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plans for people with chronic needs and conditions

AW Elliott & Associates Certified Financial & Tax Advisor
slife Insurance, health insurance, retirement planning, Income Tax preparation

AW Elliott & Associates

AW Elliott & Associates

AW Elliot & Associates knows that insurance is crucial to any business. That is why we’re here to help you select the most suitable one for your company.

There are four plan categories in the Small Business Health Options Program (SHOP) Marketplace, and they all offer the same benefits. The difference is on how the plan and your employees share the costs of care. In some states, you can choose a category, and your employees can select any plan in your chosen category.

The SHOP Health Plan Categories

Business Insurance

The category you select affects how much your employees pay for premiums, deductibles, and copayments, as well as their out-of-pocket costs for the year if they need extensive care. The plan categories are the following:

  • Bronze: This covers about 60% of the total costs of care. The employee pays about 40%.
  • Silver: This covers about 70% of the total costs of care. The employee pays about 30%.
  • Gold: This covers about 80% of the total costs of care. The employee pays about 20%.
  • Platinum: This covers about 90% of the total costs of care. The employee pays about 10%.

To learn more about SHOP health plans, read answers from CMS.

Select a Plan That Works for You

The quality of care a health plan provides does not depend on the plan’s category. All plans offered through the SHOP Marketplace offer a set of essential health benefits. Additionally, they all cover pre-existing conditions.

When you offer SHOP coverage, you and your employees each pay a part of a monthly premium. Just as essential as the monthly premium is how much your employees have to pay when they get care. The plan with the least premium may not give you or your employees the best overall value.

Balancing Premiums and Out-Of-Pocket Costs

Premiums are typically lower for plans paying a smaller share of medical expenses when your employees get care. Your employees will probably pay a lower monthly premium in a Bronze plan but will probably pay more out of pocket when they take advantage of medical services.

The plans that generally have the highest monthly premiums and least out-of-pocket costs for services are platinum plans. If your employees take advantage of a lot of services or have a health crisis, platinum plans will likely provide better financial protection.

Take note: The lower the premium, the higher the out-of-pocket expenses. The higher the premium, the lower the out-of-pocket expenses.

Give us a call. We would be more than glad to discuss your options and what makes sense for you and your employees.

An Overview of the SHOP Marketplace

The SHOP Marketplace exists to help small businesses provide health coverage to their employees. It is open to employers with up to 50 full-time equivalent employees (FTEs), including nonprofit organizations. You can enroll in SHOP at any time of the year.

Advantages of the SHOP Marketplace

Apart from allowing you to offer health and dental coverage that meets your business’ and employees’ needs, SHOP offers choice, flexibility, as well as online application and account management.

  • For 2015 coverage and later, you can apply for SHOP, pick a plan or plans, complete your coverage offering, handle employee participation, and pay your premiums online.
  • Your employees enroll online too.
  • You are in control of the coverage you offer and how much you pay towards employee premiums. You choose whether or not to offer dependent coverage (some states require it) and dental insurance. Additionally, you decide the duration of your employees’ Open Enrollment Period and the waiting period for new employees who are yet to enroll.
  • SHOP’s enrollment goes on throughout the year. The enrollment period when you can start offering a SHOP plan is unrestricted.
  • In all states, you can provide one health plan to your employees. However, it is also possible in some states for you to choose a coverage category and let your employees pick a plan from that category.
  •  If you have less than 25 employees and enroll in SHOP coverage, you may be in the running for a Small Business Health Care Tax Credit worth up to 50% of your premium costs. The tax credit is available for plans bought through the SHOP Marketplace only.

Enroll in SHOP plans with our help. Give us a call today or visit the CMS website to learn more.