ACA Group Spotlight: Coverage Misconceptions


With less than fifty days to open enrollment in the SHOP and Marketplace and parts of the Affordable Care Act (ACA) being debated, delayed, and defined we thought it was time to shed some light on some common misconceptions about group insurance under ACA.

Group Fiction: Small businesses are required to buy health insurance for employees.

The law does not require small employers to provide insurance coverage.  In 2015, employers with more than fifty full-time employees may be required to offer insurance benefits to employees or pay a fine.  There are some circumstances where a smaller employer may be subject to the requirements such as common ownership of companies totaling over fifty full-time employees, however, the majority of small employers will not fall into this classification.

​Group Fiction: Employers must offer the same level of health insurance benefits to all employees.

Coverage distinctions between groups of employees are permitted as long as they are based on employment-based classifications consistent with an employer’s usual business practice.  The most common example of this is full-time versus part-time employees.

Group Fiction: Employers cannot use an agent to purchase insurance coverage for their employees.

False!  A business can use an insurance agent find coverage both outside and inside of the SHOP-Exchange.  Employer premiums will be the same in the SHOP whether or not an employer chooses to use an agent.  An insurance agent can help employers review and compare price, coverage options, quality, and important features that may be overlooked otherwise.

Group Fiction: All health insurance plans must cover employee dependents up to age 26.

ACA required plans that offer dependent coverage to continue to make coverage available to dependents up to age 26, even if they are: married, no longer live with a parent, is not on the parent’s tax return, and is no longer a student.  This requirement, however, does not apply to plans that do not provide dependent coverage.  Beginning in 2015, large employers who are subject to the “pay or play” penalty must offer coverage to full-time employees and their dependents or pay a penalty.

Group Fiction: SHOP is delayed until 2015.

SHOP or the Small Business Health Options Program is scheduled to open on October 1, 2013 the same day as the Individual Health Insurance Marketplace.  This year, employees will not be permitted to choose from different plans.  In the future, the SHOP will  allow employees to choose from any available plan.

If you have additional questions about how ACA may impact your business or your insurance benefits,contact us.

We do more than cover small businesses and individuals with the right insurance policies and benefit plans – what motivates our team is helping you save more so you can invest more in your team, family, and goals.

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