Best Small Business Health Insurance Providers Of 2024 (2024)

• Kaiser Permanente – Best Overall
• Blue Cross Blue Shield – Best Provider Network
• UnitedHealthcare – Best for Breadth of Insurance Options

Kaiser Permanente and Blue Cross Blue Shield are the best health insurance companies for small business owners, based on Forbes Advisor’s analysis. UnitedHealthcare also received high marks.

Company	Company - Logo	Forbes Advisor Rating	Forbes Advisor Rating	Plans offered to small businesses	Size of provider network	Learn More CTA text	Learn more CTA below text	LEARN MORE
Kaiser Permanente		5.0		HMO, POS, PPO	23,900+ physicians	Learn More	On Healthcare Marketplace's Website
Blue Cross Blue Shield		5.0		EPO, HMO, POS, PPO	1.7 million+ healthcare providers	Learn More	On Healthcare Marketplace's Website
UnitedHealthcare		4.5		EPO, HMO	1.5 million+ healthcare providers	Learn More	On UnitedHealthcare's Website

The Affordable Care Act (ACA) defines a small business as a group of no more than 50 full-time employees (FTE), though some states may define it differently.

A small business owner enrolls in a group health insurance plan offered by a private insurance company and then provides their employees the opportunity to enroll in that plan. The employer pays part of their employees’ monthly premiums, while employees typically pay smaller premiums, as well as their deductibles, copays, coinsurance and services not covered by the plan.

Small business owners contract with health insurance companies and decide how many options to provide to employees.

Small business owners aren’t legally required to provide health insurance to their workers, but there are rules for those who do.

With that said, make sure you understand how your state defines a small business, as it will impact what you are required to provide, should you decide to offer health insurance to your employees.

Small business owners can buy health insurance for their employees through approved insurance companies with the Small Business Health Options Program (SHOP).

Getting insurance through the SHOP Marketplace allows employers to offer health plans from multiple insurance companies and qualifies them for the Small Business Health Care Tax Credit, which can help with the cost of providing coverage.

Your business must meet these requirements to qualify for the SHOP tax credit:

• Fewer than 25 full-time equivalent (FTE) employees
• Average employee salary is about $56,000 per year or less
• Pay at least 50% of your full-time employees’ premium costs
• Offer SHOP coverage to all full-time employees

Small business owners can also work with a health insurance broker who conducts all plan research and comparisons to find the best plan for your business at no additional charge. Or they can buy directly from a health insurance company.

If you buy coverage through the ACA marketplace, plans are organized by “metal” tiers: bronze, silver, gold and platinum. The tiers differ by premiums and out-of-pocket costs. For instance, bronze and silver plans have low premiums but higher deductibles and coinsurance. Gold and platinum plans have high premiums but lower out-of-pocket costs.

Employers have flexibility in which type of plans they choose to offer their employees.

Small business owners don’t have to provide health insurance benefits to employees. Should they choose to do so, they must meet certain requirements set by the ACA. These requirements can vary by state.

• Inclusivity: Health insurance must be offered to all employees—not just managers or any other subgroup.
• Coverage of essential health benefits: Under the ACA, a health plan offered by a small business owner must include coverage for basics, such as emergency services, pregnancy-related care and services, maternity and newborn care, outpatient care, prescription drugs and more.
• Minimum contribution: The ACA requires small businesses to contribute at least 50% of the monthly premium cost of the plans they offer to qualify for the Small Business Health Care Tax Credit. In addition to these rules, states typically require a minimum percentage of employee participation in health insurance plans offered by small businesses.

The average cost for small business owners is $612 per employee per month and $1,274 for family coverage per month, according to Kaiser Family Foundation’s 2023 Employer Health Benefits Survey.

The exact cost depends on multiple factors, including previous health insurance claims. For instance, a year of high employee healthcare costs could lead to higher health insurance rates set by the insurance company the next year.

You have several options when it comes to searching for the right plan options for your small business:

• Do your own footwork: Small business owners can sort through group health insurance options from different insurance companies to compare prices and services and enroll in a plan that meets their needs. Health insurance companies typically offer multiple plans for small businesses. You can see plan choices and costs by plugging a minimal amount of information on the ACA marketplace website.
• Work with an insurance broker: Insurance brokers know the ins and outs of health insurance plans, as well as state and federal requirements. Just be sure you’re working with an independent or agnostic broker who will show you all plans available to you to best meet your needs.
• Explore the SHOP Marketplace: At Healthcare.gov, you’ll find helpful calculation tools and clear choices for high-quality group insurance plans.

Choosing a small business health insurance plan requires you to act similar to a consumer buying an individual health insurance plan on the Affordable Care Act (ACA) marketplace.

Here’s what to look at when comparing small business health insurance plans.

Benefit design

See what types of health plans a company offers, including:

• Preferred provider organization (PPO)
• Health maintenance organization (HMO)
• Exclusive provider organization (EPO)
• Point of service (POS)

The benefit design dictates whether employees can get out-of-network care and need referrals to see specialists. One employee may like the lower premiums in an HMO and not have a problem staying in-network, while another may prefer the flexibility of a PPO with the understanding that they will pay more in premiums. Providing employees options can help with employee satisfaction.

Premiums

A health insurance premium is what members pay to have coverage. This usually gets deducted from paychecks. Employers pay most of the premiums, so businesses will need to figure out how much coverage will cost them and their employees.

Out-of-pocket costs

Health insurance deductibles, coinsurance and out-of-pocket maximums play vital roles in how much members pay when they need health care services. Choosing a plan with high deductibles may cost businesses and employees for premiums, but it also puts more costs on employees when they need healthcare.

Provider network

Health insurance companies contract with providers and medical facilities like hospitals. These contracts decide how much providers get paid and may set requirements for providers, such as requiring that they meet a minimum quality of care. A small network could result in employees needing to search for a doctor and lead to extra out-of-network costs.

We analyzed 84 data points about coverage and quality for seven large health insurance companies to determine the best health insurance providers for small businesses owners. Our ratings are based on:

• Complaints made to state insurance departments (30% of score): We used complaint data from the National Association of Insurance Commissioners.
• Plan ratings from the National Committee for Quality Assurance (30% of score): The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization that accredits health plans and produces ratings based on specific metrics, including patient experience, prevention, treatment, overall rating of the health plan and rating of care.
• Average silver plan deductible (20% of score): The deductible is how much you have to pay for healthcare in a year before the health plan begins picking up a portion of the costs. Companies with health plans that had low deductibles got more points.
• Breadth of health plans (10% of score): Health insurance companies may offer up to four types of plan benefit designs (PPO, HMO, EPO and POS). Companies that offered more types of plans got more points.
• Metal tier offerings (10% of score): The ACA marketplace has four metal tier levels. We gave points to companies that offered more tier plan options.

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