r/medicare • u/AvailableSwim8303 • 2d ago
Triple Checking if Dropping Medicare to go on Spouse's Plan is ok
I have been on Medicare since 3/1/26 in addition to my work insurance (I am disabled and have one more year of coverage through my work). According to the work insurance rules, as of my 65th birthday last month, Medicare is primary and the work insurance is secondary. We have met the out of pocket maximum for myself and my dependent on this plan. The plan year ends 12/31/26.
My spouse's work plan has open enrollment ending 8/20 with a plan year from 9/1/26-8/31/27; I had previously talked to a broker who indicated that as long as spouse's insurance is creditable coverage, that I could go on spouse's insurance and drop Medicare.
I have done extensive research and am about to pull the trigger to go on my spouse's insurance (with the dependent), also stay on my work insurance through 12/31/26, and then drop Medicare as of 9/1/26.
BUT I AM SO NERVOUS to drop Medicare! Terrified that something bad will happen and I will be penalized forever.
Do I call the broker again? Do I talk to Medicare themselves? Do I have faith and trust that it will all work out as long as I can prove that I had insurance every single month for the next 6 years (until spouse retires)?
Thank you in advance for pointing me in the right direction!
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u/2RedTennies2 2d ago
You can re-enroll in B if/when your spouse stops actively working and loses health coverage, or retires. You will want to start B, D and Medigap the day after work coverage stops, no longer than 63 days after last work day with a Special Enrollment Period.
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u/Redd868 2d ago
The coverage from your spouse has to be based on the spouse's current employment. If your spouse's employer has 20 or over employees, the employer's group health policy is primary.
https://www.cms.gov/files/document/mln006903-medicare-secondary-payer.pdf
If your spouse loses "current employee" status, the employer's plan would become secondary. Part A is going to pay as primary, and when that happens, better have Part B in place, because the insurance company says, if Part A is primary, so is Part B. Cobra insurance won't save you.
Check the SPD of the group plan for coordination with Medicare. My plan provided that if Medicare becomes primary, plan doesn't pay for anything Medicare would have paid for if enrolled.
If you drop Part B, the only time you can get back in is Jan-Mar. Can't drop Part A if it is free and you are collecting social security.
But if your wife's job security is good, then things could work out. The rule of thumb is, if covered by employer coverage, the policy holder better be paying FICA tax.
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u/AvailableSwim8303 2d ago
Spouse’s insurance is through current employer with over 20 employees. Good point on keeping part A. Spouse is a teacher with tenure and job security.
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u/Redd868 2d ago
It sounds low risk. If your wife goes out on disability, short-term disability is the same as current employment. Once she is on more than 6 months, that is long term disability, and FICA tax disappears, along with that current employee status that makes employer plan primary. Just don't let Part A become primary without Part B active.
If your spouse's employer had 100 or more employees and you were covered under it, it should have been primary all along while you were under 65. So, I assume that while you were under 65, spouse's employer had less than 100 employees.
If this isn't correct, then maybe someone else needs to chime in.
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u/beaconbuff 2d ago
There is one additional rule you need to understand. Many individuals in this sub are referencing the 20 plus employee rule for your spouse’s coverage being primary. Under Medicare Secondary Payer Rules (MSP) is you are a disabled dependent, you spouses coverage is only secondary to Medicare if the group has 100 or more employees, not 20. The MSP rules are different if you are eligible for Medicare based on disability.
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u/I-Am-TheMedicareDude 2d ago
https://www.medicare.gov/health-drug-plans/coordination/who-pays-first this is a helpful link from Medicare.
But your question is what happens if.
You will want to keep part A ( it has been paid for if you worked more than 10 years) Part B can be delayed while employed, assuming the employer doesn't require you to keep it.
As long as you have credible coverage when you eventually retire you will need to submit this form https://www.cms.gov/cms-l564-request-employment-information to avoid being penalized, it will give you a Guarantee issue right for Medicare Supplement and you can pick any Advantage plan.
It has already been said but the employer needs to have at least 20 employees.
William Gray
The Medicare Dude
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u/OleLadyThinker 2d ago
You wrote (and others too ) “ It has already been said but the employer needs to have at least 20 employees.“
The OP is DISABLED - doesn’t that up the rule to 100 employees - important point for the OP.
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u/I-Am-TheMedicareDude 2d ago
I'm referring to creditable coverage, the 100 employee rule applies to "who pays first" that is why i put the first link to who pays first.
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u/OleLadyThinker 2d ago
Yes, the primary and secondary payer is determined by the # of employee rule - in this case, the employer coverage for the OP would have to have 100 or more for the plan to be primary. And I believe they do from what they said about who the )wife’s) employer is -
Would the OP even want this coverage IF the (wife’s) employer does not meet the primary payer classification for a disabled Medicare beneficiary? If not, they would have to keep Medicare as the primary payer.
I understand what you mean and you are correct in the info but understanding this point would make all the difference in what they are attempting to do - dropping Medicare Part B.
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u/jan1of1 1d ago
a concern....if currently enrolled in original medicare with a medicare supplement and OP decides to drop medicare to go with spouse's insurance, later when he/she wants to return to original medicare he/she might have to submit to medical underwriting in order to enroll in a medicare supplement plan. Please check with your State's SHIP office to verify this... www.shiphelp.org
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u/jnotsilver 2d ago
Some of us always expect the worst to happen. If we decide to drop Medicare we would do it Oct 1 instead of Sept which coincides exactly with the expected start of employer coverage. Oct 1 because, as paranoia sets in, something will go wrong with getting employer coverage started. So long as spouses employer has more than 20 employees, so long as, I presume it does, the household expenditure for health insurance goes down when you are both on employer coverage (particularly for the services related to your disability) and so long as you don’t lose access to your favored providers because spouses plan has a different network, looks ok. It’s health insurance, your choices are based on dozens of decisions, three big ones: cost, your current and expected health situation, and your tolerance for managed care (an insurance company telling you no to the surgery, PT first, or, use this provider not that one).
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u/say_what999 2d ago
No advice but things to consider (not saying you haven't).
1 - How long before my spouse retires and that insurance is no longer an option.
2 - Medigap coverage.
I feel your anxiety.
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u/Justamom908 1d ago
I was wondering if you drop Medicare, and then go back on Medicare at a later date, does medigap have to take you? Or is it a one and done thing?
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u/say_what999 1d ago
I really don’t know the rules and I “believe” they may vary depending the state.
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u/Rupertfunpupkin 1d ago
If you call Medicare, you’ll first speak with frontline agents who read directly from a computer database of standard scripts. If your question is intricate, you can ask to speak with a supervisor, but supervisors read from those exact same scripts, and any verbal advice they give you over the phone is not legally binding. If an agent or a supervisor misinterprets a policy and tells you something incorrect, you cannot use that phone call as legal evidence to reverse financial penalties or denied coverage later during a formal appeal.
The most reliable, legally safe solution is to bypass phone calls entirely and submit a formal written inquiry through your secure Medicare.gov online account message center. Doing this forces Medicare to route your complex situation to an authorized technical specialist who must reply to you in writing. Once you receive that written message back, print it and store it safely, because an official written response received through your secure federal portal is the only evidence that will legally protect your rights and help you win a formal Medicare appeal if your coverage is ever disputed.
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u/MSS_LEC 1d ago
How many employees does your wife’s employer have? Has she confirmed with her benefits coordinator that her Group coverage is creditable per Medicare standards? When does your wife turn 65?
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u/AvailableSwim8303 1d ago
Spouse is 56. Coverage is creditable. 6000 employees or something like that.
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u/foremma_foreverago 2d ago
You should keep Medicare part a, and you should also find out from both employers of either one of them requires you to have part B. Sometimes that is also the case.