Insurance plans offered through the Small Business Health Options Program (SHOP) are job-based insurance plans purchased through the Marketplace. SHOP allows businesses with fewer than 50 employees and their employees to search for and buy health coverage. SHOP plans follow the same rules as other insurance based on current work One of the qualifications for the Part B Special Enrollment Period is to be currently working. You are considered to be currently working as long as you have employment rights at your company even if you do not work on a regular basis, are on sick leave, are a seasonal worker, or have been temporarily laid-off. You are not considered to be currently working if you receive Social Security Disability Insurance (SSDI), have received disability benefits from your employer for more than six months, or if you receive your employer insurance through COBRA. . Your plan is primary or secondary depending on: the size of your employer and whether your Medicare eligibility is based on age, disability, or End-Stage Renal Disease (ESRD).
- If you are eligible for Medicare due to age and your employer has:
- 20 or more employees, your SHOP plan pays primary
- Fewer than 20 employees, your SHOP plan pays secondary
- If you are eligible for Medicare due to disability, your SHOP plan will always pay secondary
If you like your SHOP plan and it is primary, you can choose to delay Medicare enrollment. Be sure to compare your plan’s costs and coverage to Medicare’s and make the decision that is best for you. If your SHOP plan is secondary, you may want to enroll in Medicare because your SHOP plan may pay little to nothing for your care. In either case, you have a Special Enrollment Period (SEP) to enroll in Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. .
SHOP plans may also offer creditable drug coverage. If your SHOP plan drug coverage is creditable, you can choose to delay Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. enrollment without penalty. If you decide to delay taking Part D, keep a record of your insurance until you enroll in Medicare. You may need this documentation in order to sign up for Part D later.
You should talk to your employer to see whether you need Medicare in addition to your SHOP coverage. After speaking to your employer, confirm what you have learned with the Social Security Administration (800-772-1213). Get all answers in writing.
Note: There are different rules for individuals who are Medicare-eligible due to End-Stage Renal Disease.