Small Business Health Options Program (SHOP)

Small Business Health Options Program (SHOP)

 

The Small Business Health Options Program (SHOP) helps businesses provide health coverage to their employees.

SHOP insurance is generally available to employers with 1-50 full-time equivalent employees (FTEs). If you have fewer than 25 employees, you may qualify for the Small Business Health Care Tax Credit, if you buy SHOP insurance. Learn more about SHOP eligibility rules and the Small Business Health Care Tax Credit.

If you're a sole proprietor or self-employed with no employees, you may be able to get individual coverage through the Health Insurance Marketplace for individuals and families. 

Enrolling in SHOP insurance

Employers have two options for enrolling in SHOP insurance:

  • Through an insurance company
  • With the assistance of a SHOP-registered agent or broker

To learn more about SHOP visit HealthCare.gov.

Benefits of SHOP Insurance

  • You control the coverage you offer and how much you pay toward employee premiums.
  • You can choose from high-quality private health insurance plans that meet the needs of your business and employees.
  • You can choose to offer health only, dental only, or both health and dental coverage. If offering dependent coverage and an employee enrolls, the employee’s dependents can enroll in health only, dental only, or both health and dental coverage.
  • You can start coverage any time of the year.
  • If you have fewer than 25 employees, you may qualify for a Small Business Health Care Tax Credit worth up to 50% of your premium costs (up to 35% for tax exempt/non-profit employers). You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. The tax credit is generally available only when an employer enrolls in a SHOP plan. Use the Small Business Health Care Tax Credit Estimator to find out if you may qualify and how much you may save.

 How to know if you qualify for SHOP 

  • SHOP insurance is available to employers with 1-50 full-time equivalent (FTE) employees in most states (in some states, employers with 1-100 employees qualify). Use our FTE Employee Calculator to find out if you qualify to use SHOP.
  • You must offer SHOP coverage to all of your full-time or FTE employees – generally those working 30 or more hours per week on average.
  • In many states, at least 70% of employees offered coverage must accept the offer, or be covered by another form of coverage, for the employer to participate. (Employers who apply for or renew SHOP coverage between November 15 and December 15 each year can enroll without meeting this requirement.) For help calculating the SHOP minimum participation rate (MPR) in your state, visit the MPR Calculator.
  • You must have an office or employee work site within the state whose SHOP you want to use.

Get more details on SHOP eligibility rules.

Preview plans and prices now

Browse health and dental plan information right now. See the available plans and sample prices based on the number and ages of employees and their dependents.

SHOP Tools and Resources

SHOP regulations and guidance:

 

Name of DocumentDate Finalized
Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule March 27, 2012
Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review; Final Rule February 27, 2013
Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges; Final Rule March 11, 2013
Payment Parameters for 2014 and Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rules; Patient Protection March 11, 2013
2014 Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF)April 5, 2013
Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program June 4, 2013
Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility Appeals; Final Rule August 30, 2013
CMS-9954-P: Proposed HHS Notice of Benefit and Payment Parameters for 2015 December 2, 2013
CMS-9954-F: HHS Notice of Benefit and Payment Parameters for 2015 March 11, 2014
2015 Letter to Issuers in the Federally-facilitated Marketplaces (PDF)March 14, 2014
Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015; Final Rule March 11, 2014
Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond May 27, 2014
Draft Standard Notices When Discontinuing or Renewing a Product in the Small Group or Individual Market (PDF)June 26, 2014
Form and Manner of Notices When Discontinuing or Renewing a Product in the Group or Individual Market (PDF)September 2, 2014
CMS-9954-P: Proposed HHS Notice of Benefit and Payment Parameters for 2016 November 26, 2014
CMS-9944-F: Final HHS Notice of Benefit and Payment Parameters for 2016 February 27, 2015
FINAL 2016 Letter to Issuers in the Federally-facilitated Marketplaces (PDF)February 20, 2015
Federally-facilitated Marketplace and Federally-facilitated Small Business Health Options Program Enrollment Manual (PDF)October 1, 2015
CMS-9937-P: Proposed HHS Notice of Benefit and Payment Parameters for 2017December 2, 2015
Final 2017 Annual Letter to Issuers in the Federally-facilitated Marketplaces (PDF)February 29, 2016
CMS-9937-F: Final HHS Notice of Benefit and Payment Parameters for 2017March 8, 2016
Intended Approach to FF-SHOP Enrollment Beginning in 2018May 16, 2017
FF-SHOP Offering More Flexibility when Enrolling in Healthcare Coverage for 2018May 15, 2017
CMS to Allow Small Businesses and Issuers New Flexibilities in the Small Business Health Options Program (SHOP) For Plan Year 2018 (PDF)October 27, 2017
Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019November 2, 2017

For additional resources, please visit marketplace 

Questions?

Contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445)

Page Last Modified:
09/10/2024 06:18 PM
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