What’s New for the Health Care Marketplace in 2016

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Bookstore owners and managers can head to HealthCare.gov at any time during the year to see what health care plans they can offer their employees. To use the Small Business Health Options Program (SHOP) Marketplace, a business must have 50 or fewer full-time equivalent employees (FTEs), though some states may use different employee maximums for 2016.

Starting with 2016 coverage, booksellers with at least one full-time employee can use the SHOP Marketplace to:

  • Offer their employees a single health insurance plan, or let them select any plan within a coverage category
  • Offer a health plan only; health and dental plans; or a dental plan only
  • Meet the SHOP Marketplace minimum participation rate more easily (booksellers can visit the SHOP MPR Calculator to see how many people will need to accept a chosen health plan to meet the minimum participation rate)
  • Renew their SHOP Marketplace coverage online without having to fill out a new application. Many parts of existing applications will be saved and pre-populated, including the employee roster.

Booksellers looking to get started should go to HealthCare.gov, select their state, then click the “Apply Now” button.

The SHOP Marketplace is open to employers with up to 50 employees. In early October, President Obama signed into law an amendment to the Affordable Care Act that leaves it up to states to determine whether to increase the limits for their small group markets from businesses with 1 to 50 employees to include those with 51 to 100 employees in 2016. As such, starting in 2016, some states may make the SHOP Marketplace available to businesses with up to 100 employees. Booksellers that have more than 50 employees and don’t know if they can use the SHOP Marketplace can contact ABA Senior Public Policy Analyst David Grogan at dave@bookweb.org.

In related news, this week, the Department of Health and Human Services (HHS) released the 2016 Marketplace Affordability Snapshot, an analysis of the consumer health insurance marketplace, which found that about eight out of 10 consumers will be able to buy a plan with premiums less than $100 dollars a month after tax credits. HHS also noted that about seven out of 10 will have a plan available for less than $75 a month.

Highlights of the 2016 Marketplace Affordability Snapshot include:

  • The average rate increase for a benchmark plan across 30 of the largest markets, representing 60 percent of Marketplace enrollees, is 6.3 percent. This rate increase does not account for the benefit provided by tax credits to eligible consumers.  
  • Across all markets in the 37 states that use HealthCare.gov, the cost of the benchmark plan will increase an average of 7.5 percent.
  • For 2016, more than two-thirds of counties will have three or more issuers.
  • New analysis based on the second open enrollment found that returning consumers who switched plans within the same “metal” tier saved an average of nearly $400 on their 2015 annualized premiums after tax credits, as compared to those who stayed in their same plans. (Plans in the Health Insurance Marketplace are presented in four “metal” categories: Bronze, Silver, Gold, and Platinum. Metal categories are based on how a plan split the costs of a consumers’ health care. They have nothing to do with quality of care.)

To see a state-by-state list of final, and proposed, premium rate changes, click here.