Question 1

What's the difference between SHOP and individual ACA marketplace?

Accepted Answer

SHOP (Small Business Health Options Program) is a marketplace specifically for employers with 1–50 employees offering group coverage. Individual ACA marketplace is for people buying their own coverage. SHOP plans are often eligible for a small employer tax credit (up to 50% of premiums) and are administered as group coverage; individual plans use household income for subsidies.

Question 2

I have 3 employees including family — does that count for SHOP?

Accepted Answer

Yes. The SHOP marketplace counts W-2 employees, including family members on payroll, as long as they aren't the sole owner or sole owner-and-spouse. Most family-owned businesses with 1–10 employees qualify; we'll walk through your specific census in the consultation.

Question 3

Can I cover myself as the owner on the group plan?

Accepted Answer

In most states, yes — owners and their spouses can be enrolled on a SHOP group plan as long as there is at least one non-family W-2 employee on payroll. For pure owner-only or owner+spouse businesses, an individual plan (often with subsidies) usually wins on cost.

Question 4

Tax credit for small employer group health — do I qualify?

Accepted Answer

The Small Employer Health Care Tax Credit covers up to 50% of premiums (35% for non-profits) if you have fewer than 25 full-time-equivalent employees, average wages under roughly $62,000, and contribute at least 50% of premium costs. We'll model it during the analysis step.

Question 5

What if some employees want coverage and some don't?

Accepted Answer

Carriers generally require a participation rate (often 70% of eligible employees) for group plans. We can write valid waivers for employees with other coverage (a spouse's plan, Medicare, Medicaid), and we use hybrid strategies (ICHRA, QSEHRA) when straight group enrollment doesn't fit.

Question 6

Can I offer different coverage levels to different employees?

Accepted Answer

Yes, within rules. Group plans allow defined employee classes (full-time vs. part-time, salaried vs. hourly) and the SHOP marketplace supports employee choice across metal tiers. ICHRA arrangements allow per-class reimbursement amounts.

Question 7

How does enrollment work with my payroll?

Accepted Answer

Once the plan is selected, carriers handle billing directly. Employee contributions are typically pulled pre-tax through your payroll provider (we'll coordinate the deduction setup with Gusto, ADP, Paychex, QuickBooks, or whoever you use).

Question 8

What's the cost to me for Main Street's consultation?

Accepted Answer

Zero. Independent insurance agents are compensated by the carriers, not the employer or employee. Our benefits-design consultation, plan selection, filing, employee communication, and ongoing support are all free to your business.

Insurance Questions? We Have Straight Answers.

Questions from main-street owners.