The Small Business Health insurance Options Program is also known simply as SHOP . It is an entity that helps small businesses provide medical coverage to their employees.
Health Insurance Marketplace For Small Business In The US
While the SHOP Marketplace was previously only open to employers with 50 or fewer full-time equivalent employees; As of 2016, some states may make the SHOP Marketplace available to businesses with up to 100 employees . If you have more than 50 workers and don’t know if you can use the SHOP Marketplace, contact your state Department of Insurance or the SHOP Call Center.
SHOP Marketplace, which is also open to non-profit organizations , allows you to offer medical and dental coverage that meets the needs of your company and all workers. SHOP offers flexibility, choice, and online application and account management. Another important fact to keep in mind is that you can sign up for SHOP at any time of the year. There is no restricted enrollment period when you can start offering a SHOP plan.
Lastly, businesses that offer health coverage through the SHOP Marketplace may be eligible for the health care tax credit .
What is the Premium Tax Credit in the USA?
The Premium Tax Credit, also known as the PTC , is a refundable credit that helps eligible individuals (with individual insurance) and families cover their health insurance premiums ; as long as the policy has been acquired through the health insurance market. Now, to obtain this credit, you must meet certain requirements and file a tax return with Form 8962 , this is a formality required by US Law.
Who Qualifies for a Tax Credit in the USA?
You may be eligible for the premium tax credit if you meet the following requirements:
Have family income that is within the range required by the Federal Government.
Have filed a tax return using the filing status of single or separated.
There is an exception to this rule that allows certain victims of domestic abuse and spousal abandonment to claim the credit using the Married filing status.
3. You cannot be claimed as a dependent by another person.
Meet the following additional requirements: In the same month, you or a member of your family:
They must have health insurance coverage through the Marketplace.
They cannot get affordable coverage through an eligible employer-sponsored plan.
Are not eligible for coverage through a government program, such as Medicaid, Medicare or CHIP.
When you enroll, the Marketplace will determine whether or not you’re eligible for advance payments of the premium tax credit ; these are also called advance credit payments. Advance credit payments are amounts paid to your insurance company on your behalf to reduce the out-of-pocket cost (what you must pay) of health insurance premiums.
Do I have to Report Change of Circumstances to get the Tax Credit in the USA?
If you benefit from advance payments of the premium tax credit, it is important to report life changes to the health plan provider as they occur during the year.
Certain changes in your household, income, or family size can affect the amount of your premium tax credit. These changes may alter your insurance costs or cause you to owe taxes. Reporting these changes right away will help you get the right kind and amount of financial help from the Federal Government.
Claim and Credit Reconciliation
If you receive the benefit of advance credit payments in any amount, or if you plan to claim the premium tax credit, you must file a federal income tax return and attach Form 8962 to your return. This requirement is mandatory and is only available to US citizens .
You must file a return even if you generally don’t have to. Filing your return without reconciling advance payments will delay your refund and may affect future credit payments. Even if you do not meet the credit reconciliation requirements, you can lose your health insurance .
What should I take into account when buying a policy in the US Health Insurance Market?
Next, we leave you a series of data that you must take into account before requesting a health policy with the Medical Insurance Market.
1) Coverage Available
All Marketplace health plans cover 10 essential health benefits defined by law. Now, how you and your health insurance company split the costs of care varies by plan level.
However, all Marketplace plans give you the same essential health benefits. For example, annual checkups , routine mammograms, and diabetes screenings are covered at 100% when you join the network; all this regardless of the plan you choose.
Each plan also gives you access to other vital care. For example: If you have to stay overnight in the hospital, go to an emergency room or clinic, get care for your children , or get therapy and other treatments to get better, you’ll be covered.
2) The more you pay, the greater the coverage
Higher-priced plans pay a higher portion of your eligible medical bills . In some cases, people pay higher monthly premiums to get a plan that covers most of their medical bills.
3) Take advantage of Co-Payments
Most plans have a co-pay option available . Remember that the actual co-pay amount will vary by plan and service.
4) Each Plan is Unique
Plans in the same metal tier may have different deductibles and different coinsurance. That’s because deductibles and coinsurance can vary between plans in the same metal tier. For example, two Gold plans may have the same annual maximum coverage, but different deductible and coinsurance amounts. So it’s best to read the fine print carefully before agreeing to a health insurance plan. This way, you will know what you have to pay when you receive health care.
5) Help to Make Payments
You may be able to get help paying for your health plan . Depending on your household size and income, your profile may qualify for federal financial assistance for your health plan through the Federal Government .