Individual vs. Small Group Markets

Differences between the Individual Market and Small Business Health Options Program (SHOP) Market:

• In the Individual Market, a plan year spans a calendar year and QHP certification lasts through the end of each year. In the SHOP Market, QHP plan year certification lasts for 12 months, even if the plan year ends after the calendar year in which the QHP was certified. This means that employers can start SHOP coverage at the beginning of any month, with SHOP coverage lasting for 12 months.

• In the Individual Market, enrollees are automatically reenrolled for coverage for the next plan year unless they choose and enroll in another plan during Open Enrollment. In the SHOP Market, enrollees are not automatically reenrolled in coverage for the next plan year.

• The SHOP Market has specific additional requirements that do not apply to the Individual Market, such as employee choice, premium aggregation, and minimum participation rates (see 45 C.F.R. 155.705).