Tweaking planned for SHOP small business health care marketplace


The Centers for Medicare & Medicaid Services plans to come up with changes aimed at combatting disappointing enrollment figures for the SHOP health insurance marketplace.


The plan would allow businesses to bypass the portal for the The Small Business Health Options Program (SHOP) marketplaces that offered online enrollment.

The Centers for Medicare and Medicaid stated that agent/broker participation, as well as overall enrollment in the SHOP Marketplaces has been lower than anticipated.

According to the agency, only 179 employees in Delaware are covered under the SHOP program.

Nationwide (including both federally-facilitated and state- based SHOP Marketplaces), approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals.

These numbers fall far short of the Congressional Budget Office (CBO) estimate that four million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017.

CMS stated in a release that it will look for ways to make the program more attractive to brokers and employers.

Under the approach CMS intends to propose, instead of enrolling online at, 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.

Employers would still obtain a determination of eligibility by going to

Employers that have enrolled in SHOP coverage for plan years that began in 2017 would be able to continue using in 2018 for enrollment and premium payment, until their current plan year ends.

Under the approach CMS intends to propose, it is anticipated that states operating 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 to directly enroll in SHOP plans, the release stated.

CMS anticipates that the changes it intends to propose for 2018 would reduce the burden on insurance companies, consumers, and American taxpayers, and make SHOP plans more readily available to those small businesses that need affordable health insurance options.

The announcement comes after the U.S. House passed the American Health Care Act, a plan to “repeal and replacement” the Affordable Health Care Act (Obamacare).

The bill was sent to the U.S. Senate where changes are likely.

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