If you're now enrolled in Medicaid or CHIP, here are some things you need to know.
Medicare isn’t part of the Health Insurance Marketplace®, so you don’t need to make any changes. If you have Medicare, you are considered covered.
To offer Small Business Health Options Program (SHOP) health and/or dental insurance to your employees, your business or non-profit organization must meet 4 requirements:
1. Have 1-50 full-time equivalent employees (FTEs)
- Use the FTE Calculator to find out if you qualify.
- To qualify for SHOP, you must have at least 1 FTE employee other than owners, spouses, and family members of owners, and partners.
2. Offer coverage to all full-time employees
- Full-time employees generally work 30 or more hours per week.
- You don’t have to offer coverage to part-time employees — those averaging less than 30 hours per week — or seasonal workers. (But, you can offer coverage to part-time employees if you choose.)
3. Enroll at least 70% of the employees you offer insurance to
- Use the SHOP Minimum Participation Rate (MPR) Calculator to check how many of your employees must accept.
- Some states have different minimum participation requirements. Find out if your state has a different MPR.
- You don’t have to meet the minimum participation requirement between November 15 - December 15 any year.
- Employees with other health coverage aren't counted as “rejecting” your offer.
4. Have an office or employee work site within the state whose SHOP you want to use
- Learn how to access SHOP insurance in your state. We’ll show you next steps.
- Find out what to do if your business operates in multiple states.
Questions?
- Review all SHOP tools, calculators, fact sheets, how-to guides, videos, and other resources for employers.
- Contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
More answers: SHOP Eligibility
- Do some states let businesses with more than 50 employees to participate in SHOP?
Some states may make the Small Business Health Options Program (SHOP) available to businesses with up to 100 employees. If you have more than 50 employees, and don’t know if you’re eligible for SHOP, contact your state Department of Insurance, or call the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
- What if I currently offer SHOP insurance and my business grows to more than 50 employees?
Once enrolled in SHOP insurance, businesses can renew their coverage even if a group increases to more than 50 employees.
- How do I know my state’s minimum participation rate?
In most states, at least 70% of the employees you offer coverage to must enroll in it or have coverage from another source — like a family member’s job, Medicare, Medicaid, the military (TRICARE), veterans’ programs, or individual health insurance.
Some states have different minimum participation rates:
- Iowa: 75%
- Louisiana: 75%
- Mississippi: 0%
- New Hampshire: 75%
- South Dakota: 75%
- Tennessee: 50%
- Texas: 75%
- Utah: 75%
The SHOP Minimum Participation Rate Calculator takes your state’s rules into account and tells you how many employees must accept your offer. Before using this tool, you may want to find out if your employees are interested in insurance you may offer, and if they already have coverage from another source.
There are 3 steps in the internal appeals process when appealing a private insurance company's decision
There are 2 steps in the external review process when appealing a private health insurance company's decision
You may qualify for free or low-cost care through Medicaid based on income and family size. Some states have expanded Medicaid to cover more people.
See what Medicaid and CHIP are called in your state.
How to get health coverage through certified enrollment partner websites
Already have Marketplace coverage? You should still compare plans every year .
No one plans to get sick or hurt, but most people need medical treatment at some point. Health insurance covers these costs and offers many other important benefits.
Health insurance provides important financial protection in case you have a serious accident or sickness.
Tips and Troubleshooting for using Healthcare.gov, including applying for an enrolling in health coverage.