HLP-ISBA080-GRPHLTH

The term "Group Health Plan" (GHP) refers to a health insurance policy offered to members of a group. The most common type of group health plan coverage is provided by employers and is based on current employment status. Examples of health insurance policies that are GHPs based on current employment

  • Include:
    • Small or large employer-provided plans,
    • Self-insured plans,
    • Employee organizational plans (i.e., union plans),
    • National health plans in foreign countries.
       
  • Do not include:
    • Plans that only cover self-employed individuals,
    • Health savings accounts,
    • Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage,
    • Group health plans based on severance or retirement pay.

If you or your spouse are actively working for the employer who provides your group health insurance coverage, your GHP is based on current employment.

If you have insurance from an employer-provided group health plan

Group health plans of employers with 20 or more employees are required by law to offer workers and their spouses who are age 65 (or older) the same health benefits that are provided to younger employees.

If your GHP is based on current employment, you may not need to apply for Medicare medical insurance (Part B) until after age 65. There may be a "Special Enrollment Period" (SEP) for you to apply for Medicare Part B after the employment or group health plan coverage ends. (Whichever comes first.) You should talk to your personnel office before you sign up for Medicare medical insurance.

If your group health plan is part of a retirement or severance package, please read our information about the "Special Enrollment Period."

Special Enrollment Period

If you or your spouse are still working and you are covered under a group health plan based on that current employment, you may not need to apply for Medicare at age 65. You may qualify for a "Special Enrollment Period" (SEP) that will let you sign up for Medicare Medical Insurance (Part B):

  • Anytime you or your spouse (or family member if you're disabled) are working and you are covered under the group health plan based on that work; or

  • During the eight-month period that begins with the month after your group health plan coverage or the current employment it is based on ends, whichever comes first.

Note: COBRA and retiree health plans aren't considered coverage based on current employment. If you have that type of coverage, you will not be eligible for a SEP when it ends. To avoid paying a higher premium, make sure you sign up for Medicare when you are first eligible.

If you would like to learn more, there is additional information on our "Special Enrollment Period" page.

If you have health care protection from other plans

If you have coverage under a program from the Department of Defense, your health benefits may change or end when you become eligible for Medicare. You should contact the Department of Defense or a military health benefits advisor for information before you decide whether to enroll in Medicare medical insurance.

If you have health care protection from the Indian Health Service, Department of Veterans Affairs or a state medical assistance program, contact the people in those offices to help you decide whether it is to your advantage to have Medicare medical insurance.

If you live outside the United States

We will use the same definitions of GHP and current employment if you or your spouse currently work for an employer outside the U.S. The employer does not have to be in the U.S. and the employee does not need to be working in the United States.

Also, if you or your spouse work in a country with a national health plan, your coverage is a GHP based on current employment.

If you are not sure how to answer this question and you would like to learn more, read our "Medicare" booklet or talk to your personnel office.