Turn 65 and you might think your health insurance problems are over. Although Medicare doesn’t cover every medical service or cost, for many retirees, it reduces coverage costs. But this doesn’t solve the coverage problem if you have a younger spouse who relied on your insurance and isn’t eligible for Medicare.
“People think of 65 as the finish line for health insurance,” said Zoe Lim, senior vice president of business development at DynEx Group Benefits. “For a couple with an age gap, it’s really only the finish line for one person.”
Large age gaps are not uncommon. The Census Bureau reports that in 2025, more than 5 million opposite-sex couples living together had a man who was at least 10 years older than his female partner. Another 1.3 million had a woman who was at least 10 years older than her male partner.
Even sophisticated workers can be left in the dark about their insurance choices after retirement or when becoming eligible for Medicare.
“I’ve consulted for CEOs of major corporations … and what they’re given is a piece of paper and sent on their way,” said Elizabeth Gavino, president and owner of insurance brokerage Lewin & Gavino.
One solution is to remain on an active employer plan even after becoming eligible for Medicare. In that case, a person can have both employer insurance and Medicare. Companies with 20 or more employees are generally responsible for paying medical bills of covered workers first. If it doesn’t cover the full amount, Medicare may then pay some of the remaining bill, depending on whether Medicare covers the service. The opposite is true for smaller companies, where Medicare generally bears first responsibility for paying.
If the employer option isn’t viable, the older spouse may choose to move to Medicare while the younger spouse obtains coverage through their own employer, COBRA, the Affordable Care Act marketplace or an individual policy purchased directly from an insurer.
COBRA can provide continuity because it allows the younger spouse to remain on the existing employer plan for up to 18 months, although coverage can sometimes last longer. But it can be expensive.
“I wouldn’t automatically assume COBRA is the answer for the younger spouse. It’s one option, but I would price everything before making that decision,” said Lim.
The older spouse can enroll in Medicare while the younger spouse remains on COBRA. If the older spouse has delayed Medicare Part B while covered by an active employer plan, they generally have up to eight months to enroll after the job or coverage ends, whichever happens first. Choosing COBRA does not extend that deadline, and missing it can result in a late-enrollment penalty. The important factor is that this deadline continues running, even if the person chooses COBRA.
Another bridge solution for some couples could be marketplace coverage. Generally, workers who lose job-based insurance can use a special enrollment period that runs from 60 days before to 60 days after the loss of coverage to pick a plan. Depending on household income and family size, premium tax credits and other savings may be available.
“Many couples think they are making a Medicare decision when they are really making a retirement decision that affects the whole family,” Gavino said.
Ultimately, the cost of providing health insurance for the younger spouse could end up forcing the older spouse to continue working.
“When the couple sits down to assess the real costs of Medicare and health insurance for the younger spouse, the decision to retire may be delayed,” Gavino said.
To avoid this scenario, couples can compare the premiums, deductibles, provider networks and out-of-pocket limits of each available insurance option before selecting a retirement date for the older spouse. They can also review which marketplace subsidies are available, if any, and how long any temporary coverage will last.
By modeling both spouses’ insurance costs together and understanding how various solutions operate, couples can determine when retirement becomes affordable in terms of covering the cost of the younger spouse.
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