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CMS Proposes Change in Small Employer Enrollment Procedure

On Behalf of | Jul 7, 2017 |

The Centers for Medicare & Medicaid Services (“CMS”) has proposed a change in the method used by small businesses and their employees to enroll in insurance coverage through the Federal Marketplaces. CMS says that this change may “offer employers the help they need to find affordable insurance for their employees.”

The ACA provides that small businesses can purchase qualified health plans (“QHPs”) through federal or state-level Health Care Exchanges The ACA further provides that each Exchange will include a Small Business Health Options Program (“SHOP”) component to allow small employers with 50 or fewer employees to purchase QHPs for their employees.

However, the SHOPs are unpopular. Of the nearly 30 million small businesses in the United States, less than 8,000, (or just 0.1 percent of all small businesses) currently participate in the SHOPs, and these only cover about 40,000 individuals nationwide.

CMS says it will be exploring a “more efficient implementation of the Federally-facilitated SHOP Marketplaces in order to promote insurance company and agent/broker participation and make it easier for small employers to offer SHOP plans to their employees”, while maintaining access to the Small Business Health Care Tax Credit. Beginning in January 2018, instead of enrolling online at (as is currently required), employers would enroll directly with an insurance company offering SHOP plans, or with the assistance of an agent or broker registered with the Federally-facilitated SHOP. However, employers would still obtain a determination of eligibility by going to

Under the proposal, employers that have enrolled in SHOP coverage for plan years that begin in 2017 would be able to continue using in 2018 for enrollment and premium payment, until their current plan year ends. CMS anticipates that State-based SHOP Marketplaces would be able to provide for online enrollment, or could opt to direct small employers to insurance companies and SHOP-registered agents and brokers so that the employers may directly enroll in SHOP plans.

CMS also noted that State-based SHOPs not using could continue to operate as they have previously done.