Medicare Essentials for Stay-at-Home Women

Women who have short work histories or are losing a retiring spouse’s healthcare coverage should consider these options.

By Diane Omdahl
Diane Omdahl
Diane Omdahl

With more than 30 years of experience helping people navigate Medicare, I know retirement requires careful consideration of healthcare coverage, especially for women. In this article, we will explore the challenges faced by women without long work histories and how they can navigate Medicare to ensure comprehensive healthcare coverage during retirement.

Generally, anyone aged 65 and older is eligible to enroll in Medicare. However, to qualify for premium-free Medicare Part A, both men and women must have worked and paid taxes for at least 10 years, which is equivalent to earning 40 credits.

Some women may not have worked long enough to earn the 40 credits on their own. That’s where marital status comes into play. A woman (or man) may be able to qualify based on the work history of a spouse who has earned 40 credits and is 62 years or older. There are specific requirements for those in each situation.

  • If married for at least one year: You may qualify based on your current spouse’s employment record.
  • If divorced: You may be eligible if your previous marriage lasted at least 10 years and you are currently single.
  • If widowed: You must have been married for at least nine months and currently be single.

Don’t delay

If a woman doesn’t qualify for premium-free Part A, she can purchase it and must also enroll in and pay for Part B. She must do this when first eligible at age 65 or there is a penalty. Once enrolled In Parts A and B, she can choose additional Medicare coverage options that include Medicare supplement insurance plans (also known as Medigap), Part D prescription drug plans, or Medicare Advantage plans.

It’s important to note that a woman cannot qualify for Medicare based on the work history of a domestic partner. However, Medicare does recognize same-sex marriages. The eligibility of civil unions depends on the state, and fewer states are currently recognizing them. It is advisable to consult the state insurance commissioner or relevant authorities for more information on civil union eligibility.

When a spouse retires at 65

Women who have been insured under their older spouse’s plan are faced with a dilemma where their spouse turns 65 and retires. It’s important to consider what kind of new healthcare coverage would be most suitable. Several factors come into play, including the woman’s age, how long until she turns 65, her health status, and the available options.

One option to consider is COBRA continuation coverage. Spouses can qualify for up to 36 months of COBRA coverage if the working spouse is enrolling in Medicare. However, COBRA can be quite costly, as the individual is responsible for the entire premium. The affordability of COBRA may depend on the woman’s age and health status. It’s essential to carefully evaluate the costs and benefits of COBRA coverage in relation to personal circumstances.

Another option to explore is the Healthcare Insurance Marketplace. The Affordable Care Act has eliminated pre-existing conditions as a barrier for new enrollees in the individual market and some other situations. This means that pre-existing conditions would not impact coverage options if a person decides to continue with COBRA. It may be wise to consider the Healthcare Insurance Marketplace for more cost-effective alternatives to COBRA.

When it comes to shopping for a plan in the marketplace, it’s advisable to check the state’s website for relevant information and resources. Start investigating and exploring options as soon as it becomes evident that new coverage will be necessary. This proactive approach allows for sufficient time to evaluate different plans, understand their benefits and costs, and make an informed decision that aligns with specific needs and circumstances.

Optimizing health and coverage

Regardless of your client’s work history, it’s important to focus on key considerations to ensure a smooth transition to Medicare. Here are some specific steps you can tell your clients to take to prepare:

  1. Establish or update financial and medical powers of attorney. These legal documents grant authority to trusted individuals who can make healthcare and financial decisions on your behalf. Review and update these documents as necessary to ensure they accurately reflect your wishes.
  2. Create a My Social Security account. Setting up an account allows you to access and manage your Social Security information online. Take the time to create an account and verify that your personal details are current and accurate.
  3. Confirm your eligibility for Medicare. Visit the official Medicare website (www.medicare.gov/eligibilitypremiumcalc). This will help you understand if you meet the requirements and if you’re eligible for premium-free Part A or need to pay for it.
  4. Determine your Initial Enrollment Period. This is a specific timeframe during which you can enroll in Medicare without incurring penalties. It’s important to know when this period occurs for you so that you can make informed decisions about your Medicare coverage. Missing the enrollment deadline may result in higher premiums, so it’s crucial to stay aware of this timeframe.

In an upcoming article for Rethinking65, I will help working women navigate their Medicare and employer insurance options and explain what to expect when transitioning to Medicare. I will also discuss how Medicare can address women’s specific healthcare needs during retirement. It is important to remember that all women must be as equally informed and involved in retirement planning as men to prepare for a successful financial future.

Diane Omdahl, a registered nurse, has been a trailblazer in the Medicare industry for over 30 years. She started her first company in the basement of her home and developed it into a multi-million-dollar organization providing Medicare-related training and tools for home health agencies and long-term care facilities. Diane now operates 65 Incorporated and i65, providing unbiased and expert Medicare enrollment guidance to seniors, their families and professional advisors. She recently published Medicare For You: A Smart Person’s Guide.

 

 

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