therefore, Mark’s Part A is “premium free”. Since he has chosen to delay his Social Security benefit, there is not a monthly Social Security benefit to withdraw the $170.10 Part B premium. He will be mailed a Part B bill for $510.30 (quarterly). He can elect to pay this through his credit card or checking account auto draft as soon as he receives the quarterly statement and coordinates the payment option he prefers. Mark will likely receive this quarterly bill along with his Medicare card 2-4 weeks after coordinating his Medicare with Social Security for his 04/01/2022 start date.

Now that Mark has completed the first enrollment into Medicare (Part A & B) effective 04/01/2022, he can now move to the second enrollment and start reviewing Medicare Basics 101 to begin researching the “Parts” and Medicare plan paths and Medicare insurance products. Mark has a good idea of which “Plan Path” he prefers for his Medicare coverage. Mark scheduled an appointment in late January/early February to review his plan with John and to start the paperwork for completing applications for insurance products to start along with his Medicare on 04/01/2022.

Are you actively taking your Social Security benefit and plan to enroll in Medicare when you turn 65?

You will be automatically enrolled in Medicare (Part A and B) qualifying by paying into Social Security for 10 years or 40 quarters. Your card will be mailed to you and it will indicate your Medicare coverage to begin on the 1st day of your 65th birthday month (ie. Birthday, March 21st– Medicare starts March 1, 2022). The card will typically be sent 3-4 months prior to your 65th birthday month. Assuming you’ve paid into Social Security for 40 quarters (or you qualify through your spouse), Part A is premium free to you (you were taxed!) Medicare Part B has a separate premium. The standard premium for 2022 is $170.10 (subject to change annually). The Part B premium will be automatically deducted from your Social Security benefit since you’ve already elected to start your Social Security benefit prior to your Medicare start date (you have a benefit amount established to deduct the $170.10 from monthly).

If you happen to set up your Medicare at the same time you elected to start your Social Security benefit (simultaneously at 65), the Part B premium may be deducted as an automatic monthly draft (if set up in time for Social Security billing), or it may be billed to you as a quarterly statement until the payment deduction is processed. Review your Social Security benefits statement to confirm the Part B premium draft ($170.10 or more if subject to IRMAA). Call your local Social Security office to confirm payment information or to coordinate the transition of the Part B premium payment. Once you’ve completed this enrollment, you can transition to planning out your second enrollment of choosing your Medicare insurance product(s) for that path.

Mentor One Insight

Roberta has been retired for a couple years and has been covered with an individual health plan until she is Medicare eligible. She is planning to transition to Medicare the month of her 65th birthday (when she is first eligible). She has already elected to start her Social Security benefit early at 62. Her birthday is February, 18 and wants to be sure her Medicare starts on the 1st of February (first possible day for her Medicare to begin). Let’s assume it’s the first week of November, 2021 in this example (3 months before her 65th birthday month).

Roberta will be automatically enrolled in Medicare since she is actively taking her Social Security benefit. She will get her Medicare card approximately 2–3 months prior to February. Since her Social Security benefit is already active, her Part B premium will be automatically deducted from her check each month starting in February of 2022. Her Part B premium will be the standard $170.10 and her Part A is “premium free” since she worked well over the 10 years to qualify. Her Part A and Part B effective dates on her Medicare card will both be 02/01/2022. She does not need to worry about the Part B Initial Enrollment Period (3 months before, the month of 65th bday, and 3 months after) for Medicare enrollment. Remember, Social Security automatically enrolled her using Roberta’s IEP and mailed her card directly to her. Roberta then can move on to the next step of enrollment into a Medicare insurance product of her choice.

Roberta reviewed Medicare Basics 101 under the navigation bar and continued making her way through the 5 Step Medicare Enrollment Guide to find the Medicare plan path and insurance product that will give her the coverage that suits her healthcare needs. Roberta filled out the Help/Quote Request Form on the website in late November/early December. She now has an appointment scheduled to discuss plans and enroll into Medicare insurance products with John to get everything set up for her 02/01/2022 start date.

Medicare Supplement vs. Medicare Advantage Plans?

At this point, you should have a decent grasp of Medicare Basics 101 and your path to a successful Medicare Enrollment with Social Security. Hopefully, you are planning ahead of your Medicare start date, as its best to give yourself plenty of time to get organized. At this point in the process, you may or may not have confirmation of your Medicare Part A & Part B effective dates. If you do, great. If your Medicare card is on its way, you should have confirmation of dates (online or in-person with SS office), which is just as good. If you’re still in the process of getting the enrollment process started (or planning it out), you’re still on the right track!

Choosing between these two plan types will be the DECIDING FACTOR which will dictate how your Medicare will function. Try not to think about the insurance carriers yet– once you have a plan type in mind, we can then dig deeper to shop which carriers are offering what plans to find the best value for you.

Choose your Plan Path:

Medicare (Part A & B) + Medicare Supplement + Part D Prescription Drug Plan

Medicare Advantage Plan w/ Part D Prescription Drug Plan Included (MAPD)

Keep in mind– as long as we get you enrolled in a Medicare Supplement + Part D Rx plan or a Medicare Advantage plan w/ a Part D Rx plan before your Medicare start date, either style of a Medicare insurance plan will be effective the 1st of the month you’re eligible to begin Yes, even if you were to enroll in a plan the day before your start date, although I don’t recommend waiting until the last minute. I only say this so if you’re being told to enroll months ahead by another agent/broker pressuring you, they’re full of it!

Which Medicare plan type/design do you prefer? If you’ve made your decision, but still want to confirm with me over the phone to make sure you prefer that plan for the right reasons, I can do that for you. If you’ve gone through the plan types and are still unsure, and would like me to guide you through it step by step while you follow on your computer, then let’s do that. Contact my office to schedule a phone appointment and I’ll review anything you have questions about. In fact, talking briefly over the phone typically allows me to clarify questions in matter of minutes rather than both of us writing lengthly emails back and forth. A brief chat will also give you the opportunity to put a voice to your guide. You can then decide if you would like me to help assist you with plan selection as your Medicare insurance broker. I look forward to helping you through the insurance plan selection process.

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5 Step Enrollment Guide Introduction

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Can I get a spousal benefit through Social Security and my spouse's quarters to qualify for Medicare?

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Mentor One Insight

Are you working until 65, delaying your Social Security, and plan to enroll in Medicare at 65?

Mentor One Insight

Are you delaying your Social Security benefit and plan to enroll in Medicare when you turn 65?

Mentor One Insight

Are you actively taking your Social Security benefit and plan to enroll in Medicare when you turn 65?

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Medicare Supplement vs. Medicare Advantage Plans?

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Medicare Basics 101

Medicare Plan Map View how "Parts" interact with each Medicare plan path (two paths)

Original Medicare (Part A & B) The foundation of Medicare. Keep (w/ Medicare Supplement) or Sign Over (w/ Medicare Advantage).

Medicare Supplement Plans (Medigap) View the structure & functionality of the plan. (Keep Original Medicare Add Medicare Supplement).

Medicare Advantage Plans (Part C) View the structure & functionality of the plan. Sign Over to its own "Medicare Plan".

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2060 Talbert Dr. | Suite 140
Chico, Ca 95928
(530) 433-5775

915 Highland Pointe Dr. | Suite 250
Roseville, Ca 95678
(916) 619-6553

333 University Ave. | Suite 200
Sacramento, Ca 95835
(916) 619-6553

Side-by-side comparison of Medicare Advantage Plans
(Medicare.gov - 95747, Placer, CA)

Delaying your SS benefit & starting Medicare at 65
(ie. April Bday)

Actively taking Social Security & starting Medicare at 65
(ie. February birthday)