Can small businesses use the ACA’s health insurance marketplaces (exchanges)?

Instead of having small businesses use the exchange to enroll in coverage, HealthCare.gov now directs them to seek out a broker or contact an insurance company directly.¹ And although the site still maintains a tool where employers can check to see if there are SHOP plans available in their area (for purchase directly from an insurer or with the help of a broker), the tool no longer shows any available plans in most areas. But as described below, there are still SHOP-certified plans available in parts of eight states that use HealthCare.gov.

SHOP enrollment lagged from the start

The Small Business Health Options Program (SHOP) never really took off. As of 2017, HHS reported that there were fewer than 39,000 people enrolled in SHOP coverage across the 26 states that had fully federally-run SHOP platforms at that point. Hawaii was the first state to obtain approval for a 1332 waiver, and its purpose was to eliminate the state’s SHOP exchange as of 2017.

Arkansas, Mississippi, and Utah used to run their own SHOP platforms (although all three states used HealthCare.gov for individual market enrollments), but had switched to the federal SHOP platform or a direct-to-carrier process by 2019. Arkansas noted that they would no longer have a SHOP option because insurers were no longer participating in SHOP in Arkansas.

And the lack of insurer participation in SHOP has not been limited to states that use the federally-run exchange. The same thing happened in Washington state as of 2018. And Minnesota, which has a functional state-run exchange for individuals, discontinued its SHOP platform.

Individual market QHP issuers were allowed to stop offering SHOP plans in 2018

The decline in SHOP participation was due in part to lackluster enrollment in the early years, and also to a rule change that HHS finalized in late 2016. Under the new rule (which took effect for plan years starting in January 2018), insurers that offer individual market coverage through HealthCare.gov are no longer required to offer SHOP coverage, even if they (or an affiliate) have more than 20% of the small-group market share in the state.

Prior to 2018, those insurers were required to offer at least one silver and one gold SHOP plan in order to be allowed to offer individual market coverage in the exchange. But HHS eliminated that requirement for plan years starting in 2018 or later.

Washington, Minnesota, and Nevada have state-run health insurance exchanges and previously offered SHOP coverage, but they no longer have SHOP plans available. Pennsylvania also has a state-run exchange, but does not offer small business coverage.²

SHOP enrollment tends to be much lower than individual exchange enrollment. For example, although Covered California has a fairly robust SHOP program, it had about 78,000 members as of late 2022 — versus more than 1.75 million individual market enrollees in early 2024.³

DC is an exception, with SHOP enrollment that far exceeds individual market enrollment (almost 86,000 SHOP members as of 2024, versus about 14,000 individual market enrollees). But that’s driven in large part by the fact that all small-group plans in DC must be purchased through the exchange (DC is the only place in the country where there is no off-exchange market for individual or small group health plans), and by the fact that members of Congress and their staff obtain coverage through the DC SHOP exchange (Congress members and their staffers and dependents account for about 11,000 of the exchange’s SHOP enrollees).

However, that provision (most recently in IRS Notice 2018-27) only applies to businesses that initially purchased a plan through the SHOP exchange, and then transitioned to a non-SHOP plan (in 2017 or later) within the two-year window during which they’re eligible to claim the tax credit, because SHOP plans ceased to be available during that two-year window. This is highlighted in Example 3 in IRS Notice 2018-27: The IRS clarifies that the tax credit would not have been available in 2017 for a small business that began operations in 2017 but was in an area where no SHOP plans were available.

The instructions for Form 8941 (see page 5) confirm that this provision was still applicable for the 2023 tax year as long as the employer claimed the tax credit for all or part of 2022. So if an eligible employer began its two-year tax credit window in 2022 under a SHOP plan, and was unable to purchase a SHOP plan for 2023 due to lack of availability, they could enroll in a non-SHOP plan in the second year and still obtain the tax credit.

The IRS notes that employers in most states (those that use HealthCare.gov) can use HealthCare.gov’s search tool to see if there are SHOP plans available. That tool does still work, although most areas that use the federally-run health insurance exchange do not have SHOP-certified plans available as of 2024 (if SHOP plans are available in your area, the tool on HealthCare.gov will show them to you; otherwise, the tool will simply say that there are no SHOP plans available).

According to Public Use Files published by CMS (see the Business Rules PUF; filter for SHOP), there are quite a few dental-only SHOP plans. But if we limit it to medical SHOP plans, they’re only available in the following states as of 2024 (and coverage areas are often limited to only certain parts of the state; note that insurer names come from the HIOS ID in the public use files):

• Alabama (from Blue Cross Blue Shield of Alabama)
• Georgia (from Kaiser)
• Louisiana (from Louisiana Health Service & Indemnity Company)
• Montana (from Montana Health Cooperative)
• New Hampshire (from Anthem/Matthew Thornton)
• Ohio (from AultCare)
• Wisconsin (from Security Health Plan of Wisconsin, and Common Ground)
• Wyoming (from Montana Health Cooperative)

In 2019, there were SHOP plans available in Alaska, Illinois, and Michigan, but none of those states had SHOP plans available by 2020.

In addition, there are still SHOP-certified plans in most of the states that run their own exchanges (detailed above). This includes California, Colorado, Connecticut, DC, Idaho, Maine, Maryland, Massachusetts, New Jersey, New Mexico, New York, Rhode Island, and Vermont.

So if a business is in an area that still has SHOP plans available, the small business health care tax credit is still available to newly-enrolling businesses, and can be used for two years. The tax credit is also still available to a business that began its two-year tax credit window under a SHOP plan but then had to transition to a non-SHOP plan because SHOP plans were no longer available. But businesses trying to claim the tax credit for the first time cannot do so if they’re in an area where there aren’t any SHOP plans available.

Although a small employer can purchase a group plan at any point, employees can only enroll or make changes to their coverage during their employer’s annual open enrollment period (dates vary by employer), a special enrollment period triggered by a qualifying life event, or when they’re initially eligible (when the employer first purchases coverage, or when the employee first meets the group’s coverage eligibility requirements, which may include a waiting period of up to three months of employment). This is the same process that has long applied to employer-sponsored coverage.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

1. ”How to enroll in SHOP insurance” HealthCare.gov. Accessed Oct. 11, 2024 ⤶
2. ”Pennie, You, and Your Employees” Pennie. Accessed Oct. 11, 2024 ⤶
3. ”Effectuated Enrollment: Early 2024 Snapshot and Full Year 2023 Average” CMS.gov, July 2, 2024 ⤶
4. ”Colorado Senate Bill 73” BillTrack50. Enacted May 1, 2024 ⤶