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Is it a good idea for couples to choose the same Medicare insurance plan?

Josh Schultz | November 16, 2022

Q: Is it a good idea for couples to choose the same Medicare insurance plan?

A: No, you should normally choose Medicare coverage based on your own health care needs. The exception is if both spouses are offered retiree coverage, and in that case you both may end up in a more generous plan than what is available to most Medicare enrollees.

When should couples select their Medicare coverage individually?

You should almost always choose your Medicare coverage based only on your own health care needs. Medicare is different from coverage in the individual or group market in that coverage is chosen individually – and this means spouses may end up in very different plans. People under 65 might shop on the individual market for a single “family plan” to cover their entire household – allowing for combined family deductibles and out-of-pocket maximums. But premiums and cost-sharing for Medicare coverage are always for an individual – even if two spouses enroll in the same plan.

This means each spouse can individualize their coverage. If one spouse sees a doctor who only accepts a specific Medicare Advantage plan, they may choose Medicare Advantage coverage that provides access to that specific doctor. At the same time, the other spouse could end up choosing Original Medicare with a Medigap plan, in order to have access to a broad network of health care providers.

When couples search for a Medicare Part D plan – or a Medicare Advantage plan with prescription drug benefits – each spouse should use the Medicare Plan Finder tool separately. The best prescription drug plan for one spouse may not be a good choice for the other. The same rule applies when choosing Medigap supplemental insurance. Because Medigap policies are sold on an individual basis, each spouse will need a separate plan. And depending on health conditions, it may make sense for spouses to select two different Medigap plans and two different Part D plans.

But some Medigap insurers offer a “household discount” if both spouses enroll in coverage from that insurer. So depending on the plans available in your area, you might find that you can get a lower premium if both spouses use the same insurer for their Medigap coverage. But again, even if a household discount is offered, each spouse still has their own Medigap plan, with separate premiums and cost-sharing.

When might couples want to select the same Medicare plan?

If spouses are eligible to be covered under a retiree plan offered by one spouse’s employer, both spouses may be better off enrolling in that plan, which could include additional benefits than the standard Medicare plans available to you. Unlike other types of Medicare coverage – where premiums are set individually – you might pay lower premiums overall if both spouses are covered under the same retiree plan. (Retiree coverage can be used to supplement Original Medicare, but some employers offer Medicare Advantage retiree plans; the specifics will vary considerably from one employer to another.)

And as noted above, some Medigap insurers offer a discount if both spouses sign up for one of their Medigap plans — although it doesn’t necessarily have to be the same plan, since most Medigap insurers offer multiple plans.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive.

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