Best Small Business Health Insurance Providers Of 2024 (2024)

Kaiser Permanente and Blue Cross Blue Shield scored the best in our analysis of small business health insurance. We evaluated large insurance providers that offer ACA marketplace plans to find the best health insurance companies across the country.

Providing health insurance can help a small business attract—and keep—employees. One way small businesses can buy health coverage is through the Affordable Care Act (ACA) marketplace.

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• Summary: Best Health Insurance for Small Business Owners
• How Does Small Business Health Insurance Work?
• Types of Health Insurance Companies for Small Businesses
• How Much Does Health Insurance for Small Business Cost?
• How to Compare Small Business Health Insurance Plans
• How to Get Health Insurance for a Small Business
• Methodology
• Other Health Insurance Companies We Rated
• Small Business Health Insurance Frequently Asked Questions (FAQs)
• Next Up In Health Insurance

The Affordable Care Act 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 can enroll in a group health insurance plan offered by a private insurance company and then provide their employees the opportunity to enroll in that plan. The employer generally 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 can buy health insurance for their employees through approved insurance companies with the Small Business Health Options Program (SHOP).

Employers may choose the types of benefit design, which influences whether an employee needs referrals to see specialists, can get out-of-network care and other factors. Three types of health insurance plans offered to small businesses are:

• EPO: Exclusive provider organization plans are often an affordable option. EPOs don’t usually require members to get primary care referrals to see specialists but they also often don’t cover out-of-network care.
• HMO: Health maintenance organization plans are generally much cheaper than other options, but they also have limitations not found in other plans. That includes needing primary care referrals to see specialists and not being covered for out-of-network care.
• POS: Point of service (POS) plans may allow you to get out-of-network care, but you generally need primary care referrals to see specialists and you must choose a primary care provider. These plans aren’t as common as the other types.
• PPO: Preferred provider organization plans are often the most expensive because they offer the most flexibility. That flexibility includes members not needing to get primary care referrals to see specialists and the ability to get out-of-network care.

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.

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.

Average Health Insurance Costs for Small Business

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 EPO, HMO, POS and PPO. The benefit design dictates whether employees can get out-of-network care and need referrals to see specialists.
• 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 healthcare 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.

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

	Compare Plans 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 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.

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.

Read more: How Forbes Advisor rates health insurance companies

Here are other health insurance companies we analyzed as part of our research.

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