QUESTION

My employer just told us we are enrolling in “SHOP” coverage. What is SHOP coverage?

Individuals with coverage | Coverage for Employees of a Small Employer
ANSWER

The SHOP marketplace makes determinations of whether a small employer qualifies for SHOP coverage and for federal tax credits to help pay for employees’ coverage. The determination for the tax credit takes into account the size of the employer and average employee salaries. The SHOP also ensures that participating small group health plans have been certified to meet minimum standards for the adequacy and quality of coverage. All plans also must cover a similar set of benefits, and each plan will be assigned to a precious metal level of coverage – bronze, silver, gold, or platinum – that reflects how much protection against cost-sharing the plan provides to the average enrollee. Bronze plans expose the average consumer to the greatest amount of cost-sharing, while platinum plans provide the most protection. Bronze plans will tend to have lower monthly premiums, while the premiums for platinum plans will be more expensive.

On the SHOP website, depending on your state, you will be able to find a SHOP-registered agent or broker to assist you with choosing the right plan or you can enroll directly with an insurance company. Under some state-based SHOP marketplaces, you may be able to select and enroll in a health plan. (45 C.F.R. § 155.20; 45 C.F.R. § 155.710; CMS, The Future of the SHOP: CMS Intends to Allow Small Businesses in SHOPs using HealthCare.gov More Flexibility when Enrolling in Healthcare Coverage, May 15, 2017).

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Individuals with no coverage
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Coverage for small employers
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