You already know you can depend on your spouse, but can you rely on their private healthcare plan to be there for you? If your spouse is still working, you might be confused about your needs as you become eligible for Medicare. Read on to see what rules to follow with regards to creditable coverage, including when to switch from your spouse's private health insurance to Medicare.
The first rule of Medicare and private insurance is an easy one: if you’ve got creditable coverage, you don't need to sign up for Medicare. For a deep dive on creditable coverage, check out our article here Fair Square Medicare
Once you’ve answered the first question, consider whether your insurance will pay primary or secondary.
If your private insurance is paying primary to Medicare
If Medicare pays primary, your health insurance pays secondary and is left to cover whatever Medicare will not. People often elect to sign up for Part A of Medicare
When your spouse's company has 20 or more employees, that’s considered a Group Health Plan (GHP), and your insurance will pay primary. In a Small Group Health Plan (SGHP) with less than 20 employees, your insurance will pay secondary to Medicare, so you need to sign up for Parts A, B, and likely D if Medicare is meant to pay primary.
Note: If you are under 65 and eligible for Medicare due to a disability, the number used to determine primary vs. secondary coverage jumps up to 100 employees. A plan with over 100 employees is considered a Large Group Health Plan (LGHP).
The way your Medicare plan and your GHP might work together to share costs is called the Coordination of Benefits. There are systems in place that work to ensure your healthcare claims are being billed in the right order, but it’s still important for you to know how to apply these rules to your situation in case any claims are disputed. If you have any questions about the Coordination of Benefits for your situation, you can call us at 1-888-376-2028, and you can also call the Benefits Coordination and Recovery Center (BCRC) at 1-855-798-2627.
The same rules apply; if you have creditable coverage through your spouse's private insurance, then you do not need to sign up for a Part D Prescription Drug plan. Other Medicare beneficiaries might incur a Late Enrollment Penalty for either Part B or Part D
Medicare also pays primary to retirement plans.
If you’ve got a retirement plan, your spouse’s GHP, and Medicare, it pays as follows:
1. GHP
2. Medicare
3. Retirement Plan
If your retirement plan includes creditable drug coverage, you have a special enrollment period of 63 days after your coverage ends.
Suppose you have creditable coverage and your plan suits your needs. In that case, you do not need to enroll in Medicare Part B. Talk with your health insurance plan provider for more details about your specific circumstances and your coordination of benefits. For all your Medicare-related questions, we have a team of experts ready to help you get the coverage you need. Give Fair Square Medicare a call at 888-376-2028.
How Can I Get a Replacement Medicare Card?
Aug 14, 2023
Does Medicare Cover Boniva?
Nov 29, 2022
How Much Does Xeljanz Cost with Medicare?
Jan 25, 2023
How Does Medicare Pay for Emergency Room Visits?
Nov 21, 2022
14 Best Ways for Seniors to Stay Active in Nashville
Mar 10, 2023
Explaining IRMAA on Medicare
Dec 21, 2022
How to Choose a Medigap Plan
Jan 10, 2023
Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?
Nov 30, 2022
Does Medicare Cover Breast Implant Removal?
Jan 5, 2023
Does Medicare Cover Flu Shots?
Dec 9, 2022
Can I Change Medicare Advantage Plans Any Time? | Medicare Plans
Sep 19, 2022
Will Medicare Cover it?
Oct 3, 2023
Medigap vs. Medicare Advantage
May 25, 2020
Can I switch From Medicare Advantage to Medigap?
Sep 14, 2022
How Often Can I Change Medicare Plans?
May 5, 2023
Does Medicare Cover Jakafi?
Dec 12, 2022
Does Medicare Cover the WATCHMAN Procedure?
Dec 1, 2022
Medigap Plan N vs. Plan G — Which One Fits You in 2025?
Jul 14, 2025
13 Best Ways for Seniors to Stay Active in Phoenix
14 Best Ways for Seniors to Stay Active in Washington, D.C.
Can I Change My Primary Care Provider with an Advantage Plan?
Can I Have Two Primary Care Physicians?
Can I Laminate My Medicare Card?
Can I Use Medicare Part D at Any Pharmacy?
Can Medicare Advantage Plans be Used Out of State?
Comparing All Medigap Plans | Chart Updated for 2025
Denied Coverage? What to Do When Your Carrier Says No
Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?
Does Medicare Cover Air Purifiers?
Does Medicare Cover Compounded Medications?
Does Medicare Cover Cosmetic Surgery?
Does Medicare cover Deviated Septum Surgery?
Does Medicare Cover Diabetic Eye Exams?
Does Medicare Cover Exercise Physiology?
Does Medicare Cover Fosamax?
Does Medicare Cover Hoarding Cleanup?
Does Medicare Cover Home Heart Monitors?
Does Medicare cover Hyoscyamine?
Does Medicare Cover Incontinence Supplies?
Does Medicare Cover Krystexxa?
Does Medicare Cover Kyphoplasty?
Does Medicare Cover Light Therapy for Psoriasis?
Does Medicare Cover Linx Surgery?
Does Medicare Cover Lipoma Removal?
Does Medicare Cover LVAD Surgery?
Does Medicare Cover Mental Health?
Does Medicare Cover Ofev?
Does Medicare Cover Orthodontic Care?
Does Medicare Cover Penile Implant Surgery?
Does Medicare Cover Piqray?
Does Medicare Cover Qutenza?
Does Medicare Cover RSV Vaccines?
Does Medicare Cover Service Animals?
Does Medicare Cover TENS Units?
Does Medicare Cover the Urolift Procedure?
Does Medicare Cover Urodynamic Testing?
Does Medicare Cover Vitamins?
Does Medicare Pay for Bunion Surgery?
Does Medicare pay for Opdivo?
Does Medicare Require a Referral for Audiology Exams?
Does Retiring at Age 62 Make Me Eligible for Medicare?
Does Your Medicare Plan Cover B12 Shots?
Everything About Your Medicare Card + Medicare Number
Explaining the Different Enrollment Periods for Medicare
Finding the Best Dental Plans for Seniors
Finding the Best Vision Plans for Seniors
Health Savings Accounts (HSAs) and Medicare
How Are Medicare Star Ratings Determined?
How Do Medigap Premiums Vary?
How Much Does Medicare Part B Cost in 2025?
How to Become a Medicare Agent
How Your Employer Insurance and Medicare Work Together
Is Balloon Sinuplasty Covered by Medicare?
Is Displacement Affecting Your Medicare Coverage?
Is PAE Covered by Medicare?
Medicare & Ozempic
Medicare Advantage MSA Plans
Medicare Advantage Plans for Disabled People Under 65
Medicare Guaranteed Issue Rights by State
Medicare Savings Programs in Kansas
Seeing the Value in Fair Square
The Easiest Call You'll Ever Make
Top 10 Physical Therapy Clinics in San Diego
Turning 65 and Thinking of Keeping COBRA? Here’s Why It Usually Backfires
What Are Medicare Part B Excess Charges?
What is a Medicare Beneficiary Ombudsman?
What People Don't Realize About Medicare
What to Do When Your Doctor Doesn't Take Medicare
What You Need to Know About Creditable Coverage
When to Choose Medicare Advantage over Medicare Supplement
Get the Fair Square Bulletin
Medicare savings tips, helpful guides, and more.
Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
MULTIPLAN_FairSquareMedicare_01062022_M