Health Insurance Coverage – What Small Businesses Need to Know By Ray Hurd, April 28, 2014
Small business owners looking to make sense of the Affordable Care Act and provide health insurance options to their employees have new resources available. The Small Business Health Options Program (SHOP), a part of the new Health Insurance Marketplace, gives small business owners access to available choices for quality, private health insurance plans. This helpful information and other tools allow you to compare plans and ultimately choose coverage options that work best for your company and your employees.
There are a few important points about the Affordable Care Act small business owners need to know, including:
· You’re not required to offer health insurance under the health care law if you have fewer than 50 employees, nor is there any penalty if you don’t.
· You can buy insurance through the SHOP Marketplace if you have 50 or fewer full-time employees, and you offer insurance to all full-time employees (generally those working 30 or more hours a week).
· Every plan in the SHOP Marketplace covers a comprehensive set of benefits, including doctor visits, hospital stays, preventive care, and prescriptions.
· New rules require these plans to treat you fairly; insurance companies can’t raise premiums for the group just because of an employee’s preexisting health condition or because an employee gets sick or injured, and there are new limits on charging small groups higher premiums for older employees.
In Maine, small business owners can enroll in SHOP coverage directly through an agent, broker or a health insurance company that offers a SHOP Qualified Health Plan. An agent, broker or insurer can help you find and compare SHOP health plans, give you exact prices and help your employees enroll. They can also help small business owners fill out and send in a paper application for SHOP eligibility to the SHOP Marketplace. Additionally, you can find plan information, a Premium Estimation Tool and download an application for SHOP eligibility on
You don’t need to wait to hear back from the SHOP Marketplace about your eligibility before enrolling. But if you want to apply for the Small Business Health Care Tax Credit, you will need to get a notice of your SHOP eligibility before you file your returns for tax year 2014. Small businesses that buy coverage through the SHOP Marketplace may also qualify for a tax credit worth up to 50 percent of their contributions to employee premium costs (up to 35 percent for tax-exempt employers). Small businesses have already received more than $1 billion in tax credits since this tax credit was created in 2010.
If you have questions about what the SHOP Marketplace offers or how to apply, visit Healthcare.gov or call the SHOP Employer Call Center toll-free at 1-800-706-7893 (1-800-706-7915 – TTY).
Ray Hurd is Medicare’s Regional Administrator for Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Puerto Rico, Rhode Island, Vermont and the Virgin Islands.
Courtney Porter Jenkins Regional Public Affairs Specialist Office of the Regional Administrator Centers for Medicare & Medicaid Services (CMS) JFK Federal Building, Room 2325 Boston, MA 02203 Courtney.Jenkins@cms.hhs.gov 617-565-1494 (ph) 443-934-3715 (cell)