How do I Choose Coverage That’s Right for my Business?


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How do I choose coverage that’s right for my business?
Created on October 21, 2013

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.

In 2014, SHOP is open to employers with 50 or fewer full-time equivalent (FTE) employees.

When you compare plans for your business, you'll notice that the plans are put into categories:

  • Bronze

  • Silver

  • Gold

  • Platinum

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.

What your employees can expect to 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 – depends on which plan category you choose.

Comparing plans: Bronze, Silver, Gold, Platinum

As with all health plans, you and your employees have to pay a monthly premium. You can decide up front exactly how much you can afford to contribute towards your employees’ premium costs, so you have more 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 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.

Apply for SHOP coverage right now. You’ll be taken to a page where you pick your state. Then you’ll be taken to the right website to continue.

Have questions about the SHOP Marketplace for businesses with 50 or fewer employees? Call 1-800-706-7893 (TTY users: 1-800-706-7915). Hours: Monday through Friday, 9 a.m. to 7 p.m. EST. Agents and brokers may also use this number.

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Last updated: 04/19/2017 - 4:11pm