How do I choose coverage that’s right for my business?
There are 4 categories of plans in the SHOP Marketplace. They offer similar benefits, but differ based on how enrollees and the plan share the costs of care.
The SHOP Marketplace is open to employers with 50 or fewer full-time equivalent (FTE) employees.
See plans, prices, and categories
You can preview available plans and get price estimates right now, based on the number and ages of your employees.
When you preview plans here or with an agent, broker, or insurance company, you'll notice that the plans are put into 4 categories:
The categories describe the way your employees and the plan can expect to share costs for health care. The category has nothing to do with the quality of care a plan provides.
All plans offered through the SHOP must provide a set of essential health benefits. They all cover pre-existing conditions and some free preventive services.
The category of plan you choose affects how much your employees will pay for things like deductibles and copayments – and the total amount they spend out-of-pocket for the year if they need a lot of care.
Comparing plans: Bronze, Silver, Gold, Platinum
As with all health plans, you and your employees pay a monthly premium. You can decide up front exactly how much to contribute towards your employees’ premium costs, so you have control over your company's health coverage spending.
When comparing plans, just as important as the premium cost is how much your employees have to pay out-of-pocket for covered services. The plan with the lowest premium may not provide you or your employees with the best overall value.
Balancing premiums and out-of-pocket costs
- Premiums are usually lower for plans that pay a smaller share of medical costs when your employees get care. For example, with a Bronze plan, your employees will probably pay a lower monthly premium than they would for a Gold plan. But they'll probably pay more when they go to the doctor.
- Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs for services. They will likely provide better financial protection if your employees use a lot of services or have a major health crisis.
- In general, when choosing health 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.
Learn more and apply
View detailed questions and answers on SHOP procedures, including eligibility, application, enrollment, employee communications, and more.
There is a SHOP Marketplace in each state. You must have an office or employee work site within the SHOP's service area to use that particular SHOP. Choose your state and we’ll guide you to the right SHOP for you and provide your next steps to apply.
Have questions about the SHOP Marketplace for businesses with 50 or fewer employees? Call 1-800-706-7893 (TTY: 1-800-706-7915). Hours: Monday through Friday, 9 a.m. to 7 p.m. EST. Agents and brokers helping small businesses may also use this number.
Will I have to pay more if I have employees with health problems?
No. A plan can't charge higher premiums for employees with high medical costs or pre-existing medical conditions. They can't hike your premiums when someone needs care, and they can't charge women more than men.
How do I find out how much a particular plan costs?
You can see available SHOP plans and price estimates right now. Prices are based on your location and the number and ages of your employees.
When you apply for SHOP coverage with an agent, broker, or insurance company, you’ll complete your employee roster, decide if you'll offer coverage for dental services and dependents, and get a final price quote.
Does a plan's category say anything about the quality of care it provides?
No. The category describes only the way your employees and the plan can expect to share costs for health care. The category has nothing to do with the quality of care a plan provides. All plans offered through the SHOP must provide a set of essential health benefits.