by Keith Heinly
Senior Manager, Community Impact, United Way of Brevard

I will be providing a Health Insurance for Small Businesses in Palm Bay May 12th (see flyer below). I am not a broker or agent for any insurance company. There is no cost for this service. I will be explaining how small businesses can now apply for health insurance for their employees on the Federal Health Insurance Marketplace.

Here is some general information about the SHOP Marketplace:

The Small Business Health Options Program (SHOP) Marketplace offers different types of health plans to meet a variety of needs and budgets. In all states, you can select one health plan and/or dental plan for your employees, or you can offer employees a choice of health plans within the plan category you select (like Silver or Gold).

Visit www.HealthCare.gov/see-plans/small-business to see health and dental plans and prices before you start your SHOP Marketplace application or renew coverage.

As you review your coverage options, here are some things you should know:

All plans in the SHOP Marketplace offer the same set of essential health benefits
These are many of the benefits people need when getting care. They cover things like doctor’s visits, prescriptions, hospitalizations, pregnancy, and more. Plans can offer other benefits, like vision, dental, or medical management programs for a specific disease or condition. However, specific benefits may be different in each state. Even within the same state, there can be small differences between plans. As you and your employees compare plans, you’ll see what benefits each plan covers.

SHOP Marketplace plans are put into categories

Health plans
Health plans in the SHOP Marketplace are put into 4 plan categories based on how your employees and the plan can expect to share the costs for health care: Bronze, Silver, Gold, and Platinum. If you offer one health plan, you’ll choose the plan category, insurance company and plan. If you offer your employees a choice of plans, you can select one plan category and your employees can choose any insurance company and plan in that category. The category you choose affects monthly premium costs, and the portion of the bill employees pay for things like hospital visits or prescriptions. It also affects the total amount they spend out-of-pocket for the year if they need a lot of care. The categories don’t reflect the quality or amount of care the plans provide.

Dental plans
Dental plans are put into 2 categories, low and high, based on how your employees and the plan expect to share the costs for dental care. The dental plan category you choose affects the total amount your employees will likely spend out-of-pocket for dental benefits during the year. Employers offering SHOP Marketplace coverage can now offer a dental plan to employees without offering a health plan. Employees must still enroll in a dental plan before their dependents may enroll. If an employee enrolls in health and dental coverage, their dependents can enroll in a dental plan without enrolling in a health plan.

You control your company’s spending

As with all health and dental plans, you and your employees have to pay a monthly premium. You decide up front exactly how much you can afford to contribute towards your employees’ premiums. You’ll also decide if you’ll offer and contribute toward dependent coverage. If you offer one health and dental plan, you’ll contribute a fixed percentage of the individual plan premium for each employee and dependent (if you offer dependent coverage). If you offer your employees a choice of plans, you have 2 options:

  1. Contribute a fixed percentage of any individual plan premium within a plan category (like Bronze and Silver for health plans, and Low and High for dental plans) for each employee and dependent (if you offer dependent coverage). The fixed percentage amount will vary from employee to employee based on age and the plan an employee selects.
  2. Contribute a fixed percentage of a specific “reference plan” premium amount that you choose. The reference plan is only used to determine the percentage amount you’ll contribute toward your employees’ premiums. For example, if the reference plan premium is $100 and your contribution is 50%, you’ll pay $50 toward your employees’ plan premiums, even if your employees choose a different plan. The reference plan premium amount will vary from employee to employee based on age.

Plan categories can affect out-of-pocket costs

“Out-of-pocket costs” – what your employees pay when they get care – are just as important as the monthly premium.

Plans with higher monthly premiums usually have lower out-of-pocket costs. For example, employees will likely pay a higher premium with a Gold health plan, but may have lower out-of-pocket costs when they get care. Likewise, premiums are usually higher with a High dental plan, but your employees won’t have to pay as much when they get dental care.

Plans with lower monthly premiums usually have higher out-of-pocket costs. For example, employees will likely pay a lower premium with a Bronze plan, but pay a higher share of the costs when they get care. Likewise, employees will likely pay a lower premium with a Low dental plan, but their out-of-pocket costs will be higher when they get care.

Platinum health plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if your employees need a lot of medical care. A plan can’t charge higher premiums for employees with high medical costs or pre-existing medical conditions – and a plan can’t hike your premiums when someone needs care. In general, when choosing health and dental coverage for your business, keep this in mind: the lower the premium, the higher the out-of-pocket costs; the higher the premium, the lower the out-of-pocket costs.

You may qualify for employer health care tax credits

You may qualify for a Small Business Health Care Tax Credit worth up to 50% of your premium costs if you buy coverage through the SHOP Marketplace. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. Use the SHOP Tax Credit Estimator at www.HealthCare.gov/smallbusinesses/provide-shop-coverage/small-business-tax-credits to see if your
business may qualify.

Learn more about the Small Business Health Care Tax Credit at www.HealthCare.gov.

Changing plans during the year

You can change what plans you offer to your employees and contribution amounts only during your company’s or organization’s enrollment period. However, you may add or remove eligible employees and dependents throughout the year. Your plan year is a 12-month period starting on your effective date of coverage. To remove an employee from your coverage, log on to your www.HealthCare.gov  account, or contact the SHOP Call Center at 1-800-706-7893, Monday – Friday, 9 a.m. – 7 p.m. ET. TTY users should call 711 to reach a call center representative.

Enroll  in SHOP Marketplace coverage now

Visit www.Healthcare.gov/small-businesses/ to get information about SHOP Marketplace enrollment, and available SHOP Marketplace plans and pricing. You can also enroll with the help of an agent or broker. If you already have coverage through the SHOP Marketplace, you’ll need to visit www.HealthCare.gov to renew your coverage. If you have questions or need help, contact Keith Heinly at 321-635-8885 or kheinly@uwbrevard.org or you may call the SHOP Call Center at 1-800-706-7893, Monday – Friday, 9a.m. – 7p.m. ET. TTY users should call 711 to reach a call center representative.

Come and join us for a presentation on the SHOP Marketplace on Thursday, May 12th from 3 pm – 6 pm at CareerSource Brevard, 5275 Babcock Street NE in Palm Bay.

Please contact kheinly@uwbrevard.org or call 321.631.2740 for more information.