Unlike other types of health insurance, you cannot get coverage for your spouse and dependent children when you have Medicare. However, there are other coverage options, including employer-sponsored group and government-subsidized health insurance and insurance that you can purchase through the Health Insurance Marketplace in your state. Children with disabilities can get Medicare if they meet eligibility requirements.
If You Qualify for Medicare, Can Your Spouse and Children Receive Medicare Coverage?
Medicare is individual insurance and does not provide coverage for your spouse or children. Medicare is federal health insurance for individuals age 65 and older and younger people who have a disability or end-stage renal disease (ESRD). Your spouse or children must qualify on their own to receive Medicare coverage.
Medicare has Part A (hospital insurance) and Part B (medical insurance). You qualify for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can also get Part A for free if you or your spouse had Medicare-covered government employment. There is always a premium for Part B, but you may be able to get financial assistance if you have low income and resources.
What Health Insurance Options Exist for Spouses and Children Who Do Not Qualify for Medicare Coverage?
There are several resources available if you’re looking for health insurance. Search online or speak with a trusted insurance broker in your area to help you find the best option.
Employer health insurance
You can choose to keep working and get coverage through your employer-sponsored group health plan. Your spouse may have the same opportunity and can insure themselves and your children while you use Medicare.
Medicaid or CHIP
Your spouse or children may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), depending on your income and resources. CHIP enables working parents to get health care coverage for their children when their income limits exceed Medicaid requirements but are too low for private health insurance. Visit InsureKidsNow.gov to see if you meet eligibility requirements and to apply for health insurance for your children. Search HealthCare.gov to find coverage for your spouse and/or children.
Health Insurance Marketplace
You can find health insurance plans offered by insurance companies on the Health Insurance Marketplace. You can search for plans in your state and see if you qualify for Medicaid or CHIP.
The Affordable Care Act (ACA) allows dependents to be covered on their parent’s health insurance plan (but not Medicare) until they turn 26 years old, even if they don’t live with you and you don’t claim them on your taxes.
Spouses and dependent children of veterans may qualify for health insurance coverage through one of the United States Department of Veterans Affairs (VA) health care programs. Common VA programs for vets and their family members include TRICARE and The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Search here to find more information about VA programs and how to apply.
When Can Children Qualify for Medicare Coverage?
Children may qualify for Medicare coverage if they have a disability as determined by the Social Security Administration (SSA).
Children with disabilities can qualify for Medicare coverage when they have been getting Social Security Disability Insurance (SSDI) for at least two years. The SSDI program pays benefits to adults who have a disability that began before they turned 22 years old. Social Security considers this SSDI benefit a “child’s” benefit because it is paid on a parent’s Social Security earnings record.
For a disabled adult dependent to become entitled to SSDI, a parent must be receiving Social Security retirement or disability benefits or have died and had worked to earn enough quarters of coverage to qualify for Social Security benefits.
A disabled adult dependent can get Medicare immediately if they are diagnosed with ESRD or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
Children with ESRD may be eligible for Medicare if the following conditions are met:
- You or your spouse have earned at least six credits within the last three years by working and paying Social Security taxes or are eligible for Social Security or Railroad Retirement Board (RRB) benefits.
- Your child has a kidney transplant or needs regular dialysis because their kidneys no longer work.
Contact Social Security to see if your disabled child meets eligibility requirements and to apply for Medicare.
Learn More From Our Sources
- CMS | Young Adults and the Affordable Care Act | Last accessed October 2022
- HHS | Health and Human Services: Who Is Eligible for Medicare? | Last accessed October 2022
- HealthCare.gov | Need Health Insurance? | Last accessed October 2022
- Insurekidsnow.gov | CHIP | Last accessed October 2022
- Medicaid | Health Coverage | Last accessed October 2022
- Medicaid | Children’s Health Insurance Program (CHIP) | Last accessed October 2022
- Medicare | Children and End-stage Renal Disease | Last accessed October 2022
- SSA | Benefits for Children with Disabilities | Last accessed October 2022
- VA | U.S. Department of Veterans Affairs: Family and Caregiver Health Benefits | Last accessed October 2022