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Get a qualifying health plan.
what is SHOP?
what is SHOP?
SHOP stands for the Small Business Health Options Program. It is a government-created insurance marketplace established under the Affordable Care Act that allows small businesses and non-profits to affordably provide health and dental coverage to their employees.
SHOP helps small employers with 1–50 employees offer affordable, private health and dental coverage. It’s also generally the only way to get the Small Business Health Care Tax Credit, which can save eligible employers up to 50% of their employer contribution.
DOES YOUR BUSINESS QUALIFY?
50 or Less Fulltime Employees
50 or Less Fulltime Employees
Employ 50 or fewer full-time equivalent employees (FTEs). For example, 2 half-time employees generally equal 1 Full time employee.
Employees work 30+ Hours weekly
Employees work 30+ Hours weekly
Offer coverage to all your full-time employees—those working an average of 30 or more hours per week.
Employee must be a stranger
Employee must be a stranger
Have at least one common-law employee on payroll (not including a business owner or sole proprietor, or their spouse(s) on the payroll) to enroll in coverage.
Business address must be in state
Business address must be in state
Have a primary business address in the state where you’re buying coverage or have an eligible employee with a primary worksite in the state where you’re buying coverage.
Plan Options & Enrollment
Plan Options & Enrollment
What plans are available & how do I enroll?
What plans are available & how do I enroll?
With SHOP, you can start offering insurance to your employees any time of year. You don’t have to wait for an Open Enrollment Period. You must enroll with an Licensed SHOP Insurance Broker/Agent or the Carrier directly (sometimes they refer employers to look for local agents).
With SHOP, you can start offering insurance to your employees any time of year. You don’t have to wait for an Open Enrollment Period. You must enroll with an Licensed SHOP Insurance Broker/Agent or the Carrier directly (sometimes they refer employers to look for local agents).
Verify your eligibility. Before you enroll in SHOP, you’ll need to verify that you’re eligible to participate at go.hc.gov/SHOP-eligibility. You’ll get an eligibility decision right away. Keep it for your records. You may need this to enroll or apply for the Small Business Health Care Tax Credit.
Review options and select a SHOP plan. Visit HealthCare.gov/see-plans/small-business to review plans and prices. When picking a plan, consider the monthly cost, deductible, provider network, and prescription drug coverage.
MAKE SURE TO PAY YOUR PREMIUMS OR THE CARRIER WILL TERMINATE YOUR COVERAGE.
Small Business Health Care Tax Credit & State Premium Assistance Programs
Small Business Health Care Tax Credit & State Premium Assistance Programs
The Small Business Health Care Tax Credit can be worth up to 50% of your premium contributions (or up to 35% for tax-exempt employers).
To qualify for the tax credit, you must have all of these:
Fewer than 25 full-time equivalent (FTE) employees (based on a 40-hour work week)
An average employee salary of $56,000 per year or less, adjusted yearly for inflation
A contribution of at least 50% of employee-only premium costs
Employees enrolled in coverage through SHOP Note: You aren’t required to offer coverage to your part-time employees (those working fewer than 30 hours per week) or dependents to qualify for the tax credit.
Minimum Participation Rate & Calculation
Minimum Participation Rate & Calculation
During most times of the year, if you want to participate in the SHOP, a certain percentage of your eligible employees must enroll in the plans you offer. However, if your employees enroll between November 15 – December 15, you don’t have to meet this minimum participation rate. In most states, 70% of your eligible employees must enroll in the plan(s) you offer.
SHOP participation rates are calculated by dividing the number of employees enrolling in SHOP coverage plus those with other coverage by the total number of employees offered SHOP coverage. Other coverage can include insurance from another job, individual private insurance, another person’s or spouse’s job, Medicare, Medicaid, TRICARE, VA health care programs, and the Indian Health Service.
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