Should You Get The Same Medicare Plan As Your Spouse?
There’s one question that popped up several times during the fall Open Enrollment Period.
“Should I enroll in the same Part D drug plan as my spouse?”
Now that the Medicare Advantage Open Enrollment Period has started, this question will no doubt reappear — with a twist.
“How about if I enroll in my spouse’s Medicare Advantage plan?”
I can think of three obvious reasons beneficiaries would consider this.
- Picking the same plan is definitely easier than doing the research on your own. Comparing all the available options can be frustrating and time-consuming. And many husbands and wives often had the same health plans before retirement so why change now?
- Many beneficiaries do not have any concept of the differences among all the Medicare Advantage or Part D drug plans. In other words, plans are all the same. This belief is another carryover from a previous life. Employees often had just a handful of available options for group coverage.
- Some just prefer to let their spouses handle all the important decisions.
Part D Drug Plans
Despite those valid reasons, there are two big risks in choosing the same Part D plan as your spouse.
- Cost: Every plan determines its own premium, deductible, copayments and coinsurance. Premiums for Part D drug plans can range from zero to $200, deductibles from zero to $615, and cost sharing all over the map.
- Coverage: Medicare sets some basic standards for Part D drug coverage, but then the plans are free to determine which drugs they will cover. One plan may cover a particular drug, another won’t. Or, that drug may cost $5 in one plan and $47 in another.
In late December, I talked with a couple who took off October 18 on an extended world tour. Neither of their Part D drug plans would be available in 2026 so they had to find new ones before leaving. The wife takes three drugs. She did her research and found a plan with a $4.40 premium that would work. Because the husband also took only three drugs, all generics, he opted for that same plan.
In early January, he discovered some problems. Her drugs were all Tier 1 with no copayment. However, one of his drugs was Tier 3 with a 25% coinsurance; a second, Tier 4 and a 47% coinsurance; and the third was not on the plan’s formulary. Looking at available drug plans now, he discovered that one with a higher premium would have cost less and covered all his drugs, but it’s too late to change. In his words, he is “going to pay an arm and leg for not doing his homework” and just choosing the same plan as his wife.
Medicare Advantage Plans
The biggest difference among Medicare Advantage plans is the Part D prescription drug coverage. But then, additional factors come into play.
- Provider networks: Just as with drug formularies, each plan establishes its own network. Seeing providers in-network is essential so checking provider directories is a must.
- Costs: The out-of-pocket maximum, the most a plan member will spend out-of-pocket in a calendar year for covered services, is the concern. Somone who does not require many health services could choose a plan with a higher limit and usually very low premiums. However, another person who has many and/or serious medical issues may pay a higher premium to get a lower limit, with more protection from costs.
- Supplemental benefits: Coverage of non-Medicare benefits, such as dental and vision services, gym membership, transportation or over-the-counter supplies, varies greatly by plan. It is often necessary to prioritize benefits and then compare plans.
Medicare Supplement Plans
This is the one type of Medicare coverage that both spouses who opted for Original Medicare can have. That’s because a Medicare supplement, more commonly known as a Medigap policy, provides cost protection. If Part A, hospital insurance, or Part B, medical insurance, covers a service, the supplement will pay whatever those two parts don’t, up to the limits of the policy.
There can be a benefit to choosing the same supplement and that is the household discount.
- This is a discount on monthly premiums.
- These discounts are usually labeled multi-insured and roommate.
- The discount applies when two or more people living in the same household have the same supplement. A plan may require the two individuals to be married.
- Of plans I reviewed in three ZIP codes, discounts ranged from 5% to 15%.
- The availability depends on location. For example, in Chicago, 80% of Plan G policies offer a discount and in New York City, not one.
Back to the question that started this: Should you choose the same Medicare plan as your spouse?
There’s one question that popped up several times during the fall Open Enrollment Period.
“Should I enroll in the same Part D drug plan as my spouse?”
Now that the Medicare Advantage Open Enrollment Period has started, this question will no doubt reappear — with a twist.
“How about if I enroll in my spouse’s Medicare Advantage plan?”
I can think of three obvious reasons beneficiaries would consider this.
- Picking the same plan is definitely easier than doing the research on your own. Comparing all the available options can be frustrating and time-consuming. And many husbands and wives often had the same health plans before retirement so why change now?
- Many beneficiaries do not have any concept of the differences among all the Medicare Advantage or Part D drug plans. In other words, plans are all the same. This belief is another carryover from a previous life. Employees often had just a handful of available options for group coverage.
- Some just prefer to let their spouses handle all the important decisions.
Part D Drug Plans
Despite those valid reasons, there are two big risks in choosing the same Part D plan as your spouse.
- Cost: Every plan determines its own premium, deductible, copayments and coinsurance. Premiums for Part D drug plans can range from zero to $200, deductibles from zero to $615, and cost sharing all over the map.
- Coverage: Medicare sets some basic standards for Part D drug coverage, but then the plans are free to determine which drugs they will cover. One plan may cover a particular drug, another won’t. Or, that drug may cost $5 in one plan and $47 in another.
In late December, I talked with a couple who took off October 18 on an extended world tour. Neither of their Part D drug plans would be available in 2026 so they had to find new ones before leaving. The wife takes three drugs. She did her research and found a plan with a $4.40 premium that would work. Because the husband also took only three drugs, all generics, he opted for that same plan.
In early January, he discovered some problems. Her drugs were all Tier 1 with no copayment. However, one of his drugs was Tier 3 with a 25% coinsurance; a second, Tier 4 and a 47% coinsurance; and the third was not on the plan’s formulary. Looking at available drug plans now, he discovered that one with a higher premium would have cost less and covered all his drugs, but it’s too late to change. In his words, he is “going to pay an arm and leg for not doing his homework” and just choosing the same plan as his wife.
Medicare Advantage Plans
The biggest difference among Medicare Advantage plans is the Part D prescription drug coverage. But then, additional factors come into play.
- Provider networks: Just as with drug formularies, each plan establishes its own network. Seeing providers in-network is essential so checking provider directories is a must.
- Costs: The out-of-pocket maximum, the most a plan member will spend out-of-pocket in a calendar year for covered services, is the concern. Somone who does not require many health services could choose a plan with a higher limit and usually very low premiums. However, another person who has many and/or serious medical issues may pay a higher premium to get a lower limit, with more protection from costs.
- Supplemental benefits: Coverage of non-Medicare benefits, such as dental and vision services, gym membership, transportation or over-the-counter supplies, varies greatly by plan. It is often necessary to prioritize benefits and then compare plans.
Medicare Supplement Plans
This is the one type of Medicare coverage that both spouses who opted for Original Medicare can have. That’s because a Medicare supplement, more commonly known as a Medigap policy, provides cost protection. If Part A, hospital insurance, or Part B, medical insurance, covers a service, the supplement will pay whatever those two parts don’t, up to the limits of the policy.
There can be a benefit to choosing the same supplement and that is the household discount.
- This is a discount on monthly premiums.
- These discounts are usually labeled multi-insured and roommate.
- The discount applies when two or more people living in the same household have the same supplement. A plan may require the two individuals to be married.
- Of plans I reviewed in three ZIP codes, discounts ranged from 5% to 15%.
- The availability depends on location. For example, in Chicago, 80% of Plan G policies offer a discount and in New York City, not one.
Back to the question that started this: Should you choose the same Medicare plan as your spouse?
For Part D, the answer is a resounding No, unless you both take no drugs or the exact same prescription medications (dose and frequency).
- For Medicare Advantage plans, most likely, another No, unless you are a clone of your spouse.
- Finally, for Medicare supplement plans, if a household discount is available, definitely consider this money-saving option.
The most important point: Study the plans and choose the best option for you.
- For Part D, the answer is a resounding No, unless you both take no drugs or the exact same prescription medications (dose and frequency).
- For Medicare Advantage plans, most likely, another No, unless you are a clone of your spouse.
- Finally, for Medicare supplement plans, if a household discount is available, definitely consider this money-saving option.
The most important point: Study the plans and choose the best option for you.