Offering health insurance to staff members can aid a small business in luring and retaining talent. The Affordable Care Act (ACA) is one method through which small businesses can purchase health insurance.

To identify the top health insurance providers in the nation, we examined sizable insurers that provide plans through the ACA marketplace. Our analysis revealed that Kaiser Permanente and Blue Cross Blue Shield had the highest scores.


Best Health Insurance Companies for Small Business Owners

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

How Does Small Business Health Insurance Work?

A small business is defined by the Affordable Care Act (ACA) as an organization with fewer than 50 full-time employees (FTE), however some states may have a different definition.

A small business owner gives their staff members the option to enroll in the group health insurance plan that they have chosen to enroll in after enrolling themselves in it through a private insurance provider. Employees usually pay lower monthly premiums, deductibles, copays, coinsurance, and services not covered by the plan, with the employer contributing a portion of the premiums.


Small business owners choose how many options to offer their staff and enter into contracts with health insurance providers.

Do Small Businesses Have to Provide Health Insurance?

Although it’s not legally required, small business owners who offer health insurance to their employees must abide by certain guidelines.

Having said that, if you choose to provide health insurance to your staff, be sure you are aware of how your state defines a small business, as this will affect what you must offer.

Small Business Health Insurance Options

Through the Small Business Health Options Program (SHOP), small business owners can purchase health insurance for their staff members from approved insurance providers.

By using the SHOP Marketplace, employers can offer health plans from a variety of insurance providers and become eligible for the Small Business Health Care Tax Credit, which can assist in defraying some of the costs associated with providing coverage.

To be eligible for the SHOP tax credit, your company needs to fulfill these requirements:

  • Less than twenty-five full-time equivalent (FTE) workers
  • The average annual salary for employees is $56,000 or less.
  • Cover at least half of the premium expenses for your full-time staff.
  • Provide SHOP insurance to every full-time worker.

Small business owners can also work with a health insurance broker, who will compare and investigate various plans on your behalf to find the most affordable option. They can also purchase straight from a health insurance provider.

Bronze, silver, gold, and platinum are the “metal” tiers in which plans are arranged if you purchase insurance via the ACA marketplace. The premiums and out-of-pocket expenses for each tier vary. Bronze and silver plans, for example, have lower premiums but higher coinsurance and deductibles. Plans classified as gold or platinum have higher premiums but lower out-of-pocket expenses.

It is up to the employers to decide what kinds of plans to provide to their staff.

Small Business Health Insurance Requirements

It is not required of small business owners to offer their employees health insurance benefits. If they decide to do so, they have to comply with ACA requirements. States may have different requirements.

  • Inclusivity: All workers, not just managers or any other group, should have access to health insurance.
  • Coverage of essential health benefits: Under the Affordable Care Act (ACA), a small business owner’s health plan has to cover the essentials, including prescription drugs, emergency services, maternity and newborn care, care related to pregnancy, outpatient care, and more.
  • Minimum contribution: In order to be eligible for the Small Business Health Care Tax Credit under the Affordable Care Act, small businesses must contribute at least 50% of the monthly premium cost of the plans they offer. States usually mandate a minimum percentage of employee participation in health insurance plans provided by small businesses, in addition to these regulations.

How Much Does Health Insurance for Small Business Cost?

As per the Kaiser Family Foundation’s 2023 Employer Health Benefits Survey, the average monthly cost for small business owners is $1,274 for family coverage and $612 for each employee.

The precise price is determined by a number of variables, including past health insurance claims. For example, the insurance company may raise the rates for health insurance the following year if employee healthcare costs are high.

How To Get Health Insurance for a Small Business

When it comes to choosing the best plan for your small business, you have a few options:

  • Take the initiative: Small business owners can choose a plan that best suits their needs by sifting through group health insurance options offered by various insurance providers, comparing costs and services. For small businesses, health insurance companies usually provide a variety of plans. By entering a small amount of information on the ACA marketplace website, you can view plan options and costs.
  • Collaborate with a broker for insurance: Insurance brokers are well-versed in both state and federal regulations in addition to the specifics of health insurance plans. Just make sure the broker you work with is impartial or independent and will present you with all of the options that best suit your needs.
  • Investigate the SHOP Marketplace: Healthcare.gov offers straightforward options for premium group insurance plans along with useful calculators.

How to Compare Small Business Health Insurance Plans

You must make decisions about small business health insurance plans in a manner similar to that of a customer selecting an individual plan through the Affordable Care Act (ACA) marketplace.

When comparing small business health insurance plans, keep the following criteria in mind.

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)

Whether or not employees can receive care outside of the network and need referrals to specialists depends on the benefit design. While some employees may prefer the flexibility of a PPO with the knowledge that their premiums will be higher, others may like the lower premiums of an HMO and have no trouble staying in-network. Offering options to staff members can improve their level of satisfaction.


Members must pay a premium for health insurance in order to be covered. Usually, paychecks are used to cover this. Businesses must determine how much coverage will cost them and their employees because employers bear the majority of the premium costs.

Out-of-pocket costs

When it comes to how much members must pay for medical services, health insurance deductibles, coinsurance, and out-of-pocket maximums are important factors to consider. Selecting a high deductible plan may result in higher premium costs for employers and employees, but it also increases the out-of-pocket expenses for workers in need of medical care.

Provider network

Health insurance companies have agreements with hospitals and other medical facilities. These agreements determine the providers’ compensation and may impose conditions on them, such as a minimum standard of care. A limited network may force employees to look outside of it for care, which could result in additional out-of-network expenses.


To find the top health insurance companies for small business owners, we examined 84 data points regarding coverage and quality for seven major health insurance providers. We base our ratings on:

  • 30% of the score was derived from complaints filed with state insurance departments. The National Association of Insurance Commissioners provided the complaint data.
  • The National Committee for Quality Assurance’s plan ratings account for 30% of the total score. An independent nonprofit organization called the National Committee for Quality Assurance (NCQA) accredits health plans and assigns ratings based on a number of criteria, such as patient experience, treatment, prevention, overall health plan rating, and care rating.
  • Average silver plan deductible (20% of score): The deductible is the annual amount of medical expenses you must pay out of pocket before your health plan starts to reimburse some of the costs. Businesses with low-deductible health plans received additional points.
  • Health insurance providers may provide up to four different plan benefit designs (PPO, HMO, EPO, and POS). This accounts for 10% of the total score. Businesses with a wider range of plan options received higher marks.
  • Offerings for metal tiers (10% of score): There are four metal tier levels in the ACA marketplace. Businesses that provided more options for tier plans received points from us.

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