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Dear Addy: Small Business Health Options Program (SHOP)

Dear Addy Banner

Dear Addy,

I am a small business owner with fewer than 25 employees and I have a child with hemophilia. The private insurance I provide my employees has gotten very expensive. I don’t know if I can afford it any more. Can you let me know what options I have? I don’t want to stop offering health insurance to my employees and I need good insurance so we can keep seeing the doctor at our HTC.

Signed,

Between A Rock and A Hard Place

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Dear Between,

All is not lost; there is an option that might work for you. Under the Affordable Care Act (ACA), employers with fewer than 50 full-time equivalent (FTE) employees can purchase health insurance plans through the Small Business Health Options Program (SHOP). SHOP offers small employers a selection of high-quality coverage, often at lower costs than buying on the private insurance market.

Your company may also qualify for tax credits if you buy insurance through SHOP. The tax credit is worth up to 50% of your contribution toward employee premium costs (up to 35% for tax-exempt employers like non-profits). To qualify for the SHOP program, you must have at least one full-time employee, offer SHOP coverage to all of your full-time employees, and at least 70% of your full-time employees must enroll in your SHOP plan.

Your company cannot be denied coverage based on the health status of your employees (or their dependents), even if they or their dependents have a pre-existing condition. Plus, insurers offering SHOP plans cannot increase your premium for employees with high medical costs or charge higher premiums for women. To enroll in a SHOP plan you will have to use an agent, broker, or insurance company. For more information on the SHOP program, call 800-706-7893.

~Addy

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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.

 

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