Health insurance premiums in New Hampshire

Health insurance premiums in Montana

Below is a snapshot of the lowest SHOP premiums available in West Virginia. Employers with between 1 and 50 full-time equivalent employees can offer insurance through SHOP.

Premiums shown are total costs per employee per month. You can share the cost of these premiums with your employees, if you wish.

Find the right SHOP health insurance plan for your employees

We're testing the use of star ratings for SHOP plans this year in several states and will use this test to improve the program.

These resources and tools make it easier for you to help clients in the Small Business Health Options Program (SHOP). For more resources, visit the employer’s resource page.

Advise & enroll small businesses for SHOP plans

• Custom premium estimates: Answer a few questions about your client's business to get a custom premium estimate
• The SHOP Full-Time Equivalent (FTE) Calculator: See if your clients may be eligible to participate
• The Small Business Health Care Tax Credit Estimator: See if your clients may qualify for a tax credit and how much it may be worth
• Minimum Participation Rate Calculator: Find out if your clients meet the participation requirement

Fast answers for agents & brokers

• Get fast answers to your most pressing questions.
• Check out frequently asked SHOP questions

Questions?

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

States using HealthCare.gov for SHOP no longer process employee enrollments, determine employee eligibility, or accept employee appeal requests related to enrollment eligibility. If you:

• Applied for your employer’s SHOP Marketplace coverage and were denied coverage: Contact your employer or insurance company for more information about employee enrollment and eligibility.
• Are eligible for your employer’s SHOP Marketplace coverage, due to a qualifying life event, but couldn’t enroll during a Special Enrollment Period because the insurance company denied you coverage: You can file a SHOP employee complaint. Note: Employee dependents aren't eligible for a Special Enrollment Period if your employer doesn’t offer coverage to dependents.

Ways to report that you could not enroll in SHOP coverage

You can report this information to SHOP by:

• Calling the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
• Sending an email to shop@cms.hhs.gov documenting the concern and providing supporting evidence. Note: Don’t include Personally Identifiable Information (PII) — like your Social Security Number — in your email. Call the SHOP Call Center at the number above if any PII needs to be provided as a part of your SHOP employee complaint submission.

You have 90 days from the date of your Special Enrollment Period ineligibility notice to submit this information to SHOP.

Note: Keep a copy of your complaint for your records.

After you've contacted SHOP

You'll get a response saying that your complaint was received. It will provide a description of the process and instructions for submitting additional materials, if needed.

Questions?

• An employee should contact their employer or insurance company with questions regarding their SHOP health and/or dental coverage — including plan year start and end dates, payment-related inquiries, life changes, and/or claims-related questions.
• For all other questions related to the SHOP employee complaint process, contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).

Offering health coverage is a major decision for your business. When looking for a plan that fits the needs of your business and employees, you should carefully consider things like the cost to you and your employees, and the health services covered.

For a basic guide on some health insurance products and services that may be available to small businesses, check out these resources. You can also contact a licensed agent or broker for more help.

Note: Business owners with no employees can use the Marketplace for individuals and families to enroll in a health plan that best fits their needs. Learn more about coverage options for self-employed individuals here.

Group health insurance coverage

A group health insurance plan, like a plan purchased through the Small Business Health Options Program (SHOP) or otherwise from a private insurance company, provides coverage to eligible employees. Business owners can offer their employees one plan or a selection of plans to choose from.

Small employers (generally those with 1-50 employees) may be eligible to purchase coverage through SHOP.

Enrolling in a SHOP plan is generally the only way for an eligible small employer, including non-profits, to claim the Small Business Health Care Tax Credit.

• Learn more about purchasing insurance through SHOP
• See SHOP plans and prices
• How the Affordable Care Act (ACA) affects small businesses

If there are no SHOP plans available in your area, or your business is a large employer, you can work with an insurance company or licensed agent or broker to find out what group plans may be available to you, or learn more using the resources below.

Health reimbursement arrangements

Health reimbursement arrangements (HRAs) are a type of group health plan. HRAs allow employers to help their employees pay for medical expenses, including premiums for individual coverage in some cases.

Health Savings Accounts and other tax-favored health plans

There are various health plans that are designed to give individuals tax advantages to offset health care costs. These include: Health Savings Accounts (HSAs), Health Flexible Spending Arrangements (FSAs), and Health Reimbursement Arrangements (HRAs).

For more details on tax-favored health plans, refer to IRS Publication 969.

The Affordable Care Act (sometimes called the health care law, or ACA) established the Small Business Health Options Program (SHOP) for small employers (generally those with 1–50 full-time and full-time equivalent employees (FTEs)) who want to provide health and dental coverage to their employees.

Certain employers can enroll in SHOP through private insurance companies, or with the help of a SHOP-registered agent or broker. SHOP plans are generally the only way to qualify for the Small Business Health Care Tax Credit to lower premium costs.

But other parts of the health care law may also affect employers.

Required reporting about the Marketplace to your employees

Certain employers are required to provide certain information about the Marketplace to their employees, whether they offer health insurance or not.

90-day maximum waiting period

If you offer health insurance to your employees, you must offer it to all eligible employees when they become eligible for health coverage. Learn about the 90-day waiting period from the IRS (PDF, 40.4 KB).

Summary of Benefits and Coverage (SBC) disclosure rules

Employers must provide employees with a standard "Summary of Benefits and Coverage" (SBC) form explaining what their health plan covers and what it costs. The purpose of the SBC is to help employees understand their health insurance options. You could face a penalty for non-compliance. Get details about SBCs and see a sample completed form.

Flexible Spending Accounts (FSAs)

Employees can't contribute more than the annual dollar limit set by the IRS to their Flexible Spending Accounts. That limit doesn't apply to employer contributions to the employees' FSAs. Employers have 2 options to let employees carry over unspent FSA funds into the following plan year. Get more information from the IRS (PDF, 1.2 MB).

Workplace wellness programs

The Affordable Care Act creates incentives to promote employer wellness programs and other activities that support healthier workplaces. The maximum reward to employers using a wellness program that's contingent on employee health has increased from 20% to 30% of the cost of health coverage. The maximum reward for programs designed to prevent or reduce tobacco use is 50%. Learn more about wellness incentives from the Department of Labor.

Employer Shared Responsibility Payment

Certain businesses with 50 or more full-time and full-time equivalent employees that don't offer insurance that meets certain minimum standards may be subject to the payment. Get details about the Employer Shared Responsibility Payment from the IRS.

Reporting information on health coverage by employers and insurance companies

The health care law requires the following organizations and some other parties to report that they provide health coverage to their employees:

• Certain employers, generally those with 50 or more full-time and full-time equivalent employees
• Health insurance companies
• Self-insuring employers of any size

Learn more about these reporting requirements from the IRS.

Medical Loss Ratio rebates

Insurance companies must generally spend at least 80% of premium dollars on medical care. Insurance companies that don't meet this requirement must provide rebates to policyholders — usually an employer who provides a group health plan. Employers who get these premium rebates must allocate the rebate properly. Get more details about federal tax treatment of Medical Loss Ratio rebates from the IRS.

If you already offer health insurance to your employees

If you offer health insurance to your employees that is not through SHOP, you can keep the coverage you have. In general, offering a SHOP plan is the only way to qualify for the Small Business Health Care Tax Credit.

IRS resources for small businesses

The IRS offers several resources to help employers:

• "Affordable Care Act: What employers need to know (PDF)"
• Guide to tax provisions of the Affordable Care Act for employers
• Health care questions and answers for employers

More resources for small businesses

There are many health insurance products and services that are available for small businesses and their employees. Learn more about other health insurance products and services that may be available.

The individual coverage Health Reimbursement Arrangement (HRA) is an alternative to offering a traditional group health plan to your employees. It’s a specific account-based health plan that allows employers to provide defined non-taxed reimbursements to employees for qualified medical expenses, including monthly premiums and out-of-pocket costs, like copayments and deductibles. Employees must be enrolled in individual health insurance coverage (like a plan they bought through the Marketplace) to use the funds.

Can I offer an individual coverage HRA?

Generally, employers of any size can offer an individual coverage HRA, as long as they have one employee who isn’t a self-employed owner or the spouse of a self-employed owner. HRAs are only for employees, not self-employed individuals.

Will I qualify for the Small Business Health Care Tax Credit?

Enrolling in Small Business Health Options Program (SHOP) coverage is generally the only way to qualify for the Small Business Health Care Tax Credit, which can save you up to 50% of your employer contribution for 2 consecutive years. Learn more about offering traditional group coverage SHOP plans to your employees.

How much can I contribute to my employees’ costs?

You have the flexibility to decide how much you contribute toward your employees’ individual coverage HRA for each 12-month plan year. There are no annual minimum or maximum contribution requirements.

What’s considered an “affordable” individual coverage HRA offer?

An individual coverage HRA is considered affordable for an employee and their dependents if the monthly premium the employee would pay (after the employer’s reimbursement) for the self-only, lowest cost Silver plan available to them through the Marketplace in their area is less than 9.12% of 1/12 of the employee’s yearly household income.

• If your offer is considered affordable: The employee won’t be eligible for the premium tax credit for the employee’s Marketplace coverage or the coverage of other household members who would be covered by the individual coverage HRA.
• If your offer isn’t considered affordable: If they’re otherwise eligible the employee must decline the individual coverage HRA to claim the premium tax credit for the Marketplace coverage. The employee can’t combine the individual coverage HRA with a premium tax credit.

Note: Affordability calculations for employer-sponsored coverage, including an individual coverage HRA offer, aren’t affected by savings and lower costs on Marketplace health insurance coverage that the American Rescue Plan Act of 2021 provides.

How is “affordability” determined?

If applying for coverage through HealthCare.gov, employees will provide information about their individual coverage HRA offer when completing an application for Marketplace coverage, including the HRA’s start date and their employer's contribution amount. The Marketplace will determine if the offer meets requirements for “affordability,” which will help determine an employee’s eligibility for the premium tax credit. Prior to submitting a Marketplace application, employees can also use the HRA affordability tool for an estimate of their individual coverage HRA’s affordability.

Can my employees use pre-tax dollars to pay the portion of the health plan premiums not covered by an individual coverage HRA?

Yes. You may use a salary reduction arrangement under a cafeteria plan to allow your employees to pay on a pre-tax basis the portion of the individual health insurance premiums not covered by your individual coverage HRA. However, your employees can’t use these pre-tax payments to pay for Marketplace coverage. They can still use the individual coverage HRA to buy individual health insurance coverage, but they’ll need to purchase coverage outside of the Marketplace to pay the portion of their health plan premiums not covered by the individual coverage HRA.

Which employees are eligible for my individual coverage HRA offer?

You can offer an individual coverage HRA to any eligible employee, or you can offer it only to certain types of your employees. The types or classes of employees can be determined by certain job-based criteria, like:

• Full-time, part-time, or seasonal status
• Employees covered by a collective bargaining agreement
• Salaried or non-salaried (like hourly workers) employees
• Employees who haven't satisfied a waiting period
• Non-resident aliens with no U.S.-based income
• Employee work locations
• Any combination of 2 or more employee types listed above

The individual coverage HRA rules specify the classes. You can't make up your own classes. See a full list of available classes (PDF, 408 KB). The reimbursement amount you offer can also vary within each employee class based on age (not to exceed a 3:1 ratio) or number of dependents, and you can set a waiting period for new employees. There's also a special rule for new hires. Otherwise, you must offer the individual coverage HRA on the same terms to all employees in a class.

Can I offer an individual coverage HRA along with traditional group coverage?

You can offer certain types of employees a traditional group health plan and other types of employees an individual coverage HRA. But you can’t offer the same type of employees a choice between a traditional group health plan and an individual coverage HRA, and you can’t combine an individual coverage HRA with a traditional group health plan or with SHOP coverage. For example, you can offer full-time employees a traditional group health plan and offer part-time employees an individual coverage HRA.

There are certain requirements if you offer an individual coverage HRA to one type of employee and traditional group health plan coverage to another type of employee. If you offer an individual coverage HRA only to certain employees, in some cases, there are size requirements for certain classes of employees that get an individual coverage HRA offer:

If you don't offer a traditional group health plan to any of your employees, these class size minimums don’t apply.

How to start an individual coverage HRA

You can set up an individual coverage HRA at any time. You’ll need to provide a written notice to your new employees as soon as they’re eligible to participate and to current employees 90 days before the beginning of each plan year.

Employees will need information from this notice to fill out a Marketplace application and check eligibility for a premium tax credit on a Marketplace health plan, or free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). They must be offered the chance to decline the individual coverage HRA annually before the plan year begins, or when they’re first offered the individual coverage HRA if that happens in the middle of the plan year.

See a sample HRA notice to learn what information employers must include. (PDF, 93 KB).

Remember, to use their individual coverage HRA amount, employees must be enrolled in individual health insurance coverage, like a plan purchased through the Marketplace or from a private insurance company, or have Medicare coverage (Part A and Part B, or Part C). Short-term plans, or other limited benefits coverage, like dental or vision insurance, don’t meet this requirement (PDF, 408 KB). There must be reasonable procedures in place (PDF, 70 KB) to confirm that employees and their households covered by the individual coverage HRA are enrolled in individual health insurance coverage.

You should consider how your employees can get individual health insurance coverage when picking a start date for your individual coverage HRA’s plan year. For example, offering an individual coverage HRA starting on January 1 allows employees to choose coverage during the individual market’s annual Open Enrollment Period, and in most cases, individual market plan deductibles reset on January 1 each year. If you’re ending a traditional group health plan to offer an individual coverage HRA, a class of employees is offered a new individual coverage HRA, or a newly-hired employee becomes eligible for the individual coverage HRA during its plan year, your employees may qualify for a Special Enrollment Period to newly enroll in individual health insurance coverage. To enroll in or change their Marketplace coverage through this Special Enrollment Period, employees can submit an application on HealthCare.gov and include information about when their HRA can start.

Generally, employees will need to submit an application and select a plan in time for it to take effect by the first day that their individual coverage HRA can start.

Need help deciding whether an individual coverage HRA is right for your business?

Search for a registered agent/broker or trained assister in your area. You may also want to talk with a licensed tax professional or benefits specialist.

Compare coverage options with our HRA decision guide. Find out more about how an individual coverage HRA compares to other products and services that may be available to help you cover your employees.

Employees: Understanding individual coverage HRAs

If you’re an employee who has been offered an individual coverage HRA by your employer, learn more about individual coverage HRAs and the Marketplace.

• Determine your next steps with help from HealthCare.gov’s HRA affordability tool.

Generally, if you run your own business and have no employees, or are self-employed, your business won’t qualify for group coverage. You can purchase qualified health coverage through the Marketplace for individuals and families.

With an Individual Marketplace plan, you can:

• Find coverage for yourself and your family
• Access premium tax credits and other savings, if you qualify

The Individual Marketplace

The Individual Marketplace offers flexible, quality coverage for people who:

• Run their own businesses
• Are self-employed with no employees
• Work as freelancers or consultants

All plans in the Marketplace cover the same categories of essential health benefits and are prohibited from excluding treatment based on pre-existing conditions. You can also choose between plans with lower premiums and higher cost-sharing when you need care, or higher monthly payments and lower cost-sharing when you need care.

You can only enroll in Marketplace coverage during the annual Open Enrollment Period, unless you have a qualifying life event during the year.

Looking for help with coverage? Find an agent or broker in your area. Agents and brokers are experts in health insurance and can help you find the coverage you need if they have completed registration with the Marketplace, generally at no extra cost to you.

Qualifying for Marketplace savings

To get a premium tax credit or reduction of your out-of-pocket costs, you’ll need to provide an estimate of your household income to the Marketplace for the year you’re getting coverage. This can be challenging for business owners whose income may vary. You should provide your best estimate. Talk to your tax professional for advice on how to estimate your household income.

If you qualify for a premium tax credit and/or reduction of your out-of-pocket costs and your expected household income changes during the year, you should return to the Marketplace and update your estimated income as soon as possible. At the end of the year, if you make more than what you reported to the Marketplace, you may have to pay back some or all of the premium tax credits that you received in advance. If you make less, you could get additional premium tax credits when you file your taxes.

Learn more about reporting income to the Marketplace.

Note: You may be able to get more savings and lower costs on Marketplace health insurance coverage due to the American Rescue Plan Act of 2021. Find out if you qualify for Marketplace savings.

Learn how your healthcare insurance will impact your 2015 federal tax filing. What you need to know for maximum return, premium tax credit, and more.