Who Is Eligible For The SHOP Marketplace?
While requirements vary by state, to qualify for SHOP your business must generally meet four requirements:
- Have 2–50 full-time employees1 (other than spouses, family members, or partners).
- Offer coverage to all full-time employees working 30 or more hours per week.
- Enroll at least 70% of the employees in your insurance plan.
- Have a physical work site within the state where you purchase your plan.
How To Enroll In SHOP
- Contact a private insurer like Anthem to find a SHOP plan that fits your business
- Work with a SHOP registered agent or broker to select a plan
What If SHOP Is Not Available?
SHOP Marketplace plans may not be available in all states. If SHOP is not available in your area or if your business does not qualify, you still have options.
Insurance providers like Anthem can help you find other small business health plans available in your area.
What Are The SHOP Small Business Health Options?
You can choose from five types of healthcare plans for your business.
HMO (Health Maintenance Organization)
An HMO is designed to keep costs low and predictable by only using doctors and hospitals within the HMO network. It typically has low premiums, deductibles, and fixed copays for doctor visits. PCPs are the primary point of contact for all medical care, including specialty referrals.
PPO (Preferred Provider Organization)
PPO networks let the member choose where to go for care, without a referral from a primary care physician (PCP) or having to only use providers in your plan's provider network. These plans typically have higher monthly premiums and out-of-pocket costs like copays, coinsurance, and deductibles.
EPO (Exclusive Provider Organization)
An EPO offers a local network of doctors and hospitals to choose from. If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need healthcare, you may want to consider an EPO plan.
POS (Point of Service)
A POS plan requires that you get a referral from your PCP before seeing a specialist. This plan covers out-of-network doctors at a higher out-of-pocket cost than in-network doctors.
HDHP (High Deductible Health Plan)
An HDHP has low premiums but higher immediate out-of-pocket costs. Employers often pair HDHPs with a Health Savings Account (HSA). This is a tax-free fund used to offset costs such as deductibles.
What Is The Average Cost Of SHOP Marketplace Plans?
The cost of SHOP Marketplace plans will depend on the type of plan you choose. Consider how much you want employees to contribute to help share the cost and how much coverage will be needed for all enrolled employees. SHOP small business marketplace plans are evaluated by looking at the total group of employees in your company covered under the plan.
What Is A SHOP Tax Credit?
Under the Affordable Care Act, small business owners who have fewer than 25 full-time employees, who pay average wages of $56,000 or less, or who cover at least half of their employees’ premiums may be eligible for business healthcare tax credits for their SHOP insurance plans. These credits can lower the cost of your small business health insurance.
When Can You Enroll In The SHOP Marketplace?
There is no limited enrollment period for the SHOP Marketplace, and employers can shop for a new plan any time of year. If you enroll in a plan by the 15th of each month, coverage can usually begin on the 1st of the following month.