Fair Square Medicare Wordmark

Do I Need Medicare If My Spouse Has Insurance?

Senior couple working at a computer stock image

By Daniel Petkevich

Dec 19, 2022

If they've got creditable coverage, you can stick with your insurance plan

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.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

First Rule of Thumb

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

. Your spouse's private insurance coverage is creditable if they work for a company with at least 20 employees. When weighing your options, your first question should be the size of the company providing your insurance. If your spouse works somewhere with less than 20 employees, it’s important to ask their HR representative if the insurance is creditable. If you don’t have creditable coverage, you should apply for Medicare Part A and Part B. And if you decide at any point that private insurance is not a good fit for you anymore, you can always shop for Medicare once you're eligible.

Fair Square Medicare

is the place to find your best plan. For now, all you need to know is if you have creditable coverage, stick with it.

Primary vs. Secondary

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

, Medicare pays secondary and is supplementing your employer insurance. For whatever healthcare costs pop up, your insurance takes the first swing, and if anything is leftover, Medicare comes in to cover the rest. Remember that Medicare will only pay for things covered by 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

even if they have creditable coverage. That's because it's free (as long you or your spouse have paid 40 quarters' worth of social security taxes) to get more secondary coverage.

Group Health Plans

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).

Coordination of Benefits

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.

What about your prescription drug coverage?

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

. But as long as you have creditable coverage, you have a special enrollment period of 63 days after your coverage ends to enroll without penalty.

What if you or your spouse have a retirement plan?

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.

Takeaway

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.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Recommended Articles

Medicare Explained Thumbnail

Medicare Explained

Jan 3, 2022

Diagnosis incontinence stock image

Does Medicare Cover Incontinence Supplies?

Dec 22, 2022

Cover image

How to Compare Medigap Plans in 2025

Jul 14, 2025

Senior couple working at a computer stock image

Do I Need Medicare If My Spouse Has Insurance?

Dec 19, 2022

woman in a hospital wearing a bandana being shown information by her doctor stock photo

Medicare Advantage Plans for Disabled People Under 65

Mar 24, 2023

senior couple doing yoga stock image

13 Best Ways for Seniors to Stay Active in Columbus

Mar 8, 2023

heart surgery stock image

How Much Does Open Heart Surgery Cost with Medicare?

Jan 27, 2023

doctor consulting their patient stock image

Does Medicare Cover the Urolift Procedure?

Dec 6, 2022

Senior man receiving care from an optometrist stock photo

Does Medicare Cover Cataract Surgery?

Dec 22, 2022

Closeup of a male Doctor or physiotherapist doing stretching for a patient in the clinic for examining treating injured of back stock photo

Does Medicare Cover Chiropractic Visits?

Dec 22, 2022

Cover image

Does Your Plan Include A Free Gym Membership?

Jul 12, 2023

woman sitting on sofa feeling pain in her foot at home stock photo

Does Medicare Cover Qutenza?

Jan 13, 2023

Cover image

How Often Can I Change Medicare Plans?

May 5, 2023

Senior woman checking blood pressure/heart rate at home stock photo

Does Medicare Cover Home Heart Monitors?

Dec 1, 2022

Cover image

Will Medicare Cover it?

Oct 3, 2023

senior woman doing botox stock photo

Is Botox Covered by Medicare?

Jan 19, 2023

Medicare 2025 What you need to know in the new year stock image

How is Medicare Changing in 2025?

Dec 21, 2022

Asian senior male patient having him eyes examined by laser machine

Finding the Best Vision Plans for Seniors

Jan 6, 2023

More of our articles

13 Best Ways for Seniors to Stay Active in Philadelphia

14 Best Ways for Seniors to Stay Active in Nashville

14 Best Ways for Seniors to Stay Active in Seattle

14 Best Ways to Stay Active in Charlotte

2025 Medicare Price Changes

Are Medicare Advantage Plans Bad?

Building the Future of Senior Healthcare

Can I Change My Primary Care Provider with an Advantage Plan?

Can I Choose Marketplace Coverage Instead of Medicare?

Can I switch From Medicare Advantage to Medigap?

Can I Use Medicare Part D at Any Pharmacy?

Denied Coverage? What to Do When Your Carrier Says No

Do All Hospitals Accept Medicare Advantage Plans?

Do I Need to Renew My Medicare?

Do You Need Books on Medicare?

Does Medicare Cover a Spinal Cord Stimulator?

Does Medicare Cover Abortion Services?

Does Medicare Cover Air Purifiers?

Does Medicare Cover Cala Trio?

Does Medicare Cover Cardiac Ablation?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover Compounded Medications?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover Fosamax?

Does Medicare Cover Hypnotherapy?

Does Medicare Cover Inqovi?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Kidney Stone Removal?

Does Medicare Cover Lipoma Removal?

Does Medicare Cover Macular Degeneration?

Does Medicare Cover Mental Health?

Does Medicare Cover Nuedexta?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Ozempic?

Does Medicare Cover Physicals & Blood Work?

Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?

Does Medicare Cover Stair Lifts?

Does Medicare Cover TENS Units?

Does Medicare Cover Wart Removal?

Does Medicare Pay for Bunion Surgery?

Does Medicare Pay for Funeral Expenses?

Does Medicare pay for Opdivo?

Does Medicare Require a Referral for Audiology Exams?

Does Your Medicare Plan Cover B12 Shots?

Explaining IRMAA on Medicare

Explaining the Different Enrollment Periods for Medicare

Finding the Best Dental Plans for Seniors

Gap Health Insurance: The Secret Sidekick to Your High-Deductible Plan

How Can I Get a Replacement Medicare Card?

How Much Does Medicare Part A Cost in 2025?

How to Become a Medicare Agent

How to Deduct Medicare Expenses from Your Taxes

How Your Employer Insurance and Medicare Work Together

Is Emsella Covered by Medicare?

Is Fair Square Medicare Legitimate?

Is Gainswave Covered by Medicare?

Medicare Deductibles Resetting in 2025

Medigap vs. Medicare Advantage

Moving? Here’s What Happens to Your Medicare Coverage

Plan G vs. Plan N

Seeing the Value in Fair Square

Top 10 Physical Therapy Clinics in San Diego

What is Plan J?

What To Do If Your Medicare Advantage Plan Is Discontinued

What to Do When Your Doctor Doesn't Take Medicare

What to Do When Your Doctor Leaves Your Network

What You Need to Know About Creditable Coverage

When Can You Change Medicare Supplement Plans?

When to Choose Medicare Advantage over Medicare Supplement

Which Medigap Policies Provide Coverage for Long-Term Care?

Why You Should Keep Your Medigap Plan

Will Medicare Cover Dental Implants?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2025

Terms of Use
Notice of Privacy Practices

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

Fair Square Medicare

FSM symbol - 50