Small Business Health Insurance Options
Compare business health benefits with individual coverage. Your options depend in part on whether you have eligible employees.
Joseph works directly with business owners to review available coverage. There is no fee for his brokerage services; the insurance company pays a commission if coverage is purchased through him.
Coverage for owner-only businesses
Owner-only businesses may have private ERISA plan options. These plans can require medical underwriting, and health conditions or medications may affect eligibility and the offer. They are separate from SHOP and do not qualify for Marketplace subsidies.
SHOP, if you have staff
SHOP is for a business with 1 to 50 employees, and at least one employee who is not an owner or an owner's spouse. Owner only, or owner and spouse only, does not qualify. HealthCare.gov sends that owner to the individual Marketplace.
Review the plan’s benefit options
Private business plans may offer choices of deductibles, provider networks, and eligible participants. Joseph reviews the available options before you begin an application.
Which one fits
- Owner only: compare medically underwritten private business coverage with individual Marketplace coverage, including any available premium assistance.
- Owner and spouse only: still not SHOP. HealthCare.gov treats that as self-employed.
- At least one employee who is not an owner or spouse: SHOP can be quoted. Most states also want about 70 percent of the employees who are offered coverage to enroll, except from November 15 to December 15.
- Under 25 full-time-equivalent employees, wages within the IRS limit, and the company paying at least half the employee premium: the small-business tax credit is a SHOP question. It does not apply to a private company plan.
What we review
- Who needs to be covered, including a spouse or a child.
- Your preferred doctors and the provider network you need.
- Deductible, copays, and the out-of-pocket maximum.
- Prescriptions, and whether an HSA is available.
- Optional dental or life insurance benefits.
- What the company pays, and what the person on the plan pays.
Health questions
A medically underwritten owner-only plan may ask about health conditions, medications, height, and weight. SHOP has separate eligibility and participation requirements. Discuss medical information during your consultation rather than in an email or public website form.
What to have ready
- The company name, and whether anyone else is on payroll.
- Where you live, and where any employee works.
- Ages of the people who need coverage.
- Your estimated monthly coverage budget.
A private company plan is not Marketplace coverage, and a subsidy does not apply to it. Availability depends on the state and the plan.
Discuss your business coverage See plan examples · FAGE website