According to the 2024 Data from the NY Health Exchange, the average Bronze-level monthly premium is $849 for a single employee and $2420 per family. The average deductible is $7350 for a single employee and $14,700 per family.
What is NY SHOP? Who is qualified and who is not?
The Small Business Marketplace, also known as SHOP, is a platform designed to aid employers in providing high-quality, affordable health insurance coverage to their employees. This insurance coverage is offered directly from New York State of Health certified insurers.
To qualify for SHOP, certain criteria need to be met:
- Eligible businesses or non-profit organizations must have a physical business location within New York State
- Employ between 1 and 100 Full-Time Equivalent (FTE) employees.
- Should offer, or plan to offer, coverage to all their full-time employees.
To qualify for the Small Business Health Care Tax Credit (up to 50% of premiums) is particularly beneficial for employers who:
- Have less than 25 full-time equivalent employees and
- Pay average wages of less than $58,000 a year for the 2022 tax year per FTE employee.
- Eligibility also requires these employers pay at least 50% towards the available lowest-cost individual medical coverage.
- Offer SHOP coverage to all full-time employees who work at least 30 hours per week.
Small Business Health Insurance Premiums Average for 2024
There are four tiers of small group premiums available in the SHOP marketplace - Bronze, Silver, Gold, and Platinum. These tiers offer different coverage levels and costs. For example, the monthly premium for a single Bronze plan is $849, while a Platinum plan for a couple with a child is $4,014. These rates allow small businesses to select a plan that best fits their budget and coverage needs.
Monthly premium per employee
| Tier | Single | Single + Child | Couple | Couple + Child |
|---|---|---|---|---|
| Bronze | $849 | $1,698 | $1,443 | $2,420 |
| Silver | $976 | $1,952 | $1,659 | $2,782 |
| Gold | $1,186 | $2,373 | $2,017 | $3,382 |
| Platinum | $1,408 | $2,816 | $2,394 | $4,014 |
For example, if you are planning to cover 10 employees, half have families and half don't, and plan to contribute 60% toward their premiums.
Am I Required to Offer Health Insurance?
Under the Affordable Care Act (ACA), small businesses are not legally required to provide health insurance to their employees. The Employer Mandate of the ACA applies only to large businesses with 50 or more full-time equivalent employees. These employers must provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee. However, many small businesses choose to offer health insurance to attract and retain employees, and to take advantage of tax credits.
Can I Offer Health Insurance Via SHOP But Contribute Less than 50%?
No, one of the eligibility criteria for the Small Business Marketplace (SHOP) and the Small Business Health Care Tax Credit is that an employer must pay at least 50% towards an employee's available lowest-cost individual medical coverage. This requirement is in place to ensure that employers make a significant contribution towards their employees' health insurance costs. Failure to meet this requirement may result in ineligibility for the SHOP program and the associated tax credit.
Average Deductible For Single Employees
| Tier | Single Deductible | Annual Premiums |
|---|---|---|
| Bronze | $7,350 | $10,185 |
| Silver | $3,500 | $11,710 |
| Gold | $688 | $14,234 |
| Platinum | $133 | $16,896 |
Average Deductible For Employees with Families
| Tier | Family Deductible | Annual Premiums |
|---|---|---|
| Bronze | $14,700 | $29,040 |
| Silver | $7,000 | $33,380 |
| Gold | $1,375 | $40,584 |
| Platinum | $267 | $48,162 |
How much will it cost my business on average to offer health insurance?
In a scenario where a business offers a Silver-Level Plan to 10 employees, five of whom are single and five of whom have dependents, the monthly premium payment amounts to $1879 on average.
This sum translates into an annual premium of $45,090. Based on the business's commitment to contribute 60% towards the cost of the coverage, the employer would make a contribution of $27,054 annually. Assume the SBHC tax credit equates to 15% of the employer's contribution (the smaller and lower-income the higher the credit %, maximum of 50%). Consequently, the business would receive a tax credit of $4,058.
| Silver-Level Plan offer | Single | With dependents | Total |
|---|---|---|---|
| Count | 5 | 5 | 10 |
| Monthly premium | $976 | $2,782 | $1,879 |
| Annual premium | $11,710 | $33,380 | $45,090 |
| Contribution | 60% | 60% | 60% |
| Employer contribution | $7,026 | $20,028 | $27,054 |
| SBHC Tax Credit | 15% | 15% | 15% |
| Credit | $1,054 | $3,004 | $4,058 |
What Are Alternatives To Small Group Health Insurance?
If affordability is a concern, small businesses have a few alternatives to traditional health insurance plans offered through the Small Business Marketplace (SHOP). One of the most considerable alternatives includes Health Reimbursement Arrangements (HRAs). HRAs enable employers to reimburse employees for healthcare costs on a pre-tax basis, providing the flexibility to decide the amount. As per the IRS, Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) are a viable option for small employers who don't offer group health plans.
The Professional Employer Organizations (PEOs) also offer a path to affordable health insurance for small businesses. PEOs pool together small businesses to offer benefits typically associated with larger companies, including health insurance. According to the National Association of Professional Employer Organizations, businesses that partner with PEOs have 10 to 14 percent lower employee turnover and grow 7 to 9 percent faster.
Mira also offers a non-insurance way to offer healthcare access at only $50/per month/per worker if you find other options unaffordable.
Bronze Plan OPtions for 2024:
- MTRO GT 40/75/6500/50 EPO HSA 24 BRONZE NS INN DEP 25 DP FP
- MTRO GT 7250/100 EPO HSA 24 BRONZE NS INN DEP 25 DP FP
- Anthem EPO 8450/50%/9100 Bronze INN Connection Dep 25 Wellness Pediatric Dental DP C Opt Out
- Anthem EPO 8450/50%/9100 Bronze INN Connection Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 8450/50%/9100 Bronze INN Connection Dep 25 Wellness Pediatric Dental DP FP
EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep25, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP - EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep25, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP, FP
EmblemHealth Bronze Plus H.S.A, Bronze, INN, Select Care Network non-gated, Dep 25, Pediatric Dental, DP - EmblemHealth Bronze Plus H.S.A, Bronze, INN, Select Care Network non-gated, Dep 25, Pediatric Dental, DP, FP
Bronze $7300, INN, Circle, Dep 25, Pediatric Dental, NSD, DP, FP - Bronze $7300, INN, Circle, Dep 25, Pediatric Dental, NSD, FP
Anthem EPO 8450/50%/9100 Bronze INN Blue Access Dep 25 Wellness Pediatric Dental DP C Opt Out - Anthem EPO 8450/50%/9100 Bronze INN Blue Access Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 8450/50%/9100 Bronze INN Blue Access Dep 25 Wellness Pediatric Dental DP FP
Silver Plan Options for 2024:
- MTRO GT 35/50/4000/70 EPO HSA 24 SILVER NS INN DEP 25 DP FP
- MTRO GT 30/80/3750/60 EPO 24 SILVER NS INN DEP 25 DP FP
- MTRO NG 30/80/3750/60 EPO ME 24 SILVER NS INN DEP 25 DP FP
- EmblemHealth Silver Plus H.S.A, Silver, INN, Select Care Network non-gated, Dep25, Pediatric Dental, DP
- EmblemHealth Silver Plus H.S.A, Silver, INN, Select Care Network non-gated, Dep25, Pediatric Dental, DP, FP
Anthem EPO 3250/50%/9450 Silver INN Connection Dep 25 Wellness Pediatric Dental DP C Opt Out - Anthem EPO 3250/50%/9450 Silver INN Connection Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 3250/50%/9450 Silver INN Connection Dep 25 Wellness Pediatric Dental DP FP
EmblemHealth Silver Premier, Silver, OON, Select Care Network non-gated, Dep25, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP - EmblemHealth Silver Premier, Silver, OON, Select Care Network non-gated, Dep25, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP, FP
MTRO NG 50/100/100 EPO ZD 24 SILVER NS INN DEP 25 DP FP - Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, DP, FP
- Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP
Anthem EPO 4550/50%/9450 Silver INN Blue Access Dep 25 Wellness Pediatric Dental DP C Opt Out - Anthem EPO 4550/50%/9450 Silver INN Blue Access Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 4550/50%/9450 Silver INN Blue Access Dep 25 Wellness Pediatric Dental DP FP
Silver $3000, INN, Circle, Dep 25, Pediatric Dental, DP, FP - Silver $3000, INN, Circle, Dep 25, Pediatric Dental, FP
Gold Plan Options For 2024
- MTRO GT 25/40/1250/80 EPO 24 GOLD NS INN DEP 25 DP FP
- MTRO NG 25/40/1250/80 EPO ME 24 GOLD NS INN DEP 25 DP FP
- EmblemHealth Gold Premier, Gold, OON, Select Care Network non-gated, Dep25, 3 Free PCP, Free Telemedicine, Pediatric Dental, DP
- EmblemHealth Gold Premier, Gold, OON, Select Care Network non-gated, Dep25, 3 Free PCP, Free Telemedicine, Pediatric Dental, DP, FP
Gold $1000, INN, Circle, Dep 25, Pediatric Dental, NSD, DP, FP - Gold $1000, INN, Circle, Dep 25, Pediatric Dental, NSD, FP
Anthem EPO 25/0%/8700 Gold INN Blue Access Dep 25 Wellness Pediatric Dental DP C Opt Out - Anthem EPO 25/0%/8700 Gold INN Blue Access Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 25/0%/8700 Gold INN Blue Access Dep 25 Wellness Pediatric Dental DP FP
Platinum Plan Options For 2024
- MTRO GT 15/25/100 EPO 24 PLATINUM NS INN DEP 25 DP FP
- Platinum $0 Option 2, INN, Circle, Dep 25, Pediatric Dental, DP, FP
- Platinum $0 Option 2, INN, Circle, Dep 25, Pediatric Dental, FP
- Anthem EPO 300/10%/3200 Platinum INN Blue Access Dep 25 Wellness Pediatric Dental DP C Opt Out
- Anthem EPO 300/10%/3200 Platinum INN Blue Access Dep 25 Wellness Pediatric Dental DP FP RE A Opt Out
- Anthem EPO 300/10%/3200 Platinum INN Blue Access Dep 25 Wellness Pediatric Dental DP FP
- EmblemHealth Platinum Premier, Platinum, OON, Select Care Network non-gated, Dep25, 3 Free PCP, Free Telemedicine, Pediatric Dental, DP
- EmblemHealth Platinum Premier, Platinum, OON, Select Care Network non-gated, Dep25, 3 Free PCP, Free Telemedicine, Pediatric Dental, DP, FP