All SHOP Marketplace small business health plans are offered by private insurance companies, and all must cover the same set of essential health benefits and offer coverage for pre-existing conditions. Some provide preventive services for free.
SHOP Marketplace insurance plans: Bronze, Silver, Gold, Platinum
When you compare SHOP Marketplace insurance you’ll see 4 categories of plans, sometimes called “metal levels.” The categories have nothing to do with the quality of care. They indicate how the insurance company and your employees split the costs of care.
- Bronze: The health plan covers about 60% of the total costs of care. The employee pays about 40%.
- Silver: The health plan covers about 70% of the total costs of care. The employee pays about 30%.
- Gold: The health plan covers about 80% of the total costs of care. The employee pays about 20%.
- Platinum: The health plan covers about 90% of the total costs of care. The employee pays about 10%.
See 5 questions to ask before picking a SHOP plan (PDF).
Choosing insurance that works for you and your employees
When you offer SHOP Marketplace health insurance, you and your employees each pay part of a monthly premium. But just as important as the monthly premium is how much your employees have to pay on things like deductibles, copayments, and out-of-pocket maximums when they get care.
- Premiums are usually lower for plans that pay a smaller share of medical costs when your employees get care. With a Bronze plan, your employees will probably pay a lower monthly premium but pay more when they use medical services. These plans can work well for employees with few health problems and who rarely use health care services.
- Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs for services. They probably work better for employees who use a lot of services or have a health crisis.
- In general, keep this in mind when comparing plans: The lower the premium, the higher the out-of-pocket costs. The higher the premium, the lower the out-of-pocket costs.
Offer one insurance plan or a choice of plans
When you select employee health insurance in the SHOP Marketplace, you can offer a single plan or a choice of plans.
- To offer a choice, pick any category – Bronze, Silver, Gold, or Platinum. Your employees can then choose any plan in that category available to them in the SHOP Marketplace.
- As you fill out your SHOP Marketplace application you’ll be able to make this choice and learn more.
Add dental insurance if you like
If you want to, you can add dental coverage to your SHOP Marketplace insurance offer. Learn more about dental coverage in the SHOP Marketplace
More Answers: How to choose health insurance for your small business
- As a small business owner, do I have to offer insurance to my employees' dependents?
Generally no, but some states require it. Check with your state's Department of Insurance.
- Dependents can accept or reject your offer. If they decline it, they can enroll in a plan through the individual and family Health Insurance Marketplace but won't be eligible for savings through premium tax credits or cost sharing reductions. They'd have to pay full price.
- If I offer a choice of plans, can the employee and dependent choose different plans?
No. But if you offer employees and dependents both health and dental insurance, the dependents can enroll in both the health and dental plans, or just one of them.
- If I don't offer insurance to dependents, can they get insurance through the individual and family marketplace?
Yes. If the dependents don't have access to other health insurance, they can get insurance through the Marketplace. Depending on the whole household's income, they may qualify for savings through premium tax credits and cost sharing reductions.
- If I offer dependent insurance, can I cover my dependents too?
- Can an employee reject the insurance for themselves but enroll their dependents?